Resilient Faculty, Resilient Residents

Kathleen Rowland, MD, MS

Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.¹ A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).² The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.  

Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace.  We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.  

Like other “soft” skills, we might be tempted to relegate this to a one-off lecture on change resilience or to hope that it will be covered in Balint group. But change is pervasive and for it to be a productive learning experience rather than an emotional drain, faculty must deliberately role model change resilient behaviors in everyday practice.   

The following suggestions can be implemented at the personal and program levels to get started on the journey to meeting change with resilience:

1. Model change acceptance. Model acceptance of those who do change. Be the first in your group to know and model the new clinical practice guidelines. Accept and encourage those who do successfully model change. Substitute “I’m still learning this thing!” for “I hate this thing!” while you learn and implement whatever it is.
2. Don’t use patients as a cover to avoid change. Patients rely on us to carefully integrate new information and processes, not to ignore them until compelled to update. Sometimes change can be a risky time if we lose known and familiar shortcuts. It is a reason to change carefully, rather than a reason not to change at all. Most doctor-patient relationships can survive a new mammogram guideline if the physician takes a strong lead.
3. Remember you have evolved. You are already capable of change. Your current practice is just your current practice. Today’s familiar status quo evolved from something else. Enunciate your reluctance or concerns as you discuss your plan to move forward. Let your trainees see how your plan for the future includes the change.  
4. Take your own form of action. Get on the committees, get the trainees on the committees, or at the least bring the trainees to the committee meetings. The easiest way to embrace change is for the change to be your idea. Residents and students should understand decision-making processes within organizations that influence their careers. If being involved in your medical group or hospital isn’t possible—or it isn’t your thing—consider organized medicine via the American Medical Association, Society of Teachers of Family Medicine, the American Academy of Family Physicians, or your state academy.  

The more we practice change the better we get at it. We can learn to adopt changes with minimum disruption to our workflow and a minimum of risk to our patients from the disruption, and residents and students can learn these skills from an experienced faculty. These lessons will build a generation of resilient physicians, ready to face change and prepared to propose and implement innovative solutions to the problems medicine will encounter.  

References

1. Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L. Correlates of Physician Burnout Across Regions and Specialties: a Meta-analysis. Hum Resour Health. 2013 Sep 28;11:48. doi: 10.1186/1478-4491-11-48

2. Filling the Void: 2013 Physician Outlook & Practice Trends [Internet].; 2013. Available from: https://www.jacksonhealthcare.com/media/191888/2013physiciantrends-void_ebk0513.pdf.

Thanks to Tammy Chang, MD, MPH, MS,  Chip Mainous, PhD, and Winston Liaw, MD, MPH, the STFM sharks who helped shape the cartilaginous skeleton of this post.