Voices: Wellness and cultural change | Shannon MacLaughlan David, MD

Wellness and cultural change | Shannon MacLaughlan David, MD

The SGO’s 48th Annual Meeting showcased wellness in a multidisciplinary way. A plenary session showed us the impact of burnout on productivity. We learned from a hematologist-oncologist about resilience and career fit. A social worker taught us about managing our energy, and we were reminded by a Navy Seal that medicine is, in fact, a team sport.

Shannon MacLaughlan David, MD

So, Dr. Jeff Fowler, congratulations on an amazing presidential year, and thank you for your leadership on the issue of physician wellness. The choir hears you loud and clear, but the choir can’t change the culture on our own, and the culture needs changing.

Full disclosure, I am a reformed wellness skeptic and burnout survivor. Once upon a time I rolled my eyes at those who preached “mindfulness.” I considered those who “put themselves first” selfish. I survived and thrived despite some significant health crises during my training, so I always assumed I was resilient. And I took delayed gratification to such an extreme that I forgot what I was waiting for.

And then, in the most insidious way, a light that once brought me joy in doing what I love burned out, leaving a dark void. There I was. The burned out doctor I never thought I could be. And that’s when I received the following advice:

“Shannon, you’re not in training anymore. No one is looking out for you but you.”

Wait, what?!

The reality is that 32% of SGO members and 81% of our fellows have reported burnout. If you think you are immune, you are wrong. If you think you don’t know anyone who has suffered burnout, you are wrong. Thirteen percent of gynecologic oncologists have considered suicide. Thirteen percent. In order to make a dent in these staggering numbers, we need to admit that burnout is not a failure of the individual, but a failure of the culture.

The culture of medicine has devolved, confusing patient care with consumerism, and treating physicians, as Dr. Fowler put it in his presidential address, as “interchangeable employees.” As long as that is the case, there will be a persistent and intrinsic mismatch of values between physicians and their work environment.

To effect systemic change in that environment we need the commitment of the chairs, chiefs, directors and presidents who are reading this. You are undoubtedly being pressured by your hospitals to do more, produce more, squeeze more out of your team. I assure you that your team already knows that the EMR orders need signing, and I am confident that no one ever died from a Press-Ganey score of 4. So instead of passing the pressure onto your team, I urge you to use those opportunities to enlighten your organizational leadership about the importance of preventing burnout in your physicians, if not for the wellbeing of your team and their patients, then for the bottom line.

Despite the implementation of a thoughtfully-researched “WellMD” program, Stanford Healthcare reported an increase in physician burnout recently. If they cannot reverse this trend they anticipate losing $88million in the next two years from faculty turnover. Similarly, Dr. Taylor Turner and his team made it real for us at the annual meeting, reporting that physician burnout cost gynecologic oncology 1.6 million RVUs in the first 15 years of practice.

Let me be clear, I am not equating our value with RVUs. But let’s face it, the language of healthcare is heavy on dollar signs these days, and it’s important we speak the language of the culture we want to change.

It cannot be true that no one is looking out for us but ourselves — we must reward comradeship over competition. As gynecologic oncologists we are among the world’s experts in caring compassionately for women in some of their darkest times, and it’s time we use those skills to take care of each other.

Recommended reading:

1. Cass I et al, Stress and burnout among gynecologic oncologists: A Society of Gynecologic Oncology Evidence-based Review and Recommendations. Gynecologic Oncology 143 (2016) 421-427.
2. Shanafelt TD and Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146.
3. Stanford Medicine WellMD Center research and resources: http://wellmd.stanford.edu/
4. The Way We’re Working Isn’t Working: The Four Forgotten Needs that Energize Great Performance. Tony Schwartz, 2011.
5. Schwartz T and McCarthy C. Manage your energy, not your time. Harvard Business Review, October 2007.

Shannon MacLaughlan David, MD, is a Clinical Assistant Professor, Obstetrics & Gynecology – Gynecologic Oncology at the Stanford School of Medicine in Stanford, CA.