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Timothy Brigham, MDiv, PhD on Physician Well-Being

Timothy P. Brigham, MDiv, PhD, is the Chief of Staff and Chief Education and Organizational Development Officer. He is also Co-Chair of the Physician Well-Being Task Force. See below for an interview with Dr. Brigham regarding the ACGME’s Physician Well-Being initiative.

Q: Why is the issue of physician well-being important to you personally?
Dr. Brigham: Physician well-being has been a passion of mine for a long time. Back in the 1980s, as a behavioral scientist, I ran groups with family medicine residents to address psychosocial issues they faced with their patients and on their own. In the 1990s, I led stress support groups with residents at Jefferson Medical College. Now, I’m the Co-Chair of the ACGME’s Physician Well-Being Task Force.

In addition to my professional focus on physician well-being, I am personally committed to this issue. I have a son in residency right now. Every day, I think about his well-being and that of his colleagues, and am grateful that the ACGME and our collaborators have the opportunity to make a difference in their lives. We need to protect the workforce that protects our patients.

Q: Why is the ACGME committed to physician well-being?
Dr. Brigham: As the accrediting body for residency and fellowship programs, the ACGME has always been committed to physician well-being, and it’s a critical issue that aligns closely with our mission of improving health care by advancing and assessing resident education. In fact, more than 350 physician volunteers conduct the accreditation reviews and render accreditation decisions working with the staff of the ACGME. We are an organization staffed and supported in part by physicians – this issue is very personally important to the people who work here.

We are focused on the total population of physicians: residents, fellows, and faculty members. Our Common Program Requirements state that residency and fellowship programs must promote patient and resident/fellow well-being in a supportive educational environment. These standards serve residents and fellows during training and into their future practice, as well as faculty members and patients.

Specifically, institutions that sponsor ACGME-accredited programs must provide residents and fellows with access to health services, such as confidential counseling. They must have programs to educate residents, fellows, and faculty members about fatigue management and mitigation. They need to have policies covering harassment. And, there must be systems in place for monitoring and identifying any form of mistreatment, along with processes to resolve complaints in a safe and non-punitive environment.

Q: What have you learned in the process of studying physician well-being?
Dr. Brigham: We learned quickly that this is a complex topic and that it’s critically important to have conversations with stakeholders across the medical community. In our collaborations, we’ve learned physician well-being is both an individual and a system issue; we have to address it on both levels.

There’s not just one easy solution. At all levels of medical education there needs to be an alignment between institutional leaders and faculty members to create a culture of respect and accountability. When physicians are healthy, it’s more likely they will be able to deliver the best possible care.

So now, we’re building upon what we have done. Research is showing us causes and levels of burnout in residents. There’s also heightened awareness around the ultimate tragedy of death by suicide. Because of this, we’re really looking at physician well-being in a different way. We believe we are the right leaders for advancing the issue, but realize we can’t do it alone.

Q: What areas are you focusing on to address these learnings?
Dr. Brigham: In our work so far, we’ve identified four areas where we could have the greatest impact.

One is education. We’re building awareness in a number of ways, including sharing resources and information throughout the medical continuum. We are enhancing our website to include peer-reviewed resources and webinars from the community. We are also currently planning our second annual Symposium on Physician Well-Being.

Another is through influence, or what I call ACGME levers, or people and programs in place to help us make change. We have accreditation standards (Institutional, and Common and specialty-specific Program Requirements) and we are developing new ones. We have our Clinical Learning Environment Review (CLER) Program, designed to give feedback to graduate medical education leaders and executive leadership of clinical learning environments.

A third area is research. The ACGME has been studying resident death statistics, burnout, and depression, and stimulating research to better understand and address these issues.

And finally, there’s collaboration. We work with others, including program administrators, faculty members, residents and fellows, health systems, and organizations responsible for medical education, to initiate important changes in the culture and clinical environment.

Q: What are some specific examples of work underway at the ACGME?
Dr. Brigham: We know we can have meaningful impact on physician well-being and there are several tracks in which we’re working to make a difference.

We have the CLER Program, which is creating a new focus area to address well-being.

The ACGME has a task force focused on a scheduled review of the Common Program Requirements for all residency and fellowship programs, including an emphasis on physician well-being and patient safety. We also have ongoing research about well-being, burnout, and depression, and are synthesizing that information with data from our ongoing surveys of residents and fellows.

At our Annual Educational Conference in February 2016, our session on well-being had more than 500 attendees, and our first Symposium on Physician Well-Being was a success, with more than 100 leaders in the academic medical arena committing to supporting the issue.

Q: Who are you collaborating with, and how?
Dr. Brigham: Through our Symposium, the ACGME facilitated a dialogue with other groups across the medical continuum. Our collaborators include the American Medical Association, the Association of American Medical Colleges, the American Osteopathic Association, the National Patient Safety Foundation, and the American Hospital Association, among many others.

Groups outside of medicine with experience in the prevention and management of burnout, depression, and suicide, such as the American Foundation for Suicide Prevention and the National Collegiate Athletic Association, have joined us in this discussion. Many of our partners have shared their resources for fostering well-being.

The ACGME has been working as a member of the Coalition for Physician Accountability to review the existing physician well-being work, bring together collaborators, and identify opportunities and gaps in physician well-being along the continuum. Most recently, the ACGME’s Chief Executive Officer Dr. Tom Nasca was invited to co-chair a committee with Dr. Darrell Kirch, President of the AAMC, and Dr. Victor J. Dzau, President of the National Academy of Medicine to develop a plan for national workshops.

Q: What factors in today’s clinical learning environment can contribute to burnout?
Dr. Brigham: The environment has changed. Demands on all physicians have never been higher. There are more complex patients with multiple conditions, treatment options, and surgeries. There’s the personal pressure of appearing infallible to patients, and the stigma attached to asking for help. And there are vast technological changes that have added to a compressed workload.

Physicians feel a loss of meaning and control. There’s less ability to develop long-term relationships with patients and other care providers. These factors may lead to burnout and even depression if not addressed.

And we know these issues aren’t unique to the medical profession; they’re prevalent in today's society. But that’s all the more reason physicians must be leaders in addressing the stigma of seeking mental health services and redoubling our efforts to create a compassionate environment for patients and their health care providers.

Q: What do you see as barriers to or opportunities for change in the culture of medicine and training?
Dr. Brigham: The challenge is there’s a lot of work to do, but the good news is there’s much more awareness that physician well-being is a priority. That in itself is a major shift.

Historically, physicians have been seen as the caregivers, but have not always taken care of themselves, so there’s an innate culture that contributes to their hesitancy to reach out when they need help. But as we know, physicians don’t operate alone or in a bubble. They need to feel supported by their peers, teachers, and colleagues. They need good mentoring. They need to feel safe in asking for assistance so they’re caring for themselves in a way that they can be the best caregivers for patients.

Q: Is there anything else you’d like to add?
Dr. Brigham: Overall, what we know is that when physicians are impacted by burnout, depression, or—the ultimate tragedy—suicide, there are devastating effects on their families and friends, on their fellow physicians or trainees, and particularly on their patients. It is crucial that we work together in the medical community to identify and address these issues before they escalate.

The well-being of physicians as caregivers is paramount to their ability to deliver the safest, best possible care to patients, and they need to feel supported every step of the way.

At the ACGME, we are always available to answer questions, hear what you are doing to support well-being, and collaborate on ways to address this critical issue.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255), or contact the Crisis Text Line by texting TALK to 741741

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