Representatives of a battered and stressed Canadian medical profession gathered in Montreal and virtually last week for the 7th annual Canadian Conference on Physician Health (CCPH) – the first such meeting in four years and the largest to date. One of the main pain points identified as facing individual physicians is the burden of administrative work, and this was the focus of a special cross-border plenary session featuring Canadian Medical Association (CMA) President Dr. Kathleen Ross and Dr. Marie Brown, director of practice redesign for the American Medical Association.
In introducing the conference, Dr. Ross said, “Many of us are stretched so incredibly thin and have been targets of harassment and bullying at work and in training programs.”
Later in the meeting, she released a statement referring specifically to the current conflict in the Middle East. “The Hamas-Israel conflict is causing significant tensions for Jewish and Palestinian physicians, with many experiencing antisemitism, racism, Islamophobia, and other forms of aggression,” the statement noted.
The impact of the COVID-19 pandemic and its hugely negative impact on physicians was also referenced repeatedly. “COVID is not over; it has a lingering presence. It has altered our ability to offer quality patient care … and we will never recover,” said opening keynote speaker, Dr. Jane Lemaire, co-director of WellDoc Alberta.
What emerged very clearly this year was the recognition of how interlinked the well-being of physicians is with the health care system as a whole and the health of the patients they care for. “We are caught in a vicious cycle of work overload, burnout, and attrition of the health workforce, which has critical population health and health system impacts,” said Dr. Ivy Bourgeault, leader of the Canadian Health Workforce Network.
At one point in the meeting, an emergency physician from Montreal rose to ask why it was so hard to persuade people that good physician health translates into better patient outcomes.
Dr. Edward Spilg, an associate professor of medicine at the University of Ottawa, noted that a decade ago, individual resilience was identified as the way physicians could best deal with well-being issues. Now, he said, there is a recognition that system-level interventions are essential. Dr. Lemaire said a multi-pronged approach to culture change is required to improve physician well-being, and the health care system must support such a change.
Administrative burden is one system-wide issue that national medical organizations in both Canada and the US have made a priority to address. In Canada, Dr. Ross leads a special task force created by the CMA to deal with the issue, which is a priority in its current strategic plan.
In opening the plenary session on the topic, Dr. Ross applauded work done by the AMA to recognize and introduce initiatives to deal with the issue, especially with respect to electronic health records (EHRs).
“It appears from the research … that almost 3-5 hours a day can be saved by removing unnecessary tasks,” said Dr. Brown in her remarks, adding programs are needed to deal with these tasks. “Eliminate, automate, or delegate.” Both Drs. Brown and Ross talked about the frustration of dealing with EHR systems that are not interoperable. “We need to demand complete interoperability so we can provide better care,” said Dr. Brown.
Dr. Brown said artificial intelligence (AI) may hold potential for relieving administrative pressures on physicians but not if it is just layered onto a task that is not necessary in the first place.
For the CMA, the focus has been on dealing with the massive burden placed on physicians requiring to fill out forms, especially for employees requiring sick notes from employers. Dr. Ross applauded a recent commitment by the government in Nova Scotia to reduce this requirement.
While much of the focus of the meeting was on system-level approaches, some sessions also dealt with how individual doctors could deal with the stress of medical practice today. In a keynote address, Dr. Kristen Neff, a clinical psychologist at the University of Texas, Austin, advocated self-compassion consisting of “kindness, mindfulness, and common humanity.” In another session, Collingwood family physician Dr. Caroline Bowman, who has been diagnosed with MS, discussed shame resilience as a missing component of physician wellness.
A focus on improving the well-being of medical learners and the environment of academic medicine came from two sessions discussing the Okanagan Charter, an international framework to support well-being at academic centers. Deans of all 17 Canadian medical schools have committed to following the charter, said Dr. Melanie Lewis, chief wellness officer at the University of Alberta. But she added only 12 of the 17 schools (soon to be 13) have formally adopted the charter to date, and she is the only person currently holding the position of chief wellness officer at a medical school.
Pat Rich is a digital writer and can be reached on Days of Past Futures and on Twitter @pat_health.
