The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape Report on physician burnout, over half of all physicians are feeling symptoms of burnout and fatigue. While high-intensity specialties like critical care medicine and emergency medicine rank very high on the list, even 34% of ophthalmologists are experiencing burnout.

• 42% of all physicians report being “burned out.”
• Emergency medicine is in sixth place — above the median burnout rate of 41%.
• But internal medicine is ahead of that with a median burnout rate of 46%.
• And family medicine has a median burnout rate of 47%.
• Burnout is 35% among newly minted physicians and reaches a peak at ages 45-54 of 50%!

It’s not just physician job dissatisfaction that’s at stake, though. According to the Medscape National Physician Burnout and Depression Report 2018:

60% of physicians think their burnout affects their patient-doctor relationship:

• being more short-tempered with patients (33%)
• being less engaged with patients (32%), and
• being less friendly with patients (29%).
• 14% think burnout contributes to errors, and 5% are concerned that their errors could harm patients.

78% of physicians think their depression affects their peer relationships:

• 42% report less engagement.
• 42% report increased exasperation with staff/peers.
• 21% arrive late to work, 11% think their depression attributes to errors.

Despite the clear impact of burnout and depression, 66% of male physicians and 58% of female physicians have never sought professional help for their symptoms of depression and burnout.

Clearly, there is a need for programs that address burnout and fatigue, both for patient safety as well as collegiality and career longevity. So what about this idea of “too much wellness?” Perhaps it is more that your wellness programming may be missing the mark:

1. No clear consensus on “what wellness is.” Perhaps it’s that we simply can’t agree on what makes us well. That’s OK, as long as we can identify “what wellness isn’t” and create our wellness programs around identifying and altering as many of these “burnout” and “provider fatigue” contributing factors as we can.

2. Mandatory activities. The lives of health care providers are filled with mandatory activities, from hospital compliance to TB testing to “merit badge” courses like ACLS. While workplace-sponsored wellness activities have the potential to improve the lives of providers, making them mandatory may actually diminish their effectiveness, as employees will feel pressured to participate. Consider non-mandatory activities or even a “choose your own adventure” format.

3. Too many activities. Even if not required, wellness programming needs to fit into the schedules of health care providers, which are already notoriously overbooked. If your organization is having weekly activities and attendance starts to fall off, consider semi-monthly or monthly activities instead.

4. Unstructured activities. What are the goals of your wellness activities? Certainly, social hours or beach days are an important part of wellness but consider adding structured programming. Have an expert come in and speak on imposter syndrome or compassion fatigue, and ask them to end with two or three concrete strategies that participants can take home with them.

5. Overly-structured activities. The opposite can also be true. If the bulk of your programming is structured or instructional, consider adding a “just for fun” event, like a barbecue!

6. Condescension. Most physicians (and especially those engaged in primary care), have some background in wellness and prevention. They may recoil if they felt that physician wellness programs speak to them below their level.

7. Activities limited to just one segment of the physician or provider population. Although dedicated programs for medical students are important, these can alienate older physicians. Likewise, programs limited to the hospital may overlook physicians in the community. Consider an “all-inclusive” agenda.

Of course, complaints about the wellness programming may be symptoms of a deeper problem. Are people truly dissatisfied with the wellness program, or is it a manifestation of deeper problems within the company? Is the wellness program not well-targeted to your audience? You might consider doing some of the following:

1. Perform a survey. Allow people to respond anonymously. Ask questions about overall workplace satisfaction to assess their happiness/satisfaction within their work environment. Include some specific wellness activities or topics and ask them to rank those that are most important to them. Leave space at the bottom for people to write in their own suggestions. Programs like SurveyMonkey make it easy to perform surveys and analyze the results.

2. Make a suggestion box. The plus side is these are anonymous, and participation is easy. The downside is it’s hard to tell if the ideas in the box are representative of those of the larger group, and the location of the box may influence the number and detail of the responses.

3. Launch a focus group. Even if you already have an established wellness committee, consider putting together a small group of employees and interview them (preferably over food!). Pitch some ideas to them and get their direct feedback. Ask them what sort of programming they’d like to see. Agree to implement at least one proposal that had broad support from the meeting.

4. Have a planning retreat. Take a day away from the office and invite people to engage in a 30,000-foot view of your company’s wellness program. Talk about a longer-term strategy. Consider themes and ideas to tie recreational activities to more structured activities (like workshops).

5. Finally, consider financial incentives. I know that sounds crazy, but it was the #1 suggestion to alleviate burnout from the Medscape survey. Are you paying your employees enough? Compare national standards and make sure your wages are competitive. But also consider other measures of adequacy of pay — has your corporate office recently tightened up turnaround time on charting, increased physician RVU thresholds or demanded physicians see more patients per hour?

All of these may have an impact on physicians’ perception of compensation. After all, employers and insurers reward our patients for wellness-focused activities; why not expand upon this idea to the provider side? Patients may get “points” or even cash for wellness-focused activities like exercise programs, having their lipids checked, etc. Maybe it is time to reward the physicians in a similar manner.

So maybe there isn’t “too much wellness,” so much as good intentions falling short of expectations. Consider changing up your wellness philosophy to be sure that your wellness programs are addressing the core needs of your workforce.

Larry DeLuca and Kristi Grall are emergency physicians. Matthew Freeman is a nurse practitioner.

 

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