VCH’s Interim Regional Medical Director, Medical Staff Wellness, Dr. Fahreen Dossa and VPSA Operations Director Andrew Pinfold presented an overview of the results of the recent physician wellness survey at VCH’s December Medical Staff Forum.

These high-level results will be broken down where confidentiality allows into regional, departmental and divisional results that will be shared with the appropriate parties over the next few months.

Dr. Dossa emphasized that medical staff must be well to deliver quality care and that this is a foundational priority. She reminded us that physician burnout has enormous cost and sustainability ramifications for the health-care system. The VCH core value “We care for everyone” includes medical staff and this is strongly endorsed by VCH senior leadership.

The wellness survey, she pointed out, captured burnout and fulfillment but was specifically designed to investigate the drivers of burnout. It also measured psychological and physical safety alongside the impact of EHR/CST.

While the survey was limited to physicians in this iteration, these drivers of burnout affect all medical staff. The results are an invitation to have deeper conversations at both organizational and local work-unit levels that can bring about meaningful change.

The results

The survey had a 31 per cent response rate with 1,006 out of 3,282 physicians taking part. Of those, 655 work in Vancouver Acute or Vancouver Community. The results align with survey results in other BC health authorities as well as across Canada and internationally.

There were 16 questions on fulfillment and wellness, seven questions on workplace changes to support well-being, five on electronic health records, four each on physical and psychological safety, and one open-ended question. Key demographics were also measured.

The high-level findings include that health human resources and professional fulfillment are linked and impacted by overwhelming clinical demands and workload. EHRs are currently a contributor to burnout and affect workplace efficiency. Many physicians noted they have experienced disrespectful behaviours and violence in the workplace. There were also notable results regarding workplace belonging (collegiality, commensality, and esprit de corps).

Key insights 

• Forty-three per cent of respondents experienced burnout; i.e., more than 430 physician respondents met the threshold of experiencing burnout. There were significant variations between communities of care and specialties.
• Forty-six per cent of the 430 physician respondents who met the threshold of experiencing burnout work in Vancouver Acute or Vancouver Community.
• Thirty-one per cent of respondents are professionally fulfilled. Again, there were variations between communities of care and specialties.
• Thirty-three per cent of the 280 physician respondents who are professionally fulfilled work in Vancouver Acute or Vancouver Community.
• The survey also found that women physicians and physicians between the ages of 40 to 49 experience higher rates of burnout and lower rates of professional fulfillment.
• Thirty-four per cent of respondents (342 physicians) identified EHR as a contributor to their symptoms of burnout.
• Twenty-nine per cent experienced violence (physical or threats). Of those 245 physicians, 218 reported the violence originated from patients and their supporters.
• Thirty per cent of the 245 physicians who reported experiencing violence work in Vancouver Acute or Vancouver Community.
• Sixty-nine per cent experienced disrespectful behaviour, with 423 of the 646 physicians who noted this saying this behaviour was from patients and their supporters.
• Sixty-seven per cent of the 646 physicians who reported experiencing disrespectful behaviour work in Vancouver Acute or Vancouver Community.

Next steps 

Communicating the results to wider audience stakeholders is one of the first steps post survey. Local results, where there is not a potential breach in confidentiality, will be shared with local work units, and opportunities for action will be identified.

Reports for the findings for VA and VC will be sent out to department and division leaders in January; this will coincide with VPSA opening applications for wellness funding.

Interventions can be effective when focused in areas where we have control. These can include things like identifying wellness champions within departments and divisions, organizing listening groups, sourcing PQI and other resources, and establishing commensality groups.

Dr. Dossa reminded us that it is important to recognize and celebrate the work that has been done to date. This includes the establishment of the Medical Practitioners Occupational Safety and Health (mPOSH), Physician Quality Improvement opportunities, the creation of the Regional Medical Director for Wellness role, and other organizational work including streamlining privileging and restructuring Medical Affairs.

VCH leadership responses 

VCH CEO Vivian Eliopoulos attended the December Medical Staff Forum and stated that medical staff wellness is integral to the delivery of safe, high-quality care. She said the survey provides valuable insights to the challenges medical staff face and there is a need for open, honest, and courageous conversations so we can move forward. She recognizes that the work ahead requires time and that solutions will not happen overnight. It will take a concerted effort to move the needle on medical staff wellness and she thanked everyone for their ongoing dedication as we look to build a sustainable future where everyone feels supported and engaged.

As with other VCH medical staff forums, Interim Vice President of Medicine and Medical Affairs Dr. Chad Kim Sing hosted the session and moderated the Q&A portion. One of the things that stood out for him was how moral injury, burnout and fulfillment—while distinct from one another—also often overlap. He noted that there will not be just one solution to the issue of medical staff burnout and encouraged efforts to collaborate with our health authorities and medical groups to learn from one another.

VA/VC results

Dr. Dossa will be a guest speaker at the next VMDAS quarterly meeting. She will present more detailed findings on Vancouver Acute and Vancouver Community survey responses. Mark your calendar for February 24 and keep an eye on your weekly Checkup e-newsletter for registration details.