Difficulty of turning the tide
Medical school leadership across the United States is well-aware of the problem, and there are growing resources being put in place for students who need mental health support when they are having problems. Examples include campus-embedded mental health counselors and psychologists, reduced lecture time, wellness programs (e.g., yoga, exercise class, massage therapy, nap rooms, fitness centers, and access to healthier foods). Another strategy is creation of collegia which are groupings of students across all 4 years who study, work, and socialize together to promote inter-year mentorship. However, what medical school leadership has little control over is the deteriorating emotional tenor of the healthcare system that students are exposed to when they start their clinical rotations in earnest. Preventing such student “contamination” requires addressing burnout among attending residents and attending physicians.
Organized medicine was slow to recognize this crisis but is finally beginning to act. The National Academy of Medicine, in association with over 50 other organizations including the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) have recently launched a national Action Collaborative on Clinician Well-Being and Resilience.11 The collaborative has 4 initial goals which include increasing visibility of clinician stress and burnout; improving health care organizations’ baseline understanding of challenges to clinician well-being; identifying evidence-based solutions; and monitoring the effectiveness of potential solutions.12 One immediate coalition deliverable will be creation of an online “knowledge hub” repository for available data, models, and toolkits to prevent burnout.
Among the novel solutions being proposed to curb burnout is a team-based model called ambulatory process excellence (APEX) created by the Department of Family Medicine at the University of Colorado Health System.13 In APEX, medical assistants (MAs) who have received added training proactively gather patient data, organize visits, reconcile medications, and review basic preventive care strategies. These data are then shared with the provider who sees the patient while the MA stays in the room to document the visit in the EHR. After the provider leaves the MA completes patient education. APEX requires a higher ratio of MAs to physicians but increased provider productivity appears to more than make up for the added expense.
The contagion of physician burnout has reached down to the level of our medical students, threatening the welfare of our entire profession as well as public health more broadly. While steps are being taken to mitigate medical student stressors, it is vital that we treat the source of the “infection,” which is burnout among residents, early and mid-career physicians. This cure will require “decluttering” healthcare by reducing non-value-added aspects such as ineffective regulations and administrative busywork while also creating more efficient, effective and error-free value-adding care models.
Acknowldegement: Dr. Ed Funai, Professor of Obstetrics and Gynecology at USF Health Morsani College of Medicine collaborated on this editorial. Dr. Lockwood thanks him for his contributions.
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