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STRESSED OUT
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an instrument, cooking gourmet food or spending quality time with and suicidal ideation and finding ways to address this growing crisis.
a friend and making sure they made time once a day or at a mini- Not lost on anyone is the understanding that improved care of res-
mum once a week to do it. ident trainees and practicing physicians in both the academic envi-
ronment and in the community will translate into improved care of
On the Horizon patients and an anticipated decrease in medical errors and poor pa-
Representatives from across medicine are very cognizant of the tient outcomes. In the broadest sense, academic institutions, hos-
pitals, community clinics and private offices must strive to create
enormous challenges facing physicians in both community and ac- an environment of cooperation, respect and strengthen the sense of
ademic practices. At the top of the list of challenges is the enormous community.
administrative burden due in part to the electronic health record
(EHR). In 2013, a joint study by the RAND Corporation and The tools of practice must be improved or redesigned to be effec-
American Medical Association identified the EHR as the largest dis- tive and efficient in their use, and when possible administrative bur-
satisfier for physicians, citing issues of excessive data entry, interfer- den must be lightened. There must be robust systems in place to
ence with face to face care, high cost of maintenance and inability identify physicians or trainees at risk and guide them to appropriate
of EHRs to talk to one another as reasons.1 To this end, represen- counseling or crisis services. The medical boards must find ways to
tatives from many of the major medical associations are preparing lessen the stigmatization of physicians with past or current mental
to meet this spring with representatives of the major EHR providers health issues while still maintaining its commitment and trust with
to begin a conversation on making these systems more efficient, ef- the general public it serves. Finally, individuals must understand
fective and collaborative. The increasing use of scribes and other mi- that ultimately their well-being rests within their own hands, and
dlevel providers was also discussed as an alternate solution being they must determine and put into place the physical, intellectual,
employed in some settings. emotional and spiritual practices that nourish it while eliminating
those unwanted aspects which impair it. The practice of medicine
Another major issue affecting the wellbeing of physicians involves is at its highest a challenging yet fulfilling and sacred calling and we
the stigma of accessing mental health care and the concern that ac- owe it to ourselves and to our patients to bring the best “us” to that
cessing care may potentially affect state licensure. Many states in- physician-patient partnership.
cluding Texas ask questions about diagnosis and treatment of past
mental conditions, and if they resulted in any impairment to physi- 1 Factors Affecting Physician Professional Satisfaction and Their
cian practice. Affirmative answers may raise fears of excessive ad- Implications for Patient Care, Health Systems, and Health Pol-
ministrative burden, cost, need to participate in the Texas Physician icy. Mark W. Friedberg et al. for the RAND Corporation,
Health Program, long term monitoring and even denial of license. Michael Tutty et al. for the American Medical Association.
Because of these concerns, many physicians choose to avoid access- Copyright 2013 RAND Corporation
ing care entirely or concealing the care they are getting, likely in-
tensifying the stigma. A recent survey of more than 2,000 female 2 “I would never want to have a mental health diagnosis on my
physicians showed over 50 percent believed that they met criteria record”: A survey of female physicians on mental health diagno-
for some form of mental illness but only 6 percent of physicians sis, treatment, and reporting. Dr. Katherine Gold, Dr. Thomas
with formal diagnosis or treatment of mental illness had disclosed Schwenk November–December, 2016 Volume 43, Pages 51–57
to their state licensing boards.2
* House of Medicine: Accreditation Council of Graduate Medical
Understanding this growing concern, the AAMC, the ACGME Education (ACGME)/ Clinical Learning Environment (CLER) Site
and other stake holders are working with the Federation of State Visitors, Liaison Committee on Medical Education (LCME), Edu-
Medical Boards to approach this issue. A representative from the cational Commission for Foreign Medical Graduates (ECFMG),
Federation of State Medical Boards attending the ACGME Wellness America Board of Medical Specialties (ABMS), America Medical
Symposium directly spoke to this issue, acknowledged the concerns Association (AMA), American Association of Colleges of Osteo-
and assuring the assembled group that their organization was ac- pathic Medicine (AACOM), American Hospital Association
tively working to address this issue. (AHA), Veteran’s Administration (VA), Institute of Medicine,
American Association of Medical Colleges (AAMC), Centers for
Summary Disease Control (CDC), National Board of Medical Examiners
Due in large part to the work being done by the ACGME and its (NMBE), Federation of State Medical Board (FSMB), Arthur P.
Gold Foundation President, American Foundation of Suicide Pre-
CEO, Dr. Tomas Nasca, these issues facing resident and faculty well- vention(AFSP).
being are finally being spotlighted, and stakeholders and researchers
from across the medical landscape are now working together to un-
derstand the underlying causes for physician burnout, depression
16 San Antonio Medicine • April 2017
