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Physician Well Being: Survival Strategy for Working With Underserved Populations Martha Sosa-Johnson M.D. UCI- Division of General Internal Medicine April.

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Presentation on theme: "Physician Well Being: Survival Strategy for Working With Underserved Populations Martha Sosa-Johnson M.D. UCI- Division of General Internal Medicine April."— Presentation transcript:

1 Physician Well Being: Survival Strategy for Working With Underserved Populations Martha Sosa-Johnson M.D. UCI- Division of General Internal Medicine April 9, 2008

2 Presentation Objectives Discussing factors that positively and negatively affect physician well being Understanding the deleterious consequences that can occur when physicians’ sense of well being is negatively affected. Identifying positive coping mechanisms for working with underserved populations

3 Background Olive View Medical Center/VA Sepulveda –Internal Medicine Residency –Internal Medicine Attending – Pacoima/Granada Hills, San Fernando Valley –Private Practice UCI- –Anaheim Family Health Center,1999 – July 2007 –Pavilion 3 at UCI Medical Center, 8/07 to present

4 What factors are negatively related to physician well being?

5 Studies on Physician Well Being –Increased paperwork and red tape –Lack of perceived control among physicians was the best predictor of burnout ( Western Journal of Medicine, 2001;174:13-18 )

6 Studies on Physician Well being 1998 Physician Resource Questionnaire by Canadian Medical Association indicated a serious decline in physician morale –Volume of work –Sleep deprivation –Teaching and research demands –Potential for litigation –Increased demands of the public West J Med.2001;174:5-7

7 Studies on Physician Well being In-depth interviews with 54 members of the Department of Medicine (DOM) at the University of Calgary Short questionnaire sent to all members of the DOM and residents (N=275) and 182 surveys returned Questions about quality of life, job satisfaction, stress and coping Negative determinants of physician well being excessive work hours and work to family conflict Work overload and emotional stress/demands of patient care Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005

8 “The hours. My youngest son when he was about three- years old, he said to me one day “Mommy, I wish you were just a mommy and not a doctor”.” Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005

9 “Oh, being at three places at once, so the time pressure of, you know, being late in clinic, having patients waiting. You’re an hour behind, they’re getting grumpy, you have to take a phone call, you can’t stay on schedule. Then the unpredictability of the workday, on the ends, so getting home on time, I find that most stressful.” Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005

10 Physician Well Being and Professional Behavior Minnesota Medicine. Physician Well-being and Professionalism: Colin P. West, M.D.,PhD., and Tait D. Shanafelt, M.D.

11 Consequences of Physician Distress Substance related disorder: 8%-12% of health professionals –Physician addiction is usually advanced before becomes noticeable in workplace –Addiction often shielded by “code of silence” among physicians who often do not confront colleagues exhibiting symptoms of addiction Suicide rates alarming –Male physicians 2 times more likely to commit suicide than average Americans –Female physicians 3 times more likely Annals of Internal Medicine.2001;135:

12 Consequences of Physician Distress “On average, the United States loses the equivalent of an entire medical school class each year (approx 250 physicians) to suicide”. Physician Suicide. Emedicine; March 14, 2007 Louise B. Andrew, MD, JD, Medical-Legal, Risk Management and Trial Consultant

13 Does support from others buffer the negative determinants on physician well being? Yes, especially support from spouse and coworkers, but also from positive patient interactions Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005

14 What constitutes well being for practicing physicians? “…to have a quality of life, you have to have a life outside of medicine. That’s the bottom line! Jean E. Wallace (Department of Sociology) and Jane Lemaire Department of Medicine) University of Calgary

15 Identifying positive coping mechanisms for working with underserved populations

16 Familiarize yourself with scope of services UCI – FAMILY HEALTH CENTER, ANAHEIM Internal medicine Family Medicine OB/GYN Pediatrics Classes offered: diabetes Nutrition consultation Comprehensive prenatal services Specialty programs available: Family PACT, Every Woman Counts Program

17 Familiarize yourself with the different health plans accepted and the health services covered by each health plan MSI (Medical Services for the Indigent) Medicare –Monarch One Care –Medicare only Cal-Optima –Managed Care –Direct Cash

18 Administrative Assistance Outside Resources –Radiology Centers –List of community board certified specialists –Dental Referrals –Services available at “sister” clinic, UCI Santa Ana Family Health Center, and the “Coalition of Community Clinics of Orange County”

19 Knowing limitation in resources - good source of information on patient assistance programswww.needymeds Knowing community resources (Walgreen’s Prescription Club $20/individual/yr or $35/family/yr- $12.99/90 day supply of generic meds or Target ‘s $4/month of selected generic meds).

20 Knowing limitations in resources Important to realize when patient’s medical concerns can not be addressed in clinic setting.

21 Prioritize your time *Get to work on time *Address messages/refill requests in between patient visits *Set a specific time for leaving each day *Be comfortable saying “No” when you just don’t have the time

22 Taking care of yourself Scheduling vacation every 3-4 months *Taking off birthdays *Taking a few days off for wedding anniversary *Remembering special relationships *Making time to attend special events Exercise

23 Taking care of yourself Taking care of your own medical needs as they arise Self care is not a part of the physician’s professional training Typically low on list of priorities 1/3 of physician’s did not have a doctor themselves according to a recent study that examined graduates of John Hopkins SOM (Arch Intern Med.2000;160: )

24 Maintaining Relationships *Date night with significant other, (including parent and me dates) *Regular communication with family members and friends **Relax and be yourself with someone who knows and likes you **Isolation makes it harder to get the support that is essential for the very emotionally demanding job you have chosen ***Dedication and excellence not only during your workday but also with your family/friends

25 THE PHYSICIAN’S BALANCING ACT Jean E. Wallace (Department of Sociology) and Jane Lemaire (Department of Medicine) University of Calgary, 2005


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