ASRA Pain Medicine Update

When I originally sat down to write this message a few months ago, I wanted to talk about the ways that ASRA is helping our members address physician  burnout.

I still want to talk to you about the ways that ASRA is helping our members address burnout, but the context  has changed dramatically.

I am sure you are experiencing stresses you never imagined a few months ago.  I hope that ASRA can provide a measure of support to you wherever you are in your personal challenges.

When I originally wrote this message, no one could predict where we would be today and what we all had experienced. In March, we started hearing reports from areas hard hit by COVID-19, like New York City, Detroit, and New Orleans, where our colleagues  were being called to the  front-line providing support for intubations, managing ICU patients, and staffing emergency departments. Anesthesiologists have taken a critical role in caring for COVID-19 patients along with the anxieties of personal risks to themselves and their families. The front-line stories have been shocking and upsetting. Some of our members have lost  colleagues;  others have lost friends or family members.  At least one physician suicide has been linked to COVID–related stresses. Still others in our ranks have essentially closed their practices to all but essential encounters and  are unable to work experiencing financial worries.  

In short – I don’t know exactly where you are right now, but I am sure you are experiencing stresses you never imagined a few months ago.  I hope that ASRA can provide a measure of support to you wherever you are in your personal challenges.

Physician burnout is long-term job stressor that leads  to feelings of being exhausted, overwhelmed, cynical, detached from the job, and a lack of personal accomplishment, according to the Medscape National Physician Burnout, Depression & Suicide Report.^[1] Today, this is an understatement. As burnout progresses, the individual loses perspective and becomes unable to target the drivers or find solutions.

Physician burnout and suicides have escalated dramatically in the last decade. In Medscape’s 2020 report, an estimated 41% of physician anesthesiologists reported burnout and 4% reported being clinically depressed.^[2] Clearly burnout among physicians had risen sharply before COVID. Medicine has never been an easy career, but our predecessors, though working hard, seemed to find greater reward. Today we have far less control over our careers and practices. Ten years ago, the majority of healthcare was delivered in a physician private practice setting.  Today, the majority of physicians are now working as employees with considerably less autonomy or control over their practices.  Additionally, physicians spend less time in caring for patients and  increased time spent on electronic health records.^[3],[4]

These are important concerns for ASRA as represented by many past meetings and publications on the topic (Figure 1). Although the Society cannot address all of the root causes of physician frustration, depression, or burnout, we can support physician wellness and open the conversations to address the root causes.  Furthermore, doing so is part of our core values, specifically the value of Wellness. (ASRA’s other core values are Integrity, Innovation, Inclusiveness, Service, and Compassion.) ASRA’s focus on Wellness involves mental health, physical health, and financial health.

Figure 1. ASRA wellness and burnout resources

ASRA Resource Area: Professional Issues - Wellness and Burnout Prevention

Tools and resources

• How to Meditate (article from New York Times)
• Mindfulness: How to Do It: org is part of Mindful, a nonprofit organization providing resources that “celebrate mindfulness, awareness, and compassion in all aspects of life.”
• Well-Being and Burnout: Take Charge of Your Well-Being (toolkit from the American Psychiatric Association)

Background

• Tips on Coping with Life During a Pandemic
• Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population (article from JAMA)
• Job Burnout: How to Spot it and Take Action (from the Mayo Clinic)
• It Could Happen to You (ASRA News/blog articles)
• Physician Burnout Insight and Strategies: The Data (presentation from the 16^th Annual Pain Medicine Meeting by Oscar de Leon-Casasola, MD)
• Preventing Occupational Stress in Healthcare Workers (article from Cochrane Database Sys Rev)
• Stress and Burnout in Anaesthesia (article from Current Opinion in Anaesthesiology)

ASRA News articles

• From the Editor’s Desk: This Fall, Have a Heart
• Going the Distance: Sustainability in a Regional Anesthesia and Pain Medicine Center
• From the Editor's Desk: Feel the Burn
• Electronic Medical Records: Promises, Pitfalls, and Pearls for Pain Physicians

Mental Health

At ASRA’s 18^th Annual Pain Medicine Meeting this past fall, Michael S. Weinstein, MD, MBE, MPH, of Thomas Jefferson University in Philadelphia, PA, shared his struggles with depression and a suicide attempt as a way to open the conversation for all of us. One attendee shared, “Thank you for this session, we don’t get to talk about this.”

Dr. Weinstein’s session was very moving, and it allowed our colleagues to share with each other in a way I have never experienced  at an ASRA meeting nor, in fact, at any meeting. The incredible outpouring of emotions, sharing similar personal stories, was palpable. This experience helps us to recognize an important way we can help one another – by building a support system with open communication. We hope that ASRA can be one such support system for its members. We nurture this support system in several ways. At the annual meetings, for example, we try to foster a community by breaking down the meeting to small groups like special interest group (SIG) meetings, meet and greet events in the exhibit hall, our small-group problem-based learning discussions, the “ASRA Let’s Eat” group dinners, and several other small group sessions.

We also provide an opportunity to take a break from the stressors of daily practice. Whether it is petting a dog during a “bark break,” attending a mindfulness workshop at the meeting, or dancing the night away at our closing party, we want you to escape – even if just for a moment – the stressors in your life.

Now that we are experiencing more “virtual” connections, I encourage you to engage with others through the ASRA Connect Community. You can share your stories or ask questions within specific SIG communities or post in the general member area. In addition, coming soon is an all-new ASRA Mentoring Program where you can be matched with a mentor or mentee to work on specific topics – and wellness is one of them.

We also have added significantly to our online resources. Plus, check out a plethora of wellness resources just added to our COVID-19 Resource Center.

Physical Health

Right in line with mental health is physical health. There has been a plethora of evidence linking physical activity and mental health for many years now, and the phrase “you are what you eat” has been around as long as I can remember. In recognition, ASRA has been offering a growing wellness program in conjunction with annual meetings to help you maintain physical and mental balance. During our last two meetings, we offered fun run/walk events to get attendees moving before a day of learning. We’ve also offered Tai Chi, yoga, and mindfulness meditation at meetings. Coupled with those activities are efforts to provide a range of food choices and plenty of water stations to keep your body nourished and hydrated. We continue to evaluate activities and programs to support these wellness efforts. Again, on our  COVID-19 Resource Center, you'll find several online exercise options.

Financial Health

Newer to the ASRA offerings is ASRA’s BLOC (Business Leadership Online Courses), which provides in-depth training on negotiating, financial management, and building a successful team. These courses provide practical skills that can improve your financial well-being and that of your practice. They provide CME but do not require a plane ticket – you can do it all from the comfort of your home or office, which may be appealing to those struggling to manage another wellness concept – work/life balance. Get more information on these courses as here. ASRA’s Practice Management portfolio has been extremely popular. These tools help empowered us to understand our practice and take control of our careers. 

Call to Action

Please take part in our wellness activities – whether they be in person or online – and let us know if you find them helpful as well as what else we can provide.  Although I’ve identified several wellness projects within ASRA, there is still great need for more resources.

I invite every member who has expertise and wants to help us build our physician wellness resources to send a brief introductory email with your areas of interest to ASRAmembership@asra.com by June 1. Our goal is to develop a wellness portfolio of resources.  Would you step forward to contribute your time to a Wellness SIG?  Is there interest in sharing our many non-medical talents and perhaps creating short videos of our ASRA family playing music, creating a craft or art, cooking, baking or whatever talent or hobby you may have? 

We will be developing a resource area with research, tools, and more information in the hope that we can take care of ourselves first in order to be the best caregivers for others. Please bring your ideas, talents and let us know how we can best support you!  Please be safe and be well as we navigate through these challenging times.

References

1. Kane L. Medscape national physician burnout, depression & suicide report 2019. Medscape. 2019, January 16. Available at https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056. Accessed February 25, 2020.
2. Kane, L. Medscape national physician burnout, depression & suicide report 2020: The generational divide. Medscape. 2020, January 15. Available at https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460. Accessed February 25, 2020.
3. Melnick ER, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clinic Proceedings. 2019;In press(1681-1694).
4. Fry E., Schulte F. Death by a thousand clicks: where electronic health records went wrong. Fortune. 2019, March 18. Available at https://fortune.com/longform/medical-records/. Accessed May 3, 2020.