Unstress your physicians to unstress yourself

If they’re feeling lousy, you’ll likely pay

If your physicians are blaming and complaining, displaying low morale and high burnout, you can expect that your recruiting and retention problems will only grow worse.

Those are the classic signs of stress, and unless you act quickly, the difficulties among your physicians and their staffs will grow, says John-Henry Pfifferling, PhD, director of the Center for Professional Well-Being, in Durham, NC. The center helps physicians create a more productive, collaborative workplace by assisting them in revealing and correcting unhealthy symptoms within their practices.

Neglecting to address their stress, or flat out denying it will only lead to patient dissatisfaction and physician exodus. Ultimately, physicians relations professionals will pay the price, as their own stress level skyrockets when they must struggle to recruit and retain new physicians. (See related story on coping with stress, p. 31.)

How can you prevent your own adrenals from pumping over physicians’ problems? Support physicians with group and personal training in well being such as values clarification, non-chemical coping, relationship and communication building, and teamwork, says Pfifflerling, an applied anthropologist who studied medical residents for seven years before starting the center.

First, he advises physicians relations professional to get some insight into why physicians are stressed. The reasons he often sees include:

They’re overwhelmed.

"The majority of physicians feel vulnerable, unsupported, distrusted, unaccepted, and invalidated by society and by peers," explains Pfifflerling. "They feel besieged by information overburden, litigation threat, and territorial encouragement."

Their world is changing rapidly.

Don Powell, PhD, agrees. "Physicians are seeing their practices undergoing a tremendous amount of change in response to managed care," says the president of the American Society for Preventive Medicine in Farmington Hills, MI. "They feel they don’t have the same controls as before — they may be working for different employers, with different reimbursement patterns. So their natural response is one of stress."

They may lack time management skills.

A consequence of this rapidly changing world of health care is the frantic effort to keep up with payer demands. "Many physicians lack time management skills and perceive themselves as not being able to accomplish everything that is demanded of them such as seeing all the patients and completing the required paperwork," he says.

Pfifferling concurs that the mountains of paperwork alone "predisposes depressive symptoms."

They may not communicate effectively.

Physicians are also vulnerable to relationship issues with colleagues, nurses, allied health professionals, Pfifferling and Powell say. Often the crux of this conflict is dysfunctional communications among the various groups.

"They may communicate aggressively, or passively, satirically or unclearly," Pfifferling says.

They may lack coping mechanisms.

Sometimes it’s a case of sheer exhaustion for physicians who have been working practically non-stop for years. Other times it’s a case of trying to control the uncontrollable or setting up unrealistic expectations, Pfifferling says. (See related story about controlling stress, p. 32.)

Doctoring the doctors

Once you’ve identified the problems, develop a systematic approach to helping physicians identify and correct their stress-causing behavior.

For example, the Massachusetts Medical Society is developing a Physician Education Center to help physicians in this changing environment," says Corlette Moore McCoy, director for program development. "The center will provide support for physicians who wish to maintain and or improve their levels of expertise in medicine, business, or their personal lives," she says.

It will also prescribe focused education programs for physicians who perceive themselves as having communication deficits. "We will provide evaluations to identify problems areas, and if appropriate, recommend, refer for implementation, monitor, and provide follow-up for each concentrated educational plan," she says.

Resources used to relieve stress

Both Pfifferling’s and Powell’s organizations also offer models and resources to combat physician stress.

For example, The Center for Professional Development, created an approach called PRIME, short for "professional revitalization in medical environments," which assesses the level at which a practice functions within these five program areas:

• principle of practice;

• practice development;

• communication and conflict management;

• support group formation;

• individual assessment.

"Every practice member answers the survey, and the results are complied into a diagnostic report on the well-being of the practice," Pfifferling says. Based on the survey findings, Pfifferling then prescribes an action plan that includes training for collaborative problem solving, change management, effective communication, peer support, and life change or career counseling.

Another training model, called Systematic Stress Management is offered by the American Institute for Preventative Medicine. This includes booklets and cassette tapes and instructor-led programs that focus on practical skills that enable participants to reduce or eliminate stress.

"During the program, we practice relaxation techniques and other stress management tools such as visualization and mediation to ensure that you understand and develop the skills of stress management," says Powell.

He also focuses on the concept of cognitive restructuring. "We help them to understand that an event is not necessarily good or bad, but what we think about it makes it so," he says. "The message is: We may not be able to change an event, but we can change our reaction to it."