1
|
Amano A, Makowski MS, Trockel MT, Menon NK, Wang H, Sliwa J, Weinstein S, Kinney C, Paganoni S, Verduzco-Gutierrez M, Kennedy DJ, Knowlton T, Stautzenbach T, Shanafelt TD. A qualitative study of strategies to improve occupational well-being in physical medicine and rehabilitation physicians. PM R 2024. [PMID: 38837667 DOI: 10.1002/pmrj.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout. OBJECTIVE To identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-month period. DESIGN We employed two quantitative surveys spaced 6 to 9 months apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey timepoints. These physiatrists were subsequently recruited to participate in a qualitative study using semi-structured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment. SETTING Online surveys and interviews. PARTICIPANTS Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile. MAIN OUTCOME MEASURE Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. RESULTS One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges. CONCLUSION Our findings illustrate that, in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.
Collapse
Affiliation(s)
- Alexis Amano
- Stanford University, Stanford, California, USA
- Los Angeles Fielding School of Public Health, University of California, Los Angeles, California, USA
| | | | | | | | - Hanhan Wang
- Stanford University, Stanford, California, USA
| | - James Sliwa
- American Board of Physical Medicine and Rehabilitation, Rochester, Minnesota, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Stuart Weinstein
- University of Washington, Seattle, Washington, USA
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Carolyn Kinney
- American Board of Physical Medicine and Rehabilitation, Rochester, Minnesota, USA
- Mayo Clinic, Phoenix, Arizona, USA
| | - Sabrina Paganoni
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Association of Academic Physiatrists, Baltimore, Maryland, USA
| | - Monica Verduzco-Gutierrez
- Association of Academic Physiatrists, Baltimore, Maryland, USA
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David J Kennedy
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
- Vanderbilt University, Nashville, Tennessee, USA
| | | | - Thomas Stautzenbach
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | |
Collapse
|
2
|
McClafferty H. Workforce Concerns: Professional Self Care, Personal Readiness, Impact of the Pandemic, and Other Factors that Impact the Workforce. Pediatr Clin North Am 2024; 71:413-429. [PMID: 38754933 DOI: 10.1016/j.pcl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.
Collapse
|
3
|
Palamara K, Shanafelt TD. Physician Coaching: Establishing Standards and Core Competencies. Mayo Clin Proc 2024; 99:693-696. [PMID: 38702121 DOI: 10.1016/j.mayocp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Kerri Palamara
- Center for Physician Well-being, Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Tait D Shanafelt
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
4
|
Neary S, Ruggeri M, Roman C, Hoover E, Butaney B, Weller I. Foundational Skill-Building in a Novel Well-being Curriculum. J Physician Assist Educ 2023; 34:224-230. [PMID: 37126074 DOI: 10.1097/jpa.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Mental illness and decreased well-being are pervasive throughout physician assistant (PA) training, and the accreditation standards require a wellness curriculum. The purpose of this study was to determine if a mandatory, multifaceted virtual wellness curriculum can mitigate the decline in well-being experienced by first-year PA students. METHODS First-year PA students from 5 programs (n = 259) participated in a 16-week asynchronous virtual course. The course integrated evidence-based content on vulnerability and stigma, mindfulness and decentering, and reflective writing. Total weekly content averaged 30-60 minutes and was presented in multiple formats including recorded lectures and panels, readings, and discussion forums. Students completed anonymous pre- and postsurveys, and ordinary least squares (OLS) regression with a fixed effect for each school was used for data analysis. RESULTS In total, 157 of 259 (60.6%) students completed both surveys with matching unique identifiers. The majority of students (73.6%; 134/182) thought this course had a positive impact on their training as a PA student. Baseline scores were significantly predictive of end-point scores for the PHLMS, OMS-HC-15, SSOSH, RPQ, and UCLA-3 (see Methods section for full names of surveys). Race was significantly predictive of PHLMS and OMS-HC-15 scores; age was significantly predictive of SSOSH scores; and gender was significantly predictive of RPQ scores. DISCUSSION For a student with low baseline well-being who is entering a PA program, dedicated curricula focusing on foundational wellness skills can be successful in improving well-being. Future work is needed to more fully characterize the scope and extent of this program's impact on PA learners. Additional efforts are also necessary to optimize the delivery and provide access to PA students nationwide.
Collapse
Affiliation(s)
- Stephanie Neary
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| | - Mary Ruggeri
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| | - Christopher Roman
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| | - Eve Hoover
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| | - Bhupin Butaney
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| | - Indigo Weller
- Stephanie Neary, MPA, MMS, PA-C, is an assistant professor adjunct and director of didactic education, Department of General Internal Medicine, Yale University, New Haven, Connecticut
- Mary Ruggeri, MEd, MMS, PA-C, is the clinical site supervisor for the Yale Physician Assistant Online Program, Yale University, New Haven, Connecticut
- Christopher Roman, DMS, PA-C, was an associate professor at Butler University in Indianapolis, Indiana during the time this work was conducted. At the time of publication, he is a medical science liaison at Takeda Pharmaceuticals, Cambridge, Massachusetts
- Eve Hoover, DMSc, MS, PA-C, is an associate professor, Department of Physician Assistant Studies, Midwestern University-Glendale, Glendale, Arizona
- Bhupin Butaney, PhD, is an associate professor and associate program director of clinical psychology, Department of Behavioral Sciences, Midwestern University-Glendale, Glendale, Arizona
- Indigo Weller, MFA, MS, MBE, is an independent scholar and researcher
| |
Collapse
|
5
|
Rodriguez-Unda NA, Mehta I, Chopra S, Vicente-Ruiz M, Navia A, Fernandez-Diaz OF. Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4889. [PMID: 37051210 PMCID: PMC10085483 DOI: 10.1097/gox.0000000000004889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 04/14/2023]
Abstract
Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees. Methods A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire. Results One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout. Conclusions Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were "protective." Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.
Collapse
Affiliation(s)
| | - Ishan Mehta
- Division of Plastic Surgery Department of General Surgery, Baylor Scott-White, Texas A&M College of Medicine
| | - Shiv Chopra
- Global Trainee Representative to the International Confederation of Plastic Surgery Societies [ICOPLAST]
| | - Miriam Vicente-Ruiz
- Plastic, Reconstructive and Aesthetic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Alfonso Navia
- Section of Plastic and Reconstructive Surgery, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oscar F. Fernandez-Diaz
- Department of Clinical Sciences, Medical School University of Guadalajara, Guadalajara, Mexico
| |
Collapse
|
6
|
Trockel MT, Menon NK, Makowski MS, Wen LY, Roberts R, Bohman BD, Shanafelt TD. IMPACT: Evaluation of a Controlled Organizational Intervention Using Influential Peers to Promote Professional Fulfillment. Mayo Clin Proc 2023; 98:75-87. [PMID: 36464536 DOI: 10.1016/j.mayocp.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/15/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To determine the effects of a popular opinion leader (POL)-led organizational intervention targeting all physicians and advanced practice providers (APPs) working within clinic groups on professional fulfillment (primary outcome), gratitude, burnout, self-valuation, and turnover intent. PATIENTS AND METHODS All 20 Stanford University HealthCare Alliance clinics with ≥5 physicians-APPs were matched by size and baseline gratitude scores and randomly assigned to immediate or delayed intervention (control). Between July 10, 2018, and March 15, 2019, trained POLs and a physician-PhD study investigator facilitated 4 interactive breakfast or lunch workshops at intervention clinics, where colleagues were invited to discuss and experience one evidence-based practice (gratitude, mindfulness, cognitive, and behavioral strategies). Participants in both groups completed incentivized annual assessments of professional fulfillment, workplace gratitude, burnout, self-valuation, and intent to leave as part of ongoing organizational program evaluation. RESULTS Eighty-four (75%) physicians-APPs at intervention clinics attended at least 1 workshop. Of all physicians-APPs, 236 of 251 (94%) completed assessments in 2018 and 254 of 263 (97%) in 2019. Of 264 physicians-APPs with 2018 or 2019 assessment data, 222 (84%) had completed 2017 assessments. Modal characteristics were 60% female, 46% White, 49% aged 40 to 59 years, 44% practicing family-internal medicine, 78% living with partners, and 53% with children. Change in professional fulfillment by 2019 relative to average 2017 to 2018 levels was more favorable (0.63 points; effect size = 0.35; P=.001) as were changes in gratitude and intent to leave among clinicians practicing at intervention clinics. CONCLUSION Interventions led by respected physicians-APPs can achieve high participation rates and have potential to promote well-being among their colleagues.
Collapse
Affiliation(s)
| | - Nikitha K Menon
- Stanford University School of Medicine, Palo Alto, California
| | | | - Louise Y Wen
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Rachel Roberts
- Stanford University School of Medicine, Palo Alto, California
| | - Bryan D Bohman
- Stanford University School of Medicine, Palo Alto, California
| | | |
Collapse
|
7
|
Shanafelt TD, Larson D, Bohman B, Roberts R, Trockel M, Weinlander E, Springer J, Wang H, Stolz S, Murphy D. Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clin Proc 2023; 98:163-180. [PMID: 36603944 DOI: 10.1016/j.mayocp.2022.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
Health care delivery organizations are positioned to have a tremendous impact on addressing the variables in the practice environment that contribute to occupational distress and that, when optimized, can promote clinician well-being. Many organizations are committed to this work and have clarity on how to address general, system-wide issues and provide resources for individual clinicians. While such top of the organization elements are essential for success, many of the specific improvement efforts that are necessary must address local challenges at the work unit level (department, division, hospital ward, clinic). Uncertainty of how to address variability and the unique needs of different work units is a barrier to effective action for many health care delivery systems. Overcoming this challenge requires organizations to recognize that unit-specific improvement efforts require a system-level approach. In this manuscript, we outline 7 steps for organizations to consider as they establish the infrastructure to improve professional well-being and provide a description of application and evidence of efficacy from a large academic medical center. Such unit-level efforts to address the unique needs of each specialty and occupation at the work unit level have the ability to address many of the day-to-day issues that drive clinician well-being. An enterprise approach is necessary to systematically advance such unit-level action.
Collapse
Affiliation(s)
- Tait D Shanafelt
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA.
| | - David Larson
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryan Bohman
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Rachel Roberts
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mickey Trockel
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eva Weinlander
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jill Springer
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Hanhan Wang
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sherilyn Stolz
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Daniel Murphy
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
8
|
Cordova MJ, Gimmler CE, Osterberg LG. Foster Well-being Throughout the Career Trajectory: A Developmental Model of Physician Resilience Training. Mayo Clin Proc 2020; 95:2719-2733. [PMID: 33276844 DOI: 10.1016/j.mayocp.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
Physician burnout is common across specialties and largely driven by demands of the current health care industry. However, the obvious need for systems change does not address the unavoidable impact of providing care to those who suffer. An intentional, developmental, longitudinal approach to resiliency training would not distract from fixing a broken system or blame physicians for their distress. Existing models and approaches to resilience training are promising but limited in duration, scope, and depth. We call for and describe a career-long model, introduced early in undergraduate medical training, extending into graduate medical education, and integrated throughout professional training and continuing medical education, in intrapersonal and interpersonal skills that help physicians cope with the emotional, social, and physical impact of care provision.
Collapse
Affiliation(s)
- Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, CA, and VA Northern California Health Care System, Martinez, CA.
| | - Christophe E Gimmler
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University School of Medicine, Stanford, CA
| | - Lars G Osterberg
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
9
|
Sharma N, Upjohn D, Donald C, Zoske KE, Aldridge CL, Lal D. Leveraging Advanced Practice Providers in an Otolaryngology Practice. Otolaryngol Head Neck Surg 2020; 164:959-963. [PMID: 33201762 DOI: 10.1177/0194599820972924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Advanced practice providers (APPs) may see patients independently or assist in "collaborative" clinics in otolaryngology practices. Our goal was to redesign the collaborative physician-APP clinic model to increase patient access, maintain financial sustainability, and optimize patient and staff experience. METHODS The study was performed in a tertiary care academic rhinology clinic seeing adult patients. The DMAIC framework (define, measure, analyze, improve, control) was used to develop the new model. The process shift between old and new models was analyzed by utilizing a statistical process control chart. Patient and staff surveys were tracked. RESULTS The collaborative physician-APP model was redesigned into 2 parallel and independently run ("concurrent") physician and APP clinics. Patient access increased by 38.9% from a mean of 17.9 patients per collaborative clinic (n = 15 days, 269 patients) to 29.3 patients per concurrent clinic (n = 12 days, 352 patients). Medicare reimbursement rate modeling showed the collaborative clinic to operate at a loss of $1341.51 per day, while the concurrent clinic model operated at a $1309.88 gain (200% positive change). Patient and staff experience tracked positively. DISCUSSION Otolaryngology clinics can become overwhelmed by the volume of empaneled established patients. Traditional collaborative physician-APP clinics see the same panel of patients together. However, these can be successfully redesigned to a concurrent model. Concurrent clinics improve patient access and provider satisfaction while maintaining patient satisfaction and fiscal performance. IMPLICATIONS FOR PRACTICE Leveraging an experienced APP to run a parallel and independent clinic alongside the physician (concurrent clinic model) may improve patient access, financial metrics, and patient/staff experience.
Collapse
Affiliation(s)
- Nita Sharma
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - David Upjohn
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Carrlene Donald
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Katie E Zoske
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Chelsea L Aldridge
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology Head-Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| |
Collapse
|
10
|
Shanafelt T, Stolz S, Springer J, Murphy D, Bohman B, Trockel M. A Blueprint for Organizational Strategies To Promote the Well-being of Health Care Professionals. ACTA ACUST UNITED AC 2020. [DOI: 10.1056/cat.20.0266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tait Shanafelt
- Professor of Medicine, Chief Wellness Officer, and Associate Dean, Stanford University School of Medicine, Stanford, California, USA
| | - Sherilyn Stolz
- Executive Administrative Director, Stanford Medicine WellMD Center, Stanford University School of Medicine, Stanford, California, USA
| | - Jill Springer
- Administrative Director, Stanford Medicine WellMD Center, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Murphy
- Professor of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Bryan Bohman
- Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Stanford, California, USA
| | - Mickey Trockel
- Associate Professor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|