Psychological Stress Among Faculty and House Staff

Transcription

1 Psychological Stress Among Faculty and House Staff The Faculty and Physician Wellness Program Work/Life Connections-EAP Mary I. Yarbrough, MD, MPH Paul W. Ragan, MD James W. Kendall, LCSW, CEAP Daniel W. Byrne, MS

2 Objectives Update Faculty and Physician Wellness Program Share results of Vanderbilt Faculty and Housestaff Stress Survey Suggest ways to limit stress 2

3 The Faculty and Physician Wellness Program Work/Life Connections- EAP Behavioral Emotional Relationships Career Addiction 3

4 Utilization Faculty and Physician Wellness Program Participants (No.) PWP FY

5 Faculty and Physician Wellness Program Problem Distribution % FY Psychological Relationship/Family Workplace Alcohol & Other Drugs Other 5

6 FPWP Referral (%) Types Mandatory 8 Voluntary 92 6

7 Retention: 18 months from Date of First Visit VMG Physician Faculty seen in FPWP: 80% All VMG Physician Faculty: 79% 7

8 As Program Matures Shift from Treatment to Prevention Reactive Proactive

9 Depression in Physicians Depression no more common in physicians than in the general population 12.8% in men (lifetime prevalence) 19.5% in women (lifetime prevalence) physicians Compared to comparable populations Male physicians commit suicide 1.4 times more often Female physicians commit suicide 2.3 times more often Confronting depression and suicide in physicians: a consensus statement JAMA, 2003: ) 316) 9

10 Addressing Depression in the Workplace Counseling Partner with Physician Wellness Committee and other key stakeholders to improve education Partner with AFSP (American Foundation for Suicide Prevention) to begin anonymous web based counseling service Life Balance Presentations Academic Leadership Course Orientations (Housestaff and Faculty) Departmental Workshops Psychological First Aid Techniques for Katrina Residents Housestaff Alliance-Medical Marriages CISM Interventions Death of Patients and Faculty/Staff 10

11 Vulnerabilities of the Academic Researcher International Status Isolation Professional Orphans Personality Factors Expectations Publications Grants Scientific Discovery Lack of Regular Feedback 11

12 Organizational Recommendations Define Expectations Regular Performance Feedback Academic / Professional Mentor Pro-Active Procedure when Funding Ends Assistance with Job Opportunities Emotional Support Recognize and Reward Work/Life Balance for Academic Scientist 12

13 Recognizing Associations of Stress in the Workplace Decreased Satisfaction, retention, and productivity Increased Absence and health care costs 13

14 Study Design Observational (no intervention) Cross-sectional sectional (factors and outcome measured at same time) Mailed questionnaire Anonymous responses Self-reported Target audience : 2510 VUMC faculty and house staff

15 Response Rate 27.5% response rate 330/1200 (returned/mailed) Gender 185 male 139 female Current Position 43 residents 55 fellows 85 assistant professors 40 associate professors 49 full professors.

16 How do you describe yourself? (30% under much stress or burned out) Don t t report having great amount of stress 1% - I am under no stress 13% - I am under little stress 55% - I am under some stress Report great amount of stress 29% - I am under much stress 2% - I am burned out 16

17 The issue is not the amount of stress you have but rather how well you cope with it.

18 How well do you feel you are coping with your current stress load? (30% trouble coping or unable to cope) 24% - Coping very well 46% - Coping fairly well 24% - Have trouble coping at times 5% - Often have trouble coping 1% - Feel unable to cope 18

19 Stress Check-Up 1. I get at least 8 hours of sleep on a typical night. No 2. I work <55 hours in a typical week. No 3. I take quiet time for myself. No 4. I feel satisfied with my workload. No 5. I chose the right career. No 6. I have an optimistic outlook on life. No 7. I regularly give and receive affection. No 8. I feel satisfied with my social/love life. No 9. I organize my time effectively. No Yes Yes Yes Yes Yes Yes Yes Yes Yes

20 Stress Related to Lack of Sleep Percent Under Much Stres or Burned Out % 4-5 (n=18/34) 6 (n=38/113) P<0.001, chi-square for a trend 33.6% 7 (n=37/136) 27.2% 8 (n=6/41) Average Hours Sleep Per Night 14.6% P=0.018 for the comparison of 4-7 vs. 8 hours; P=0.100 for the comparison of 7 vs. 8 hours. Only 6.1% (41/324) reported 8 hours of sleep per night.

21 Satisfaction with Workload Satisfaction with Workload % P<0.001, chi-square for a trend 51.7% 36.4% 17.8% 5.9% 5 (n=14/18) 4 (n=30/58) 3 (n=32/88) 2 (n=19/107) 1 (n=3/51) "I feel satisfied with my workload" 5=Never 1=Almost always Percent Under Much Stres or Burned Out

22 Stress Related to Career Choice Stress Related to Career Choice % 55.0% P<0.001, chi-square for a trend 36.4% 38.4% 19.5% 5 (n=2/4) 4 (n=11/20) 3 (n=16/44) 2 (n=38/99) 1 (n=30/154) Percent Under Much Stres or Burned Out "I feel I chose the right career" 5=Never 1=Almost always

23 Stress Related to Lack of Optimism Stress Related to Lack of Optimism % P<0.001, chi-square for a trend 61.5% 41.8% 30.0% 17.2% 5 (n=8/10) 4 (n=8/13) 3 (n=28/67) 2 (n=33/110) 1 (n=21/122) "I have an optimistic outlook on life" 5=Never 1=Almost always Percent Under Much Stres or Burned Out

24 Stress Related to Lack of Affection Stress Related to Lack of Affection P<0.001, chi-square for a trend 58.3% 40.9% 50.8% 26.4% 19.2% 5 (n=7/12) 4 (n=9/22) 3 (n=33/65) 2 (n=19/72) 1 (n=28/146) Percent Under Much Stres or Burned Out "Regularly give and receive affection" 5=Never 1=Almost always

25 Stress Related to Social/Love Life Percent Under Much Stres or Burned Out P<0.001, chi-square for a trend 50.0% 52.2% 5 (n=8/16) 4 (n=24/46) 3 (n=22/66) 33.3% 21.6% 23.7% 2 (n=21/97) "I feel satisfied with my social/love life" 1 (n=22/93) 5=Never 1=Almost always

26 Stress Related to Lack of Time Management Skills Percent Under Much Stres or Burned Out P=0.013, chi-square for a trend 50.0% 40.0% 42.5% 23.1% 27.9% 5 (n=6) 4 (n=20) 3 (n=80) 2 (n=147) 1 (n=68) "I organize my time effectively" 5=Never 1=Almost always

27 Stress Related to Area of Responsibility Patient Care (P=0.029) Teaching (P=0.849) Research (P=0.001) Administration (P=0.048) Percent Under Much Stress or Burned Ou % 26-50% 51-75% % Percent of Typical Work Week P values based on a chi-square for a trend test.

28 Stress Related to Hours Worked Percent Under Much Stres or Burned Out P<0.001 chi-square for a trend 16.2% (n=11/68) 15.3% (n=15/98) 43.7% (n=31/71) 48.2% (n=41/85) Hours Worked in a Typical Week (self-reported)

29 Stress Related to Lack of Quiet Time Percent Under Much Stres or Burned Out (n=13/18) 72.2% 48.1% 4 (n=26/54) P<0.001, chi-square for a trend 26.9% 26.0% 3 (n=25/93) 2 (n=25/96) "I take quiet time for myself" 15.0% 1 (n=9/60) 5=Never 1=Almost always

30 Protective Effect of Quiet Time. Proportion under much stress Or Burned out Do not take quiet time Take quiet time Hour of Work in a Typical Week

31 Protective Factors If Working >55 hr/wk Quiet time Participate in healthy lifestyle choices (hot meals, exercise twice a week, do something fun weekly, sleep at least 7 hours) Give and receive affection Consider the spiritual aspects of life Strive for open communications

32 The Cone of Silence 32

33 Impact of Stress on Productivity Self-reported productivit (0-100, mean and 95% C n=77 n=147 n=76 n=17 coping very well coping fairly well trouble coping at times Those coping very well have significantly higher levels of self-reported productivity, P=0.004 Level of stress often have troupble coping/unable to cope

34 Relationship Between Stress and Retention VU Stress Study Findings Percent somewhat or very likely to leave VUMC % No stress (n=0/3) P<0.001, chi-square for a trend. 7.0% Little stress (n=3/43) 11.7% Some stress (n=21/179) 34.8% Much stress (n=32/92) 83.3% Burned out (n=5/6) 34

35 Stress Check-Up 1. I get at least 8 hours of sleep on a typical night. No 2. I work <55 hours in a typical week. No 3. I take quiet time for myself. No 4. I feel satisfied with my workload. No 5. I chose the right career. No 6. I have an optimistic outlook on life. No 7. I regularly give and receive affection. No 8. I feel satisfied with my social/love life. No 9. I organize my time effectively. No Yes Yes Yes Yes Yes Yes Yes Yes Yes

36 Stress Protective Factors and Stress/Burnout Percent under much stress o burned out % 27.6% 5.7% 0-3 (n=85) 4-6 (n=152) 7-9 (n=88) Total Number of Stress Protective Factors 36

37 Stress Protective Factors and Retention Percent somewhat or very likely to leave VUMC % 16.3% 10.1% 0-3 (n=86) 4-6 (n=153) 7-9 (n=89) Total Number of Stress Protective Factors 37

38 How Might We Impact Stress Proactively?

39 Lessons Learned: Individual Focus 100% retention is not the best measure of success Personality types can be assets or liabilities Career and professional needs vary at different life stages Federal/State laws are applicable to physician/faculty 39

40 Stress By Life Phase Percent Trainees (n=98) Junior Faculty (n=117) Mid/Sr Faculty (n=95) Coping well with stress load (P=0.004) Unlikely to leave due to stress (P=0.510) 40

41 Stress Related to Age and Hours Worked in a Typical Week Percent Under Much Stress or Burned Ou Hours Worked in a Typical Week 60 years Age:

42 Recommendations from Respondents on Way to Reduce Stress Exercise Meditation Pleasure reading Prayer Socialization Focus on family relationships 42

43 Lessons Learned: Leadership Focus Problems not addressed will return Leadership skills are important Everyone needs feedback Mentors are important Leadership is the organization 43

44 How Leaders Can Help Make VUMC a Less Stressful Workplace From VU Stress Survey Increased expression of appreciation (thanks, good job, etc.) Be sure everyone has an opportunity to get special recognition. Clearly defined goals, expectations, priorities. Give Feedback: How am I doing? 44

45 Recommendations for Leadership Embrace in the Elevate Initiative Set goals and outcomes Round : : Those who report to you are likely to be under more stress than you realize. Give special recognition for a job well done Thank you provides a strong incentive 45

46 Lessons Learned: Organizational Focus Physician/faculty need orientation to the workplace Paradigm shifts have consequences Anticipate, prepare, and communicate Communicate again Work units need to function as teams 46

47 Which area of training might have made your life less stressful? How to balance research, teaching, patient care, and family life 40 % How to supervise & manage people 28 % How to build a happy marriage and family life as a physician 13 % How to manage the business aspect of a medical practice 13 % How to manage stress associated with a malpractice suit 3 %

48 Recommendations for Training and Development Balancing work and home life Management/leadership skills. 48

49 Time-Management Techniques From VU Stress Survey Make time to do what you enjoy Use a home computer and convert to online bill paying Making a list and trying to complete 70% Multi-task task and keep lists Eat 3 meals daily and exercise times weekly Plan your spending and spend how you plan Prioritize-Do most difficult first Stay on task Be aware that work will consume you if you let it 49

50 Conclusions Most were coping well. Stress is important to the organization as it impacts productivity and retention. Malpractice, lack of pay or lack of skill set were not the factors identified as creating much stress or burn-out within this population. We can take control of some major factors (taking quiet time, optimistic outlook, sleep, exercise, expressions of appreciation, etc)

51 Faculty and Physician Wellness Program Clinical Paul Ragan, MD : FPWP Medical Director Jim Kendall, LCSW: Manager Ellen Trice, LCSW :Recovery Support James McFerrin, MD Ellen Clark, LCSW Carol Milam MD Organizational Mary Yarbrough, MD MPH: Director Health and Wellness 51

52 We would like to thank the following people Steven Gabbe,MD, Dean of School of Medicine Medical Center Medical Board Executive Faculty Committee Physician Wellness Committee The Vanderbilt University Medical Center Faculty and Housestaff who participated in the survey 52

53 Resources The Resilient Physician: Effective Emotional Management for Doctors and Their Medical Organizations Authors: Wayne Sotile, PhD and Mary Sotile, MA Publisher: American Medical Association, Chicago, IL, 2000 ISBN: Problems in Identification and Treatment of Emotional Disorders in Physicians Author: Ernest Miller, MD Jacksonville Medicine (October 1997) The Painful Truth: Physicians are Not Invincible Authors: Merry Miller, MD; Ramsey Mcgowen, PhD Southern Medicine Journal 93(10): , 972,

54 Resources Physician Stress: A Handbook for Coping Authors: Joseph Benton Howell,II, PhD, David P. Schroeder, MD University Park Press, Baltimore The Well-Being of Physicians Authors: Tait Shanafelt, MD, Jeff A. Sloan, PhD, Thomas Habermann, MD Association of Professors in Medicine American Journal of Medicine; Vol 114: April 15,2003 The Truth About Burnout: How Organizations Cause Personal Stress and What to do about it Authors: Christina Maslach, Michael Leiter Jossey-Bass: A Wiley Company 1997 ISBN:

55 Resources Physician Well-Being Being- Special Issue Editors: John Christensen, Anthony Suchman Medical Encounter Vol. 16 No Spring 2002 Burnout in Chairs of Obstetrics and Gynecology: What Lessons Can Be Learned Authors: Steven Gabbe, MD Canadian Medical Association (CMA) Policy on Physician Health and Well-Being West J Med2001; 174: 5-75 The Relationship Between Modifiable Health Risks and Health Care Expenditures Authors: Ron Z. Goetzel, PhD et al J Occupational and Environmental Medicine Vol. 40 No 10 Oct

56 How the Faculty and Physician Wellness Program Works Education Proactive information Referral to Program Self-refer or leadership Designate as mandatory or voluntary Evaluation Initial assessment Verify events Diagnosis and treatment Determine payor source: insurance coverage vs. department Connect with appropriate provider Assess any work restrictions Confidentiality Separate from all other filing systems (Not in medical record system stem or personnel files) Release of information required Monitoring Condition specific Coordinate treating provider, supervisor, legal, professional organization In compliance with medical leave, FMLA, ADA, Worker s s Compensation Contract compliance in cases of addiction Reporting Medical Center Medical Board (non-identifying information only) Compliance as required 56