Faculty and alumni make pioneering strides in Oregon physician wellness

Dec. 7, 2017

Written by Todd Murphy, illustrated by Maggie Wauklyn

Mark Meyers, M.D. '96, stumbled over the word, as if he just couldn't get it past his lips.

The family physician from Springfield, Ore., was on the phone, making his first appointment with a psychologist. And he had a tough time admitting outloud, to a stranger, that the word might apply to him.

"Depression."

It was 12 years ago, six years into Dr. Meyers' medical career. His wife and children had been in a serious car accident the year before. The children were okay, but his wife had suffered a severe head injury.

While she recovered, Dr. Meyers did the laundry, cooking and got the children to school. That, on top of performing his job as a physician and partner in an independent family practice group.

"My focus at work was deteriorating," Dr. Meyers said. "I was irritable. I was becoming forgetful and distracted."

It was his wife's psychologist – whom she was seeing for her own recovery – who asked Dr. Meyers one day how he was doing. How he was really doing.

Not so great, Dr. Meyers realized. He got a referral for another psychologist and made the phone call. A dozen years later, he is forever happy that he did.

Dr. Meyers' stress was significantly impacted by his family's accident. But stress in general and its effect on physician wellness is something the medical world is just beginning to talk about.Some studies suggest upwards of 45 percent of physicians today are exhibiting signs of psychological distress. Fifty to 60 percent are suffering "burnout" in their jobs, other studies document. About 400 physicians commit suicide every year in the United States, twice the rate of the general population.

More medical leaders are insisting on a fourth aim – caring for the provider – in addition to the traditional triple aim of improving population health, increasing patient satisfaction and reducing overall health care spending. The goal is to increase physician engagement and satisfaction and support well-being. In many ways, Oregon – and OHSU – have been pioneers in this area for well over a decade.

From grief, a model for others

The OHSU Resident and Faculty Wellness Program began 13 years ago after the suicide of an OHSU resident in 2002, a suicide believed to be at least partly related to the resident's work stresses.

In the wake of that devastating event, the school's Graduate Medical Education office – led at that time by Donald Girard, M.D. R '73, M.A.C.P. – leapt into action. It established and paid for a free resident wellness program staffed by faculty from the Department of Psychiatry.

From its beginning, the OHSU program was set up to deal with barriers. "We knew it was important to address all of the fear – and it is real fear," said Mary Moffit, Ph.D., associate professor of psychiatry, OHSU School of Medicine, and director of the OHSU Resident and Faculty Wellness Program. "'If I sought treatment, would I be considered weak? Would I have to report receiving counseling on licensing or credentialing applications?'"

As a result, confidentiality is vital to the program, Dr. Moffit explains, and all records are kept outside of OHSU's electronic health record. Participating in the wellness program isn't reportable to the Oregon Medical Board nor on professional applications, she says. 

Participants meet with the team in a private, non-clinical OHSU location and learn effective ways to help relieve stress and restore well-being. The team may introduce cognitive behavior strategies, teach mindfulness and breathing exercises or provide medication to help with sleep or mood concerns.

Over the years, use of the program by residents has grown. In the program's first year, 2004, 5 percent of residents participated. Last year, 23 percent of residents participated.The program was expanded to all OHSU School of Medicine faculty in 2008.

"I thought being suicidal during residency was normal,"wrote a second-year resident in an anonymous survey. "But then counseling helped me realize how important I am to my family and how to make changes to protect my health."

Among the first of its kind at a U.S. academic health center, OHSU's program has now become a national model, and other residency programs frequently seek guidance on howt o implement a wellness program at their institutions.

The program also inspired the Oregon Wellness Program for Health Care Providers, a new statewide effort that Dr. Girard helped to create. The project is currently under development by a coalition of medical groups and The Foundation for Medical Excellence.

OHSU isn't waiting for residency, though, to address physician wellness. As part of their M.D. education, medical students take part in a program that includes a focus on physical, mental and financial wellness. The school also hosts an annual wellness fair and has wellness retreats each year for first-year and second-year medical students.

Invincibility

People who pursue medicine are generally very accomplished students, explains Sydney Ey, Ph.D., professor of psychiatry, OHSU School of Medicine, and associate director of the Resident and FacultyWellness Program. Then, once in residency, they describe a "steep learning curve," she says, and they worry about making mistakes in patient care decisions.

"They have a high standard for themselves and for other people," said Dr. Ey. "And they have concern about meeting other people's expectations."

Healthy types of coping such as exercise, adequate sleep and spending time with friends and family, says Dr. Ey, become more difficult due to long duty hours as a resident. 

Research has shown that by the time medical students become residents, up to one-third of them may be clinically depressed, with up to 12 percent of them reporting having thoughts of suicide.

Of course, stresses apply to physicians as well, because while the work schedule improves after residency, many physicians continue to experience incredible work demands, burnout and increased risk for depression and anxiety.

Underlying all that is a certain mindset. "The culture of medicine – one of invincibility, of always being a rock – has been the major problem," said George Mejicano, M.D., senior associate dean for education, OHSU School of Medicine. "It's a culture that propagates that any sign of weakness is a failure."

Opening up

Yet, the culture is changing. The attitude of invincibility is much less common among residents and younger physicians, say Drs. Ey and Moffit. Megan Furnari, M.D. R '16, now a neonatal hospitalistat OHSU Doernbecher Children's Hospital and instructor of pediatrics, OHSU School of Medicine, participated in the program all three of her residency years, she says, and is grateful for the strategies and resources it provided.

Even among older physicians, that mindset has softened significantly. On several occasions, Drs. Ey and Moffit recall,they were giving presentations about the wellness program to residents when senior faculty members volunteered they'd been helped personally by the program. The self-disclosure had an effect on everyone in the room, says Dr. Moffit.

"This is an indication that the paradigm is shifting," she said.

In Springfield, Dr. Mark Meyers also sees change – starting in himself. "I wasn't suicidal, but I was clearly overloaded," he said of his mindset before that first counseling appointment. "And stressed. And struggling." After several sessions with the psychologist, "things improved," he said.

Dr. Meyers tells his story – in fact he's often been open about his story – because of something that's very important to him: that physicians and other medical professionals understand the stress in their lives, how it might affect their mental health and their work and to get help when they need it.

The Lane County Medical Society, for which Dr. Meyers served as president from 2014 to 2015, started its free Provider Wellness Program in 2012 after three physicians committed suicide over an 18-month period. This year, the program was expanded to include nurse practitioners and physician assistants.

Over the years, Dr. Meyers says, he's learned to recognize when stress is affecting him. At times, he's pulled back on the number of committees he serves on. He started playing piano again, something he loved to do in college. 

And he remains grateful for that caring intervention from his wife's psychologist. "Part of it was just knowing I wasn't crazy – that there were good reasons for me to be feeling the way I was feeling. And, there were things that I could do."

This article first published in the Fall 2017 issue of Bridges, the school's alumni magazine.