lifeline DECEMBER 2018 What’s The Magic Formula for BURNOUT PREVENTION AND RECOVERY? Page 4 TABLE OF CONTENTS | 8 10 4 PRESIDENT’S MESSAGE EMPAC SCORES BIG 8 ADVOCACY UPDATE in 2018 ACEP 10 GUEST ARTICLE Council Meeting Recap 2018 16 ANNOUNCEMENTS 17 UPCOMING MEETINGS & DEADLINES GENERAL 18 CAREER OPPORTUNITIES ELECTION California ACEP DECEMBER 2018 Board of Directors & Index of Advertisers Lifeline Editors Roster 2018-19 Board of Directors Independent Emergency Physicians Consortium Page 6 Chi Perlroth, MD, FACEP, President Vivian Reyes, MD, FACEP, President-Elect Vikant Gulati, MD, FACEP, Vice President Sujal Mandavia, MD, FACEP, Treasurer Lori Winston, MD, FACEP, Secretary Mission Hospital Page 18 Aimee Moulin, MD, FACEP, Immediate Past President Harrison Alter, MD, FACEP (At-Large) Reb Close, MD, FACEP John Coburn, MD, FACEP Carrieann Drenten, MD, FACEP Philip Fagan, MD Page 18 Jorge Fernandez, MD Michael Gertz, MD, FACEP Doug Gibson, MD, FACEP John Ludlow, MD, MBA, FACEP Karen Murrell, MD, MBA, FACEP Ventura Emergency Physicians Page 18 Mitesh Patel, MD, MBA, FACHE, CPE Hunter Pattison, MD (CAL/EMRA President) Patrick Um, MD, FACEP, FAAEM Advocacy Fellowship 41st Annual Emergency Medicine In Yosemite Page 15 Carrieann Drenten, MD, FACEP, Advocacy Fellowship Director Sam Jeppsen, MD, Advocacy Fellow Lifeline Medical Editor Richard Obler, MD, FACEP, Medical Editor Lifeline Staff Editors Elena Lopez-Gusman, Executive Director Kelsey McQuaid-Craig, MPA, Director of Policy and Programs Lucia Romo, Membership and Education Coordinator Lauren Brown, Government Affairs Associate Meri Thresher, Administrative Assistant 2 | LIFELINE a forum for emergency physicians in california WELCOME new members! Caitlyn Olivia Anderson Kenneth Taeyoung Kim Jason Rogers, MD Alfonso Avila, DO Ethan Salomon Kimball Andre Sahakian Whi Inh Shirley Bae Chia-Yuan Michael Lee Federica Sarti Joelle Brown Sarah Kim Lee Alec Samuel Small Sheik Cale, MD Chinyu Jean Lo, MD Ruthy Tam Somil Chheda Sally Mahmoud-Werthmann, MD Carol Tang Brian Wai Wen Chin Lesly Victoria Martinez, MD, MBA, MPH Kyaw Min Thein, MD Danielle R. Cohen Ryan McDonald Daryn Towle, MD Kayla Maria Conover James Edward McDonough Ty Tran Taylor Docter Tarakarama Musunuri Prabhdeep Uppal Amy Do-Nguyen Amol Sanmukh Patel Irene Velarde Juliette Gerardo Lisa G. Patrick, MD Gregory Whitcher Alejandra Gonzalez Jesse Perez Samantha Ashley Wong Marissa Hood Enid Picart Jarred Anthony Worthy Vincent Huynh Emily Pott Jeremy Yenpasook Roopam Jariwal Joseph Powers Mitchell Zekhtser Esther Kim Ranjita Raghavan 100% GROUPS Central Coast Emergency Physicians Loma Linda Emergency Physicians Tri-City Emergency Medical Group Emergency Medicine Specialists of Napa Valley Emergency Medical Group University of California, Irvine Medical Orange County Newport Emergency Medical Group, Inc Center Emergency Physicians Emergent Medical Associates at Hoag Hospital Front Line Emergency Care Specialists Pacific Emergency Providers, APC DECEMBER 2018 | 3 PRESIDENT’S MESSAGE | What’s The Magic Formula for By Chi Perlroth, MD, FACEP BURNOUT PREVENTION AND RECOVERY houldn’t someone have created the magic formula for burnout prevention and recovery by now? There are daily articles on how burnout is linked to “lower quality care, lower patient satisfaction scores, higher medical error rates, higher malpractice Srisk,” not to mention “more frequent disruptive physician behavior, higher rates of physician divorce, increased depression and suicide.” Much of the literature claims that we are all responsible as individual physicians, emergency department (ED) leaders, and hospital systems to do something about it. In fact, even our friends at the Joint Commission have required health and wellness programs in our healthcare organizations because even THEY think burnout is an issue (I know, I chuckled at the irony). Can someone whittle down all the information out there into a menu contributing to your own personal stress levels. You continuously of things we can do to decrease our levels of burnout and improve blame or complain about patients in the break room or try to our success for well-being and recovery? And yes, there are lists of normalize by calling it “healthy venting.” You blame the system or things our medical directors, hospital administrators, and even CMS others about how much stress you feel can change to make our lives better and I will include some examples of those for people who might serve in those roles, in this and future (3) Lack of efficacy: “My work isn’t really helping anybody or serving articles. But what we do as individuals (and together as colleagues) any purpose” or “I worry about making a clinical mistake.” will most impact the course of our careers as emergency physicians, Maybe I don’t feel that I’m ENTIRELY unable to recover, but I do find and perhaps translate into how we contribute to the health of our myself tired a lot, and sometimes I just can’t believe how fast my few department more broadly. days off have flown by. To deal, I tell myself, “at least I don’t dread going back to work EVERYDAY.” And I don’t really feel cynical about ALL of I know some of us may be tired of hearing about what my friend calls my patients, just those with special chief complaints (you know which “woo-woo” methods—mindfulness, meditation, journaling, exercise, ones). And I think I’m still doing a good job at work, but some days I yoga, work-flow tools, strategic planning, communication, emotional can’t really identify a person whose life I may have made a difference intelligence tools, and life-scheduling techniques. They may sound in. Does this sound familiar? too emotion-based or pseudoscientific. Sure, I signed up for the heavy breathing session with several of my very nice work colleagues at a Is this really something everyone deals with and do we really need lovely restaurant learning about what mindfulness means. I’ve even to keep talking about this? Does burnout really affect me and my taught myself meditation to help me during a stretch of insomnia. And colleagues? Sadly, my answer was yes. I was hired on to one of my first yeah, I try hard to schedule exercise regularly (even yoga on occasion— jobs because a physician committed suicide. I found out on Facebook too boring for me although it seems to keep my neck and back issues that a close medical school friend jumped off a 20 story building. in check). But writing this article, of course I had to ask myself first, “Do Soon thereafter, I received word that a residency colleague, who was I have symptoms of burnout?” also a high school friend of mine, took her own life. I can definitely relate closely to this issue. I am not trying to imply that all paths lead According to Dr. Dike Drummond’s book, Stop Physician Burnout, to the same result but we have to do something to change course for burnout is defined as: ourselves and our medical colleagues. (1) “Exhaustion—extremely tired and unable to recover Unfortunately, despite all the research, surveys, and experts on this topic, there is no Magical Formula. That’s because, wait for it, we’re (2) Depersonalization—Compassion fatigue—You feel cynical all different. Because our stressors come from different aspects of our and sarcastic about your patients. You blame the patient for 4 | LIFELINE a forum for emergency physicians in california practice and personal life, our path will be different. What I can offer is people that could help you out of this downward spiral. And when a consistent approach suggested by many of the experts: you do those things, you are giving away your power to change things. Playing the victim means you missed an opportunity to take charge.” (1) Get out of denial and recognize your own burnout symptoms 3. TAKE ACTION. WHAT DEPLETES YOU, WHAT (2) First change the behaviors and thoughts that prevent change REPLENISHES YOU? (3) Identify what depletes you and start making changes one by one, “Many of us feel stress and get overwhelmed not because we’re taking and identify what replenishes you and put those activities in your on too much, but because we’re taking on too little of what really calendar one by one strengthens us,” states Marcus Buckingham. Dr. Drummond states (4) Find someone to do this with to keep each other accountable and everyone is different in how they experience and deal with burnout. to help each other “Recovery is a process of switching out old habits with new ones, one at a time.” But we have to TAKE ACTION. “Try things out in your life. Do 1. BURNOUT: RECOGNIZE THE SYMPTOMS something new in order to get new results. If it works, keep doing it. If it doesn’t, move on.” He also notes, “More is not better. Find a few things What does Burnout feel like? You find yourself thinking, “I just want to that you think might get your juices flowing.” “Move from avoiding the get through the day,” or worse you dread going into work. You become things you don’t want. Move to figuring out what you really want, and frustrated, fatigued, or angry during many of your shifts. You find going to get it.” yourself the “Lone Ranger” doing everything yourself, despite having a team around you. You act the perfectionist when you agonize over Understand what depletes you. This could be job specific stresses, details that are not clinically relevant or chastise patients and staff for such as your schedule, patient volume expectations, EMR, ICD-10, minor imperfections. In some cases your colleagues or administrators documentation requirements that keep changing, patient satisfaction may talk to you about your attitude and energy or disruptive behavior. scores, mergers and more mergers, your compensation formula, profit Typically you feel bad about the incidents they call you out on, while sharing, your relationship with staff or leadership, or fear of litigation justifying what you did or said as a reasonable response given the (again).