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November Medical Director’s Minute

Work-Life Balance and Physician Burn Out

Why did you become a doctor? Was it to help others in a significant way? Was it to make a living in a leadership role? Was it to have interesting, diverse work experiences that could engage you in lifelong learning? Was it to apply skills and knowledge in a well-respected, well compensated, and always-in-demand field?

Some combination of these likely applies to every one of us who pursued the challenging and rewarding life of a physician.

So given the above high-minded motivating ideals, it’s clearly problematic that 1/3 to 1/2 of physicians report burnout, according to Medscape’s annual report on the matter.

What is burnout? Christina Maslach and her University of San Francisco colleagues developed the accepted standard for burnout diagnosis in the 1970s, highlighted by three main symptoms:

1) Exhaustion (decreased physical and emotional energy levels, often headed into a downward spiral)

2) Depersonalization (highlighted by “compassion fatigue”)

3) Decreased belief in the meaning and/or quality of your work

For physicians this can then manifest in many as a loss of enthusiasm for our work, decreased satisfaction and joy, increased detachment, emotional exhaustion, and even cynicism.

And while specialty matters to a degree in this struggle, no specialty is immune from it. On the high end of the spectrum, nearly half of critical care specialists, family physicians, OB/GYNs, neurologists, emergency medicine physicians, and internists report burnout. While on the low end, still one-third of orthopedists, ophthalmologists, pathologists, and dermatologists report it. (The only outlier is plastic surgery, but one out of every four plastic surgeons still report burnout.)

So, what causes this rampant burnout within our noble profession? As one would expect, there are many factors, but leading causes include:

  • Too many bureaucratic tasks
  • Too many hours at work
  • A lack of respect from co-workers and/or administrators
  • Insufficient compensation
  • Inefficient EHR systems

And all the above plus more can contribute for many to poor satisfaction with work-life balance.

Maybe you’d rather spend more time with family or volunteer your time to a cause that is dear to you. Maybe you’d like to take some non-vacation time to provide care on a medical mission or you have a non-medical passion that you want to better engage. And perhaps you don’t feel you have the time because of the demands your job entails that don’t help you care for patients, demands that feel beyond your control.

So, what can be done? It’s probably not surprising to you to find out it’s much easier to assess the numbers and root causes related to physician burnout than it is to understand how to solve the problem, let alone implement the changes needed to do so.

But there are certainly a variety of solutions that have been successfully implemented in our profession. They tend to share these overarching themes:

  • Physician choice (having at least some control over our delivery of care)
  • Camaraderie (feeling a connection to our colleagues)
  • Excellence (feeling you’re a part of something meaningful)

How those areas are addressed can vary, but, regardless of specialty, they need to be actively addressed when concern for physician burnout exists, whether in a small practice, a large system, or something in between. The solutions don’t manifest themselves, but with active engagement by physicians and other members of the healthcare and administrative teams, they are out there.

Docs Who Care is a physician founded and physician-centered company that provides medical care to rural areas in need and a company that has been actively preventing and treating physician burnout for over 20 years by:

  • Eliminating bureaucratic issues that drain our energy and joy
  • Allowing us to know our work is valued in the places we serve
  • Allowing us to control how much or how little we work
  • Respecting our autonomy

-Dr. Andy Bukaty, Docs Who Care Senior Medical Director

References:

Peckham, C. (2018, Jan 17). Medscape National Physician Burnout and Depression Report 2018. Medscape. Retrieved from https://www.medscape.com.

Maslach C, Leiter, MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. San Francisco: JosseyBass; 1997.

Drummond, D. (2015). Physician Burnout: Its Origins, Symptoms, and Five Main Causes. Family Practice Management, 22 (5), 42-47.

Berg, S. (2018, Aug 3). Physician burnout: It’s not you, it’s your medical specialty. AMA Wire. Retrieved from https://wire.ama-assn.org.

Hasan, H, Kuzmanovich, D. (2018, May 16) The solution to physician burnout? EHR optimization. Advisory Board. Retrieved from https://www.advisory.com.

Parks, T. (2016, Dec 14). Physician burnout: Detailing the impact, exploring solutions. AMA Wire. Retrieved from https://wire.amaassn.org.

2020 – The Year of Resilience and Compassion

No matter how you slice it – the Year of COVID – will go down unlike any other year in our recent history. When the final day of 2020 arrives, a majority of people will be more than ready to place 2020 in a box, padlock it, and place it high on a shelf!  Yet, others will cherish memories as they reflect upon the birth of a child, a marriage celebration, or serving in the hotspots of COVID-19…or, what??!! 

Patty Ridings, a Nurse Practitioner from Cherokee, KS has been a healthcare provider for nearly 30 years – and 2 years with Docs Who Care.  When COVID-19 became more of a threat than anyone realized, Patty knew if the opportunity presented itself, she was ready to serve wherever needed. That calling led her to serve as one of the first volunteers of the COVID Care Force sent to New York City on April 8th.

Joining a team led by Dr. Gary Morsch and partnering with International Medical Corps., Patty found herself immersed in the epicenter of COVID-19 – Queens, NY at Flushing Medical Center. Patty recalls, “I was seeing things I had never experienced before. It was an ‘all hands-on deck’ situation around the clock. When a physician at the hospital learned I had left my family in Kansas to come to NYC to serve two weeks, she immediately teared up – tears of thankfulness.  She could not believe anyone would volunteer to come into such a high-risk environment. As hard as it was to lose patients, it was such a victory when a patient was released.  And every evening, after the day shift was over, people living near the hospital would open their windows or stand on their balconies banging pots and pans cheering on the hospital workers going home while the night shift arrived. It gave me chills every evening.”

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Patty served in Queens until April 23rd.  It was only 3 short days later, she received a call from Dr. Morsch.  This time there was a need for the COVID Care Force to send an advance team to the Navajo Nation located in Gallup, NM.  A city who had closed the city’s entrances trying their best to temper the pandemic moving through the area at a rapid rate.  Again, Patty answered the call.  “The Navajo Nation was in such need before the pandemic struck. PPE and medical supplies like touchless thermometers and water were so sparse. We were able to secure masks from Masks of Mercy, face shields from Heart to Heart International donated by Ford Motor Company, gloves, gowns, and water. It was so encouraging to see all these organizations coming together and doing what they could to support our efforts. I was honored to be a part of the Advance Team. It gave me the perfect opportunity to share knowledge learned from my experience in the New York City area.  That was a really satisfying feeling.”

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While serving in both New York and New Mexico, Patty met Dr. Lytitia Shea.  Dr. Shea and Patty became fast friends and have kept in touch since serving together in New York.  This friendship became even more treasured as Patty would find herself infected with the COVID-19 virus on August 31. Dr. Shea would check in with Patty every day and of course, Patty used her own personal experience to educate and encourage her own patients, family and friends through Facebook posting her symptoms and practices that helped her rest and recover while at home.  Thankfully, Patty was back at work just in time to celebrate the one year anniversary – September 10 – of Ridings Healthcare Clinic where Patty sees hundreds of patients in the Pittsburg, KS area and even offers house calls if best for the patient.

Patty Ridings has embraced the value and essence of serving others.  Not only by choosing a career in healthcare, but in her willingness to take her skill set to the areas of greatest need.

When asked what has been her greatest takeaway after her personal battle with COVID and her weeks of volunteer service, Patty was quick to say, “I have experienced the resilience of the human spirit and compassion in new ways I will never forget. And, I have new friends I would have otherwise never met.”

This unpredictable year of 2020 will soon be gone.  With it a lot of losses, but there is still good to treasure. Thankfully, there are those willing to come alongside others when life gets the most challenging – those with a resilient spirit and compassionate heart – like that of Patty Ridings.

Patty, thank you for the example you set for all of us.

Docs Who Care Appoints Graham Morsch as CEO

Docs Who Care Appoints Graham Morsch as CEO 

Morsch replaces founder Gary Morsch, M.D. as group celebrates its 25th anniversary year providing critically needed health care to rural areas

OLATHE, Kansas (Jan. 2, 2020) — Docs Who Care announces the appointment of Graham Morsch as CEO, effective Jan. 5, 2020.

Gary Morsch, M.D., Docs Who Care’s founder, will step back from his role as CEO and become Chairman. He will remain involved in strategic planning, vision casting, provider recruiting and strengthening hospital partnerships.

Docs Who Care is a group of physicians and healthcare providers who partner with rural hospitals to provide clinic and emergency department staffing, hospital inpatient care and other administrative services in the Midwest.

Graham Morsch joined Docs Who Care in January 2015 as Accounting Manager and was promoted to Chief Operating Officer in September 2016. He has been instrumental in advancing the organization’s growth strategy. Since 2016, Docs Who Care provider hours have increased by 30% and administrative staff has grown with nine new hires.

As CEO, Morsch will oversee all aspects of Docs Who Care’s operations including personnel, finance, site and provider management and strategic planning.

Before Docs Who Care, Morsch worked as the communications coordinator for the office of admissions at Southern Nazarene University in Bethany, Oklahoma, and was an accountant for Chesapeake Energy Corp in Oklahoma City.

“I’m excited and honored to step into the CEO position,” said Morsch. “I’ve had excellent role models and mentors and am ready for this new challenge.”

Morsch believes he has big shoes to fill, “but I’m confident with our incredible staff that we’ll continue living out our mission to bring exceptional healthcare to the rural hospitals we serve.”

His vision as CEO includes expanding the organization’s market reach and scope of services.

“Graham grew up with Docs Who Care, traveling with me on weekends when I covered the ERs in rural hospitals across Kansas,” said outgoing CEO Dr. Morsch.  “Little did I know, 25 years ago, that Docs Who Care would someday grow into the premier medical staffing company it is today, or that my son would one day be the CEO.

“Graham has the perfect combination of people skills, organizational leadership, and financial oversight that a successful CEO requires,” Dr. Morsch continued. “More importantly, he is committed to the vision that has energized us from the beginning — bringing high-quality doctors and advanced practice providers (Physician Assistants and Nurse Practitioners) to rural America!”

Active in the community and professionally, Morsch has served on the board and as a trustee of the finance committee at Living Hope Church in Olathe. He is a member of Madison Place Elementary School Site Council, volunteers for Heart to Heart International and serves on the Board of Directors for DisasterDoc.

About Docs Who Care

Headquartered in Olathe, Kansas, Docs Who Care is a group of physicians and other healthcare providers who partner with rural hospitals to provide clinic and emergency department staffing, hospital inpatient care and other administrative services in states throughout the Midwest. Established in 1995, Docs Who Care matches high-quality physicians and advanced practice providers to community hospitals and gives providers an opportunity to work on a job-sharing basis, allowing them the time and flexibility to make a difference in the world through volunteer service.

Today, Docs Who Care works with more than 300 physicians and advanced practice providers in 112 hospitals in seven states. Docs Who Care founder Gary Morsch, M.D., also created Heart to Heart International, a non-profit medical relief organization that strengthens communities by improving health access, providing humanitarian development and administering crisis relief worldwide.

A Job Well Done: Celebrating 17 Years with DWC

Q&A With Retiring Medical Director, Paul Wardlaw, M.D.

Why did you decide to become a physician?

As a high school student I did very well in math and science and always enjoyed it.  In my high school years I was beginning to think about what I would do with my life and had begun to consider becoming a minister like my father.  I was listening to a missionary lady speaking one evening and she stated, “the need for doctors and teachers is so great.”  Immediately, I felt an impulse within me, that I attributed to “God prompting,” telling me I should become a physician.

What advice would you have for a new DWC provider?

Stay flexible.  Carry an appropriate expectation or minimal expectation of what you might find at a site.

What will you miss most about being a “Doc Who Cares?”

Meeting people and hearing their non-medical histories.  The paycheck.

What is something you won’t miss about working for DWC?

Getting up at 3 AM for a case of constipation.

Any idea how many DWC hospitals you worked at during your career?

At least 35.  7 in Missouri, 2 in Iowa, 6 in Colorado, and 20 in Kansas

What is your favorite memory of working for DWC?

A patient came into the ER with a cucumber in one of his body orifices. After appropriate actions to remove said cucumber one of my nurses asked if I would like to go out to get a cucumber salad.

One of my most moving memories – diagnosing a case of lung cancer on Thanksgiving evening in a 60ish man whose wife was frustrated that he had not been feeling well for 3 months and had been in 3 different ERs.

Personally, my wife and I had some great times living for several days in our RV at some of the rural hospitals.

Where is the best hospital food you’ve ever eaten?

No best hospital food – that is an oxymoron.  But I never refused to eat a hospital meal that was offered.

What else would you like us to know about you or your career?

My career has been blessed by variety!

  • Three years at an Indian Health Service clinic in central Washington
  • One year traveling to the IHS clinics in Oregon, Washington and Idaho writing protocols for the management of diabetes and hypertension by nurses where physician help was limited
  • Nine years working at a large mission hospital in southern Africa
  • Nine years in a fairly traditional family practice in Olathe with Dr. Morsch and others
  • 12 years as physician director for the Olathe Health System with 16 clinics and 60 physicians while maintaining some clinical practice
  • Finally, the fun of working with DWC the past 17 years overlapping some of the administrative years

I’ve practiced 47 years in all.  Probably least known is that my wife and I have sung in the Summit Choral the past 3 years and we sang in Carnegie Hall this spring.

What plans or dreams do you have for your retirement?

I plan to relax, continue volunteering as a Copper Mountain ambassador greeting people and giving directions and tours, hike and bike with my wife of 51 years, travel some, and continue to enjoy seven grand-kids and their parents.  I also hope to read, fly fish in my backyard, stay fit as long as God gives me health, and continue to sing in the Summit Choral Society, and stay active in Dillon Community Church.

Feel free to leave a comment below about how Dr. Wardlaw has made an impact on your life!

Provider Spotlight – A Selfless Act and Humbling Gratitude

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Like most of us, Dr. Dana Greene, juggled the many parts of her life – kids, work, volunteering, friends and home. She made her way through the seemingly unending “To-Do” lists until one day she made a decision to step outside the daily demands of life to change the life of another, forever.

“Keisha and I had known each other for about five years,” explained Dr. Greene. “We met when I joined the board of the charter school my youngest child was attending. She was the president of the board, and our kids were friends.” Dr. Greene found Keisha to be “motivated, effective and sassy” and enjoyable.

It wasn’t long until Dr. Greene learned of Keisha’s liver issues, and one day she developed spontaneous bacterial peritonitis that landed her in the ICU where she almost died.

When Keisha’s cousin began promoting the idea of liver donation on Facebook, Dr. Greene decided to pursue the idea of helping her in a more significant way. “Honestly, at that point, I didn’t even think twice about it. I just thought, ‘Well, let’s see if I’m a match.’”

She was.

Dr. Greene and her husband had a history of losing friends to illness or injury. In fact, they went through about a decade of losing one-two per year. Throughout this process, it struck her that this was the first time she may actually be able to have an influence on her friend’s outcome.

“At that point, one of the persistent thoughts was my favorite passage from the Talmud: “Do not be daunted by the enormity of the world’s grief. Do justly, now, love mercy, now, walk humbly, now. You are not obligated to complete the work, but neither are you free to abandon it.”

At that time, she had also been pondering connections and community, and the “paradox of feeling isolated in this global internet-connected society.” She became keenly aware that life often happens to us rather than the other way around. “We get so wrapped up in the day to day demands of life that stepping outside of our ‘To Do’ lists can be difficult. It’s easy for us to miss the opportunities for us to happen to life.”

Dr. Greene knew that her commitment was really “our commitment,” so after a long discussion with her husband in which they both discussed the measures of risk, she decided to commit to the liver donation.

“As far as logistics, I have this amazing flexible job, my sister-in-law lives with us, and my dad is in town. Therefore, having help with the kids was pretty straightforward. I thought, ‘If I can’t make it work, how can anyone?’”

Both surgeries were largely uneventful. For Dr. Greene, it was about ten weeks before she felt close to normal, as her surgeon had warned her, but for her friend, the differences were apparent even just a few days after surgery. “She was noticeably less jaundiced (and now not at all). She started working again and is now able to drive again!”

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“We do scold each other that neither of us have kept our promise of taking more time for ourselves – something that seemed like such a great idea while we were recovering. We are just naturally ‘over-busy’ people. But she has new Nordic ski gear, and we’re both excited to hit the trails together when winter returns.”

Dr. Greene reflects on the whole experience as humbling. “I realized that I can’t do everything alone. I’ve gained insights from my own debility and rejoiced in small victories. I’ve witnessed the small army that took over, largely unbidden, to run the household, cook meals and help get the kids to various activities and appointments. It was deeply humbling, and I am filled with gratitude for it.”

 

Dr. Dana Greene has worked for Docs Who Care since 2008

and has served in more than 14 of our Colorado Hospitals.