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This process is important because it helps healthcare workers make confident decisions to seek care for mental health conditions when they need that care without a concern that the act of of getting help is going to jeopardize their ability to care for patients you Austin, welcome to off the chart, a

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business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the Assistant Editor of medical economics, and I'd like to thank and I'd like to thank you for joining us today in this episode medical economics, senior editor Richard perryton spoke with Dr Stephanie Simmons, Chief Medical Officer of the DR Lorna Breen heroes Foundation, a nonprofit working to improve the well being of the healthcare workforce. Dr Simmons shares where things stand with burnout in medicine today, what's getting better, what still needs work, and how the foundation is driving real change. She talks about efforts to remove stigmatizing mental health questions from licensing and credentialing forms, and why addressing burnout requires more than just wellness programs. It takes systemic change and supportive leadership. They also talk about how technology and artificial intelligence are shaping the workplace and what practical steps organizations can take right now to better support clinicians and staff. Dr Simmons, thank you so much for joining us, and now let's get into the episode.

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Dr Simmons, thank you for joining us today. It's my pleasure. Richard, thank you.

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I think most of our audience is familiar with the DR Lorna Breen heroes foundation, but for those who may be new, can you introduce the organization? Sure, the DR Lorna Breen heroes foundation is the leading nonprofit in the United States looking after the professional well being of the healthcare workforce, and to build upon that, what is the all in well being first for healthcare initiative. So the all in coalition is a group of national organizations that come together to meet and to advise the foundation on our work, as well as to collaborate and lead work together. So the all in coalition has developed the licensing and credentialing champions challenge, as well as advising on the impact wellbeing guide

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in collaboration with the CDC and NIOSH and newly launching the all in for Mental Health Initiative. I'm glad you mentioned those different factors, and I want to get to those here momentarily, just to again, kind of build on some groundwork here, in your own words, how would you describe the state of healthcare, so to speak, as it relates to workplace burnout for doctors and other clinicians? Well, it's a thorny it's a thorny issue, and so our healthcare workforce is facing really unprecedented levels of change and stressors as we,

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as we transition, sort of our national approach to public health, and also as we transform our our health care delivery structures, health care workers are very mission driven to care for patients, To take care of our communities. And so as we, as we work to do our best to care for our patients and communities, there's just a tremendous amount of turmoil and change. In addition, there is a large amount of administrative tasks and administrative burden that healthcare workers face when caring for patients, and so we find ourselves torn in our time and our efforts between caring for patients and caring for the sort of administrative of the of the work in terms of charting, documentation, billing and trying to navigate the complex payer and regulatory environment.

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I am curious, though, just about your contact with, obviously, a lot of healthcare leaders, doctors, other clinicians, are there specific specialties or care settings where burnout is more severe or more rapidly increasing, and maybe the opposite of that? Are there any specific specialties or care settings where you've seen marked improvement. So overall, if you look at like all physicians in the past year, we've seen a slight downtick of burnout levels

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over the sort of peak in 2023 2024

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having said that we're still not back to 2019 levels, which is when the National Academies of medicine had declared an emergency levels of burnout for the healthcare workforce. So while, while things did increase over time during the pandemic, and we're starting to see.

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A slight decrease, we're still not back to that 2019 level, which was deemed, you know, dangerously high. Emergency medicine really does have higher levels of burnout than other specialties in medicine when we when we survey, and I hypothesize that that's because it's a it's a safety net specialty, and when there's a stressor in the healthcare system that's often seen in emergency medicine, but but we are seeing burnout across the boards in the medical specialties, nursing, pharmacy, dentistry, all of these sort of areas of healthcare show high levels of burnout. Now when you look at suicide rates, female physicians do show higher suicide rates relative to

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other women than male physicians show relative to other men. So there may be additional stressors that we're seeing in the female physician

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population as well, and definitely wanted to talk about, hopefully some, frankly, I'd love to pick your brain about emergency medicine, but that's a conversation for another time. We'll keep, keep that one in our back pocket for the moment.

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But like I said, hopefully to turn to maybe some, some good news or some improvement. Recently, the Foundation announced a milestone in progress to improve mental health for healthcare workers around the country. Can you discuss that? So we were thrilled to update and have a press release on the changes in state licensing and hospital credentialing. So we track and provide technical assistance to the state licensing boards for for physicians, for nurses, for pharmacists and for dentists. And you know that we were happy to be able to announce that we now have 37

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state medical boards who have eliminated invasive and stigmatizing language around mental health from their applications, as well as multiple pharmacy, nursing and dentistry boards and that we've been able to verify, over 10% of hospitals in the country now have removed this invasive and stigmatizing language from their credentialing re credentialing and peer reference forms. So this process is important because it helps health care workers make confident decisions to seek care for mental health conditions when they need that care without a concern that the act of of getting help is going to jeopardize their ability to care for patients. What that does is it not only allows health care workers to receive the mental health care that they may need, but ensures a safe, thriving workforce for our communities and our patients. That was a great explanation. I'm glad you brought that up, because I was going to ask about that very specifically, and frankly, was also very curious, though, about your thoughts in terms of maybe on a little bit less formal

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scale, I guess you'd call it, but you know, obviously the licensing and credentialing is a little bit more formal process that involves, you know, review of the healthcare workers abilities to practice, like I said, maybe on a little bit less formal level, how is the what is the feeling among peers for, say, peer support and mental health services. Do healthcare workers, are they understanding for each other when they feel stressed, or are they, you know, sometimes people have an attitude, oh, you just got to tough it out. Peer support is really one of the most effective and impactful forms of support for healthcare workers. It's it can be incredibly isolating to have had a difficult case, an adverse event, a string of hard shifts, and it's really critical to be able to talk to someone else who has gone through the same thing. And so that that sort of informal and formal peer support is critical for healthcare workers. It really is a unique work environment. And so talking to someone who gets it at a really visceral level can be a really important resource. That's one of the reasons why revising the peer reference forms is so critical. We want a peer reference to be able to give feedback on someone's ability to practice and professionally and excellently, but we don't want to be asking our peer references about any history of depression or anxiety or mental health conditions, because those are the very peers that we need to be able to go to to talk about, you know, our hardest times.

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Say, Keith, this all well and good, but what.

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If someone is looking for more clinical information, oh, then they want to check out our sister site, patientcareonline.com.

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The leading clinical resource for primary care physicians. Again, that's patient care online.com

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based on on age and training and experience, do you see a generational divide in how younger and more experienced clinicians and physicians are coping with burnout or seeking greater work life balance?

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You know, it's interesting. There's often a pushback

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about the newest generation of professionals, saying, Oh, that, you know

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kids these days. And I'm using air quotes, because these aren't kids. These are people exiting residency. Are in their early 30s, often, right? So these are, these are young professionals.

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If you look throughout history, I think our earliest example of this is about 3000 years old, right? There's this generational pushback. Of you know, the young professionals coming into the

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career have a different way of doing things than the folks who are 20 or 30 years down the road. I think that's universal and healthy in human experience that we learn from a new way of doing things as a new generation of professionals come in, what I would say is I am seeing more openness in talking about the mental health challenges of practicing Medicine, of receiving seeking and receiving care when it's appropriate.

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And the young professionals who are entering medicine and other health professions right now have worked incredibly hard, have met admission and graduation requirements that are much more stringent than when mid or and careerists were going through their training as well. So they're incredibly hard working, but they are also demanding that there is a work environment that allows them to take proper care of patients, because we know that after we've been up for and working for 18 hours, 24 hours, we're not taking great care of patients anymore. You can't out train the physiological need for sleep, rest and and, you know, the need to have a degree of

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sort of cognitive deloading right during during your day. And so, you know, a lot of these concerns are really responding to what we know about the science of human performance, just like we wouldn't ask athletes right to to perform over the course of 24 hours multiple times a week without rest. We shouldn't be doing that for the cognitive athletes who are providing health care or surgical care, right physical tasks to take care of us. I would also say that there, there are the highest burnout levels are seen in mid careerists. So these are the folks who are caring for families. May be caring for elderly parents, and also trying to meet the rigorous requirements of a professional career. And so

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those who are in their mid to late careers stand to benefit the most from the shift in attitudes that the newest generation of professionals are bringing.

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I like that analogy. That's the first time I've heard anybody kind of describe it in those terms of, you know, comparing medical practice, you know, in human performance and athletic performance. Frankly, that's been something, you know, we all have, I think a lot of people, I shouldn't say everybody, but a lot of people have an interest in sport, and even if they don't work in medicine, may be able to relate, you know, to that example. So that's a great one. Well, I, you know, I think it's a it's really salient in a lot of ways. You train for decades to be able to perform at a high level as a physician, a pharmacist, a dentist, nurse,

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and you need to be able to rest in order to perform like we build muscle when we rest right after you lift something heavy, you build the muscle during the rest time, and that is also when we do some of our most creative thinking, when we might have some insight about a case, it's actually in those down times, and if we're constantly driving people to perform at the highest level all the time, not only will that performance degrade, but some of the unique insights and creativity and new ways of doing things and.

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We may lose that if we are pushing people like we would machines to produce widgets, right? So there really needs to be this idea of human factors incorporated into how we design systems. In healthcare, there's a whole field human factors engineering that focuses on this, and there's a lot of opportunity in medicine to use human factors engineering to redesign our systems to be maximally effective.

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We also know that some of the same interventions that we use for athletes are really impactful for healthcare workers, like coaching, right? And there has been, you know, sometimes coaching is thought of as like a remedial or a remediation intervention, but it really can be used as a performance intervention. And I'll often say, you know, even the best athletes have a coach, so even the highest performing healthcare worker or executive can use that coaching to stay sharp and make sure that they're balancing their training needs, their performance needs, and, frankly, their rest needs as well. You know what? If I may, I want to switch gears slightly, because you had mentioned earlier in our conversation about the impact well being guide, and definitely wanted to catch up on that and find out if there had been say in the course of the last year, because it is still relatively new. Have there been any case studies or examples of successfully integrating some of those principles? Yeah. So thank you for the question the impact well being guide was one of two major outputs from the original authorization of the doctor Lorna Breen healthcare provider protector Act that was signed into law in 2022

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and the the first output was really these 45 grantees from across the country that built well being programs in their organizations, and there was a focus on rural health the impact well being guide was a leader guide on what you can do in your hospital or health system to positively impact the professional well being of the workplace. And what we found during our original piloting and

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workshops around the impact well being guide is that organizations really benefit from some technical assistance as they go through the guide, because there are so many competing priorities in the health system in an organization that there it's helpful to have that focus as you move forward. And so at the DR Lorna Breen heroes Foundation, we created the caring for caregivers program to serve as that technical assistance program, and we run this at the state level. We have learning communities in Virginia, North Carolina, New Jersey and Wisconsin to go through at the state level, the steps of licensing and credentialing reform, leadership, education and then a learning collaborative that uses human factors engineering to improve an aspect of the environment of care for the healthcare workforce. In Virginia, we have eight health systems that are working on EHR optimization projects to positively impact the experience of providing care for health care workers. This opens up more time to spend with patients on, you know, rapport, building communication and really ends up being one of those, good for patients, good for healthcare workers and and good for the organization type interventions. So we're excited to continue to see the impact in these four states. We're seeing, you know, just an acceleration in the adoption of change in licensing and credentialing hospital leaders and health system leaders having a greater understanding of the systems approach to well being. And then these learning collaboratives are really accelerating the pace of change. So that's a direct implementation of the impact well being guide across four states. That's fantastic. And actually, you teed me up on a couple other questions that I want to make sure we get to here. And not least is, what is the status of the DR Lorna Breen healthcare provider Protection Act? So there is currently an introduction of the reauthorization of the act. It is in committee in the House and Senate. We would love to see it come to a vote and passage for reauthorization. The reauthorization is for five years with an emphasis on reducing the administrative burden that healthcare workers face when they're caring for patients, so removing some of the

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barriers that get in between healthcare workers and their patients, this will benefit the healthcare.

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Workforce and also our patients and communities.

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Hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at mjh life sciences.com, with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute,

21:02
a few moments ago in our conversation, you did mention about electronic health record and administrative burdens. Has been, as I understand it, you know, one of the leading causes of work. You know, workplace stress, and that leads to burnout in physicians and other clinicians. And of course, in the last couple years the technical I'll call it the tech question, because everybody talks about artificial intelligence, and wanted to ask, What has been your experience with AI programs, and do you agree with assertions that they may have the potential to really help alleviate those administrative burdens? Absolutely. So there are a number of ways in which artificial intelligence or large language model programs can reduce the administrative burden that healthcare workers face, whether that is helping, you know, remove the burden, the cognitive load of having to chart during the patient encounter, so that healthcare workers can really focus on their interaction with patients in the moment, or whether that is collating from the the you know, the knowledge that's available in references, so that you have focused information available for you in decision making. There are numbers of ways in which AI can support healthcare workers in their work. There's also a lot of back office function in healthcare that that can be augmented or improved by by AI, for example, we were talking earlier about healthcare workers and athletes having similarities, right? So

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it would be great if we had some support in scheduling health care workers in a way that was physiologically advantageous, so that you are able to maintain your circadian rhythm and your rest, and that's something that would be very amenable to support

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electronically.

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There's never going to be a replacement of the need for individual care, and a conversation with a healthcare worker who can understand what you need and to help deliver that. And so what I really hope for the future is that we are thoughtful in how we are implementing AI technologies, so that we are making care better for patients. We are making the experience of providing care better for health workers, and we're we're finding those efficiencies right where we can do this in a way that cuts out the unnecessary work and really focuses on that human interaction, which is at the core of care. We've

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covered a lot of ground in a short amount of time, and I'm certainly grateful for your time. What did I not ask about regarding the foundation or the current state of burnout that you'd like to talk about or discuss? Sure,

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I think there, you know, there's a lot of

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hope in this area.

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If you go back in time six years, there were people who were thinking about, focused on and researching how to optimize the experience of providing care for our health care workforce, how to ensure that we have a thriving continued healthcare workforce to care for our patients and our communities, but it was a small number of people. It was often hard to get the attention of leaders in healthcare around this issue, and I think over the last six years, we've really seen what it looks like when our health care workforce is critically,

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critically low in numbers, particularly through the the

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nursing shortage crisis, and when we had a large number of health care workers leave the health care workers.

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Force over the past six years. So there's a real burgeoning and intensifying understanding of the critical nature of this work to ensure that we have healthy, thriving workforce now and into the future. So to me, that that's very hopeful, because there, there is a lot of,

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there's a lot of room to improve, and there is, you know, there's lots of opportunities to grow in this area. And so as healthcare leaders

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think about and plan for the future, there's an opportunity to make a substantial impact in this area and and to me, that's very hopeful. And for a healthcare leader who's who's looking to

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make change in this space, there are, there's lots of opportunities to do so. Of course, our main audience is primary care physicians. What would you like to say to them? Or what would you like them to know primary care physicians really serve as the backbone of our health care for the country. So you know, every single member of the community should have access to a primary care physician for health care, for preventative health care, and to have that that medical home. So really, this is the, the foundation and the basis of all health in our country. And notice, I didn't say health care, but all health in our country is, is really those, in addition to healthy living environment and healthy individual actions is access to that primary care,

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that primary care provider, and so I think you know, there's, there's a few key messages I'd like to share. One is just overwhelming gratitude for choosing to do this work, to continuing to serve your community and your patients, a recognition that the work is very difficult, and some hope that, you know, there are some of these efficiencies, both in documentation, in scheduling, that are starting to be rolled out and have and have really a positive impact in the future, also a recognition that, you know, there's a team in the in the primary care setting, and you know, there's physicians, there's there's NPS, pas Ma's, clerks, techs, phlebotomists, right? Like there's this whole team that works together, and as we're thinking about ways to improve primary care, really thinking about ways to improve that experience of care for the whole team, I'll tell you what, like I said, we've covered a lot of ground in a short amount of time, and I could keep you on for at least another hour for with some more questions and discussion points here. But thank you for taking the time. If I have follow up questions, I'll email, but otherwise, just thank you again, and certainly have a great rest of the day. Yeah, thank you, Richard, once again.

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That was a conversation between medical economics senior editor Richard Pearson and Dr Stephanie Simmons, Chief Medical Officer at the DR Lorna Breen heroes foundation. My name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with healthcare experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business of medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Luttrell. Medical economics physicians practice and patient care online, are all members of the MGH Life Sciences family. Thank you.

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You.