Nearly half the physician workforce is considered unwell — burned out, depressed, in some cases suicidal. Unwell physicians provide suboptimal care to patients. Their patients’ satisfaction scores are low. They are less productive compared with physicians who are well. They commit more medical errors, and their rate of malpractice litigation is higher. The work-life balance of a burned-out physician is way off-kilter — and tragically, about one physician per day commits suicide in the United States.
All of these known effects have become attention-getting headlines. Health care organizations, however, have been slow to provide a fix despite the negative impact unwell physicians have on their bottom line — through staff turnover, lawsuits, decreased productivity, and disability claims. One meta-analysis showed that medical costs were lowered $3.27 for every dollar spent on wellness programs, and absentee day costs fell by about $2.73 for every dollar spent. The authors of the study concluded: “This return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.”
Although other studies have failed to show financial returns on wellness programs, several high-profile institutions (e.g., Stanford, Johns Hopkins, Mount Sinai (New York), UC Davis, and the University of Alabama) have recently appointed chief wellness officers (CWOs) to counter staff burnout. They are discussing strategies and best practices in the cultivation of personal self-care and workplace wellness. They are beginning to allocate essential resources to help stem the tide of unhappy, dissatisfied, and impaired physicians. CWOs have been hired directly into the C-suite to work with other executives to deliver enterprise-wide solutions to drivers of burnout.
The essential responsibilities of the CWO vary by scope and type of organization. Based on my review of CWO positions described in academic health care systems, CWOs are tasked to establish a “Wellness” or “Work-Life” Center and manage the on-going, day-to-day operations – clinical, business and budgetary – as well as oversee growth and expansion of the Center. They are responsible for evaluating the Center’s impact on employee wellness, professional fulfillment, patient satisfaction, and patient safety. Ultimately, the CWO is responsible for creating and maintaining a system-wide culture of wellness by promoting and supporting staff well-being. This entails working with mental health leaders and department heads to decrease stigma and improve awareness and diagnosis of mental health disorders.
Of course, there are skeptics who believe that creating a CWO position simply satisfies an organizational checklist and pays lip service to the epidemic of burned-out doctors. It may create a distraction or deplete resources, they argue, unless the components of a physician wellness program are already in place: a wellness committee and leader, a burnout prevention strategy, a reasonable budget (minimum of $150,000/year), up-and-running projects, and metrics to prove the program’s effectiveness. The appropriate time to hire a CWO may be debatable, but one thing seems certain: merely offering resiliency training under the guise of “wellness” puts the onus on physicians to deal with their own burnout and does not address its systemic causes.
The CWO will face several significant challenges: 1) establishing a working connection with front-line providers while based in the C-suite; 2) maintaining influence without being perceived as disruptive; 3) competing against other executive leaders for resources and status in the organization; 4) adding immediate value to the organization; and 5) demonstrating a return on investment for physicians (a highly specialized group for which the benefits of corporate wellness programs have been inconsistent).
But if the CWO does their job effectively, senior leaders will forever be reminded of the importance of a culture that embraces psychological health and improves the professional lives of clinicians. Anything less jeopardizes the goals of the Triple Aim.
Arthur Lazarus, MD, MBA is a 2019–2020 Doximity Community Fellow and member of the Physician Leadership Journal editorial board. He is an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.
