March 29, 2022

Successful physician peer support programs

If there is anything positive to come from this pandemic, perhaps it will be the heightened realisation of the importance of peer support. Physician peer support programs with an emphasis on preventing burnout and growing community have are being piloted and implemented in different ways and organizations around the country.

It seems that while we have much in common as MDs, there are also specialty specific challenges. In fact, burnout rates seem to vary by specialty. Whether this is due to the challenges of these clinical areas, or the types of doctors attracted to them, is another discussion.

In this article, we explore a number of successful peer support programs to support our fellow physicians.

What are physician peer support programs?

The key is that they are run by and for doctors. These may be formal or informal programs of 1:1 or group physician-only support based on equality and mutual understanding of what it’s like to be a doctor.

Informal peer support

Here a colleague inquires how a peer is doing after an adverse event, can sometimes be helpful but can also be insufficient or occasionally even counterproductive.

Oftentimes colleagues feel helpless and unsure of what to say in these situations. They may try to minimize the emotions of their peers with comments such as, “You really shouldn’t feel that way,” or, “Why are you so upset? This is part of our job.”

Formal peer support

Here, a non-mental health clinicians offer support to their colleagues after adverse events or other professionally stressful circumstances, is fundamentally different from informal peer support. Fundamental to successful formal peer support are active listening skills, empathy, non-judgementalism, equality, and compassion. Formal peer support allows everyone to develop a better understanding of the emotions and reactions of others in their team in order to normalize these emotional responses to their work and make headway in reversing the negative stigma. With peer support, it is important to learn to accept that physicians cannot “fix” their peers’ pain. For this reason, peer support training is necessary in order to train physicians to offer support in a way that most are not accustomed to doing. Formal peer support programs provide such enhanced peer support to our colleagues in times of need.

What are the benefits of physician peer support programs?

Peer-to-peer support overcome the physician professional fear barrier. A survey of 112 doctors revealed that 88% would potentially seek support from a physician colleague if needed, whereas only 48% who would access mental health professional support. The benefits of good peer support cannot be overstated, ranging from protecting wellbeing to improving reflective ability and providing psychological safety.

88% of doctors would potentially seek support from a physician colleague if needed, whereas only 48% who would access mental health professional support.

Beyond supporting wellbeing, peer support is closely associated with improved resilience, the idea of ‘coping, adapting or thriving from adverse or challenging events.

The benefits of good wellbeing extend beyond the individual: the wellbeing of doctors is directly linked to the quality of patient care, improved patient satisfaction, improved treatment, and even lower rates of hospital-acquired infections. Moreover, there is evidence that improving staff wellbeing has measurable financial advantages – CEOs, are you listening?

Successful examples of physician peer support programs

It is imperative that health care institutions devote resources to programs that support physician well-being and resilience. Doing so after adverse and other emotionally stressful events, such as the death of a colleague or caring for victims of a mass trauma, is crucial as clinicians are often at their most vulnerable during such times.

To this end, the Center for Professionalism and Peer Support at Brigham and Women’s Hospital redesigned their peer support program in 2009 to provide one-on-one peer support. The peer support program was one of the first of its kind; over 25 national and international programs have been modeled off of it.

Important components for the peer support conversation included: outreach call, invitation/opening, listening, reflecting, reframing, sense-making, coping, closing, and resources/referrals. The authors argue that creating a peer support program is one way forward, away from a culture of invulnerability, isolation, and shame and toward a culture that truly values a sense of shared organizational responsibility for clinician well-being and patient safety.

The more recent “Scholars of Wellness” program at Northwestern Medicine has developed 10 specialty-specific peer-support solutions to physician burnout.

Since launching in February 2020, the peer-support program has reached out to 160 physicians. These physicians have had peer support interactions through email, Zoom, a phone call or in person. System wide expansion of the program began September 2021 and over 59 peer support coaches have been trained across the institution with more than 3,000 physicians across all specialties in 10 hospitals using the well-being intervention.

Primary care

Anne Schultz, MD, focused on previsit planning to close patient care gaps identified by quality indicators. Through team-based care, medical assistants and licensed practical nurses were trained to review the schedule prior to the patient visit to identify patient care gaps. This assured that all team members were working at the top of their licensed and reduced physician workload.

Internal medicine

Rajan V. Shah, MD, reorganized the team structure to include medical assistants and patient service representatives to improve physician support. He also created more efficient workflows for support staff and heightened individual awareness of team member roles. Physicians reported better teamwork, improved professional fulfillment and decreased burnout.

Emergency medicine

Mark Courtney, MD, found that 71% of physicians perceive the EHR to be a major detractor to professional well-being and spend excessive amounts of time in it. His solution? He provided individualized data on actual time spent in Epic and allowed for comparison to identify outliers. This allowed for targeted and personalized optimization for attendings that wished to receive additional training to improve their efficiency and satisfaction with the EHR.

Obstetrics & gynecology

In O&G, for example, many gynecologists reported emotional exhaustion due to surgical and obstetric complications. Angela Chaudhari, MD, created a peer support group for these adverse events. The program was able to reach out to 100% of physicians within 72 hours of event identification allowing for physicians to feel cared for and learn coping skills.

Surgery

Physician educators find meaning in teaching, but the administrative components can be burdensome. In a true win-win, Amy L. Halverson, MD, turned to administrative assistants to simplify the trainee assessment process. This improved timeliness of student assessments and reduced faculty workload.

Anesthesiology

Jenna Swisher, MD, expanded a peer support program for the anesthesia department. She was able to increase peer support utilization and expand relationships in the organization for event notification.

Surgical oncology

More than half of surgeons say they don’t have enough time to complete their work. Anthony Yang, MD, worked with surgeons and administrative assistants to create a standard list of support functions. This list for administrative assistants encouraged collaboration and reduced faculty workload.

Psychiatry

A significant source of distress and burnout in psychiatry is a lack of clinical coverage for planned and unplanned absences. After conducting focus groups, Mehmet Dokucu, MD, PhD, worked with department leadership to approve defined financial and motivational incentives. This helped create a voluntary pool of faculty who can be relied on to provide coverage for their colleagues.

Ophthalmology

About half of ophthalmologists expressed a need to spend less time after work in the EHR. To improve satisfaction, decrease stress and relieve workloads, Manjot Gill, MD, introduced medical scribes. With scribes, burnout was decreased while enhancing the patient-physician relationship.

Radiology

Sitting at a workstation all day can lead to repetitive stress injuries and decreased productivity. Jeanne M. Horowitz, MD, found that one size does not fit all. She created an ergonomics committee so that faculty voices could be heard, and a sense of control returned. The committee recommended ergonomic improvements such as new adjustable chairs, wrist pads and computer mice.

Conclusions about physician peer support programs

We have presented a number of physician-developed peer-support programs across 10 different specialties in a large US healthcare system. What are your experiences?

If you would like to join a peer-support group of physicians in a safe and confidential space, check out our forums and join the waiting list for the next group. The next peer support group will start when we have enough physicians ready to join.

We would love to hear about success stories, and learnings from failure, too!

Dr Corrigan

A recovering physician who left medicine after burning out and more. Overachiever. Impostor syndrome. Had never heard of Corrigan's Secret Door* until it was too late. Thankfully now in a way better place. Co-founded Physicians Anonymous with intention to solve physician burnout, mental illness, and addiction. Hopes to prevent future medical career disasters through peer support, advocacy, policy change, and innovation. * https://physiciansanonymous.org/corrigans-secret-door-and-other-stories/

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