August 2016 | Physician Magazine by Los Angeles County Medical Association

PLUS:

PHYSICIAN

BURNOUT

HEALING THE

HEALERS

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

LACMA INNOVATORS SERIES FEATURING

Leo Treyzon, MD AUGUST 2016

P U B L I C

A T

O F F

O F F C

N I O

P U B L I C

See the L.A. artists you’ll be hearing about. Don’t miss Made in L.A. 2016: a, the, though, only The third iteration of the Hammer Museum’s biennial exhibition continues to highlight the work of emerging and under-recognized artists in the Los Angeles area. The exhibition will run June 12 – August 28. The museum is always free. Made in L.A. is presented by Wells Fargo. For more information, visit hammer.ucla.edu/made-in-la-2016/.

AUGUST 2016 | TA B LE OF CONT ENT S

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL

ASSOCIATION

Volume 147 Issue 8

16 COVER STORY 8 LACMA INNOVATORS SERIES Leo Treyzon, MD

FEATURE

Physician Burnout

Explore what we know about physician burnout, prevention and remediation strategies and look at the current culture in medicine that has led to this point.

16 Working Together | LACMA partnership with the NMA

FROM YOUR ASSOCIATION 4 President’s Letter | Vito Imbasciani, MD 6 An Agile and Innovative LACMA | Gustavo Friederichsen

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine,801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request.

AUG US T 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1

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as well as medical students, interns and residents. For more than 100 years, LACMA has

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been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, government relations and community relations. Through its advocacy efforts in both Los Angeles County and with the statewide California Medical Association, your physician leaders and staff strive toward a common goal— that you might spend more time treating your patients and less time worrying about the chal-

Vito Imbasciani, MD William Averill, MD C. Freeman, MD Sion Roy, MD Peter Richman, MD

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COUNCILOR – DISTRICT 2

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VLGPF TRUSTEE

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Jerry Abraham, MD David Aizuss, MD Emil Avanes, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Amanda de la Cerda Troy Elander, MD Samuel Fink, MD Hector Flores, MD Sidney Gold, MD Stephanie Hall, MD Po-Yin Samuel Huang, MD David Hopp, MD Marvin Kaplan, MD Kambiz Kosari, MD Jeffery Lee, MD Paul Liu, MD Maria Lymberis, MD Ashish Parekh, MD Jinha Park, MD Anantjit Singh, MD Stacy Songco Heather Silverman, MD Diana Shiba, MD Nhat Tran, MD

lenges of managing a practice.

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

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P RES IDEN T ’S LET T ER | VIT O IM B AS C IANI, M D

It’s a truism to say that we physicians must take care of ourselves first in order to care for our family, our patients and the communities in which we live and work.

E V E R Y N E W P R E S I D E N T O F L A C M A has 12 opportunities to reach out to all the physicians of the county – regardless of where and how they practice – with news of the profession and the challenges it faces in the immediate present. Many great writers of the past (think Charles Dickens and Alexander Dumas) also wrote in installments, but I cannot guarantee that any of my letters to you will reach similar literary heights. Medical journals and the lay press are full lately of reports of studies showing a high rate of burnout among physicians. The burnout rate tops 50% according to some studies, making us 15 times more likely to reach that point than professionals in any other field. Physicians routinely work 60 hours a week, 10 hours more than non-medical professional peers. Fortyfive percent of primary care physicians would quit practicing if they could afford to do so. The divorce rate among physicians is almost 20% higher than the general population. The number of physicians’ children entering the profession seems, anecdotally at least, to be dwindling; at the same time the physician workforce is predicted to reach 90,000 by the year 2025. It’s a truism to say that we physicians must take care of ourselves first in order to care for our family, our patients and the communities in which we live and work. Success at righting the work-life imbalance that is endemic in the modern practice of medicine, regardless of one’s specialty, takes a combination of information on what works; commitment to achieving the goal; and time, the most precious commodity of all. The Washington Post has reported on one of a growing list of programs to help doctors rebalance their lives. The Emergency Department at Stanford University has instituted a “time bank” that allows physicians to exchange hours worked on emergency shifts, committees and/or mentoring for any of a long list of personal concierge services (food preparation; cleaning; shopping; errands) that make life easier at home. Unfortunately, most physicians are not working in this kind of supportive staff model, and will have to look to other resources. LACMA is concerned about this burnout, and will address this issue in the months to come in different formats, including this magazine, social media and special events. A thriving, healthy physician workforce is important to all. To the extent physicians take the necessary time to tend to their practice and their patients, they are left precious little time to become involved in the health-related issues of the community at large. The issues are myriad: obesity; tobacco use; gun violence; mosquito-borne infectious diseases; mental health and homelessness; and the role of parks, cycle paths and public spaces in public health. This is one of the fundamental reasons for the existence of LACMA: to give voice to concerned physicians who have increasingly little time or energy, at the end of a busy day at the office, to address these important issues.

4 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

THE STRENGTH TO HEAL and stand by those who stand up for me. Learn the latest treatments and play an important role in the care of Soldiers and their families. As a physician on the U.S. Army Reserve health care team, you’ll continue to practice in your community and serve when needed. You’ll work with the most advanced technology and distinguish yourself while working with dedicated professionals. You’ll make a difference. For more information, visit healthcare.goarmy.com/eb22 or call 310-216-4433.

LAC M A C EO | G U S TAVO F RIEDERIC H S EN

F O R S O M E O R G A N I Z A T I O N S , the middle of summer means higher temperatures and a cooling off of activity. Not at LACMA. Thanks to a revitalized relationship with the California Medical Association (CMA) and aligned efforts with Jay Hansen, CMA’s chief strategic officer, we were successful in negotiating a historic partnership with the Los Angeles County Health Services Department (LADHS), led by Mitchell Katz, MD. The agreement calls for the addition of 768 new LACMA members. Los Angeles County Supervisor Mark Ridley Thomas played a key role in the success of the partnership, which took over a year to cultivate, nurture and negotiate.

Both LACMA and CMA will support Dr. Katz’s vision to deploy housing as a solution for the mentally ill, homeless and those transitioning from incarceration in need of viable options to cope with a variety of complex health issues.

Now the real work begins: LACMA and CMA will deliver leadership development, recruitment and retention support, residency placement and physician wellness programs, while CMA provides strategic advocacy and integration with Tobacco Tax and Prop. 30 efforts. Both LACMA and CMA will support Dr. Katz’s vision to deploy housing as a solution for the mentally ill, homeless and those transitioning from incarceration in need of viable options to cope with a variety of complex health issues. July also saw the renewal of our relationship with Allied Pacific IPA and its more than 100 physicians. In the past few weeks alone we have had profound discussions with Allied and LADHS and will continue to serve their growth, quality improvement and physician development strategies. The Los Angeles County and Allied partnerships represent a new “pace” at LACMA built on a solid foundation of collaboration with CMA and transparent dialogue with current and prospective partners. In the past few weeks we’ve launched several initiatives to help transform our platform from one that was traditionally reactionary to one that is agile and innovative. LACMACares serves the needs of retired physicians or those facing crisis. We’ve initiated discussions with Uber to provide transportation services for those retired doctors who want to be more active and engaged. LACMAGrants is a new method of working closely with each LACMA District to discuss growth, retention and member experience and provide funding for these efforts. I was excited to host a productive meeting with all District presidents in late July to discuss strategies and mechanisms for funding. Common Ground is our new specialty society outreach program whereby LACMA works closely with the more than 30 specialty organizations in the region and/ or state. Thanks to Bill Averill, MD, LACMA Board Member, we’re able to have substantive conversations with Norman Lepor, MD, President, California Chapter, American College of Cardiology, on how to work together to attract and retain our respective specialists. The Chapter is holding its Inaugural Technology Fair at the Loews Hollywood Hotel on Aug. 6. Better, Together is our ethnic physician outreach program, and our first strategic partnership is with the National Medical Association (NMA). NMA hosted its 114th annual convention in Los Angeles from July 30 through Aug. 3 and LACMA hosted the welcome reception for new NMA President Richard Williams, MD. I want to thank Drs. McMillan, Chavis, Baker, Washington and Staveren for their unwavering support of our partnership with NMA and how LACMA can better serve the needs of African-American physicians in Los Angeles County. As we enter the fall season, LACMA members will see a refreshed member website, continued physician feedback regarding the aforementioned programs, additional strategic partnerships so we can continue to grow and outreach campaigns to Latino, Asian Pacific Islander and female physicians across the county. The fundamental goal is to consistently unveil a progressive LACMA, well positioned for an unprecedented end to 2016 and poised for a strong start to 2017.

Gustavo Friederichsen Chief Executive Officer

6 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

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AUG US T 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 7

LACMA INNOVATORS SERIES FEATURING

Leo Treyzon, MD Dr. Leo Treyzon, co-founder of Kumba Health

I N A N E R A O F R I S I N G H I G H - D E D U C T I B L E health plans, declining

reimbursements and a continued lack of transparency, Leo Treyzon, MD, and his best friend, a Los Angeles-based entrepreneur, decided there had to be a better way. So in 2013, Dr. Treyzon, a gastroenterologist in solo practice in Los Angeles, and his friend, Philip Klaparda, envisioned “a movement,” dubbed Kumba Health, that they hope will turn burdens created by the factors above into new opportunities, leading to healthier and happier doctor-patient relationships. Now a year old, Kumba Health, a network of some 50 physicians mostly in solo or small physician practices in the Los Angeles County area, invites patients to go online, find a physician of their preference by specialty and in their ZIP code, then schedule an appointment. What makes Kumba Health different is that all services are offered for cash only – to eliminate the middle man or insurance carriers – and that provider costs are listed on the physician’s profile along with the physician’s rating from patients. “The Kumba Health service was created with the end goal of eliminating the insurance hassle for both you and your healthcare provider,” said Dr. Treyzon. The basic

“Many physicians reduce their standard billed charges 10-30% for Kumba patients and still benefit financially, but your Kumba Health fees are your decision”

8 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

premise is that patients pay directly at the time of service. Doctors, in turn, are encouraged to offer discounted rates, given that they are saving on administrative costs associated with billing, producing insurance claim forms, coding diagnoses, payment delays, collection risks, etc. “Many physicians reduce their standard billed charges 10-30% for Kumba patients and still benefit financially, but your Kumba Health fees are your decision,” Dr. Treyzon said. What drives Kumba Health, he said, is the trend toward high-deductible health plans where patients often don’t know how much they need to pay for medical care until the bill arrives. With greatly varying costs from one healthcare facility and one hospital to another, patients are left in the dark in terms of pay. With Kumba Health, there is no ambiguity, Dr. Treyzon said. Patients can go online and research a doctor and know exactly how much they will need to pay here or there. “It’s really catching on with the advent of the Internet,” he added. “When people become responsible for their own high-deductible plans, they will look for clarity.” For physicians, Kumba Health is attractive for the same reasons – a lack of ambiguity in pricing, running a cashpay practice and attracting more satisfied patients. Doctors can decide their own fee structure and establish fees.

Meet

Stephanie Booth, MD

A good guideline, Dr. Treyzon said, is to match or beat average reimbursement from existing insurance carriers. Becoming a Kumba Health doctor currently happens by invitation from an existing Kuma Health provider only. That is followed by a rigorous review of credentials as well as satisfactory consumer ratings.

At LACMA we have so many committed, talented physicians that it seems fitting to spotlight some of them and their accomplishments. If you’re active in LACMA, then chances are you’ve met Dr. Stephanie Booth! Hailing from Long Beach, Dr. Booth is a wellknown pediatrician, loved by her patients and staff. Along with her busy practice, she balances her many LACMA roles as chair of the Women Physicians Action Committee, president of District 3, LACMA Board Member, delegate to CMA and member of the MediCal Physicians Committee. With over 20 years of physician experience, Dr. Booth brings attentiveness and care to her patients, giving them peace of mind both in the office and after. By making follow-up calls to her patients, Dr. Booth communicates with compassion and a personal touch. It’s no wonder she’s won so many awards: Patients’ Choice Award, Compassionate Doctor Recognition, Top 10 Doctors in Long Beach, On-Time Doctor Award.

Here’s what her colleagues have to say

“We have a quality standard that every physician needs to meet,” Dr. Treyzon noted. “We use a professional consulting firm that does quality investigation in the community.” Kumba Health is self-funded to date, and Dr. Treyzon said he’s looking for investors to help grow the organization and wants to align with LACMA community groups and co-market and co-network. “As it expands as a physician network, we hope the people will simultaneously grow with LACMA; I think our missions are aligned.” A returning LACMA member, Dr. Treyzon said he’s excited about the appointment of Gustavo Friederichsen as LACMA’s new CEO. “Gustavo is an innovative type of individual who brings a lot of excitement to the physician community,” Dr. Treyzon said. Friederichsen worked with Dr. Treyzon on the vision and marketing strategy for Kumba Health, giving them a voice. For the future, Dr. Treyzon hopes that Kumba – which means to band together – will roar into the marketplace and take back that original notion of creating a natural, healthy alliance between doctors and their patients.

“Stephanie was one of the first to welcome me when I joined LACMA, and she continues to inspire me each day with her enthusiasm, compassion and dedication to helping patients and supporting her fellow physicians.” Gustavo Friederichsen, LACMA CEO “In the many years that I have known Dr. Stephanie Booth, I have always found her to be a very dedicated, hard-working, and caring physician. She puts the needs of her patients first, seeks to improve the doctor-patient relationship, and promotes the advancement of women physicians throughout the healthcare industry.” Susan Reynolds, MD, PhD “Dr Booth is always enthusiastic, engaged and asks critical questions, making her an invaluable board member for LACMA. Her engagement is superior—she is ALWAYS paying attention regardless of the banality of the issue.” Sion Roy, MD “Dr. Booth is a shining example of what a physician should be —determined to help others no matter the barrier, persistent in her passion to practice and protect the house of medicine, and strong enough to be depended on in times of high stress which regularly occurs in the delivery of care to patients and their families.” C. Freeman, MD, MBA Thank you for all of your hard work!

AUG US T 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 9

Physician Burnout:

Healing Healers the

P H Y S I C I A N B U R N O U T I S A L L O V E R T H E N E W S and the issue certainly needs attention. Over the coming months, we’re going to look deeply at this issue in a coordinated campaign here at LACMA through webinars, events, articles and social media. We’ll explore what we know about physician burnout, prevention and remediation strategies and look at the current culture in medicine that has led to this point. The goal is to find and share deep, lasting solutions to help doctors avoid burnout and find their way back to health. Here in LA County, we’ve got the resources, talent, drive and creativity to tackle this complicated issue in a meaningful way. What we know: At LACMA, we know that finding work-life balance can be difficult to achieve. We want to find the ways that we can help with that. Recognizing the signs and symptoms of burnout is important, but we can’t stop there. Doctors are generally the last ones to seek help for health or well-being. Changing that culture is key. Susan Reynolds, MD, (District 5) talks about how shaken the community was when three women doctors out of St. Johns committed suicide over a span of 18 months. She said

Using the Maslach Burnout Inventory, there are three key scales used in evaluation: 1. Emotional exhaustion measures feelings of being emotionally overextended and exhausted by one’s work 2. Depersonalization measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction 3. Personal accomplishment measures feelings of competence and successful achievement in one’s work1

1 0 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

there was a “come to Jesus moment” and points to the work of doctors like Maria Lymberis, MD, and Laurie Reynard, MD, who drew people together to help open up discussion about burnout at St. John’s. Dr. Reynolds highlighted Dr. Reynard’s work and said that she would “go around and set up small focus groups…to get this committee going and to educate the whole medical staff little by little about what the Well-Being Committee has to offer.”

Do you know who chairs the Physician WellBeing Committee for your organization? What is the committee’s function? Is it a support for physicians or a disciplinary committee? What we know:

Modern Healthcare Network recently ran an article about physician burnout. Author Catherine Miller lists the top five causes for burnout from a 2015 Medscape Physician Lifestyle Report. Too many bureaucratic tasks, increased computerization and the effects of the Affordable Care Act were all on the list. Miller quotes Ann Whitehead, vicepresident of risk management and patient safety for CAP Assurance, who wasn’t surprised by these results.

In September, we’ll tackle work-life balance head on. We’d love to hear your input during the webinars. You can find more information on the LACMA website.

“Healthcare reform has dramatically changed the way medicine is delivered, and we’re all in the process of transformation. Physicians are now asked and required to do much more to keep their practices going, whereas in the past, physicians would call us with basic risk management questions. It is now not uncommon to field calls with questions on a wide range of compliance and regulatory issues--MU2, ICD-10, HIPAA, EHR, reimbursement issues, telehealth, CDS, and many more. It is inevitable that this increase in responsibilities would detract from time spent with patients and career fulfillment.”2

What kind of support or changes would help you the most? LACMA is starting a webinar series called the “Physician Survival Toolkit.” This pilot program kicks off with a discussion of financial and business issues on Aug. 10. In September, we’ll tackle work-life balance head on. We’d love to hear your input during the webinars. You can find more information on the LACMA website.

What we know:

In spite of problems inherent in the medical field, when it comes to heading off burnout, relationships do make a difference. Dr. Lymberis is a psychiatrist and former LACMA District 5 president. She said, “One of the most crucial issues in dealing with burnout is social support.” Dr. Reynard is actively exploring practices that make a difference in the physician community at St. John’s. She referenced an article in JAMA that demonstrated a clear benefit for doctors who meet regularly to talk about difficult cases. Dr. Reynard stressed that “these doctors weren’t talking about medical facts—they were talking about their feelings around the cases.” And that’s an important distinction to keep in mind. The Physician Well-Being Committee at St. John’s is working on incorporating this model and other support measures into its program for physicians. Dr. Reynard talked about doctors as being the “second victim” when there’s an untoward outcome in a case or an unwarranted malpractice claim. “There is fallout for the doctor. It can come in the form of things like

depression or anxiety,” she said. One idea at St. John’s is to have a psychologist on staff for the doctors, a professional who understands the culture. Doctors could meet with the psychologist off-site through a self-referral and not worry about a negative impact on their credentialing. This relationship with the psychologist would be confidential. The same psychologist could reach out to physicians when they face a difficult case or malpractice suit. The hospital and medical staff would pay for the psychologist helping to ensure an impartial support for doctors. According to Dr. Reynard, this model has been used at Providence Little Company of Mary Medical Center Torrance for the past three years. One of LACMA’s functions in working to help with physician wellness could be to act as a clearinghouse for best practices and then share the information across districts.

What does leadership look like around physician wellness in your practice or organization? What best practices can you recommend? What we need to explore: Physician burnout has recognizable symptoms, but it’s critical that we understand that the causes and effects of stress and burnout are not always the same across different populations of physicians. Women physicians are 250-400% more likely to commit suicide than other professionals, according to a 2005 JAMA article.3 There are still issues of access to solid medical care in underserved communities. What impact does that have on the physicians serving those populations? We need to look at the factors that cut cross the physician population, but also recognize the varied conditions within different groups of physicians. There are many questions to be answered and different approaches to be explored. As an organization, LACMA is making a lot of changes. Going forward and looking at this issue, we’ll report in from the upcoming webinar, look at the connection between burnout and EHR and keep you updated on all our findings. We hope you’ll reach out and join the conversation as we all look for ways to heal the healers.

1 Christina Maslach and Susan E. Jackson, The Measurement of Experienced Burnout, http://onlinelibrary.wiley.com/store/10.1002/job.4030020205/asset/4030020205_ ftp.pdf;jsessionid=9AB9C24C901E0B602AE0C4499DDF4D64.f01t02?v=1&t=iqmq465d&s=f9102126b2763cb71e6b1cb6205397112c022f4c 2 http://medicaleconomics.modernmedicine.com/medical-economics/news/what-price-physician-stress-and-burnout?page=0,1 3 http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

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PHYSICIAN BURN PRACTICING

MEDICINE

HAS

NEVER

out

BEEN AN

EASY

CAREER,

but today’s healthcare environment has created even greater challenges for physicians, all of which have led to rising physician burnout. While there is a greater awareness of physician and medical

student burnout today, the statistics are alarming. Various studies indicate, among other things, that

the physician burnout rate has topped 50% and that doctors are 15 times more likely to burn out compared to professionals in other lines of work. Moreover, 45% of primary care physicians report that they would quit if they could afford to do so, and the divorce rate among physicians is 10% to 20%

greater compared to the general population. The LA County Medical Association, California Medical

Association and other groups around the state and country are working hard to address the issue. In this issue of Physician Magazine, we have culled the best expert advice and tips to help physicians

understand, identify and manage burnout. You’ll also find a list of upcoming workshops in the LA area and valuable resources to learn more about the issue and help address it.

The path to burnout

About one-third of physicians experience burnout at any given point. Some experts believe that the genesis of negative feelings that doctors experience is multi-fold. High stress levels and dealing with death on a regular basis are two factors that rank high on that list. Physicians are supposed to not only cure but also help heal families when cure is not possible. A lack of control over schedules and time can result in poor sleep patterns, interference with family activities and events, and poor self-care, Elaine Cox, MD, wrote in an article published in US News. For many physicians, setting limits when dealing with sick patients is extremely difficult and often leads to physical and emotional exhaustion, which then translates into cynicism and burnout. Add to that the anguish that comes from living in a litigious society, and doctors are being pushed beyond their limits, she argued. 1 2 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

Dr. Cox wrote that the practice of medicine itself may be the main culprit. The pressure starts early. Once the decision is made to pursue a career in medicine, she said, students are expected to excel, sustain long hours and perform while learning to treat patients and be compassionate without getting so emotionally involved that they can’t function. Hence, burnout starts early. According to a recent study, medical students reportedly report a rate of depression that’s 15% to 30% higher than the general population, which can lead to poorer performance, including 6.2 times more medication errors. As healthcare has changed to reflect a business and mission model where doctors are expected to keep up with the latest trends in medicine while watching the financial side, she said, too many physicians become overwhelmed. Yet, even when symptoms of burnout arise, such as fatigue, dissatisfaction and doubt, physicians often hesitate to seek help, for good reason.

The fear of losing privileges and their medical licenses when doctors are being treated for substance abuse or depression is a risk too many doctors aren’t willing to take. Consequently, many doctors try to “self-heal” or “self-medicate,” which is usually not a good strategy, Dr. Cox said. Often the help from a colleague out of camaraderie and respect aids in underestimating the severity of the problem.

A personal story

He cited a 2013 study in the Journal of Addiction Medicine that revealed that 69% of doctors abused prescription medicine to “relieve stress and physical and emotional pain.”

For one doctor, getting the help he needed to overcome an He also finds that addicted doctors rarely seek help out of fear opiate addiction didn’t come until the state police and DEA sat of losing their medical license if they come forward. He feels that in his office. if state medical boards, made up of doctors, were enlightened to Peter Grinspoon, MD, a primary care physician in Boston and treat addiction as a disease, not as a crime, it could lead more instructor at Harvard Medical School, who is also the author of doctors to come out of their shadows of addiction and avoid “Free Refills: A Doctor Confronts His Addiction,” wrote an article disasters such as a DUI or getting charged with a serious crime. in the LA Times about his tough journey from losing his medical Though Physician Health Services offers resources for distressed license to regaining it and now helping other doctors with addiction. Dr. Grinspoon wrote in the article that doctors are prone to drug and alcohol abuse and cited estimated rates of addiction of 10% to 15% among doctors vs. 8% to 10% for the general population. “What appears to account for the difference is physician distress, and in the case of drug abuse, plentiful access,” he wrote. He said in the U.S., practicing MEDICAL PRACTICE PURCHASES, SALES AND MERGERS medicine has never been easy, but today doctors work longer and faster with less reward, spending as much time battling insurance companies and maintaining electronic medicine as treating patients, which all leads to distress. And when distress is high, he said, humans reach for the relief that’s close – which in the case of doctors translates into a large supply of free samples of pills from drug makers, Assisting physicians with access to scripts, patients bringing their unused pills into the office, and legal issues for over three decades. colleagues willing to write scripts to help, all of which makes prescription Fenton Law Group, LLP drug abuse the obvious choice. He 1990 South Bundy Drive Suite 777 cited a 2013 study in the Journal of Los Angeles, CA 90025 Addiction Medicine that revealed that The brand physicians trust 310.444.5244 69% of doctors abused prescription www.fentonlawgroup.com medicine to “relieve stress and physical and emotional pain.”

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AUG US T 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1 3

doctors, signing up voluntarily exposes doctors to punishment by the medical board, given that the board works closely with Physician Health Services, he wrote in the article. Dr. Grinspoon said he didn’t make use of Physician Health Services until he served two years of supervised court probation, had lost his medical license, lost his marriage and was out of work. Today, Dr. Grinspoon said he has regained his medical license and was asked to join the Physician Health Services as an associate director, helping other addicted doctors. He said that once doctors get the help they need, they often excel at rehab with a 70% to 80% success rate.

Burnout survey of primary care and ER doctors

A recent microsurvey by InCrowd, a provider of real-time data reporting for the medical, healthcare, pharmaceutical/life sciences industries, found that some 200 primary and emergency care physicians, who have been practicing for 10 or more years, reaffirmed a perceived lack by healthcare facilities or practices to take effective steps to address and prevent physician burnout. Out of 200 respondents, 74% reported more needs to be done to address the issue. Key findings included that 57% of physicians in both fields said they experienced burnout; 37% said they felt frustrated at work a few times weekly, or every day; 58% said they were unsure if they would recommend a career in medicine to a child or family member, or knew if they would; and one ER doctor expressed frustration about losing his autonomy and practicing based on metrics that often aren’t patient-centered, or evidence-based.

Implementing change

Dr. Cox said for many doctors, recognizing the need to live a healthy lifestyle in every way, including emotionally, is the first step. Helping to identify a more realistic definition of professional commitment, guiding doctors through exercises on limit-setting and conflict-resolution, and instituting reasonable work hours are good places to start. Sue Jacques, a medical and corporate professionalism consultant based in Calgary, Alberta, recommends the following four decisions that medical practitioners can make today to begin lessening their workload and enhance their satisfaction so they don’t feel burned out, according to an article in Diagnostic Imaging. She calls the decisions the four “D’s”:

The Four “D’s”: Delegate

For many physicians delegating is tough, but vital, Jacques said, to avoid stretching themselves too thin. It starts with delegating tasks to staff or colleagues, but also asking patients to come to the practice prepared with a list of symptoms and requests.

Diversify

Diversifying can mean many things, from setting up a specialty clinic like a flu clinic to planning out schedules, budgets and assigning providers and staff members ahead of time.

Decline

Learning to say no and avoiding overcommitting is often hard for physicians, but warranted.

Decompress

Setting aside time for yourself, family and doing the things you love is as important as treating your patients. 1 4 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

For many medical students, entering a career to care for others often means putting their own health and well-being on hold. At UC San Francisco, UCLA and UC San Diego, three of the nation’s top-ranked medical schools for research and primary care, medical students pay the price of experiencing burnout, frustration and emotional exhaustion, according to a recent survey and article published in the Daily Bruin. Almost 50% of medical students surveyed for a 2014 study in the journal Academy Medicine reported experiencing burnout vs. 36% of age-matched college graduates. People who experience burnout are emotionally exhausted and express cynicism and detachment toward patients, according to the 22 item Maslach Burnout Inventory, a scale used to quantify and assess levels of burnout. Burnout among medical students often peaks in their third year of medical school. Susan Rosen, MD, a primary care provider and medical director at UC San Francisco’s Student Health and Counseling, told the Daily Bruin that first- and secondyear medical students spend time with each other in large lecture-based classes, study together and talk about their problems. But by the time medical students reach their third-year clinical rotations, stress can reach critical levels, she told the Daily Bruin. Rotations expose students to dozens of clinical specialties and help students gain experience at future careers, but working in different clinics where students face strict hierarchies and are constantly reminded that they rank on the bottom rung combined with less time in the classroom with the familiar group can make students feel isolated.

Another way to stamp out physician burnout is to change up the work environment. Jacques suggests offloading tasks such as dictating a long patient note or struggling with the EHR by using medical scribes instead. Converting to a concierge or direct-pay practice cuts red tape and allows many physicians to spend more time with patients. Finally, joining a physician organization or group practice can help an economy of scale and, as such, reduce stress.

Resources for help On Aug. 24, the California Public Protection & Physician Health Inc., in collaboration with the California Society of Addiction Medicine, will be offering a workshop called “Keys to Physician Wellness: From Burnout to Professional Satisfaction—Personal and Organizational Stories and Solutions” at the Anaheim Marriott.

The day-long workshop is designed for physicians, medical leadership, medical staff administrators and others who are interested in improving physicians’ satisfaction and individual and organizational health. Program attendees receive a maximum of 7 AMA PRA Category 1 Credits. To register, visit: www.regonline.com/Register/Checkin. aspx?EventID=1831529 The Physicians’ and Dentists’ Confidential Assistance Line is a phone line for physicians, dentists and their families to get help with problems of alcoholism, drug dependence or mental illness within their families. For Southern California, call 213-383-2691; for Northern California, call 650-756-7787. While there is greater awareness today of physician burnout, everyone agrees that effective prevention tools are not disseminated widely enough and more needs to be done to promote doctors’ well-being from both an individual and organizational level. The 2015 Association of American Medical Colleges survey, which surveyed fourth-year medical students on their experiences, showed that nearly half, or 46.3%, of 13,886 medical students reported they’ve been publicly embarrassed; 19.5% said they’ve been publicly humiliated; 14.1% reported having been exposed to offensive sexist remarks; and 7.3% reported having been exposed to racially or sexually offensive remarks. Lance Raynor, a mental health provider at UC San Francisco’s Student Health and Counseling, said in the article that constant moving from one hospital to another can block students’ access to care and therapy, resulting in problems like social anxiety and frustration. Some students don’t express their frustration and stress out of fear they are formally diagnosed with a mental illness that may go on their medical records, reportedly said Jessica Lloyd,

the associate program director for the UCLA pediatric residency program. Students also reported being afraid to take days off and mentioning mental and emotional hardship to their attending physician. The California medical licensure application asks residency applicants to disclose mental illness that could hinder their ability to treat patients, and states that it will decide if a student is eligible for a medical license based on the severity of the condition, according to Lloyd. Students’ stress in thinking about their futures and their lack of time to go to therapy appointments create barriers that aren’t easily fixed, Lloyd added. Rosen agreed that, at UC San Francisco, students also aren’t comfortable telling their supervisors about their therapy sessions and appointments out of fear it may affect their performance grades and letters of recommendations for residency programs. As part of therapy, Raynor said he’ll assign students to visit landmarks like Coit Tower on top of Telegraph Hill in San Francisco during a weekend to change up the pace. Many medical students have never even toured the city, he said in the article, because they’ve been so focused on their studies. Rosen, who also sees students who complain of burnout, said that when students break their routine long enough, they come back refreshed and ready to go about their studies and clinical work. Burnout and depression among medical students can be prevented if medical schools acknowledge the stigma around mental health issues and work with staff to ensure that medical students are being treated properly.

All three medical schools have existing programs to try to help medical students. At UCSF, the Medical Student Well-Being Program works exclusively with medical students, faculty and staff and offers special evening appointments to accommodate students’ busy schedules. At UC San Diego School of Medicine, an online diagnostic system, called the Healer Education Assessment and Referral Program, seeks out and screens at-risk medical students who may not have the time or energy to travel to the main campus. UCLA David Geffen School of Medicine offers medical students appointments at Counseling and Psychological Services, an on-campus facility, and offers access to a school-affiliated psychologist, according to the article. But medical students reported that more needs to be done to help students cope. Capping resident hours to 80 hours a week, treating medical students with dignity and respect, and not expecting them to know procedures they weren’t taught, were some of the suggested solutions by medical students. Facilitating procedures that would allow for honest communication between physicians and medical students was also mentioned as well as UC medical schools starting a conversation on how to improve and implement programs for mental wellness among students. AUG US T 2016 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1 5

Working Together NMA & LACMA

T H E N A T I O N A L M E D I C A L A S S O C I A T I O N is holding its annual conference -- July 30 to Aug. 3 -- in Los Angeles for the first time. LACMA is pleased to announce a partnership with the NMA to find ways to collaborate and further the mission of both organizations. LACMA CEO Gustavo Friederichsen commented on the new partnership: “Central to the reinvention of LACMA as a viable, relevant organization is a major focus on collaboration. This organization supports African-American physicians on a variety of fronts, and we are proud to partner with NMA, not just during their historic convention but on a consistent basis, to look at ways to help local physicians.” The NMA was formed in 1895 in response to the American Medical Association’s refusal to let black doctors join the organization at that time. Since then, the NMA has sought to serve the African-American community and medically underserved populations. They are advocates for both physicians and patients. Among the many programs and sessions being offered at the annual conference is the swearing in of Richard Williams, MD, as the new president of the NMA. An accomplished cardiologist in Beverly Hills, Dr. Williams is also an expert on healthcare disparities, author of eight books and an internationally recognized authority on hypertension, heart failure and sudden cardiac death. LACMA congratulates Dr. Williams on his new role with the NMA.

NMA Mission and Values

In formulating the collaborative effort between LACMA and the NMA, it’s important to understand the mission and values of the NMA to then see where the goals of the organizations overlap. With that in mind, Anne Staveren, MD, president of the Charles R. Drew Medical Society, the LA affiliate of the NMA, shared about the history of the organization and current key issues. Although the NMA came into existence in response to discrimination and to serve the African-American community of patients and doctors, Dr. Staveren emphasized that the organization is not about exclusivity. Rather they seek to remedy the disparity in access to healthcare services that

1 6 P H Y S I C I A N M A G A Z I N E | AUG US T 2016

still exists today. She described the work of the NMA as promoting optimal health and increasing the pipeline of care in the African-American community. Patients ask the NMA where they can find AfricanAmerican doctors. Dr. Staveren said they get “requests for cultural sensitivity and culturally competent physicians” who understand the issues specific to the community. She said that aside from creating a directory of doctors, the NMA is also working to educate patients on how to navigate the medical system. The NMA is striving to teach people about the Affordable Care Act and how to obtain coverage.

In its work with physicians, the organization emphasizes mentorship as a key program. The LA affiliate has a Saturday Science Program for young students at Charles R. Drew University in an effort to bring more African-Americans into the field of medicine. They also mentor residents and have physician advocacy programs for new residents and fellows.

A Call to Action for LACMA and NMA?

Both LACMA and the NMA have a strong tradition of advocacy for physicians and addressing issues important to local communities. The American Pediatric Association and many other groups have called gun violence a public health issue. Some use stronger language and call it a crisis or epidemic. In formulating a road map for meaningful collaboration between LACMA and the NMA, tackling the issue of gun violence could be a strong, purposeful use of the voices of these two organizations. The devastation in communities across the U.S. has affected everyone, but the African-American population has been disproportionately impacted. Additionally, physicians are on the front line in emergency rooms and in caring for victims. They are facing their own difficulties from from having to bear witness to the ravaging effects of gun violence.

In dealing with public health issues such as a viral outbreak, Dr. Staveren pointed to the methodical approach to prevent, control and eradicate an outbreak. Physicians seek to discover the root of the source and control the outbreak. How do we do that with gun violence? Is there a role for LACMA and the NMA in bringing together a global response from physicians, nurses, medical societies, national and local groups from all backgrounds to optimize an approach? “At LACMA, we’re committed to physician wellness across the board. That means we can look at the consequences of gun violence, and all that entails, with a special focus on the impact on our physicians who are on the front lines in treating the victims of the violence,” said Friederichsen. This conversation has just started at an organizational level. The partnership between LACMA and NMA has just begun. We’ve got LACMA members such as Dr. C. Freeman, Dr. Toni Chavez, Dr. Richard Baker and Dr. Lemmon McMillan who are also active in the NMA. The African-American Physicians Advisory Committee is active and remains committed to advocacy on behalf of physicians and their communities. We’re looking forward to pooling our resources and collaborating in the coming years.

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