Fifty-six patient messages wait to be answered by telephone while two nurses work busily to assist two providers administering injections and other procedures in the pain clinic. This is an example of an average clinic day in September 2021 in a medium-sized health care institution in the Midwest. How will these calls be answered in a timely fashion so patient satisfaction is preserved? The task is impossible and repeats itself day after day in most health care institutions across our nation. We have opened the floodgates on access to providers without a way to meet the demand. Bob Wachter, chair of the University of California, San Francisco’s department of medicine, describes this 24/7 access to your provider as being like turning on “access and capabilities and information flow while mostly working with the same chassis. If you put in some incredibly souped-up engine, but your car chassis was old and fragile. You start driving 120, and the wheels fall off.”
The wheels are definitely falling off the health care vehicle. More is not always better when you are expending the vital source of your work model: the health care workers. Will we come up with reasonable solutions to this dilemma in time, before our providers are 100 percent burned out? The Health Resources and Services Administration has just closed the grant application window on a $103 million funding from the American Rescue Plan to strengthen resiliency and address burnout in the health workforce. Now we wait to see the ideas of how to buffer against burnout from the best and brightest who will receive these grants. Will it be too little too late? You could argue we should have better thought through the time and energy drain the EMR and continuous access to providers would have on this workforce. While patients desire instant gratification for all their health care questions, providers experience progressive burnout.
Data gathering vs. taking action
The past ten years’ worth of physician burnout literature has mostly reported on the phenomenon of physician burnout. Now is the time for an active, hands-on approach to be applied to the issue. What are the best techniques and strategies to improve provider wellbeing and reduce burnout? This task of finding the best provider support strategy seems insurmountable, and for many institutions funding, time, and administrative support seem in short supply. At our institution, we offer internal peer coaching support to providers. Our coaching team, physician coaches who offer peer support to physicians, simply explore wellbeing techniques with providers and invite feedback after the experiences. The coaching programs we offer allow providers to come for support without judgment or stigma attached. Furthermore, coaching is not therapy (we have the employee assistance program for therapy needs), but it is about the coach being a thought partner who comes alongside an individual to help them explore who they are and what they deeply desire to accomplish. Coaching offers an opportunity to find our best self, gain resilience, and practice self-compassion in the process.
Creating the program
Our coaching team was given autonomy to develop the coaching programs, and this is key to the success of our internal coaching program. A variety of excellent coaching training programs exist and our administration chose to fund the training of five coaches. We have been given FTE time, IT, and secretarial support. Coaching is not mandatory, remedial, or punitive. Our marketing services have helped spread the word of this service for providers, and now two years into our program the word is on the street as providers share their experiences with others, more are coming forward for coaching.
Coaching program examples
We are a medium-sized institution, 500 plus physicians, and are unable able to churn out huge amounts of data about the impact of our programs, but we are actively trying to be present, listen and provide service to the burned out providers in the trenches. Some of the programs we have designed that have been well received include a Clinician Virtual Lounge, offered twice monthly where small groups of providers gather virtually to explore a variety of resilience tools. Group and individual coaching around burnout, imposter syndrome, and time/energy drains have been some of the favorite topics. Emails with wellbeing tips are frequently shared, and the coaches are actively engaged in improving the EMR experience. We offer rapid deployment coaching to clinics that are struggling. Recently, a rural clinic was down two providers, and the work was overwhelming for the remaining small crew. We spent two sessions just listening to the team, hearing their frustrations, offering self-management and self-compassion tools they can use at the moment when they feel exhausted and overwhelmed.
Let’s return to the wheels falling off analogy mentioned earlier. Currently, in health care, our wheels haven’t fallen off, but they are definitely spinning. There is no overnight fix to the mounting pandemic of burnout our providers are facing. It will take a slow internal organizational culture shift to improve wellbeing for all workers in any health care setting, and the final strategy will not be one size fits all because each worker and organization is so incredibly unique. This is a call to stay strong, develop your personal and organizational strategies now for overcoming what is certainly progressive burnout in a population of fatigued, yet dedicated, workers who have put their own needs second to those of others. At our institution, we strongly believe developing an internal coaching program, by training physicians to be coaches, is one of the cost-effective vital steps in what is a grassroots strategy to stopping the burnout pandemic among our providers.
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