Shortly after the COPWB first convened, the COVID-19 pandemic closed in around us. Priorities shifted! However, the pandemic quickly exposed cracks and vulnerabilities within our health care system while bringing aspects of the challenges we face as health care providers to newspaper front pages. Clinician well-being could no longer be brushed aside as an abstract or superfluous concept; it was an imperative to the demands now placed on a health care system fighting the first global health care crisis of our lives. Workers spoke out and leaders listened. At this unique moment, we have an opportunity to engage in meaningful well-being initiatives and an opportunity to transform medical culture.
“The new ASA Well-Being Resources webpage (asahq.org/wellbeing) contains individual, institutional, and societal well-being resources, as well as resources for suicide prevention and substance use disorders.”
As chair and vice chair of the COPWB, we want to acknowledge the hard work of our committee members who are truly dedicated to physician well-being. We wish to share the vision, mission, values, and work of your COPWB. The following text was approved by the ASA executive committee in March 2020 (just in time for the COVID-19 pandemic).
Vision Statement: A professional culture wherein the pursuit of well-being is accepted as the professional norm, and in which supportive resources for achieving well-being are readily available, without stigma, to all clinicians.
Mission Statement: The Committee on Physician Well-being is focused on building access to individual, organizational, and systemic well-being endeavors. The Committee seeks to drive changes that eliminate barriers to care, promote well-being, reduce stigma regarding mental illness, and empower physicians to care for themselves so that they can better care for patients.
- Foster an environment where professional fulfillment includes personal and organizational well-being
- Find organizational, systemic, and individual solutions for achieving well-being that impact all members of the anesthesia care team
- Build community to decrease isolation and increase connectivity
- Create best practices to facilitate well-being, including wellness education; burnout and suicide awareness and prevention; emotional and psychological support; and advocacy
- Model self-care as the norm to drive cultural change
- Improve the health (emotional, mental, and physical) of all clinicians
- Eliminate stigma for accessing mental health services
- Raise awareness on physician suicide statistics and identify and implement best practices to lower the risk for all members of the anesthesia care-team.
Organization of the COPWB
The committee’s work is organized into four working groups, which are open to all ASA members regardless of committee membership status. ASA members interested in being involved in our committee’s working groups should contact Amy Vinson (email@example.com) or Jina Sinskey (firstname.lastname@example.org).
Working Group on Systems & Policy Impacting Well-being
The purpose of this working group is to focus on high-level policy and health care system organizational factors that drive well-being or burnout. The group has created a one-page document on Creating a Just Culture of Support, which can be found on the ASA Well-Being Resources webpage (asahq.org/wellbeing).
Working Group on Education & Endeavors
The purpose of this group is to focus on individual interventions, skills building, and well-being curriculum development. The working group is creating a database of well-being educational programs and initiatives throughout the U.S.
Working Group on Mental Health & Suicide Prevention
This working group focuses on mental health in members of the anesthesiology care team, particularly regarding the epidemic of physician suicide. This group is researching methods to better understand factors that contribute to anesthesiologist suicide and supporting endeavors to destigmatize seeking mental health care.
Working Group on ASA Outreach
The purpose of this group is to inform all ASA members of well-being resources in an organized and effective manner and includes online presence, social media strategy, presentations at national and regional meetings, collaboration with subspecialty and component societies, and a physical well-being kiosk as part of ASA resources at the ASA annual meeting. The new ASA Well-Being Resources webpage (asahq.org/wellbeing) contains individual, institutional, and societal well-being resources, as well as resources for suicide prevention and substance use disorders. These online resources are open access and available to all.
Impact through collaboration
In addition to the efforts of the working groups, the COPWB will often collaborate with other committees with shared interests. For example, the committee is working with the World Federation of Societies of Anaesthesiologists (WFSA) leadership to share well-being resources with colleagues around the world and raise global awareness of clinician mental health issues. The WFSA has designated 2021 as the International Year of Health and Care Workers. At the 17th World Congress of Anaesthesiologists in September 2021, the annual Harold Griffith Lecture was dedicated to examining the health work force crisis with a talk from Professor Christina Maslach titled “Reinventing the Workplace: Lessons Learned from Burnout.”
ASA has maintained continued representation to the National Academy of Medicine’s Action Collaborative on Clinician Well-being and Resilience, a high-level confluence of health care influencers and decision-makers who are focused on creating meaningful structural change in the health care industry. ASA’s current representative to the action collaborative is the chair of the COPWB (Vinson). Our place at the table here ensures the representation of the unique perspective and experiences of anesthesiologists as it pertains to workplace stress, culture, and professional fulfillment.
Finally, the committee also presented “What Can Societies Do?” at the 2021 Anesthesia Patient Safety Foundation’s Stoelting Conference and spoke on the role of professional societies in driving positive change toward improved well-being. In fact, the recent meeting was entirely focused on clinician well-being as a patient and clinician safety imperative.
COVID-19, where we are, and where we are going
The COVID-19 pandemic significantly accelerated the rate of burnout among health care professionals (Int Arch Occup Environ Health 2021;94:1345-52; EClinicalMedicine 2021;35:100879). COVID-19 increased the stress of moral injury on health care providers (Gen Hosp Psychiatry 2021;71:88-94; Int J Environ Res Public Health 2021;18:337). Examples include the need to ration scarce resources (e.g., ventilators, ICU beds, PPE), separating patients dying from COVID-19 from family members to protect the family, other patients, and health care providers, and the continuing stress of the fourth “Delta variant” wave of the pandemic, a largely preventable tragedy exacerbated by vaccination hesitancy and misinformation. Many physicians have experienced the same whipsaw as public health individuals – initially lionized as “heroes” by a grateful public, but later demonized for standing up for science-based health care decisions and public policy. Discussions of well-being often center on occupational burnout, likely due to the availability of quantitative data pertaining to clinician burnout, but that is far from the only surrogate marker of overall well-being. Anesthesiologists, like other clinicians, also suffer from other symptoms of unwellness, such as substance use disorder, depression, and suicide (Can J Anaesth 2017;64:158-68; JAMA Psychiatry 2021;78:1-8; Acad Med 2017;92:976-83; JAMA Psychiatry 2020;77:587-97; Am J Psychiatry 2004;161:2295-302; JAMA 2013;310:2289-96; Anesthesiology 2020;133:342-9).
The COVID-19 pandemic has exacerbated health care staffing shortages around the country. One reason is directly related to the disease itself: workforce loss from COVID, from quarantining when exposed, and from the need to care for family members at home. Another reason is that clinicians are reaching a breaking point due to moral injury and burnout (Gen Hosp Psychiatry 2021;71:88-94; Int J Environ Res Public Health 2021;18:337). As the pandemic wears on, more clinicians are making the difficult decision to leave their institutions or the practice of medicine altogether due to concerns for their own physical and mental health (asamonitor.pub/3lqAwwU). This creates a vicious cycle, since the clinicians who stay in medicine will become increasingly exhausted and overworked over time. Indeed, the Association of American Medical Colleges predicts a shortage of between 17,800 and 48,000 primary care and between 21,000 and 77,100 non-primary care physicians by the year 2034 (asamonitor.pub/3mEPtdS).
As many institutions are beginning to realize, the major limitation to providing health care services is not bed availability, but rather the number of qualified health care professionals available to care for patients (Am J Surg 2021;S0002-9610:00411-6; Int J Evid Based Healthc 2020;18:265-73; Int J Environ Res Public Health 2020;17:6147). Clinicians are our most precious resource due to the sheer amount of resources and temporal investment required to train a single individual. It takes close to a decade (four years of medical school, four years of residency, and in some cases one to two years of fellowship) to train an attending anesthesiologist. Much like the activated clotting time (ACT) test, there is no workaround to accelerate the process of training qualified health care professionals.
We stand at a crossroads. For decades, the sprawling health system has prioritized short-term profit over sustainability – likely driven by the increased influence of private equity firms on health care systems – thereby devaluing clinicians and pressuring them to do more work with fewer resources (J Clin Anesth 2020;65:109841; JAMA 2020;323:663-5). This is a short-sighted strategy that is no longer sustainable in today’s environment (Anesthesiology August 2021). The COVID-19 pandemic did not create staffing shortages; it has simply exposed the unavoidable consequences of continually undervaluing clinicians.
If health care institutions wish to continue to provide quality patient care, they must adopt a long-term strategy focused on retention based on employee engagement, well-being, and professional fulfillment (JAMA Intern Med 2017;177:1826-32; asamonitor.pub/3iGSYQ4). This will require a cultural transformation in medicine, where clinicians’ time and energy are respected and viewed as finite resources to be carefully preserved. Only then may we begin the long process of healing ourselves and our colleagues.
This is the basis of our vision statement: “A professional culture wherein the pursuit of well-being is accepted as the professional norm, and in which supportive resources for achieving well-being are readily available, without stigma, to all clinicians.”