With growing attention surrounding the importance of physician well-being, organizations are institutionalizing physician well-being efforts. Promoting well-being requires a understanding of the components, barriers and promoters of physician well-being, While other books exist in this space, many are focused on individual resilience-building strategies or are too broad to apply to specific groups of physicians, such as pediatricians. A critical gap in the existing literature is a book that uses an evidence-based model of well-being and applying this model to unique experience of pediatricians.
Rather than a work-centric approach, the physician well-being model we describe in this book takes a comprehensive approach to well-being, integrating evidence and expertise from a broad body of well-being research and translating this knowledge to the lives and work of pediatricians. Further, while other texts focus on negative consequences of a lack of well-being, such as burnout, this text is organized around defining, understanding and optimizing well-being. Each chapter will provide strategies for both individual pediatricians and healthcare organizations to consider to improve pediatrician well-being at their institution. This book integrates well-being science from disciplines outside of medicine, offering innovative strategies to addressing this important issue.
This is a book designed for pediatricians, health care leaders, and organizations looking to better understand and implement strategies for pediatrician well-being. The authors will take readers on a journey through the history of physician well-being leading to the current state of well-being in the context of modern medical practice, technology, society, policy and family life. Using an integrated model of physician well-being, readers will learn about the current state, solutions, tensions and future directions of physician well-being.
Author(s): Sarah Webber, Jessica Babal, Megan A. Moreno
Publisher: Springer
Year: 2022
Language: English
Pages: 386
City: Cham
Preface
Acknowledgments
Contents
Part I: Introduction to Pediatrician Well-Being
Chapter 1: Physician Well-Being Challenges: An Historical Perspective
Introduction
Part 1: The Foundation of Organized US Medicine
Early Century Physician Factions Develop, Creating Divisions and Hierarchies
Regular Physicians
Homeopathic Physicians
Eclectic Physicians
Physician Factions Enabled Philosophical Divides and Hierarchies in Medicine
Regulars Fuel Scientific Reductionism and Emotional Minimization
Homeopaths and Eclectics Assimilate
Part 2: The Influence of the Flexner Report (1910)
Flexner and the Triple-Threat
Flexner and Mind–Body Dualism in Medicine
Part 3: Physician Leaders Cultivate Structural Inequities
Impact of Gender Discrimination, Racism, and Ethnocentrism on Physician Well-Being
Flexner and Inequities in Medicine
Part 4: Foundational Shifts in Twentieth Century Healthcare
Major Shifts in Public Trust of Medicine
The Boom and the Bust in Twentieth Century Public Trust in Medicine
Physicians Begin to Advocate for Patient-Centered Care but Mistrust Remained
The Corporatization of Medicine
Personalized Medicine
The Electronic Health Record (EHR)
Conclusions
References
Chapter 2: Defining and Conceptualizing Pediatrician Well-Being
Part 1: What Is Well-Being?
“Western” Medicine’s Conceptualization of Well-Being
Key Issues in Current Well-Being Constructs
The Diversity Problem
The Individual and the Collective
Critiques of Happiness
Where Does Suffering Fit in?
Toward a More Holistic and Inclusive Model of Well-Being
The Ecologic System
Equanimity
Re-defining Self-Care
Part 2: Pediatrician and Physician Well-Being
The Evolution of Physician Well-being
Part 3: A Model of Pediatrician Well-being
Sources and Roots of Our Model
Foundations of Well-Being
Activities
Identity
Environment
The System
Physical Environment
Psychosocial Environment: Culture and Climate
Well-Being Domains
Emotional and Psychological Well-Being
Physical Well-Being
Connection
Meaning and Purpose
Authenticity
Conclusion
References
Part II: Challenges to Pediatrician Well-Being
Chapter 3: Acute and Chronic Illness in the Physician
Some Herons
My Story: The Diagnosis
28 August 2017 10:00 AM
20 September 2017 08:00 AM
26 September 2017 12:00 PM
27 September 2017 12:00 PM
Illness in the Physician
Barriers to Care
Lack of Support for Physicians with Mental Illness
Lack of Assistance for Identifying and Treatment of Substance Use Disorders in Physicians
My Story: The Treatment
October 2017
8 October 2017–4 July 2018
Paid Sick Leave and FMLA
My Story: Working while in Treatment, Working while Ill
1 March 2018
My Morning Daily Meditation
Burden of COVID
Conclusion
Still Here
My Story: In Remission, Almost…
12 Sep 2021
My Story: My Mission Statement
References
Chapter 4: Importance of and Barriers to Preventive Health
Introduction
Physician Preventive Health
General Health Status
Summary of Published Data (Table 4.1)
Association with Pediatrician Well-Being
General Preventive Care in the Clinical Setting
Summary of Published Data (Table 4.2)
Association with Pediatrician Well-Being
Barriers
Nutrition
Summary of Published Data (Table 4.3)
Association with Pediatrician Well-Being
Barriers
Exercise
Summary of Published Data (Table 4.4)
Association with Pediatrician Well-Being
Barriers
Sleep
Summary of Published Data (Table 4.5)
Association with Pediatrician Well-Being
Barriers
AAP Pediatrician Life and Career Experience Study (PLACES)
General Health Status and General Preventive Care in the Clinical Setting
Exercise and Sleep
Work–Life Balance
Conclusion
References
Chapter 5: Substance Use Disorders and Recovery
Introduction
Epidemiology
Substance Use in Medical Students
Substance Use in Resident Physicians
Substance Use in Pediatricians and Other Physicians
Treatment and Recovery
Physician Health Programs
Substance Use Disorders and Pediatrician Well-Being
Impact of Healthcare Culture
Emotional and Psychological Well-Being
Physical Health
Connection
Meaning and Purpose
Authenticity
Workplace Supports for Physicians with SUD
Work–Life Integration
Influence, Challenges, and Opportunities of Technology
Conclusion
References
Chapter 6: Chronic Stress and Workload
Understanding and Cultivating Pediatrician Well-Being
What Is Stress? (An Evolving Understanding)
Stress: Why Does It Matter?
Eustress
Negative Stress
Stress and Our Health: The Mind–Body Connection
The Effects of Cumulative Stress
The Stress Response: Physiology
Chronic Stress
The Relaxation Response: An Antidote to Stress
Understanding Workload
Physician Work Demands Elaborated
Physician Workload and Its Impact
Work Out of Balance
Job Control and Workload
Work Resources, and Solutions
The Electronic Health Record: A Complex Case of Demands and Resources
On Efficiency
Critical Steps in Systems Design to Optimize Physician Work for Well-Being
Stress and Workload
References
Chapter 7: Physician Burnout
Definition of Physician Burnout
Epidemiology of Burnout
Consequences of Burnout
Drivers of Burnout
Individual Drivers
Systemic and Institutional Drivers
Job Demands and Workplace Flexibility
Leadership Behaviors
Electronic Medical Record
Other Factors
Conclusions: Solutions and Strategies for Mitigating Burnout
References
Chapter 8: Moral Distress and Injury
Moral Injury: Basic Concepts
The Moral Injury of Healthcare
The Origins of Moral Injury Theory
Medical Community Embrace of the Moral Injury in Healthcare Concept
Should Moral Injury and Burnout Be Considered Overlapping Concepts?
Similarities in Healthcare Worker and War Veteran Personal Characteristics That May Pre-dispose to Moral Injury Symptomatology
The Continuum Between Moral Distress and Moral Injury
Evidence for the Impact of Moral Distress on Well-Being
Moral Distress and Burnout
Moral Injury and Burnout
Impact of System, Organizational Factors, and Healthcare Culture on Moral Challenges and Physician Well-Being
Moral Injury and the Coronavirus Pandemic
Approaches to Mitigating Moral Distress and Injury
Conclusion
Moral Distress, Moral Challenges: Cases
References
Chapter 9: Challenges in Diversity, Equity, and Inclusion
What Is Diversity, Equity, and Inclusion?
Epidemiology and Construct of Diversity, Equity, and Inclusion
Intersectionality
Benefits of DEI Extend Beyond Minority Physicians Alone
The Intersections of Health and Well-Being with Diversity, Equity, and Inclusion
Epidemiology: Who Are Pediatricians in the USA?
Race and Ethnicity in Medicine
Gender and Gender Identity in Medicine
Sexual Orientation in Medicine
Physical, Emotional, and Psychological Well-Being
Effects of Racism on Physical and Psychological Well-Being
Bias, Discrimination, and Racism in Medicine
Sexism and Gender-Based Discrimination in Medicine
Sexual Orientation and Homophobia/Transphobia in Medicine
Effects on Evaluation, Recognition, and Career Progression
The Minority Tax
Authenticity
Professionalism
Who Is Allowed To Feel?
Connectedness
Meaning and Purpose
The Path Forward: Diversity, Equity, and Inclusion Are Foundational to Well-Being
References
Part III: Fostering Pediatrician Well-Being
Chapter 10: Emotional Resilience and Mindset
Introduction
Why Emotional Resilience and Mindset Matter
Mindfulness
Positive Psychology and Self-Compassion
Dynamic (vs. Fixed) Mindsets
Cultivating Caring Connection
Leading for Resilience
Conclusion
References
Chapter 11: Compassion, Meaning, and Purpose in Medicine
Meaning and Purpose
The Purpose of Medicine
Compassion as a Source of Purpose
Physician Well-Being and Compassion
The Needs of Patients and Parents
Where Does Compassion Come from?
A Deeper Understanding of Compassion
A Relaxed Mind Is a More Compassionate Mind
Thoughts
Meditation
Six Qualities of Compassion
Generosity
Ethics
Tolerance
Perseverance
Concentration
Wisdom
Managing Our Sense of Self
Putting It All Together
References
Chapter 12: Social Connection and Belonging
Introduction
The Umbuntu of Medicine
Social Connection and Belonging (SC&B) Definitions and Theory
Social Connection and Belonging: Professional Attrition and Burnout
Social Connection and Belonging: Professional Fulfillment and Satisfaction
Peer Support Programs
Role of Mentorship and Sponsorship
Institutional Utilization of Mentorship and Sponsorship
Effective Mentorship
Mentorship Training
Professional Medical Organizations
Professional Medical Organizations: Women and Underrepresented Physicians in Medicine
SC&B and Personal Well-Being
SC&B and Personal Health Outcomes
Challenges and Opportunities in Cultivating SC&B at Work
SC&B Among UIM and Historically Excluded Groups
Establishing and Nurturing a Pipeline of Underrepresented Students and Faculty
Promoting Authenticity Among UIM and Historically Excluded Physicians
SC&B and Impostor Syndrome
Healthcare Culture/Systems/Organizations
SC&B and the Electronic Health Record
SC&B as an Institutional Financial Investment
SC&B and Patient Interactions
SC&B and Physical Spaces at Work
Conclusions
References
Chapter 13: Spirituality and Well-Being
History
Chiron the Healer, an Origin Story for Physicians
The Evolution of Spirituality and Medicine
Cultural Beliefs Reinforce the Separation of Medicine and Spirituality
Spirituality and Its Relationship to Spiritual Beliefs, Values, and Practices
Spiritual Beliefs
Spiritual Values
Spiritual Practices
Are Physicians Spiritual?
Physician Spirituality Compared to That of the General Population
How Does Physician Spirituality Compare Internationally?
How Does Spirituality Influence Well-Being?
Emotional and Psychological Well-Being
Physical Well-Being
Connection, Meaning and Purpose, and Authenticity
Challenges to and Opportunities for Physicians’ Spiritual Well-Being
Spiritual Well-Being Support for U.S. Physicians
Final Thoughts: An Allegory of the Hospital Chapel
Conclusion
References
Chapter 14: Arts and Humanities
Introduction
Setting the Stage and Developing a Framework
Debunking Myths: Medicine Vs. the Arts and Humanities
Breaking It Down: Definition of Medical Humanities [10]
Establishing a Framework
Delving Into the Arts and Humanities
History of Medicine and Philosophy
History of Medicine
Philosophy of Medicine
Visual Arts
Narrative Medicine and Storytelling
Poetry and Prose
Music
Theater Arts
Incorporating Humanities into to Medicine: From Training to an Academic Niche
Medical Humanities in Medical Education
Medical Humanities Within an Academic Career
Making It Count: How to “Academicise” Work in the Medical Humanities
Research in the Medical Humanities
Conclusion
References
Chapter 15: Values Alignment
Why Is Values Alignment Important?
Challenges to Pediatrician Values Alignment
Values Alignment at the Individual (Micro) Level
Interactions in Clinical Practice
Conflict Between Personal and Work-Related Values
Values Alignment in a Diversifying Pediatric Workforce
Values Alignment at the Institutional (Meso) Level
Administrative Burden in the Workplace
Fixed Versus Flexible Work
Constraints of Pediatric Practice
Values Alignment and Wellness
Inclusivity in the Workplace
Values Alignment at the Structural (Macro) Level
Cultural Differences in a Diversifying Workforce
Values Alignment in Socio-Political Contexts
Practical Opportunities and Solutions
Conclusion
References
Part IV: Bringing It All Together Through a Career
Chapter 16: Developmental Milestones of a Career
Introduction
Professional Identity Formation
Exploring Well-being Throughout the Career
Early Career Pediatricians
Professional Identity Formation for the Early Career Pediatrician
Risk of “Survival Mentality”
Work Schedule
Academic Pressures
Mentorship
Imposter Syndrome
Burnout
Early Career Pediatrician Resources
Internal Resources
Emotional, Psychological, and Physical Well-Being
Authenticity
External Resources
Connection at Work
Workplace Flexibility
Parenthood or Caregiving Outside of Work
Unique Challenges of Parenting as a Pediatrician
Fertility Challenges
Parenting Newborns
Additional Parenting Challenges
Impact of Parent-identity on Professional Identity
Resources for Pediatrician Parents
Internal Resources
Emotional and Psychological Well-Being
Authenticity
External Resources
Psychological, Emotional, and Physical Well-Being
Connection
Mid-career Pediatricians
Expanding One’s Niche
Mid-career and Mentorship
Unique Mid-career Challenges for Pediatrician Sub-populations
Health Status
Resources for Mid-Career Pediatricians
Internal Resources
Authenticity
External Resources
Connection
Late Career and Retirement
Physical Ailments and Outside Responsibilities
Ageism
Identity Shift Nearing Retirement
Retirement Resources
Internal Resources
Creating a Professional Bucket List
Emotional and Psychological Well-being
External Resources
Succession Planning
Financial Security
Social and Spiritual Support
Conclusion
References
Chapter 17: Leveraging the Power of One’s Brand: How Applying a Marketing Framework Can Help You Thrive in Academics
Identifying Your Personal Brand
Leveraging Your Brand Sweet Spot in Academics
Rebranding
Going from Hobby to Academic Recognition
Rejection Resilience and Academics
Expecting Rejection
Increasing Transparency
Leveraging Mentorship
References
Chapter 18: Integrating Well-being into Pediatrician Culture and Practice
Introduction
Creating a Culture of Wellness
The Importance of Culture for Pediatrician Well-Being
Understanding the Culture of Medicine
The Hidden Curriculum
Recentering on the Core Values
The Ethics of Self-Care
Integrated Well-Being
Challenging the System
Culture and Values
The Individual Approach to Fostering Wellness Within a Healthcare System
Mentorship
Professional Development
Improving the Efficiency of Practice
The Operational Approach to Fostering Wellness in a Healthcare System
Leadership Training Programs
Creating Norms and Expectations That Foster a Culture of Wellness
Professional Development Programs
Team Engagement, Celebration, and Reward Programs
Service Recovery Programs
Peer Support Programs
Work Environments, Staffing, and Supporting Efficiency of Practice
Personal Resilience
Individual
Work Unit
Organization
National
Work-Life Harmony
References
Index
