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Featured topic and speakers
Why are physician wellness programs important? What are Physician Health Services? What is a physician health program? Why is physician well-being important?
Our guest is Chris Bundy, MD, MPH, chief medical officer for the Federation of State Physician Health Programs and the executive medical director of the Washington Physicians Health Program. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Chris Bundy, MD, MPH, chief medical officer, Federation of State Physician Health Programs and executive medical director, Washington Physicians Health Program
Transcript
Dr. Bundy: It's a courageous step to ask for help, but don't be afraid to do so. The risk of not getting help, in my experience, is far greater than any concerns you might have about reaching out.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about the importance of physician health programs, or PHPs, and the role they play in supporting physician well-being. Our guest today is Dr. Chris Bundy, chief medical officer for the Federation of State Physician Health Programs and the executive medical director of the Washington Physicians Health Program in Seattle. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Bundy, welcome.
Dr. Bundy: Hello, Todd. It's a pleasure to be here.
Unger: Dr. Bundy, you are deeply involved in physician well-being efforts in Washington and around the country. Why don't we just start with a 10,000 foot view on why it's so important that medical associations support physicians, students and other clinicians who are seeking care for mental illness or substance use disorder.
Dr. Bundy: Great question. Todd, medical associations, at both local and national levels, have this incredible expertise and influence, which they can direct to decreasing stigma by normalizing mental health and substance use disorder problems and encouraging help seeking with educational offerings to their members about self-care, including how to address concerns of impairment if they arise. The Federation of State Physician Health Programs and physician health program leaders have great expertise and can collaborate with those that are interested in producing those kinds of educational offerings, advocating for accessible and affordable mental health and substance use disorder resources that are tuned to the needs of safety sensitive workers.
This can be done through society benevolent funds, collaborations with physician health programs, advocating for insurance reimbursement reforms, and encouraging systems that benefit from the work of physicians to do more to provide financial assistance for those services that may not be adequately covered by insurance. And then I would say, finally, supporting state PHPs, which were specifically created by organized medicine 40 years ago, to be a support for these very issues.
Unger: Well, let's go into a little bit more detail, because I'm not sure everyone out there is familiar with physician health program concept, or PHP, that is. So why don't we talk a little bit more about what the program is and how physicians can access that.
Dr. Bundy: Yeah, it's not well known that these programs really evolved out of the AMA's efforts. The 1974 landmark report published in JAMA, called the "Sick Physician", was really a report that prompted state medical societies to create programs to address physician impairment and concerns of impairment. This call to action recognized that the physicians deserve confidential, non-disciplinary pathways to healing when illness could negatively impact practice.
Healthy physicians mean safer patient care, and this has been the guiding principle linking physician well-being to patient safety for over 40 years. Today, nearly every state has a legislatively authorized physician health program to address mental health, substance use disorders, co-occurring conditions, and increasingly, to assist with non-psychiatric medical conditions that are due to an aging physician workforce. We're supported by organized medicine and medical regulators, backed by legislation, that allows confidential referrals to our programs as an alternative to making a report to a medical board.
And this unique legal protection, I think, underscores the trust that the health care ecosystem places in PHPs to rehabilitate physicians while safeguarding patient care. This trust is reinforced by exceptional outcomes. PHP graduates have better recovery rates compared to general care in the general population and lower professional liability risk compared to same specialty physicians who have not been through a physician health program. So this benefits patients and the public significantly.
When physicians reach out to a physician health program, they are met with experienced clinicians who understand their unique professional challenges. They get tailored support from resource connections to comprehensive evaluations and treatment referrals, and ongoing structured follow-up to ensure successful outcomes and verification of readiness to return safely to practice. Currently, all PHPs assist about 10,000 physicians per year, annually, and in addition to many other health professional types. And no other care model has saved more lives or careers in health care, which is why I'm so passionate about this work.
Unger: Now, back to what you started with, which is quoted something from the 1970s. Who would have thought 50 years later that we'd be at or near a peak in physician burnout. Obviously, there's a huge need here. For a physician to get in contact with this kind of program, a physician health program, how do they actually do that?
Dr. Bundy: You can go to the Federation of State Physician Health Programs. The state pages have every program contact information. State medical societies often are partnered with their physician health program. So reaching out.
We're not too hard to find. Almost every state physician health program has a website. Look us up and start that conversation, especially if you're concerned about yourself or a colleague. You can always call us anonymously and just talk about the situation and receive some, I think, well-informed and expert guidance and support.
Unger: Now, one of the obstacles, and we've talked about this on other episodes, surprisingly, lies in credentialing applications. And I know that one thing that you've also been working on is updating licensing and credentialing applications to remove stigmatizing language. Will you tell us a little bit more about what goes into that work and why it's so important?
Dr. Bundy: I think this work is critical because these kinds of questions just reinforce stigma and bias and discourage physicians from getting care. I think the questions are well-intentioned in the sense of trying to protect patient safety. But they're counterproductive in that regard, when doctors who might otherwise seek care are reluctant to do so because of fear of asking about or being asked about these kinds of things in the future. I think there are better ways to protect patient safety and to address impairment, including involving and collaborating with a physician health program.
Unger: It's such a great thing to have recognized this particular obstacle. And I know you've been working in partnership with the AMA and many other folks out there. Tell us a little bit about the progress that you've made in removing this particular obstacle.
Dr. Bundy: Well, it's been an interesting journey. We, in the physician health program world, have been working on this for years because our participants themselves have been subject to these kinds of questions in ways that have been discriminatory. And so we've needed to advocate for them. In Washington, in 2017, we were able to work with the Washington Medical Commission to adjust the licensing question to be in alignment with what was emerging best practice at the time.
And that was coming out of work that the AMA was doing, and the American Psychiatric Association, and others, who were working on developing this model language. And then in 2019, the Federation of State Medical Boards came out with its policy on physician well-being, which kind of codified and brought together all of this guidance in a way that it was a call to action, really, for medical boards to evaluate their questions, bring them into alignment with best practice and to be non non-discriminatory.
That work has extended to the Board of Osteopathic Medicine now, in Washington, and we expect all the healing arts in Washington to be on board. Washington then adjusted its question again in 2022 to an advisory model. So the board doesn't even ask about prior health issues. They simply provide an advisory to.
And other states, North Carolina, Tennessee, Mississippi have all been doing this work. And, really, I think 15 states have changed their questions in collaboration with the Physician Health Program. So we've definitely had this as a priority at the federation, been working collaboratively with state medical associations and regulators to get this work done.
Unger: That's fantastic. And, I'm curious, with all this progress that you are making, do you see a tangible change in the well-being of physicians, which I believe would be the outcome of this?
Dr. Bundy: I mean, what I hear from my program participants is that they are relieved when it comes time for re-credentialing, or if they're trying to credential at a new institution or for insurance contracting, or what have you, that they're not being asked these questions. And their recognition that the physician health program has played a role in bringing this about helps them feel supported and cared about.
And so I get I get a lot of feedback in that direction. I think it's going to take time. These are really the preconditions. And realizing the full potential of removing these institutional drivers of stigma is going to take some time to realize, but is a necessary first step.
Unger: Well, you've had a lot of success in this area, and I'm curious, do you have one piece of advice you'd give somebody who's looking to get involved in efforts like this, to improve physician well-being?
Dr. Bundy: Don't hesitate. Get engaged. Get educated. If you don't know much about your state physician health program, reach out, learn about how that works and be ready to refer a colleague in need or help support efforts within your institutions to address things like impairment, but also just the opportunity to join in communities, whether it's your state medical society or others that are working towards these advocacy goals, connecting with the Lorna Breen Heroes Foundation. They're always looking to bring on ambassadors and advocates to support this work.
It's a wellness activity itself, to be engaged in purposeful, meaningful activity to benefit our peers and colleagues. So that's what I would recommend.
Unger: What would you say to a medical student, a resident or a physician who is reluctant to seek help? Maybe they're not aware that these questions have been removed from many state credentialing applications. How would you reassure them that to do the right thing, take care of themselves?
Dr. Bundy: I would say that it's normal to be fearful. It's a courageous step to ask for help, but don't be afraid to do so. The risk of not getting help, in my experience, is far greater than any concerns you might have about reaching out.
Unger: Well, thank you so much for sharing that. I'm sure it resonates with a lot of people out there. How can we keep working to reduce that stigma that people fear, as you said? Is there one thing that comes to mind?
Dr. Bundy: I think we have to continue to change the culture around health seeking and help acceptance, and make access to resources seamless. Opt out models that provide counseling support for medical students and residents, peer support models that begin in medical school can really normalize the idea that we need help and building connections to healthy supports proactively so that when problems arise, there's already a system of support in place. Being engaged in support should be a professional expectation, not an exception reserved only for those who fall ill.
Unger: Well, thank you so much, Dr. Bundy. Really appreciate you joining us and telling us more about your work. It's having such an impact, and we're always look forward to working with you. As a leader in physician well-being, the AMA has made reducing physician burnout a top priority. To support our efforts, you can become an AMA member, at ama-assn.org/join.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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