Beginning in January 2019, Mariah Quinn, MD, MPH, assistant professor (CHS), General Internal Medicine, is taking on a newly created role: Director of Medicine Provider Well-being. The focus is a natural extension for Dr. Quinn, who has long been interested in how external and individual factors affect the physical, mental, and emotional health of physicians.
Dr. Quinn serves as associate program director and director of Medical Humanism for the Internal Medicine Residency Program, and as faculty champion for the Internal Medicine Residency Wellness Committee. The new well-being directorship has been designated as a 0.1 FTE position devoted to working with department and institutional leadership and department members to assess cultural, environmental and operational factors that affect well-being, and make recommendations for improvements.
The work is timely, explains Dr. Quinn; national and local statistics on rates of provider burnout, depression, and suicide are sobering. According to the National Academy of Medicine, 39 percent of physicians in the nation are affected by depression, and 400 physicians die by suicide per year – a suicide rate that is double that of the general population.
“I’ve been interested in this topic since I was a resident,” said Dr. Quinn, who had completed a research project following mood symptoms in a cohort of residents training in Boston that found an estimated period prevalence of depression as high as 60 percent. This further catalyzed her desire to understanding how to prevent, detect, and treat distress in physicians. As the first physician in her family, she found herself describing to others what it was like to navigate a complicated terrain of what has been termed the “hidden curriculum” of medical training, which all too often reveals itself as “the degrees of suffering, the amount of exhaustion, the potential abuse you can experience from your patients or even your colleagues.”
Within the field of medicine, thinking has become more nuanced on the topic of provider well-being. In 2017, the National Academy of Medicine (NAM) launched the Action Collaborative on Clinician Well-Being and Resilience, marking a turning point. “If you were looking at this topic 10 to 15 years ago, the prevailing thought was ‘physician, heal yourself.’ Get more sleep, do more yoga, but also - make sure to close your charts, see more patients….also, also, also,” she said.
“But there are only so many hours in a day.”
Now, there is increasing focus on systems-level contributors to well-being and, conversely, to burnout, low engagement and poor professional satisfaction.
Dr. Quinn notes a recently published conceptual model from NAM that gives greater weight to external factors affecting clinician well-being and resilience. These include organizational factors, the learning and practice environment, the regulatory and business environment, and socio-cultural factors. “This model overlaps nicely with the approach that the UW Health Provider Well-being Committee is taking,” said Dr. Quinn.
“From my perspective, I see that well-being is personal, but also highly related to the system and work environment. We need an approach to address well-being that looks at all of those domains,” said Dr. Quinn.
For the past 6 months, she has served on the UW Health Provider Well-Being Committee alongside approximately 30 other representatives from all clinical departments in UW Health and the UW School of Medicine and Public Health. The committee is co-chaired by Cory Geisler, JD, UW Health Vice President of Provider Services and Nizar Jarjour, MD, professor and head, Allergy, Pulmonary and Critical Care Medicine and SVP/President, UW Medical Foundation. It views well-being contributing factors as comprised of equal parts efficiency of work (such as EHR optimization and clinical team staffing structures), promoting an organizational culture of wellness, and pursuing personal resiliency.
“This group is focusing on top-level organizational changes such as optimizing electronic health record (EHR) use, benefits packages, and the like,” said Dr. Quinn.
Contextualizing interventions aimed at improving provider well-being will require close attention to the needs and experiences of specific provider roles, she explains. Her initial tactics will include conducting listening sessions at division meetings, analyzing provider well-being survey data, and presenting Division Grand Rounds, and continuing to be a voice for department members on organizational committees. Though the well-being directorship scope is initially centered upon faculty and front-line providers, she hopes that it will ultimately encompass all department members, including staff.
“During the first year of my role in this position, my main focus will be on getting a better understanding of what is going on in divisions so I can represent them well. As department members have ideas for interventions, we can organize those concepts, do local goal-setting, and develop action plans,” she said. “The work dovetails well with efforts of the UW Health Provider Well-Being Program.”
And she is available to share information about existing organizational resources to support well-being. For example, Dr. Quinn advises that members take advantage of Employee Assistance Programs (EAPs), which offer services to promote emotional well-being, as well as respectful and productive work environments. UW-Madison faculty and staff can make use of the university’s Employee Assistance Office. Residents and fellows also have access to the Empathia LifeMatters EAP, which provides 24-hour, 365 days-per-year assistance with well-being issues through free, confidential counseling sessions. To access LifeMatters, trainees can call 1-800-634-6433 or visit the LifeMatters portal and enter password UWH1. UW Health also offers Choose Your Path, a directory of wellness resources organized by role and institutional affiliation.
Given the variety of efforts and interventions focused on well-being throughout UW-Madison, SMPH, and UW Health, Dr. Quinn maintains that localizing and tailoring activities is important for success. “The voices of individual departments has to be heard, and we have to be bringing back interventions at the department level,” she said. “The goal is to situate us at the table and take advantage of momentum on this issue.”
That momentum is needed, said Elizabeth Trowbridge, MD, interim chair, Department of Medicine and Phillip August and Sarah Neely Herrmann Professor in General Internal Medicine, noted the significance of Dr. Quinn’s new role as director. “Dr. Quinn’s expertise in this area will help us to move forward on this critical priority for the department.”