1. PHYSICIAN WELLNESS THE PRACTICE OF MEDICINE CAN BE HARZARDOUS TO YOUR HEALTH Gary S. Nye, MD Chair, Physicians’ Advisory Committee and Committee on Litigation Stress Alameda Contra Costa County Medical Association

2. WELLNESS VS. WELL-BEING, IS THERE A DIFFERENCE? Some controversy, e.g. MBC WELLNESS COMMITTEE Some controversy, e.g. MBC WELLNESS COMMITTEE Some variations in the literature Some variations in the literature Historical differences, e.g. ACCMA Historical differences, e.g. ACCMA Functional institutional differences, e.g. Kaiser, UCSF Functional institutional differences, e.g. Kaiser, UCSF

3. PHYSICIAN MORALE HOW IS YOUR MORALE? HOW IS YOUR MORALE? DO YOU HAVE A DEFINED COPING STATEGY? DO YOU HAVE A DEFINED COPING STATEGY? ACPE SURVEY 2006 - 1200+ responses ACPE SURVEY 2006 - 1200+ responses 60% considered leaving medicine 60% considered leaving medicine 77% fatigue biggest problem 77% fatigue biggest problem 66% burnout 66% burnout 32% family discord & depression 32% family discord & depression 4% suicidal thoughts 4% suicidal thoughts

4. MAJOR SOURCES OF STRESS Lack of Control Lack of Control Unpredictability Unpredictability Intense Sense of Responsibility Intense Sense of Responsibility Change - Rapid change Change - Rapid change Finances and Regulation Finances and Regulation

5. PRACTICE & BUSINESS ISSUES MEDICAL SCHOOL DEBT MEDICAL SCHOOL DEBT ECONOMIC CREDENTIALING ECONOMIC CREDENTIALING MALPRACTICE MALPRACTICE REIMBURSEMENT PROBLEMS REIMBURSEMENT PROBLEMS REGULATORY CHANGE REGULATORY CHANGE RECORD KEEPING RECORD KEEPING MBC AND RECREDENTIALING ACTIONS MBC AND RECREDENTIALING ACTIONS

6. SOME WAYS WE COPE? (ACPE SURVEY) 53% Talk to colleagues 53% Talk to colleagues 35% Search for jobs outside of health care 35% Search for jobs outside of health care 27% Lobbying and political activism 27% Lobbying and political activism 26% Personal counseling 26% Personal counseling 1% Substance abuse treatment 1% Substance abuse treatment

7. GETTING INTO TROUBLE IMPAIRMENT (Can be anyone at any time) IMPAIRMENT (Can be anyone at any time) 10 % OF MDs at any one time (soft data) 10 % OF MDs at any one time (soft data) 6-7% SUBSTANCE ABUSE 6-7% SUBSTANCE ABUSE 3-4 % MENTAL ILLNESS 3-4 % MENTAL ILLNESS 1-2% PHYSICAL IMPAIRMENTS 1-2% PHYSICAL IMPAIRMENTS 3-4% OVERLAP WITH MORE THAN ONE CATEGORY 3-4% OVERLAP WITH MORE THAN ONE CATEGORY

8. PATTERNS OF ILLNESS / COMPLAINTS ALABAMA STUDY ’ 91-97, 1000 referrals (PHP) ALABAMA STUDY ’ 91-97, 1000 referrals (PHP) 50% CD 50% CD 12% Disruptive 12% Disruptive 12% Quality of care 12% Quality of care 10% Psychiatric (29% affective illness) 10% Psychiatric (29% affective illness) 1% Licensure issues 1% Licensure issues 7% Sexual misconduct (boundary issues) 7% Sexual misconduct (boundary issues)

9. WHAT CAN HAPPEN TO US DEMENTIAS AND AGING DEMENTIAS AND AGING LITIGATION STRESS LITIGATION STRESS MARITAL AND FAMILY CONFLICT MARITAL AND FAMILY CONFLICT BURNOUT BURNOUT MEDICAL ERRORS MEDICAL ERRORS

10. DEPORTMENT DISRUPTIVE BEHAVIOR DISRUPTIVE BEHAVIOR SEXUAL MISCONDUCT SEXUAL MISCONDUCT SEXUAL, ETHNIC, OTHER INSENSITIVITY SEXUAL, ETHNIC, OTHER INSENSITIVITY UNCOOPERATIVENESS UNCOOPERATIVENESS

11. PROFESSIONAL DANGER ZONES Fatigue Fatigue Isolation Isolation Compulsivity Compulsivity Self Treatment – Substance Abuse Self Treatment – Substance Abuse Curbstone Consultation Curbstone Consultation Denial – Suppression – Repression Denial – Suppression – Repression Depression/Anxiety Depression/Anxiety

12. WHAT PLANET ARE YOU ON? WHAT IS THE STATE OF YOUR LIFE “ CULTURE ” ? WHAT IS THE STATE OF YOUR LIFE “ CULTURE ” ? SELF AWARENESS AND SELF CARE SELF AWARENESS AND SELF CARE RELATIONSHIPS- family/professional/personal RELATIONSHIPS- family/professional/personal SUPPORT FOR AND OF OTHERS SUPPORT FOR AND OF OTHERS SPIRITUAL AND RECREATIONAL LIFE SPIRITUAL AND RECREATIONAL LIFE CONSTANT PERSONAL INVENTORY / MINDFULNESS CONSTANT PERSONAL INVENTORY / MINDFULNESS

13. WHAT TO DO OR WHERE TO GO? YOUR PERSONAL PHYSICIAN- Don ’ t self treat! YOUR PERSONAL PHYSICIAN- Don ’ t self treat! COUNSELOR OR CLERGY COUNSELOR OR CLERGY WELL-BEING / WELLNESS COMMITTEE WELL-BEING / WELLNESS COMMITTEE LITIGATION STRESS COMMITTEE LITIGATION STRESS COMMITTEE CMA CONFIDENTIAL LINE CMA CONFIDENTIAL LINE SELF HELP AND SUPPORT GROUPS SELF HELP AND SUPPORT GROUPS

14. California Patient Protection and Physician Health Program (C3PH) MBC Diversion vs. C3PH MBC Diversion vs. C3PH Regional Workshops Regional Workshops