Today's speaker is Olivia J. Wolfe, MBA. Olivia is an executive with orthopedics in Alaska, so I'm going to turn it over to her now to get us started. All right. Thank you so much, Jessica, and thank you to everybody for being here. I'm going to share my screen and just confirm that everybody can see it before we jump in here. All right. You should see my first slide, which is shifting paradigms. Okay. Awesome. Looks great. Well, again, welcome, everybody. First, I want to thank the AAOE for giving me this opportunity to present. I'm very passionate about this topic, and so I really appreciate the opportunity to be here. And I want to thank all of you for taking time out of especially your Friday, still my Friday morning here in Alaska, but I know for many of you, it's into your early and maybe even late afternoon. So I just want to say thank you for that. And so, yeah, today's presentation, Shifting Paradigms, Seeing Physician Burnout Through a New Lens. If I had a primary objective, and we'll go over some other objectives, but my primary objective really is to get us to think about this topic in ways that we haven't thought about it before. In a fast-paced environment, which health care is, and in today's society where we have information overload, sometimes it's really easy to get into the mindset that the most articles that are written from a certain perspective or the most vocal voices are the lens through which we should be thinking about these things. And so today is really a challenge to think about things a little bit differently, ask ourselves a lot of questions to get to that different perspective. And we talk a lot about the US health care system being broken. We know that. But it's almost always from the perspective of harm to patients, which is a very important lens. I'm not suggesting that we set aside that lens. But one of the questions that we don't often ask is how our broken health care system impacts our physicians. And that's primarily what I want to talk about and get us to think about today. I read this article recently, it was about social change, and this quote really stood out to me, that all change, reform, or progress must start with conversation. The status quo can be changed when conversation occurs. And when conversation occurs, the forces affecting change are activated and become agents attempting to influence the outcomes of the conversation. And so as executive leadership, I would also ask us to think of those agents as ourselves, that we are the change agents in this conversation, and that we can impact change in our practices. And so what you can expect, we're going to do a little bit of a little more get to know me. I'm going to identify some problems with the current conversation around physician burnout. I'm going to ask us to look at this through a systems perspective. And then I'm also going to ask us to analyze our roles. We play a big part in our orthopedic practices. And one of my core leadership values is that leadership is not about me, but it must start with me. And so as leaders, I'm really going to challenge us to think about the ways that we might contribute to the systems that lead to harm to our physicians. Even if we're not actively creating harm, what are some things that we're could actively be doing to reverse that harm? Because we do play a role. So I'm going to talk about our role, and then give you some resources to help the physicians in your practices who might be struggling. A little bit of get to know me, Jessica already kind of told you some of my career accomplishments and where I've been, what I've done. I have been an orthopedic since about 2013, I've been in healthcare my entire life. Started out as a CNA at a hospital in rural Idaho, actually as a candy striper. So before I could even get paid, I had been in healthcare. But really, I wanted to get to know me a little bit on my, according to my values. And I already said one of my primary leadership values or core values is that leadership is not about me, but it has to start with me. So I want you to remember that value from which I'm coming in this conversation. And I really value integrity, I value curiosity, there's a lot of curiosity scattered throughout this as we ask a lot of these questions. And so I'm excited to jump into this from that perspective. Just gonna spend a quick and dirty here on the data. There are a plethora of sources that have released similar data, this is just one. But we do know that physician burnout is at an all time high. Back when this survey was taken, it was about 63 total percent. There's some breakdown here. As far as emotional exhaustion, depersonalization, they had a few different variables that they measured. But overall, we were at about 63% in 2021. And even though there was some decrease before COVID, even in the 40s here at the lowest point before COVID, that's not great. It looks like a downward trend on the chart. And it is a downward trend on the chart. But if you think about this from the perspective of, okay, if 40% of physicians at that point in time were feeling several symptoms of burnout, think of yourself as a patient. That means when you go to your doctor, system wide, there is only a 60% chance that your physician is going to be on their A game that day. And so really try to personalize the data would be one piece of advice that I have is to think about it from the patient's perspective. I'm also a very big believer that COVID didn't really create the problem. It just highlighted it and put that little bit of extra pressure on a fracture that finally just kind of broke it to a degree that we hadn't seen before. So we all know the data and data is good. This is one of my favorite, I love seeing leadership stuff in pop culture. I have had this sign hanging in my office. I've had it hanging in break rooms. And I use it even with problem solving between parties. And that is Captain Jack Sparrow, that the problem is not the problem. The problem is your attitude about the problem. And I would alter that a little bit here to say that maybe not our attitude about it, but the lens through which we're viewing it. And so what are the problems with the current conversation? And so again, my goal isn't to necessarily add volume to the current conversation as it exists, but ask us to think and speak about it very differently and have a different platform about it. When I was doing my MBA research, which focused on the role of coaching for physicians as a mitigant for burnout, I came across this in May of 2019, the World Health Organization published a definition of burnout. They classified it in the 11th revision of the ICD, not as a medical condition, but an occupational phenomenon. Their definition was a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. They note that burnout refers specifically to a phenomenon in the occupational context and should not be applied to describe experiences in other areas of life. They identified three dimensions, which were feelings of energy depletion and exhaustion, increased mental distance from one's job or depersonalization, and reduced professional efficacy. And as I really started to kind of pick apart the language of the World Health Organization's publication, I really ran into what I consider to be problematic language, at least for physicians. First off, they defined it as the occupational phenomenon, which is a syndrome that is not applicable to other areas of life. And I took two issues with this. One is that it sterilizes the humanity out of it. It's not a phenomenon, it's a form of suffering. These are very real people suffering from very real pain and stress. And so to kind of whitewash it or distance ourselves from it with that language, I found to be a little bit disturbing. And then for a physician, their identity can't really be separated from their other areas of life. They might have to cancel seeing their kids' baseball game because they had an emergency surgery, or they were on call, or they're on call and at home, but they're woken up in the middle of the night when a call comes in. So it really isn't applicable to our physician cohorts to say that this is separated from the rest of their life, because it's not. And we also just know about the physician personality in general. What they do very often is who they are. And so unlike some other professions, even some of us who can kind of leave it at the door or separate our personal from our professional lives, that really can't be done in the physician context. And so that was the first issue that I took with it. The other issue that I took is to say that chronic workplace stress that has not been successfully managed, that might be true, but it fails to specify who is responsible for the unsuccessful management of stress. And in all of the current narratives, the physicians as individuals are the ones who are responsible. They're not getting enough sleep. They're not going to yoga often enough. They're not doing this. They're not doing that. And it puts the burden on the physician specifically or on the individual specifically, which I also just found to be a little bit problematic. And here's why I found it to be problematic. E. Edwards Deming, he's post World War II. He's called the father of quality management. If you've studied quality management, I don't think you can study it without running into his name, just thoroughly vetted quality improvement and quality management philosophy and practices. And one of the things that he said, and he wrote about it in his book, Out of the Crisis, that he estimates most troubles and possibilities for improvement add up to something like 94 the system, which is a responsibility of leadership. He actually said management, I changed it to leadership for this context and that there are 6% other special circumstances and that a bad system will beat a good person every time. And that 85% of the reasons for failure or deficiencies in the system and process rather than the employee. And so we need to start thinking about that, that physician burnout is not a physician problem. It is a systems and a process problem. And that really it is the role of management or leadership to change the process rather than badgering individuals to do better. And physicians are leaders. That is true. We are also leaders. And so it's important for us to understand and examine the ways that we can have an impact on that for good or for bad. And so I really started to look at this through a systems approach and not an individual physician approach. And that was the glaring problem that I found is that this incongruency, knowing through the Deming approach that it is a systems issue, but constantly blaming it on the physicians as individuals creates misdirected responsibility. If you don't have correctly directed responsibility, you can't actually fix it. And to blame physicians for something that is systemic further drives burnout. So one of my theories is that the current conversation around burnout that is a physician problem just further creates physician burnout because we're asking them to be responsible entirely for something that they are not entirely responsible for. And so we need to really shift from individual responsibility to institutional and systemic responsibility. Through this graphic in here, if I had to boil it down to one graphic, my question would be, why do we talk about physicians burning themselves out without talking about the system that set them on fire to begin with? And so that's a question that I would ask you to chew on and even take away and think about later after this presentation is shifting from blaming to responsibility and putting it in the right spot. So what do we know? Here's the thing about health care. It is a system. We know that. We use that language. One of the complexities that we don't often think about, maybe, though, is that it is a complex dynamic system that is comprised of many, many subsystems. And all of those subsystems have their own problems and their own contribution to physician wellness and physician burnout. And towards the end, I will I take a moment and a slide to just give a few other points about some of the way these other systems do contribute. But I think one of the things that we also forget about the health care system is that it is first and foremost a social system. It is a system in the service of people. It is a humanities profession. And so this isn't like a assembly line system or a system in a vehicle. This is a social system. And social systems are comprised of a lot of unwritten rules and cultural norms that come about from leadership and systems of influence. These aren't necessarily things that are written in policies and procedures that we go to. For an example, it's a function of a social system or culture that allows or doesn't allow for things like MDs feeling superior to DOs and treating them as such. Social influence is what attributes CEOs and administrators commanding and controlling operations instead of cultivating cultures that influence behavior. The whole culture of silence that physicians don't suffer. They do, but we don't talk about it and neither do they. That part of our culture is very, it's a function of the fact that this is a social system. This isn't written down anywhere that we can't talk about it. We just don't. And so the main system that I want to focus on today and which is at the bedrock of social systems is belief systems. And so what are our belief systems around physicians? Who they are, what they're supposed to do, the role that they play in society and in our organizations. And so we can talk about all the other systems, but today I want to focus on the systems of belief. So let's define what is a system of belief. A system of belief is any set of principles or convictions that are accepted as true by an individual. That could be us, that could be the physicians and or a group, which is all of us and all of that group would include patients and what patients think about physicians. And they create the lens through which the complexities of the world are interpreted and understood. And so again, I'm going to ask us to think about the things we have interpreted and think we understand about physicians and to view that through the belief system that exists now. And then ask us to think about how that belief system might change. And so the functions, it's a guidance for decision-making. How are policies and procedures established, not just in our practices, but at state and federal levels in the regulatory bodies? What we believe guides those decision-making. It has an influence on perception. How do we perceive physicians? How do they perceive us? Our belief systems drive those perceptions. It provides motivation and purpose, which can be really good. And it helps us to respond to challenges. And so one of the, when I was thinking about physician burnout and it felt at a point where banging my head against a wall because all of the data says that it's a problem, but then the numbers are still going up. So how can we have so much literature around the problem, but it's not fixing anything? And so if everything that we know today isn't doing anything to respond correctly to the challenge, then we need to change our beliefs about it. I don't know how many of you watch Chicago Med, Chicago Fire, all of those. I remember one of the very earliest episodes, there was this conversation, I believe, between these two physicians. And one of them asked, what's the difference between God and a doctor? And the answer is that God knows he's not a doctor. And we laugh about it. We make fun of it. Those stereotypes can definitely be true. But I'm using this as an example of one of the ways that our belief system shows up in society and even pop culture. And we've had experiences that support this, but I want to look at this from two sides, which is the provider perspective and then the rest of us. And then when we talk about the health care system, again, we also have to include the patients. They do play a role. The recipients of our care are as much a part of the system as the physicians. It does get unbalanced, but we'll talk about that a little bit as well. And so one of the belief systems that I found in my research was around the physician identity. If any of you have an opportunity to look at the work of Dr. Michael Mattis, I highly encourage it. He coined this term, the personal operating system for physicians. And this is what he defines as what he calls the med school operating system. And again, these are social systems, not necessarily written down. They don't learn these as a class, but they learn it by observation. They learn it influence from students that are ahead of them, attendings, residents, those kind of things. And so he identified the five core pieces of the physician identity, which is to say yes to everything. Discipline, keep going no matter what. Be strong and pretend you're okay. Self-sufficiency, I can do it on my own. And number five, I can fix everything. And so learning this, and again, we all kind of know this anecdotally, but it's really helpful to put it really succinctly into kind of a list and understand that, yes, our physicians are individual people and no two people are alike. And in the med school system, there is this operating system that is kind of embedded into them about who they're supposed to be, the core ways that they are supposed to behave. And so that is very set, even though it's applied and adopted by multiple individual unique people. There are some underlying similarities that you can say about our physician population and the need to be understood that this is. The other thing that I would point out here is this is not necessarily the people they were before they came into their training and understanding that, that any system like this will, can fundamentally change who you are or at least the ways that you behave. And some of that is good. I mean, that's it's discipline is needed, right? It's a very high functioning, high performing profession. Discipline is needed. Strength is needed. Self-sufficiency is needed. The problem, which Dr. Mattis also identifies, is that taking all of these very good things and applying them as they're needed to your profession versus making them the core of your identity and an always every time is where the problem comes. And so these, again, they're good and useful habits, but they really become a problem when they become an identity. And that is unfortunately a case a lot of the time. I ran across this study recently. It was in 2020, super fascinating to me, but it was a study in the physicians as God archetype is basically what I would call it. But the title of it is the doctors are seen as Godlike and talking about moral typecasting in medicine. And this is one of the ways that our belief system shows up in the research. And I was really thankful for this article, because again, I think we know this anecdotally, but it's good to really bring it all together and put some finer points on it. And so the first part of the study, they asked a representative sample of Americans, so non-physicians, how they view the mental capacities of doctors compared to other target groups, which included patients, other workers of other professions, and they included God. And the results showed that people see physicians as highly capable of thinking-related capacities, which are remembering, self-control, planning, and that they did make it equal to God, but that physicians are less capable of any feeling-related capacities, like experiencing fear, pain, embarrassment, and hunger. The second part of the study was a profession comparison. They asked the same representative sample of Americans about the capabilities of physicians compared to other professions, and the results showed that people believe that relative to the average working profession, physicians are better able to ignore physical and mental issues, and that bodily and emotional limitations have less impact on their job performance compared to other professions. Putting that all together, what they would call moral typecasting, and this is how moral typecasting works. So medicine is a moral enterprise. I called it a social profession or a humanities profession earlier in the presentation. You could say the same of education. These are our children that we're dealing with, right? They're not machine parts. We don't work for a grocery store. These aren't things on the shelves. These are people. And so by definition, medicine is a moral enterprise. Most people divide the moral world into only two categories, and that is good and evil. There's no spectrum. It's right or wrong, good or evil. And so from that framework, there are really only two roles in the moral world. There are moral agents, which are the doers, and moral patients, which are the receivers. Further, breaking it down into only two categories, we have the moral agents or doers who can only be heroes and only be villains. And I'm curious how many of us are thinking about all the Marvel movies right now, right? There are the heroes and there are the villains, and that's it, as far as moral actors. The moral recipients then also only fall into two categories, which are the beneficiaries, if the act is good, and victims, if the act is bad. And so people primarily view moral agents, in this case, the physicians, as thinkers, and moral recipients, as the feelers. So the conclusion is, people neglect, and that includes us, neglect the wellbeing of moral agents because they are seen as less sensitive to pain than the average person. So if you really take a moment and sit with this information, by and large, as a society, and I know it's been true for myself, just in my upbringing and training as an administrator and the business side of the system that I've been raised in, we believe, by and large, that physicians are only really capable of thinking and not feeling. And so why would we protect anybody who doesn't feel? And so a lot of our systems that we've built have been built around that. It's only very recently that med schools have changed the number of hours that they allow med students to work. And there's, I mean, there's a plethora, I could talk forever on the ways that we don't protect our physicians because we don't believe they can feel. Why would you protect something that doesn't feel? And so we really need to rethink that. And so the implications for physicians then, again, we emphasize their knowledge and skill, but are very, very uncomfortable with the idea that doctors may have their own personal feelings and needs. I remember the one of, I would say, the paradigm shifting moments for me was, I had been in internal medicine for a long time. And my time in internal medicine was during the part of my career where I was kind of coming up through the ranks. And so I worked at the front desk and I worked in revenue cycle. And so I worked alongside and near my physician population, but not directly like we do as administrators. And then my first job in orthopedics, I was the administrator of the practice. And so I got to experience for the first time, not just working with physicians in the same environment, but up close and personal, face-to-face, them coming to my office and airing all their grievances or telling me about their day. And I had a surgeon who was really, really upset about something. And I just remember thinking, I don't know what to do with this. I thought, well, men first, second of all surgeons, I thought they didn't feel. So it was a very weird. And so I had to address that cognitive dissonance of everything that I'd been taught to believe in the experience right in front of me being so, so different. And so our perceptions of moral goodness are tied to unrealistic self and other expectations about physical and mental invincibility. And so if people see physicians as invulnerable thinkers that are not affected by pain, fatigue, or stress, then why would we need to consider policies that protect their wellbeing? And we'll get into that about the way that that shows up, but really laying the groundwork to think about, okay, if we started to think of our physicians as fully human and fully feeling and capable of all these feelings, whether they express them well or not is a separate part of the conversation, but that they do feel they do have needs just like the rest of us. How would that change the way that we organize our organizations, the way that we advocate for them at a policy level, the way that we might advocate for change at the licensing or board level or hospital credentialing level? And so then what are the implications for patients? If physicians are the moral agents and patients are the moral beneficiaries, then patients are likely to participate in their own care. And I think we see that a lot. We saw it a lot more, I did at least, in orthopedics than other subspecialties. We go to the physician, they're the expert. We listen to what they say. They do the operation, then we do what they say. There's not a lot of active participation in their own care. And you see that across the system and other subspecialties as well, but it really sets up unrealistic expectations about their role. It sets up unrealistic expectations about recovery even. And then if a patient, in a few cases where maybe the patient really does participate in their own care, if they feel like they don't wanna do this physical therapy or this particular recovery effort doesn't feel right to them, they're seen as non-compliant, right? So there's not this real symbiotic working relationship between patients and physicians when there's only those two agents. And so patients can be really surprised when they have a bad outcome because it's all on the physician who we believe is God and who should just miraculously fix it. Or it might confuse them and make them upset when perhaps it's not a clear diagnosis. It's something that hasn't been seen before. And so that's where our belief system can really show up in the room between physicians and patients in the way that diagnoses happen or when an outcome happened differently than everybody thought because of circumstances that we didn't consider. So the question that I also started asking myself when I started looking at the humanity of our physicians and viewing them as God, one of the questions that I started to ask was, is believing that someone or a group of people are God-like, is that as dehumanizing as the opposite end of the spectrum, which is treating people like trash and things that lead to genocide, things like that? And the more people that I asked and the more that I explored this, the answer is yes. Human is human. Subhuman is dehumanizing and over humanizing to the God-like level is just as dehumanizing. And so my theory and the question that I ask people to think about all the time is how we are actually dehumanizing our physician population because we think too much of them. And that does not mean we should start disrespecting them, but just honoring their humanity and not having such high God-like expectations, particularly when it comes to stresses and life events. I mean, a physician struggling with infertility, for example, is not any more immune to the grief around that than any of us in the general population. And so I did some study around what dehumanization on a spectrum looks like and how that might show up for us in our everyday lives. At the very lowest end is implicit bias. These are automatic assumptions about individuals. And the impact is that it can influence our perceptions. It reduces people to stereotypes. If you ask physicians to describe administrators, probably some immediate not great things are gonna come to mind and the same can be true. I've asked a group of people a few times, like surgeons are fill in the blank and there's all sorts of negative stereotypes that we put onto the end of those statements. And that is implicit bias. Objectification is regarding a person as a commodity. It diminishes a person's individuality and really focuses on them as a utility. And this one in particular, I would ask us as people in the business and the finance side of things to really talk about. The few times I've gotten physicians into vulnerable moments, and even some are being really vocal about it on places like LinkedIn, physicians feel commoditized. They feel often that they are a commodity, that they are there to produce and produce and produce. And we measure them against all these benchmarks. And if they're not doing well, then that's a problem. And we really like the business side of healthcare and our practices is important and it does matter. And I think there is a lot of room for us to rethink the way that we have those conversations and the way that we present that data so that it doesn't reduce people to simply what they can produce and the numbers and the RVUs and the case numbers. And not all of that is up to us. A lot of that is embedded into their training before they ever even show up in our practices about the number of cases they have to do to get into a good fellowship. So this is not, I'm not blaming us as administrators. I am asking us to understand our role and our responsibility in the little piece of the pie that we have. Dehumanization also shows up in language. The use of derogatory language can reduce people to a single characteristic. I have heard some MDs who believe that DOs were people who just couldn't hack MD school. And they talk about it that way. That's not okay. It reduces and diminishes a person on a level that it is not okay. And it really removes everything about them as individuals and the complexity that makes them beautiful and human. And then social exclusion. Again, the way that doctors separate themselves from mid-levels and mid-levels separate themselves from nurse and we call the nurses the back, but we call the front desk the front instead of thinking about it circularly as an entire, well, like rev cycle is a cycle, right? The experience of the patient is a cycle. They go through the whole thing. Instead of kind of separating ourselves in top to bottom, side to side, if we can think of our teams as whole circles, I think that can really help in more inclusion in our practices that we all play a role that every team member has a role to play and that no one of us could do it without any of the other of us. But those social exclusions, those do lend to dehumanization. And then of course at the, well, the farthest end, which is, you know, way socially, things like genocide and things like that, I did not put on here. But then at the end of the spectrum here is the systemic issues where the policies and practices create environments where individuals are stripped of their dignity. And I will get a little bit into that in our next slide and some of the ways that those shows up. But I have this in my office. I refer to it often just to remind myself, look, I have a responsibility as a leader to be human myself, to humanize and treat as human the people that I work with, whether they're the front desk or all the way up to the physician. And so just having this in front of me to remind me this is the way that dehumanization can show up really is a good barometer for me and a good reminder of, okay, I need to improve here. Or yeah, that was not okay. I need to correct that or really work in that area. And I would really challenge each of us to do that. So I wanna talk about the impact in some of the other subsystems. The way that the systemic issues show up that lend to the wellness or not of our physicians shows up in academics. It shows up in their work hours. It shows up in the work. One of the things that we don't talk about a lot is what it takes from a person to sit with another person in their suffering. There have been studies about ER physicians who spent their lifetime in the emergency room and have actually witnessed more death and suffering and carnage than a soldier who served 48 years in the military. And PTSD is talked about in the military. It's not talked about for our physicians. And we don't talk about the way that the work can harm. And the work needs to be done, but there are not a lot of preparations or things built into the system to help our physicians deal with the co-suffering that goes on when they enter into that suffering with that other person. To hear another person's pain takes a lot of emotional and mental energy. And then the pressure of fixing that pain, you add all those things together, it becomes really complicated and a lot more stress than I think we like to talk about. Treatment by attendings. Again, you get a physician in a trusting relationship, start to have a dialogue with them. There's a lot of abusive behaviors that go on in the medical school environment. And that's, unfortunately, the way that abuse cycles work. We know this. Those cycles have to be interrupted. And so very often, the way that med school students are treated when they get into our practice, they think it's their turn. And we see that sometimes in those behaviors. And so we need to understand that yeah, those behaviors are not okay. We do need to have strategies for interrupting those behaviors. And understand it is more, as much, if not more, an issue of the environment and the training than their character or their person. And so really understanding that. I'll talk a little bit more about that as well. And again, because it's a social system, there's unwritten curriculum that you never call in sick. You always say, yes, strength is showing up even when you're not, you should be at home in bed, right? And then really unhealthy competition. It's always curious to me how much we talk about in healthcare that on one side of the conversation that we're facing this cliff of no providers and not enough nurses and physician shortages. And yet the kind of indoctrination, I would use that word as a strong word and I know it, the competition that is built into our industry, that there's never enough cases and there's never enough patients and there's never enough room on my schedule. I have to fill, fill, fill, fill, fill. And so this idea that there's not enough to go around has become really, really damaging and completely flies in the face of everything we know about physician shortages. And so how do we interrupt that really unhealthy level of competition because it does lend to the problem. And licensing and credentialing, this is probably a big one. I don't know how many of you know or have been involved in credentialing, but when a physician applies for a license at the state level and I don't know about their DEA, I'd have to check that, but for sure hospital and surgery center credentials, part of what they signed in that application is signing away their HIPAA rights. They give authority to state licensing bodies and to hospitals and surgery centers to have access and knowledge of what would be HIPAA protected for any other patient is fair game for all of these regulatory bodies to know what's going on. Very often they are punished for that care, especially if it is a mental, emotional or addiction. You answer yes, that you've seen a therapist. I mean, Alaska's was bad. It's since changed, but originally the application didn't even talk about a diagnosis. And I also believe that's appropriate, but had you even really seen a therapist, if you answered yes to that, the state medical board is allowed to come in and ask why are you in therapy? What's the topic? What's the diagnosis? Are you being given any medications for it? It just becomes this super intrusive, inappropriate probe into a physician's suffering and their care. And so all of the things that we demand of them towards their own patients, we strip from them in order for them to practice in their profession. And there is no federal standard. Every single state medical board is different. Every single hospital and surgery center is different. And so for a physician who's undergoing any kind of particularly mental, emotional or addiction care, they could fill out a license in, I don't know, Alabama and be just fine, come to Alaska and it would be a problem. So there's not even, it limits their mobility even in the ways that they have to report their own care. And then payers. Reducing the autonomy in their care decisions is a massive driver of burnout. They, our physicians spend all this time in training learning these really high level, high functioning skills. And then they come into practice and the thing that they know is best for the patient comes into question about whether or not it can be done because insurance may or may not pay for it. And yes, insurance companies may have peer review. I would argue that it's not necessarily peer review. When you've got a pediatric heart surgeon making a peer review decision on an MRI for an orthopedist, I wouldn't necessarily call that a peer review. There does need to be some work there, but payers should not be driving care decisions, but they are. And that slowly chips away at the autonomy and decision-making of our care providers. And then they get blamed a lot for costs. How much do physicians get paid and physicians charge too much and all this other stuff when you have hospital systems and we have other forms of care that lend, pharmaceuticals is a massive part of the industry that costs way too much, but a lot of the dialogue and the narrative gets blamed on physicians as individuals. And that's really important to understand. One of my arguments too then is that all of this is really an issue of justice. And why is it an issue of justice? Unequal treatment of a group of people within a society is one of the definitions of justice. And somehow the higher standard that we expect of physicians has become a double standard. Again, we demand compassion, we demand empathy, we demand excellence, they demand privacy, which we give them. And then when it is the physician's turn to be the patient, all of that is stripped from them so that the licensing board and all of the credentialing bodies can know what's going on in their lives. Another definition of injustice, is there any action taken that infringes upon a group's rights and marginalizes their opportunity? Again, their mobility is limited because they can't depend on a standard set of answers if they want to move to a different state to practice. It's waiving the rights to their privacy for any application that they fill out. Another definition of injustice is a situation where the rights of a person are ignored. Again, there's a lot of conversation, again, a lot of it's on LinkedIn, where physicians are starting to really call out C-suites as being uncaring and willfully blind to the physician concerns and pain. And I don't know that that happens so much in our context. We work in much smaller systems. A lot of us were in small practices and we see those things and see our physicians face-to-face and as people more easily perhaps. But in big hospital systems, it is a problem. There is a divide there that does lend to physician burnout. And we need to talk about that and figure out how to bridge that divide. And you see this sometimes in the older generation mocking the younger. I've seen older orthopedic physicians complain about how much harder they worked than the new guys in the younger generation. And so that's also because it's a social issue, there is a justice issue there. And then inequality relating to the unfairness or undeserved outcomes. Again, physicians take an oath to do no harm and then are actively harmed by the system in which they work in practice. And so there's an incongruency there that is an issue of justice in my mind. And then the work of medicine, we know it causes mental and emotional distress and yet when they reach out for care, it's punished. I think a lot about like peak performance athletes. There is no way that Russell Wilson at the top of his football career was denied coaches and denied physical therapy and denied massage. Whatever, you know, the team cares for the team in the sports environment. But for physicians, they're on their own. Physician heal thyself is the motto of our social system when it comes to the care for our physicians. And it's wrong. So I want to talk a little bit about the leadership imperative. What is it that's up to us? And I think really rehumanizing our physicians is one of the first and most important steps that we can take. Talking about solutions can get really hard because it's overwhelming. This is a massive system with so many subsystems. There's no silver bullet. And so I know for myself, sometimes it's a struggle to just not throw out my hands and think, well, I can't do anything. I can't change CMS. I can't change the Department of Health and Social Services. I can't change our state medical board. And so we tend to do nothing because it's overwhelming. And so one of the calls to action that I would say for us is to rehumanize our physicians any way that we can. I remember I really was not a James Bond fan until the Daniel Craig versions. And it was the first time really that James Bond got dirty and he bled. And it really changed. I think it's a good visual to help us understand that even heroes bleed and that's okay. And so the question needs to become instead of like, why are you bleeding or what did you do? Like, how can we help that bleeding? How can we think more like sports teams and provide care for our physicians first as humans and then second as high functioning professionals who need to stay at the top of their game. And so just remember that they have feelings. They do bleed. Their souls are wounded. They are not exempt from any of the things that all of us are subject to as well. And so how do we hold that all together? Again, like what now? What is the non-physician executive responsibility? And why am I making the argument that we do have a responsibility? And this is where I usually in a room full of people can ask for a show of hands. But I'm just curious if anybody knows what the ratio for every one physician in the United States, how many non-physician executives are there? I'm just seeing, I don't know where my chat went. Jessica, are you able to, if anybody's in the chat giving some answers, can you tell me what some of the answers are? I haven't seen anything yet. So if anyone wants to take a stab at it, I'm keeping an eye on the chat there. Okay. Or. Okay. Anybody else? Oh, there it is. It's over there. Six. Okay. One more. Anybody else want to guess? I'll go in between and guess five. Okay. Where are we now? Do we go forward? There we go. The answer is 10. For every one physician in the United States, there are 10 administrators or non-physician executives. And the reason that I want to point that out is because when you take those numbers and you pull them down again into social sciences and start talking about power dynamics, and I'm, so I'm not talking our practices because our practices are smaller, but when you look at the whole system, who holds all of the power in our healthcare system, it's us. It's not the physicians. It's not our PAs. It's not the people providing the care and performing the core function of what we do. It's us. And so going back to that leadership imperative and that my personal, one of my personal core values that it's not about me, but it starts with me. My call to action for all of us is to ask how it starts with us because the power dynamic is definitely shifted in our direction and not theirs. And some of the grievances that physicians will air about the relationship between administrators and physicians is valid. Not all of it is valid. I will definitely say that, but when we talk about ownership and accountability and responsibility, let's say you have a pie chart. We all love pie charts. Any of us are data nerds and we're living in this stuff every single day. And let's, let's just talk about like my relationship with one of my physicians. If we're having an interpersonal conflict or there's a problem, it doesn't matter if my slice of the pie is 2% or 90%, 100% accountability is fully owning whatever percent is mine. And that's all we can do. We can point the physician, we can point the finger at physicians all day long. We can even be right technically and correctly about their, or behaviors or things that we don't like, doesn't do anything about our own responsibility and the responsibility we need to take for our part. And so that's what I want to talk about today is what is our part and fully owning that, even if it's a little bit, or if it's a lot having, um, the courage and the vulnerability to say we have a big piece of the pie to own here. So again, why non-physician executive leaders, uh, many of the subsystems are starting to have these conversations. When I was first doing my undergraduate work actually, and started asking the question, cause I had, uh, pause for a little story share for a minute. Um, I had been still kind of new to orthopedics and one of my docs is going through a really hard time. And I said, you know, have you thought about talking to a counselor or getting a doctor's appointment? I said, you know, have you thought about talking to a counselor or getting a therapist? Like therapy really, really helped me. And he just like grinned at me and turned around and left no answer. And then not even a few weeks later, I was helping him renew his medical license. And for the first time I was able to see all of these questions about how have you ever seen a therapist? What was the diagnosis? Did they prescribe you any medication? What was it? Are you impaired by it? And the thing is those questions are not asked separately. If you answer yes to, have you ever been to therapy? All of those questions become open. And so I started to ask the question, who's caring for the people who are caring for us? And the answer is hardly anybody. Very often physician heal thyselves. It's them. They're self-medicating, they're self-diagnosing, they're handling it all themselves because that's what they've been taught to do. And so when I started talking to some people who have been deep in this research for a while, I started to ask the question about, because I was thinking about changing my MBA actually to counseling instead of business because I see a need for our physicians. And the answer that I was told was no. Like, well, I mean, not no, like I could have if I wanted to, but the recommendation was these conversations are starting to happen in med school. They're starting to happen at the legislative level. Physicians are becoming more vocal, although there is still a lot of blame and pendulum swinging and we can talk about that in a minute. But the point that she was trying to make was you are an administrator. You have a strong network of other administrators. You're the only cohort not talking about it yet, but you started talking about it. We need you in those conversations. And so it was a really good feedback for me to understand that, okay, we need to really catch up here. Our understanding of this has been lagging and yet we're the ones with most of the power making a lot of the decisions. So we need to catch up and the lives of our physicians are at stake. So again, what can I do? It's kind of overwhelming. And this is definitely part of my personality is just like face the beast and jump right in and swim in the deep end of the pool because accountability is important. And so what are the ways that accountability can show up for us? We need to listen, learn our role, identify themes. And I'm just going to want to make sure to leave time for some questions. I'm going to speed this up a little bit, but this is a survey of physicians about what contributes most to the burnout. I made a star of the ones that pointed out to me most specifically. The third one is lack of respect from administrators, employers, colleagues, or staff, and then lack of respect from patients. So if you put those together, they actually would tie with the 62% of too many bureaucratic tasks. But then you measure that. And what's interesting about that is then you measure it against the same survey that asked what would help. It doesn't necessarily match. They want more support staff. They want more flexibility in their schedules. They want more respect. So it's interesting to me that in the top three was a lack of respect as a driver, but it was lower score that they wanted more respect as a solution. And I wonder about the lack of safety to be vulnerable in their answers when it doesn't match up on either side. And then lightening the patient loads. So just really when we look at results like this, the challenge that I would issue, I guess, is to don't just look at the numbers, but really think about what they're actually saying in some of these things. And how does it actually show up as a solution? Because it was very interesting to me that a lot of the solves were practical when they said one of the biggest issues was the lack of respect. Again, thinking critically about the results, it was interesting to me that the survey identified these as coping mechanisms. What that says to me is that even the things that they're doing to make it better are from a point of surviving instead of thriving. And our physicians deserve better than to be in survival mode. It was also interesting to me that the fourth highest answer was to spend time alone. Time alone can be good for reflection. And so some of these things that happen, I would say in the right kind of alone time is okay, but we also need to be very, very aware of the fact that there's a difference between solitude and isolation. And isolation drives burnout. Isolation drives addiction. Isolation drives suicide. And so it was disturbing to me that not only does this say it's coping mechanisms and that they're still just surviving even in the solutions, but that one of the highest reported was to be alone. I'm an introvert. When I don't feel like being with my people is when I force myself because I know that I need it. And that's a skill that you have to work very hard to develop. And so then what are some of the practical tips? Again, humanize, make it a safe space to feel. And I do want to say this about safe spaces. A lot of myths around safe space being, well, I'm just, it's just safe for me to behave however I want to behave. And that is not what I'm saying here. When I say a safe space to feel, it is they have a safe space to actually own their feelings and to own that they're having a hard time, not just to come in and scream and yell and holler at us and do all those things. That's not what I'm talking about, but allow them time off. Physicians have babies, physicians lose parents, and really figure out ways to value our physician cohort outside their production. Some language modification. There's actually a big movement to stop using the word provider and start using the word physician. Provider kind of amalgamates everybody and doesn't really draw clear distinctions about why someone chose to go to medical school instead of become a PA or stay in nursing school when they could have become a PA. So identifying people by their licensure is actually okay and should be done more of. And that's something that if you really take a look into the, where those conversations are happening, that's something that physicians are asking for. Figure out a way to make productivity less reducing them to commodity. One idea would be in our board meetings when we go through all of the numbers, ask each of the physicians first to check in what was the most challenging patient they saw that day or what was the most rewarding patient that they saw that week or that month and really personalize the care that they do before you start talking about the numbers. And again, taking accountability for our role in the culture setting is very, very important. It is important to require respect from all parties. If a radiology tech could not scream at a surgeon without getting fired, a surgeon should not be able to scream at a radiology tech. And we need to start having those conversations and developing the skills to have those hard conversations because respect should be required from everyone. We need to take responsibility for our role in building trust and having conversations is part of that. Sometimes you may need to bring in a facilitator. Some of us may have been in our practices for a really long time and aren't objective enough to have those conversations. And so being willing to bring somebody in and have some of those difficult conversations while we still honor all of our humanity is really, really important. I think it's important to adopt and develop human-centric leadership skills. So studying healthy leadership continuum, what that looks like, studying compassionate inquiry and trauma-informed leadership, and then taking on a coaching leadership style are some other things that we can do. And I'm running out of time, so I'm going to skip ahead to some of the resources for your physicians. Highly recommend physician coaching programs. I personally know all three of these coaches, highly, highly recommend them. Part of the reason I didn't go into counseling instead of business, again, is because physicians need physicians. We can care, we can help, but physicians really need that peer support. The other thing that I absolutely love about coaching is that while it is therapeutic, it is not therapy, and it is not reportable to state medical boards on a licensing application. So they can get support, like true, good, solid peer support, and do it in safety and not have to have it reported. Physicians Anonymous is another great spot. I've not been in them because I'm not a physician, but from what I've been told, a lot of the same rules as AA, but a lot of conversations go on here that aren't related to substances. These are, you know, sometimes just really hard feeling conversations, but they're in a safe place to do it. So if you have a physician who's struggling, but doesn't feel safe, this is a really great resource. Any work that you can do or understand around the Lorna Breen Heroes Foundation, they're doing a lot of really, really great work to change medical licensure and hospital applications to not be so intrusive. Some things do need to be asked, you know, if somebody has a history with addiction, that's important to know, and there's a lot more humane ways to ask about it. State medical associations, I will, and physician health committees, their purpose is really to sit kind of adjunct, I think there's one in every single state, they're supposed to sit adjunct to state licensing boards and protect them. But there are some valid criticisms from people who've worked in them and actually run them about kind of the structure of it, the lack of standardization. So I am not here to make a judgment either way, except you should know that they exist, you should explore the ones in your state, maybe even develop a relationship with them. But also proceed with caution, they are one of those subsystems that does have their own flaws, and those need to be understood. And then always proceed with caution, consult legal, maybe your malpractice carrier, if you find yourself in a position with a physician that really is kind of dire, and needs to be addressed, but I would not use it flippantly. And so kind of in conclusion, physician burnout is a systems and a leadership problem, it is not an individual physician problem. They do have their responsibility, but baseline self care, like sleep, exercise, what they're eating, that's basic human self care. It should not be used as the bandaid to fix a much larger systemic issue. And just remember to that there is no one answer. This is very complex, it's okay to dig into those complexities and find out where you can help. We can't all help everywhere. Remember that your physicians are human and that burnout is a form of suffering. It's not a phenomenon that we get to kind of distance ourselves and not think about because it's too hard. And then just again, a challenge to all of us that it is a non physician executive leader imperative to improve the systems and cultures where we can and take accountability for our part. And I we are right at the hour. And so I was hoping to have more time for questions. I'm happy to stay on a little longer, Jessica, I don't know how that works. But definitely here if anybody has any thoughts or questions, and if they can, I'd love for people to come off mute and actually talk instead of the chat. So it looks like people had to jump to other calls. So I didn't see any questions come in. But I do want to make sure you see this from Nicole saying that it's been I think she meant so good and eye opening. And thank you. So appreciate the presentation. I actually learned a lot to myself. So there's a local physician in our community that was affected by, you know, some burnout and had a terrible, you know, conclusion to that. And so understanding this, especially from our perspective to know about it. I'm, I'm glad to understand it. And I'm excited that we're going to have this at conference too, because I think it's really important needed information. So thank you so much. Thank you for the presentation. And with this being recorded, we'll have it in the AOE Learning Center soon. Great. Well, and again, thank you for this opportunity. I appreciate it. And my contact information is in my membership profile with AOE. If anybody wants to reach out and have, you know, has some questions, or even if you're struggling with anything, I'm definitely a resource for this. So please feel free to reach out. Awesome. Thanks, Olivia. Have a great afternoon. Thanks. You too. Bye.

physician burnout

systemic issue

leadership transformation

Olivia J. Wolfe

healthcare system

humanizing physicians

emotional support

compassionate leadership

flexible scheduling

peer support

systemic lens

leadership accountability

World Health Organization

dehumanization

social systems

emotional well-being

physician coaching

stakeholder responsibility