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Washington Physicians Health Program

New workshops to help decrease stress and increase happiness in physicians and other medical professionals.

Steps for a better lifeDr. Charles Meredith is medical director of the Washington Physicians Health Program. He spoke with the WSMA recently on a new program to help alleviate burnout in health care professionals through mindfulness training.

Q: Physician burnout is a critical area. How did your program start?

A: The Washington State Medical Association founded and created the program and we report directly to them. The WSMA created the program in 1986 as an impair-ment-monitoring program. Its mission was to intervene and rescue physicians at—or getting close to—impair-ment from medical conditions, addiction or other ill-nesses. In the last 10 years, we broadened our scope to other illnesses that can cause impairment, such as depres-sion, bipolar disorder or other medical challenges. But the focus has always been getting someone into treatment.

Q: What have you changed about your services?

A: In addition to those critical areas, recently we’ve focused on actively promoting wellness, rather than intervening only after problems begin or just treating the illnesses I mentioned. To that end, we’re developing our

own wellness program for physicians. This is has become a mission with other health care organiza-tions as well. For example, the UW and Franciscan systems have been explor-ing setting up wellness program for medical staffs

because it’s shown to promote the longevity of staff careers. We know that in many health care organizations, medical providers are at high risk of burnout. We also know that with mindfulness programs we can increase productivity. Meanwhile, it’s clear that burnout impedes performance. I’ve been pleased to see some health care organizations in other parts of the state start to build wellness programs for people who may not have access to ours here in Seattle. We’re still getting off the ground, and are currently developing several different program components to offer over the year.

Q: Tell me a little about what will be offered.

A: Our first step is mindfulness workshops. There is a fair amount of data in clinical literature telling us that mind-fulness-based, stress-reduction training is beneficial to many different groups by increasing performance and job satisfaction. It’s specifically been shown in a number of studies to decrease burnout in health care providers.

Mindfulness does not eliminate life’s pressures, but it can help us respond to pressures in a calmer way, helping our heart and head. We have created a five-week series to teach the concept of mindfulness. The workshops are led by professional facilitators.

Q: When will the workshops be offered?

A: We are hoping to run two or three in Seattle through-out the year. If there’s enough demand, we will try to offer in other cities around the state. We’d like to look at some places especially in Eastern Washington where we could host the workshops. Our workshops are heavily subsi-dized, by the way. They generally cost just 40 percent of what a similar workshop would be in the community.

Q: Who exactly are the workshops aimed at?

A: Medical and osteopathic physicians, physician assis-tants, dentists, podiatrists and veterinarians. They are our core mission audience. The cost is $150 per person for the complete five-week series. Spouses and significant others are welcome to attend.

Q: Any feedback from the first mindfulness workshop?

A: What I heard from the wellness program director is that there was very positive feedback—a lot of people said “I’m glad I did this.”

Q: Does it help to limit the groups to medical professionals?

A: Taking the workshop with other people who know exactly what you do means you can have discussions around shared experiences, experiences our participants can all relate to. Participants can also broaden their social networks by meeting other people in their larger commu-nity they can bond with.

Q: Give me a sense of content of the workshops.

A: Participants do active listening and reflection with colleagues, for example. You might speak briefly about some memorable, emotional experience for about 30 seconds to the group while they sit quietly and then reflect back what they are feeling in response.

In other exercises, you’ll do a very simple yoga posture while you clear your mind of external thoughts and think of a focal point. You might also be given mindfulness homework to implement into a daily practice, say for

In many health care organizations, medical providers are at high risk of burnout. But with mindfulness programs, we know we can increase productivity and well-being.

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stroke patients, has shown in studies that it can pick up qualitative and quantitative changes in the white matter in the brain. Resting-state MRI is different from the more common MRI in that the patient doesn’t have to tap fingers or talk or demonstrate language skills because the imaging looks at the connectivity of the brain and how areas are activated during rest.

“What that means clinically and how to integrate that into the management of the patient is not clear at this time,” Dr. Browd says. “At our center, at the University of Washington and at Children’s, and also nationally, people are very interested in these two techniques.”

But these tools won’t be available anytime soon, he says. “These are very, very early studies.”

Letter to the editor

Dear Editor,

Thank you for the thoughtful article on the use of medical scribes in the January WSMA Reports. A recent article in JAMA offers a slightly differing view and valid criticism of medical scribes and the medical scribe training industry. (The Rise of the Medical Scribe Industry: Implications for the Advancement of Electronic Health Records. George A. Gellert, MD, MPH, MPA, Ricardo Ramirea, LVN, S. Luke Webster, MD. JAMA.)

I personally share Gellert et al’s criticism of those with a minimal educational background being quickly trained as medical scribes. However, my prior group’s experience demonstrates an alternative that supports the enthusiasm of the author in the WSMA Reports article.

In 2007, using the eMD’s EMR platform, Olympia Family Medicine began supporting its providers with two medical assistants whose duties were expanded beyond their traditional role to include scribing during patient encounters. Our results were overwhelmingly positive from all aspects. Economically, we were able to increase patient volumes by on average three patients per day without added work hours. Typically, the higher volume producers in the office exceed this level. In 2007 dollars roughly this “penciled out” as follows: three patients per day times $145 (average charges per patient) times .72 (collections

rate per charges) times 180 days per year average work level, or $56,376 in additional revenue. This was balanced by expenses of $15 per hour wages times 2200 hours per year times 1.3 (additional costs of benefits plus salary), or $42,900, which provided a net positive revenue of $13,476 per provider per year, again roughly in 2007 dollars.

In addition to the financial positives of this move, there were other positives of equal value to the practice. Employee satisfaction with this expanded role was very positive—the medical assistants were in a role where they were exposed to greater depth of involvement and greater learning opportunities from the expanded clinical exposure. Patient satisfaction was by far and away positive. Provider satisfaction was exceedingly high; the ability to delegate much of the transcription allowed the provider to give undivided attention to patients, and actually people were getting out of the office sooner with the day’s tasks fully completed.

It was unfortunate when in 2009 our practice was acquired by a for-profit hospital chain and the corporate decision-makers were unable to adopt this paradigm. Forward-thinking providers and administrators would do well to consider the advantages and disadvantages of adding medical scribes to the exam room experience for primary care providers. My prior experience would strongly suggest that rather than making this solely an economic decision that leads to employing the lowest level of trainee, there are substantial benefits beyond the smaller amount of net dollars gained that support expanding the role of medical assistants to include scribing duties.

Respectfully,

Stephen Albrecht, MD, FAAFP

Steps for a better life • continued from page 6Coping with concussions • continued from page 3

perhaps 10 minutes a day. You’ll practice following through on what you learned in class. When you come back to the workshop, the facilitator will go back and forth with participants discussing what worked, what didn’t, identifying the ongoing stressors in your job and what negative thoughts were in your head you were unable to get rid of. By reflecting on all those points, we hope to improve the happiness, well-being and effective-ness in everyone’s daily life. We have one program cur-rently underway.

For more information, call toll-free 1(800) 552-7236 and ask for the Wellness program director, or check the website at www.wphp.org.