Physician wellness: Doctors taking care of doctors
The four Joint Collaborative Committees (JCCs), a partnership of Doctors of BC and the BC government, work collaboratively to lead system change. The committees—General Practice Services Committee, Specialist Services Committee, Shared Care Committee, and the Joint Standing Committee on Rural Issues—are unique partnerships in Canada. Physicians partner with government and work closely with health authorities to make system change while strengthening the role of physicians as leaders in innovation at provincial, regional, and community levels.
Physician health and wellness is paramount, and every day the JCCs work toward reducing the burdens that contribute to physician burnout and stress, but there is much more work to do. The strong relationships developed at these committees, and through divisions of family practice and medical staff associations (MSAs), have helped to realize significant changes that have improved doctors’ lives by tackling some long-standing organizational-level issues. Rates of physician burnout and moral distress were rising before the COVID-19 pandemic, and they continue to rise due to increasing demands on physician time and resources in a complex and, at times, constrained health care system that involves heavy workloads and clinical practice requirements, inefficient system processes, and evolving technology. However, this burden is not experienced equally by all. Sponsored by a JCC initiative, a 2020 physician-led study found that emotional exhaustion and feelings of low personal accomplishment were higher in physicians who identify as a woman or a person of color. Physicians in rural communities have also felt a higher level of professional and personal isolation during this challenging time.
During the pandemic, the JCCs supported BC’s quick pivot to ensure equitable access to health care for all patients by initiating virtual care fees, funding and deploying Zoom licences, and ensuring access to free personal protective equipment for community physicians. In 2021, the JCCs partnered with the Physician Health Program of BC to start developing and supporting provincial resources, including:
- Networks of trained physicians offering their colleagues one-to-one peer support.
- Services to match physicians with their own family physician to support their primary care needs.
- Core cognitive behavioral skills training for physicians to support their health and wellness.
Through the JCCs, physicians continue to lead a spectrum of quality improvement initiatives to energize and stimulate better practice environments for other physicians.
Breaking down systemic and organizational barriers and burdens
Vancouver Coastal Health and the Vancouver Physician Staff Association have joined forces to address physician wellness and are encouraging department-level solutions. They polled members to assess the complexity of factors contributing to physician burnout. Guided by these insights and supported by JCC engagement funding, department and division heads are further discovering specific impediments, developing interventions, and identifying trusted and respected wellness champions from within the profession.
For example, at the Vancouver General Hospital Emergency Department, four physicians are now part of an interdisciplinary wellness team and have identified improvements such as new radiology processes, outpatient clinics, and shift scheduling. They are also exploring space optimization and deeper systemic issues such as clinical and administrative workloads.
Managing immediate impacts to support resilience and balance
Through the Rural Coordination Centre of BC (RCCbc)–led Real-Time Virtual Support (RTVS) pathways, 150 physician colleagues (referred to as virtual physicians) now provide rural health care providers with on-demand, 24/7 clinical support via video or telephone. RTVS offers three patient-facing pathways and four peer-to-peer pathways that enhance health equity in rural, remote, and First Nations communities across BC. The program has facilitated more than 40 000 encounters/calls since April 2020. The peer-to-peer pathways in particular have seen significant, steady use by clinically courageous physicians in low-resource settings across 91 communities. Participants report that this helps build communities of practice and stronger interprofessional and collegial relationships, and promotes and enhances practitioner recruitment and retention. In addition to improving access to patient-centred care and reduced out-of-pocket costs for patients, participating end users have also expressed that the RTVS strengthens core competencies, clinical skills, and confidence; reduces feelings of isolation, loneliness, and stress; and improves psychological well-being.
Many practical, meaningful efforts have been organized to foster a culture of collegial appreciation and respect to help maintain and restore physician health and wellness, such as the following examples:
- The Campbell River Spirit Awards honoring local physician peers and community heroes who keep the community healthy.
- A dedicated space for physicians’ children at smaller division meetings and supervised child-friendly activities/play stations at larger events hosted by the Thompson Region Division of Family Practice to help support member attendance and engagement.
- A new healthy snack program at Powell River General Hospital introduced by the Powell River Division of Family Practice after learning that some of its members felt unsafe to leave the facility to get meals while challenged with managing patient loads.
Doctors are encouraged to connect with their division, MSA, or RCCbc to learn more about supports for physician wellness in their area. For resources from the JCCs, visit www.collaborateonhealthbc.ca.
—Ahmer Karimuddin, MD
—Alan Ruddiman, MB BCh
This article is the opinion of the Joint Collaborative Committees (JCCs) and has not been peer reviewed by the BCMJ Editorial Board.
1. Khan N, Palepu A, Dodek P, et al. Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: The role of gender, ethnicity, and sexual orientation. BMJ Open 2021;11:e050380.
2. Walters L, Couper I, Stewart RA, et al. The impact of interpersonal relationships on rural doctors’ clinical courage. Rural Remote Health 2021;21:6668.
Ahmer A. Karimuddin, MD, FRCSC, Alan Ruddiman, MBBCh, Dip PEMP, FRRMS. Physician wellness: Doctors taking care of doctors. BCMJ, Vol. 63, No. 10, December, 2021, Page(s) 433,435 - Joint Collaborative Committees.
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I am delighted to find that you are out there supporting physicians health. It gives me great hope for the future!