Podcast

Well Doc Alberta

March 25, 2022

Listen as host Dr. Caroline Gérin-Lajoie discusses how Well Doc Alberta is addressing physician wellness at the system-wide level. This podcast features the insights of Well Doc Alberta Directors Dr. Jane Lemaire and Alicia Polachek, MA.

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This episode is available in English only

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Physician Wellness: The Time Is Now
A discussion with Well Doc Alberta

We've known for decades that because of the work physicians do, they are vulnerable to being unwell. The study of physician wellness has come to the forefront in the last number of years due to an increased recognition of the physical and mental health threats to physicians, along with a growing appreciation that when physicians are unwell, patient care – in fact, the entire health care system – suffers.

In addition, the COVID-19 pandemic has amplified the gaps in supports for physician wellness and reinforced the importance of building foundational support programs within health care systems.

Occupational distress is common in the practice of medicine because the job of a physician is to help people be well, even when at times it comes at a personal cost to themselves. In addition, the culture of medicine tends to perpetuate the ideal of the superhuman doctor, impervious to any type of distress. In the early days, there was a focus on individual resilience for physicians — the notion that if a doctor was just a bit grittier or tougher, they could successfully weather the challenges inherent to the job. But physicians are human, like everyone else.

While we are witnessing the impact of COVID-19 on health care workers first-hand, the science related to their risk of being unwell has also evolved; there's more emphasis on teasing out what those occupational risks are and articulating the occupational distress syndromes that physicians might be exposed to. We now know that the main causes of physician burnout are due to system factors – related to excessive workload, lack of resources, lack of control and flexibility over their work, and challenges with social support, among others.

To fundamentally shift the culture that views physicians as impervious to distress, we need system-level interventions aimed at improving physicians’ work environments, work structures and the toxic aspects of the culture of medicine.

We also know we need to focus upstream. To illustrate, we can use the example of cardiovascular disease. We treat heart attacks, we stent blocked arteries, we perform angioplasty and we administer thrombolytics, but the real answer to treating cardiovascular disease is risk reduction. And so, over time, our approach has evolved to address the factors that initially put these patients at risk.

The same is true with physician wellness. It’s time for us to go upstream and implement those risk reduction strategies.

At Well Doc Alberta we are working with 45 formal collaborators – most of whom are physicians – who want to help support physician wellness within the system. We are working together to develop and deliver education sessions and other real-time supports that are helping shift the culture of physician wellness and promote positive and productive system-level interventions.

And we find that our efforts are most effective when we do work at both the grassroots and leadership levels, ensuring that there’s support and engagement from everybody who's involved.

Increasingly, there is more awareness about the need for physician wellness strategies and we are seeing more work happening in the field.

Ultimately, our goal at Well Doc Alberta is to help all health care stakeholders understand how important physician wellness is and help organizations implement strategies that have been shown to be effective. This critical evolution will help organizations support their physicians, both in terms of reducing the risk of occupational distress syndromes and promoting mental health.

As a result, we know we can bring about significant change at the system level. It’s time to take our commitment to physician wellness to the next level, taking care of ourselves and each other.

The time is now. The profession of medicine and health care systems are poised to take physician wellness to the next level. Physicians deserve to be protected from occupational distress syndromes and supported in their mental health, and well physicians fundamentally contribute to quality patient care and quality health care systems.

The Canadian Medical Association (CMA), MD Financial Management Inc. (MD) and Scotiabank together are firmly committed to supporting the medical profession and advancing health in Canada. As proof of this commitment, Scotiabank, in collaboration with the CMA and MD, is investing $115 million over 10 years to support physicians and the communities they serve across Canada.

Physicians First Podcast Transcript | Episode 1: Well Doc Alberta

Dr. Caroline Gérin-Lajoie: Welcome. My name is Dr. Caroline Gérin-Lajoie, your host, and I am pleased to welcome you to the first episode of the Physician First podcast, exploring important topics related to the critical issue of supporting physician wellness.
We are pleased to kick off this series of discussions with a conversation with Dr. Jane Lemaire and Alicia Polachek, both of whom are directors at Well Doc Alberta. Well Doc Alberta is an initiative aimed at advancing a collaborative, co-operative, pan-provincial approach to physician wellness. Well Doc Alberta is focused on education and prevention, supported by the science of physician wellness and driven by need.
In their roles, Jane and Alicia, and the rest of the core and extended team, work with physicians at the grassroots level and with leadership to grow capacity, empower change, shift culture and achieve the organization's vision of shaping the future of physician wellness together.
Welcome to you, both.
Dr. Jane Lemaire: Merci, Caroline.

Alicia Polachek: Thank you for having us.

Dr. Caroline Gérin-Lajoie: Jane, to begin with you. Can you talk to us a little bit about what made Well Doc Alberta necessary?

Dr. Jane Lemaire: Well, I think we've known for decades that because of the work that physicians do, we are actually very vulnerable to being unwell.
Occupational distress is really common for physicians because our job is to help people be well and then we feel compelled to keep going despite a cost to ourselves. And then you add to that the fact that the culture of medicine tends to perpetuate the ideal of physicians being superhuman and impervious to any type of distress; we’re actually we're just human, like everybody else. So, the science of physician wellness that looks at occupational distress syndromes for physicians, it's relatively new. In the early days, there was really this focus on individual resilience for physicians, just get grittier, be tougher and you're going to weather through this profession.
But the science related to physicians and our risk of being unwell has evolved, and there's more emphasis now on teasing out what are the occupational risks and the occupational distress syndromes that we might be exposed to. And in fact, as the study of this science has evolved, we now know that the majority of these drivers are actually entrenched in our work environment, and that makes perfect sense because of the work that we do. Science has taught us that 80% of the drivers of burnout are at the system level, and they're related to things like excessive workload, lack of resources, lack of control and flexibility over our work, challenges with social support, a community at work, among others. So, to come back to why is Well Doc Alberta necessary? We know that we need system-level interventions to fundamentally help shift that culture about physicians being impervious to distress. We need to improve our work environment and our work structures.
And we need to ensure support for physician wellness, both for our occupational distress syndromes and for our mental health.

Dr. Caroline Gérin-Lajoie: Alicia, where did the idea for Well Doc Alberta come from?

Alicia Polachek: Thanks for asking about that. So, Jane and I have been working in the area of physician wellness for over a decade, and as we've been doing that work, we know there's a lot of other people across the province of Alberta who have also been doing work in that area. But we identified that there was still a lack of capacity to meet the needs, and that was in large part because the science is relatively new, as Jane mentioned.
So, we saw that there were some people working in certain areas of physician wellness, but there still wasn't enough capacity collectively across the province to meet the needs that we were seeing.
We get requests weekly from groups looking for guidance about how to implement physician wellness and interventions, how to establish wellness positions and roles, or running to offer education sessions to their members. And there just wasn't an ability for any one group to keep up with the number of asks that were being received.
And so, we identified that having a vehicle to help bring people together and to help increase that capacity, both in terms of training trainers, as well as helping to augment the resources that were available for implementing both system-level interventions, would really allow us collectively to get further than any one person or group would be able to on their own.

Dr. Caroline Gérin-Lajoie: Alicia, can you tell us a little bit more about how Well Doc Alberta is addressing some of the challenges you just talked about?

Alicia Polachek: Well Doc Alberta is really quite an innovative model, so we're a cooperative of sorts where we have experts that come together to collaborate in order to achieve our vision of shaping the future of physician wellness together. And I think there is kind of four key components to our model that I think really help us in supporting physician wellness. First, because we're a collaborative program, we welcome experts with a variety of relevant backgrounds to come and work with us.
And actually, as of right now, we have 45 formal collaborators that are working in Well Doc Alberta, and that list is constantly growing. We're always onboarding new people. These collaborators are primarily physicians who want to help support physician wellness within the system, and everyone is bringing their unique expertise and their training to the table to look at physician wellness from different angles. And collectively, we then work together to develop and deliver education sessions that really do help to shift culture and promote system level interventions that support physician wellness.
The second component is that everything that we do is based on and grounded in the science. So, we don't conduct any research within Well Doc Alberta, but we look to the literature to identify the best practices and to share information that helps increase understanding about the science.
Third, we see ourselves as being here to assist groups with supporting physician wellness, so we don't tell organizations what they need to do or what they need to put in place.
But they come to us, they identify a need and they explain what they think they need, what some of the challenges are that they're having. And then we tailor our programs and our sessions to work with them and meet their unique needs.
And we find that it's really most effective when we do that work at both the grassroots level, as well as with leadership to really ensure that there’s support and engagement from everybody that's involved.
Finally, Well Doc Alberta is an independent entity that's funded through the Affinity partnership made up of the Canadian Medical Association and MD Financial Management and Scotiabank, and we work very closely with the health care organizations in the province. But it's been invaluable for us to be independent, and so we're really lucky to be able to do this work.

Dr. Caroline Gérin-Lajoie: Jane, can you explain, in what ways is Well Doc Alberta's model different than other models?

Dr. Jane Lemaire: Yes thanks, Caroline for that question. I think Alicia has already laid the groundwork, explaining how we really are this collaborative cooperative. And it's been really exciting to see how many physicians want to contribute to that collaborative. The other key fact is that we in Alberta have a wonderful physician health program, and our medical association makes space for that program; it's called the Physician and Family Support Program (PFSP). So, there's this foundation for treating distressed physicians. The PFSP offers formal psychological support, but we recognized it's time and there's a great need for upstream work so that we can help lessen or mitigate these occupational distress syndromes.
We know our work will never be perfect and stress free, but we really want to try to lessen things like burnout. So, Well Doc Alberta specifically aims to fill that gap in the continuum of support for physician wellness, that upstream gap and we work really closely with the PFSP also to ensure that our work is aligned, but we're not duplicating resources, so it's just a great partnership. So, as I said, we're kind of focused on that upstream work. And if you think about it, we can use an example of cardiovascular disease. So initially we treat MIs, we stent people, we do angioplasty, we do thrombolytics, but the real crux of this illness is risk reduction. And so, at the same time, now we make sure that people at risk for coronary artery disease attend a risk reduction clinic and we address the factors that put them at risk.
So that's the analogy with physician wellness and our philosophy at Well Doc Alberta. And because we have such a strong physician health program that offers formal psychological support, it's time for us to go upstream to do that risk reduction approach.
So then coming back to the question that you asked, why are we different than other models? We really think that we're perhaps the first organization that's been able to focus entirely on upstream prevention and again, not just telling doctors that they have to be more resilient and, you know, take courses in mindfulness, et cetera.
Those things are important, but we're really looking at upstream prevention at the system level. We want to offer access to tools and resources that Well Doc Alberta helps to develop, but we also want to coach organizations on how to use those resources, make them available so they don't have to reinvent the wheel, and then that helps bridge that gap between the demand that Alicia talked about. So many people reaching out and saying, how do we do this? Are the resources already developed? And then the capacity to actually deliver these solutions and most importantly, really embed them at the system level.
So that's us, I think our model is really unique, I think we are pioneers. We use this collaborative cooperative model where we bring people and groups together, and then we can increase our capacity to share. And this is a really innovative model, and as I said, to our knowledge, it's the first of its kind and there is no doubt that the groups that we work with, of course, there are people that, as Alicia said, they're reaching out and this is something they want to do and their culture is ready for it.
But when we work with them, we're really successful in embedding these changes within the systems that the physicians work within, and that's the whole goal. It has to be system-level change for these types of preventative initiatives to be successful.

Dr. Caroline Gérin-Lajoie: Alicia, can you give us an example of how well Doc Alberta was able to pivot during the pandemic and respond to the needs of physicians?

Alicia Polachek: It's a great question, Caroline. I think when Jane and I first had the idea and started implementing Well Doc Alberta we didn't anticipate what these three years would look like. We thought that it might be a little bit smoother sailing in the last two years than what we've seen. But I think because of Well Doc Alberta and because of the really solid foundations that we had in Alberta with over 15 years of active work in the field of physician wellness, we were actually really well positioned here in the province. There was already a breadth and depth of expertise. So, we were able to help anticipate some of the needs that we would see arising from physicians. There was a lot of formal wellness physicians within many of the organizations across the province, not just within Well Doc Alberta.
There was emerging leaders and groups that were advocating for physician wellness, who really, truly understood the science and we were already starting to see a culture shift within the profession of medicine in Alberta and more broadly over the last 20 years.
And wellness was really becoming more welcome and more normalized and brought to the conversation. And because of those solid foundations, physician wellness was formally represented at many of the pandemic planning committees in the province, and we were fortunate compared to many other groups that we spoke with.
We had outreach from people across the country and we had conversations with people in other countries as well, where wellness wasn't part of the planning, they weren't at the table and they were trying to kickstart wellness interventions from scratch.
And so, we tried to provide some consultation, but it's really hard to implement new programs in the midst of a pandemic.
One of the specific needs that we saw during the pandemic was around moral dilemmas and moral distress.
We know that at baseline, the practice of medicine has a lot of moral challenges involved in the work. But we've really seen that amplified over the course of the pandemic, and we've had a lot of groups reaching out to us wanting guidance about how to support their members and wanting education sessions and opportunities to reflect about the moral dilemmas and the moral distress that they've been experiencing. And so that's become one of our most popular sessions over the last year in particular, I would say, where we've had a lot of interest and appetite in learning more about that concept.

Dr. Caroline Gérin-Lajoie: Alicia, how is Well Doc Alberta measuring its success?

Alicia Polachek: In the early days of Well Doc Alberta, almost three years ago, one of our first tasks was to develop a robust evaluation framework, so we actually evaluate each of our education sessions for feedback that we use to help improve our future offerings. Over the next several months we're also tapping into some additional programmatic measures to better understand the impact that our programs and the system-level interventions that we're helping groups implement are having. One of the key acknowledgments that we do want to make is that it's quite challenging to measure some of the outcomes, such as culture change.
And it takes time to implement interventions within the system and then to see the impacts that they're having. But ultimately, there is literature that now outlines a blueprint for supporting physician wellness through ensuring that foundational programs are developed and available, and we're helping groups understand those best practices that are in the field of physician wellness, and we're providing guidance and education about how to implement those foundational programs. So, we feel that because we’re relying on the science and the best practices, it’s clear that we’re going to be having an impact.
We also know that Well Doc Alberta is having an impact in terms of the capacity that we've already talked about today.
So, as I mentioned earlier, there has simply been an overwhelming demand for this kind of education and support. And this has been the case for many years, but it's only grown over the last two years as well, with the increasing attention that's been given to physician wellness as part of the pandemic.
So, by leveraging the collaborators that I spoke about, we have really been able to start increasing that capacity and we've been able to meet more of the need than we could previously. We kind of look back at some of our numbers over the last year. So, for 2021 we actually collectively delivered 57 sessions and reached over 2,100 physicians across the province, which were quite impressed by. This would have been pretty much impossible for any one person to have achieved before. And so, our success was partly evident in the breadth of our reach and in that ripple effect in terms of how the information is continuing to be shared and culture is starting to shift and change as we connect with more and more groups across the province.

Dr. Caroline Gérin-Lajoie: Jane, can you tell us a little bit about Well Doc Alberta's long-term goal?

Dr. Jane Lemaire: I think that's the exciting part, as we're coming to the end of our three-year pilot funding, and we're so grateful to have had the opportunity to be a pioneer really in this area of upstream mitigation of occupational distress for physicians.
But Well Doc Alberta really is a pilot project, even though we were fortunate to pilot it in Alberta. We really want to share our expertise and our learnings with others. And that way we can extend the impact of what we've been able to do here in our province across the country or to others who feel like they might benefit from some of these learnings as well. So, we're entering the stage where we have our organization built, we have a really nice model, a solid foundation, our processes seem to be working, and our approach and the information that we share is continually evaluated. So, like Alicia said, we have a rigorous evaluation process in place. We know there are programs that we use to help groups implement are evidence-based and best practices, they're shown to impact occupational distress, lessen burnout, et cetera. So now it's time to roll them out more nationally, and we have started to have conversations with other jurisdictions about how we might support them. So, it really is time to offer this resource to others.
And then more specifically, Caroline, our long-term goal pending funding for us, is to work with other groups and just help coach them on how they can also implement these foundational programs locally and then adapt them to other contexts because obviously, it won't be the same as it is in Alberta in terms of implementing the programs. So, we have some logistics to sort out with other groups.
So, what's our long term goal?
I think the key takeaway is that our long-term goal is to really help physicians so that they're less at risk of occupational distress syndromes because we know that if physicians are well, patient care is better, and the quality of the health systems that we work in are better.
And that's really our long-term goal. So, we need to understand how important physician wellness is, and there's a blueprint of what organizations and systems need to implement. The science has taken us to this space. And so those system-level interventions and those foundation programs are what are critical to physician wellness and with the funding that we've been provided that we're so grateful for, it has given us the infrastructure to help groups launch these interventions. And so, it's time to take it to the next level.

Dr. Caroline Gérin-Lajoie: Alicia, can you talk a little bit about the role of funding in supporting the development of a program like, Well Doc Alberta?

Alicia Polachek: The funding that we've received has been instrumental to us being able to do the work that we do.
I think physician wellness is often under-funded and there aren’t formal positions and formal funds for interventions at the system level. And so, we see a lot of people who are trying to do this work off the side of their desk without institutional and organizational funding support to do that.
And so, by having the funding that we've received for Well Doc Alberta, we really have the time and the resources to be innovative and to do things well and pilot new programs and interventions and then to share that with others and grow that capacity.
I think that's been key to our success because without that funding, we wouldn't have had the time and the capacity to be able to do that. And I think the next step is to make sure that there's also funding available within the institutions and the organizations to sustain much of the work that's going on. So, looking at resources for funding formal wellness roles and interventions to keep all of those important aspects of work moving forward.

Dr. Caroline Gérin-Lajoie: I have a bonus question to ask, Jane.
I heard you say in a previous conversation that in the world of physician wellness, this is our time. And I wonder if you can inspire us by adding a few thoughts around that quote.

Dr. Jane Lemaire: Thanks, Caroline, I'm smiling here. You know, I've been doing this for 15, 18 years, and Alicia, alongside me for a better part of a decade and so many other people. You know, we could go on and on naming pioneers in this field Mamta Gautam, you know, yourself and so many others. And we've had a lot of people kind of pooh pooh the work that we do, or roll their eyes at us and culture shift takes a really long time. I think that before the pandemic, the science had reached a point where leaders and organizations started to understand that by keeping physicians well, it keeps their systems well. So that was starting to happen and the culture was starting to shift. The silver lining of this pandemic is that it really has heightened everyone's awareness for the need for mental health supports, not just for physicians, of course, but for the entire population that suffered this mental health trauma related to the pandemic.
But physician wellness has really come to the forefront because of the both the physical, biological and then the mental health threats to physicians and people recognize even more so that when we're unwell, the system crumbles around us.
So yes, I feel like this is our time and that's going to be the silver lining from this pandemic. And I think that there's been this amazing acceleration of leaders, systems, individual physicians, organizations recognizing that if we support physician wellness, we support quality patient care.
And in the end, that's what we're here to do.

Dr. Caroline Gérin-Lajoie: Thank you to Dr. Jane Lemaire and Alicia Polachek. Well, it seems our time has come to an end, but I wanted to thank you both for joining us today and sharing a glimpse of your work with Well Doc Alberta and your efforts to address physician wellness at both the grassroots and systemic level. We really appreciate you sharing your expertise, your insights and all your passion with us.
Thank you as well to everyone listening today for joining us for this important conversation. I'm Dr. Caroline Gérin-Lajoie, your host, and this is the Physicians First podcast.

END

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Physicians First Podcast Transcript | Episode 1: Well Doc Alberta

Physician Wellness: The Time Is Now
A discussion with Well Doc Alberta