by Elizabeth Hofheinz, M.P.H., M.Ed., June 6, 2019
“…Forget your perfect offering. There is a crack in everything. That’s how the light gets in.”
– Leonard Cohen
We are all fractured souls at some point in our lives. However, in the world of medicine—and surgery in particular—the implicit demand is that physicians will achieve perfection 100% of the time.
But with the rising administrative pressures on physicians, in addition to the existing clinical responsibilities, these titans of medicine are reaching the breaking point.
To Alexander Vaccaro, M.D., Ph.D., M.B.A., president of The Rothman Orthopaedic Institute, that is unacceptable.
“We exist in a pressure cooker environment,” says Dr. Vaccaro. “Each day we must make critical decisions that alter the lives of patients and families. Years ago, we accepted this responsibility, but as time has gone on, the mounting administrative and regulatory burdens imposed on physicians have pushed many of us to the brink of desperation. Add to these pressures the fact that physicians have little or no opportunity to recharge, dwindling autonomy, waning respect—coupled with the human tendency to not admit to having an emotional problem—and doctors are committing suicide, dropping out of medicine, drinking too much, etc. We are in a crisis.”
And how did Dr. Vaccaro reach the point of action?
“Since the year 1999 the Institute of Medicine has been writing about safety and how hospitals can be dangerous places. In 2013 Thomas Jefferson Hospital hired Lifewings, a consulting firm that works with healthcare facilities to enhance safety, quality and cost reduction. With Lifewings as a guide, we reviewed each and every process related to the operating rooms at our facility. As we moved through this quality review and examined the literature, it became evident that regards to patient safety physician wellness significantly effects patient outcomes and satisfaction.”
So, Dr. Vaccaro took to the podium.
“I began lecturing on physician well-being and then I assigned Drs. Gerald Williams, Paul Marchetto and administrator Ed Tufaro to launch a wellness program for our doctors. Working with consultants from Harvard University and the published experience of the Mayo Clinic and Stanford they undertook an audit of physician well-being. We wanted to know where our doctors stood as far as satisfaction, autonomy, etc.”
“The Rothman wellness program, still relatively new, includes the following: 1) An inventory of well-being; 2) An open forum where issues are addressed as a group; 3) Any time a new rule or regulation is enacted we try to eliminate one existing rule regulation so as not to increase physician work burden; 4) We ensure that call schedules and hard work are appropriately rewarded; 5) Periodic review where all physicians are re-surveyed after the changes have been instituted changes. Lifestyle assistance, such as Uber for late nights and Uber Eats for physicians’ children, are made available. 6) Winter and summer parties to celebrate our achievements; 7) A Board of Councel that includes a physician representative from each of our practice regions.”
One of the survey findings was related to the fact that there is a significant gender bias in medicine. “Only 19% of orthopedic residents are female; as for spine fellowships that number is less than 5%. As for leadership positions, females do not have a large presence.”
“Well, that won’t do,” thought Alex Vaccaro.
“The research shows that female doctors who are married to doctors and who are mothers are less satisfied with their jobs. I had to do something to move the needle on that for our physicians.”
Using funds from his Chair account, Dr. Vaccaro initiated regular meeting forums where female orthopedic surgeons discuss research topics and actively promote women in orthopedics. “Any female surgeon at Rothman who displays excellent leadership qualities will be promoted. Period.”
“When I started the concept of a wellness program,” says Dr. Vaccaro, “the hospital administration didn’t ‘get it.’ But after I laid out the data indicating that physicians are burning out at an alarming rate—and what might be done about it—they got on board.”
As for the orthopedic surgeons, if they want any peace, they will do that survey, says Dr. Vaccaro. “I want 100% participation, not 99%. The computer lets me know who did not complete it and I just hound people until they do…because it is more important than they think.”
Your typical surgeon is not one to leap forward and ask for help. So how to address the issue of shame or reluctance to get assistance?
Dr. Vaccaro: “Our human resources department arranged at the beginning of my tenure for our group to have a psychologist on call so that anyone who needs help can get it right away—and in a confidential manner.”
But what if someone needs help but isn’t reaching out? “Let’s say, for example, that a physician has an outburst in the OR. Instead of sending that person through the medical executive committee, which can be viewed as punitive, the hospital has agreed to our new process where the physician meets with the conduct committee who works with him or her to understand and rectify the situation. If the Rothman psychologist would be helpful, then that is part of the process as well.”
“My overarching goal,” says Dr. Vaccaro, “is that someone with a problem is not punished, but instead is helped. Within our hospital I have lobbied against punitive measures, asking that less than perfect actions on the part of the physician not be used against them in the re-licensing process.”
Going forward, says Alex Vaccaro, he would like to highlight the value of grit, otherwise known as resiliency. “We all have our frailties and at some point, we all fail. But having the tools that help you get up each time is critical…and very teachable.”
“We are in the beginning phases of this initiative,” says Dr. Vaccaro, “but everyone is very optimistic that things are going in the right direction. We will continue to monitor the well-being of our physicians and adapt to their needs.”
Surgeons possess the courage necessary to hold the knife…sometimes, holding the mirror up to oneself is no less important.
If you are a physician in crisis, assistance is available:
- 1-800-273-8255 (National Suicide Prevention Hotline)
- 911 for immediate help
- Your primary care physician
Elizabeth Hofheinz is Director of Communications at Ortho Spine Partners. She can be reached at firstname.lastname@example.org