Embarking on a new chapter in one’s career path is filled with opportunities for growth and positive change. It marks a significant transition that can greatly impact a physician’s well-being, especially when the focus is on supporting and preventing burnout among colleagues. Elizabeth Harry, MD, an internist, embraced this journey when she assumed the role of chief well-being officer last fall at Michigan Medicine.
Through this experience, Dr. Harry gained valuable insights into the challenges faced by all clinicians today, including at Michigan Medicine. This firsthand experience has equipped her with a deeper understanding of their needs and has empowered her to identify effective strategies to enhance physician well-being. By immersing herself in this role, Dr. Harry has been able to contribute positively to the well-being and professional fulfillment of her colleagues, fostering a supportive and nurturing environment within the health care community at Michigan Medicine.
Going through onboarding helped with learning “the culture, the things that are strong and powerful and maybe different from places I’ve been in, and identifying the areas of opportunity and growth and where I can bring things that I’ve learned from the strengths of the places that I’ve been to help advance this even further,” Dr. Harry said. “One of the things that was really important to me when I started was understanding how people think of the well-being office, what they know about the office, what their experience with the office has been and their clarity around what the office does.
“That gives me an idea of where we need to go in terms of clarifying what our office does and how we’re different,” she added.
What also helped in the process was looking at the numbers and conducting the AMA Organizational Biopsy®. The survey uncovered that 71.6% of resident physicians reported feeling satisfied with their job, compared with 81.6% nationwide. On top of that, 63.6% of residents reported job-related stress, compared with 42.4% across the country. Meanwhile, 62.3% reported burnout, compared with 40.6%.
The upside, though, was that 61.1% of residents agreed that Michigan Medicine values their well-being and 60.5% felt they could freely express their opinions and concerns to program leadership. While this data was collected prior to Dr. Harry joining Michigan Medicine, it has served as a starting point for assessing well-being.
Michigan Medicine is currently conducting a survey with the AMA to get a better understanding of well-being as a whole. In the meantime, Michigan Medicine is already taking steps to address top resident stressors such as adequate support staff and schedule flexibility.
As further data is collected, Dr. Harry isn’t staying put. She is working with her colleagues to take steps to address burnout and improve well-being for resident physicians and all the doctors and other health professionals who deliver excellent patient care at Michigan Medicine.
In an interview with the AMA, Dr. Harry provided a broad overview of the ongoing work to address burnout and improve well-being at Michigan Medicine.
Turn to the AMA for guidance
“The AMA is so helpful. One of the things that I love—and I tell people this all the time—is the AMA Debunking Regulatory Myths site because I will hear people cite things that I know are on there and I will say: I’m not sure that is a barrier. Let’s check the myth buster site,” Dr. Harry said, emphasizing “that has been very helpful.”
Additionally, the AMA STEPS Forward® toolkits “are huge and it’s a great level-setter,” she said. For example, “one of our leaders sent me the peer-support toolkit by Dr. Jo Shapiro and asked where we are with this. And it gave us the opportunity to have a great conversation and learn about the resources that we do have in place.”
The engagement made possible through the AMA Organizational Biopsy “and having even the opportunity to have the AMA come out and speak has been great,” she added. “The AMA has been a great partner all along in this space.”
Earn well-being recognition
In 2023, Michigan Medicine received silver-level distinction from the AMA Joy in Medicine™ Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
“It’s fantastic to receive the recognition. Just the fact that the AMA has put together this program to be able to not only recognize organizations that are advancing this work, but also to really help define what best practice means in advancing this work is so helpful,” Dr. Harry said. “It’s very helpful in driving our future initiatives because there is a road map to follow, which is great, and we know the road map is evidence-based and best practice.”
“It also gives us something to tell people that the institution really is working hard on this and maybe every moment of every day you don’t feel it, but we are working, advancing and moving forward,” she said. “Those pieces are huge. So, I thank the AMA for putting this together to give organizations the opportunity and the structure to be able to advance this work.”
Implement coaching programs
At Michigan Medicine, 32.1% of resident respondents reported feeling valued, compared with 55.6% nationwide. This is where coaching can help.
For example, several residency programs are doing the “Better Together” coaching program with Adrienne Mann, MD, and Tyra Fainstad, MD, said Dr. Harry, noting there are “two large, randomized controlled trials that have been published in JAMA Network Open showing great reductions in burnout and imposter syndrome.”
“We also use the Positive Intelligence coaching program, and that’s an asynchronous coaching program that we’re putting some of our folks through,” she said. But “we have to be careful how we message it. We are offering these things not because the individual is the problem or that burnout is their fault. It’s an occupational hazard.”
The AMA’s Coaching in Graduate Medical Education book offers best practices and recommendations for creating coaching programs in graduate medical education.
The standard of care in physician well-being recognition
Institutions in this article have been honored by the Joy in Medicine™ Health System Recognition Program.
Emphasize mentoring and leadership
“Mentorship, leadership development, sponsorship … are all really important,” Dr. Harry said.
“We have cohorts of people in medicine who are maybe even overmentored and under sponsored,” she said, noting that the focus is to ensure that physicians “know the difference between them, they know how to have those conversations and ask for mentorship or sponsorship.”
For leadership development, “we’re partnering with our faculty development office and then partnering with our department of surgery,” Dr. Harry said. “Their chair, Dr. Justin Demmick, has done incredible work with a leadership-development program around the Michigan Promise.”
“We’re working to help them scale that as well and add well-being-centered leadership content to that too,” she said.
Use AI to lower cognitive load
When it comes to addressing physician burnout, administrative workload cannot be overlooked. For example, over 42% of residents reported spending more than six hours on the EHR outside of normal work hours.
That is why Michigan Medicine is looking into how augmented intelligence (AI) can help “lower cognitive load of our daily work and take away some of the administrative burden,” Dr. Harry said, noting “there’s a lot of opportunity in the AI space and that’s going to be a big focus of where we spend our attention this year.”
“However, there’s a lot of opportunity to reduce cognitive burden in other spaces, such as redundancy in in-basket messages,” she said. That means “not only just the in-basket burden, but also duplication in types of messages that we get, duplication in where messages go and how many times people touch those messages.”
Get the data to support the work
Michigan Medicine is “also spending time developing reports to be able to show what's happening with our synchronous work in ambulatory care and what's happening with our asynchronous work in ambulatory,” which includes inbox messages and the patient portal, Dr. Harry said. “I’ll give you a hint: The asynchronous work is exploding, and the synchronous work is staying pretty similar because there isn't a lot of room to add synchronous work, but that asynchronous work is filling in all the cracks and taking a lot of people's time outside of work.
“Just being able to document and show that change in asynchronous work is huge, so making sure that we're getting the data to address what are the drivers of cognitive load and then how can we think about them,” she added.
At a broader level, none of this is possible without having the right data to support what is working and what needs to change. That is why the work with the AMA is so important.
Michigan Medicine is “continuing to measure so that we understand how we're doing, add some accountability throughout the organization so that everybody's rowing in the same direction,” Dr. Harry said. “Then making sure that we're getting that quantitative and qualitative feedback.”
Well-being “needs to be approached as an intellectual problem that we’re working to solve together,” she said. “Let’s work together to advance this together.”
