Melanie Cole: Physician burnout is an epidemic in the U.S. healthcare system. And, according to a study published in Mayo Clinic Proceedings in 2019, 44% of physicians are reporting signs of burnout, such as emotional exhaustion and depersonalization, at least once per week.

Melanie Cole: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and joining me today is Dr. Angela Chaudhari. She's the vice chair of Faculty Development, system director of the P2P Network for peer-to-peer support and associate professor of Minimally Invasive Gynecologic Surgery in the Department of Obstetrics and Gynecology at Northwestern Medicine. Dr. Chaudhari joins us today to discuss the P2P Network and how the program offers support to physicians facing emotional stressors and burnout.

Dr. Chaudhari, it's such a pleasure to have you with us again. I'm so glad you're joining us. In 2017, Northwestern Medicine created the Scholars of Wellness Program, which included a selection of 10 physicians to champion wellness programs that combat physician burnout. As a scholar in the first cohort, what inspired your peer-to-peer wellness program?

Angela Chaudhari, MD: Well, first of all, talking about that Scholars of Wellness Program, probably one of the best programs that I ever participated in. It was really an honor to be part of our inaugural class. The Scholars of Wellness Program really was designed to create physician leaders in well-being here at our institution such that we can really begin to combat physician burnout at individual levels, department to department.

And when I applied for that program, I had this idea that really, we, as obstetrician-gynecologists, experience burnout maybe differently than some of our colleagues. We worked really and had to deal with the very high, high highs of delivering life into the world. We also had to deal with the worst of the worst, you know, the really low times when people lost a child. And those highs and lows, really, I think can contribute to physician burnout.

So as a scholar, I created a survey of my colleagues in OB-GYN to better understand how they felt about the ups and downs of our job and really try to figure out how to best find ways to support us through that, and that's really where the inclination, the idea for the peer-to-peer support network came from. 
 
Melanie Cole: So, how has the P2P network shifted as a result of the pandemic? And now as things are getting back to a new yet more normal, how has the program shifted to help physicians in these unprecedented times? You and I spoke once before, kind of nearer to the pandemic about this. So, how has it sort of shifted since then?

Angela Chaudhari, MD: Oh, Melanie, it has shifted tremendously over the last few years. You know, we started this program for OB-GYN back in 2019, and we were actually due to go live with our program right at the start of the pandemic, February 2020. And very quickly, we had to pivot, not just to support doctors around adverse events and complications, but also to really begin to support doctors around the distress of the COVID pandemic. So really, it was a lot of our COVID response, and we were lucky to have amazing physicians already trained in psychological and stress first aid to really assist our colleagues through some of that. So, we worked really closely with Employee Health, Employee Assistance Services to really be the peers that supported our colleagues through some of these events.

But, you know, since the pandemic, you know, burnout has not gone away. And in fact, we've seen physicians continue to be burnt out. I think the most recent Medscape survey for OB-GYN said 53% of OB-GYNs are burnt out and experience some of the symptoms you mentioned in your first line of this podcast. And what we know is that the pandemic has actually brought along new issues. We're finding that our physicians, really, their wells are dry. They're not really able to kind of bounce back as quickly as they were before. And that's just because they've been working, working, working so hard over the last few years.

And so, our program has really, really expanded. The first thing we did was take our adverse events program and say, "This isn't just an OB-GYN problem. This isn't just a downtown academic medical center problem. This is a system-wide hospital problem. And we're able to really work with our colleagues out in our north, northwest and now south regions, really find leaders in those areas that really found that this was a really important area for wellness for our physicians. We were able to identify network leaders, really, physicians that are really drawn to peer support as the thing that brings them meaning and purpose in their work and have brought them into our Office of Well-Being. And we've been able to expand that program to physicians across the system.

In addition to adverse events though, with the advent of the COVID pandemic, we really found that it wasn't just adverse events that was getting us down. There is so much more. Our colleagues really experience this idea of compassion fatigue. The idea that they care so much that they're exhausted by it on a regular basis, so any small adverse event actually can tip them over to really running down that burnout path. We also found that doctors undergoing things like peer review or legal cases, or maybe even experiencing difficult patient situations where maybe discrimination or racism came into play from patient to physician was really, really detrimental to their overall well-being as well. And our program has now expanded to train our supporters to support around all of those different areas for our physician colleagues.

Melanie Cole: Such an important program. And I'd like you to tell us, Dr. Chaudhari, why it's so important for physicians to connect with one another for that support as opposed to just individual strategies. Obviously, those are important. The ones to increase resilience such as yoga, meditation, resilience training. I'm an exercise physiologist. I understand the importance of those, and those approaches and modalities help with that mental health aspect, but it's also important for physicians to connect together, yes? Tell us about that.

Angela Chaudhari, MD: Oh my gosh. I think connection is one of the most important things to get through some difficult times. And I think most of us can recognize that even in our personal lives, right? Connecting with our families, connecting with friends. I think if nothing else, the pandemic brought that to the forefront where, when we were so separated from our personal lives, that we had to really reach out and find different ways to connect, whether that was, you know, Zoom cocktails with friends or, you know, meeting with family that lived far away over video chats.
But I think when it comes to physicians, in general, physicians are pretty good at taking care of themselves. They do yoga, they do meditation. In fact, there's been studies to say that physicians are some of the most resilient professional workers that we have out there. There's been studies comparing them to people like ambulance workers and firefighters. And you know, we live in that same type of trauma every day when we take care of patients. And yet, physicians were 30% more resilient in the study I'm thinking of. And yet, we're actually about 30% to 50% more burnt out than some of those other professionals.

And so, really, what we know is we need more than yoga and meditation and resilience training. We probably need changes in our systems that really allow physicians to work and optimize their work. But what we can do, as individuals and what we aim to do with our P2P platform, is really begin to connect physicians because we recognize that those who've experienced similar traumas, similar difficulties in their work, are able to better support others. And to be honest, physicians are the absolute worst about connecting with mental health therapists or meeting with our Employee Assistance Services. We've shown that at our own institution. And so, really, meeting with colleagues is what makes all of the difference.

Melanie Cole: Thanks for telling us about that. And tell us some of the tools and strategies that physicians can use to stay well and that you're using in that peer support network as they're interacting with each other and discussing these things. Tell us some of those tools and strategies that you recommend.

Angela Chaudhari, MD: Well, you know, when a physician or any healthcare worker really goes through a difficult situation at work, be it a discriminatory patient situation or an adverse event, that really is a trauma. And our program is really designed around the ideas that those small traumas that we experience every day are occupational hazards of the work that we do, right? And so, in order to protect ourselves from those occupational hazards, obviously one of our goals in the Office of Well-Being is to really create systems to improve the way our efficiencies and our resources work around us to protect our healthcare workforce.

But in addition, we know that no matter what happens, we all get wrapped up in individual patient care and the trauma that can occur with patient care. And so, that's why we really think peer support is a critical component of that. And in fact, Melanie, we are actually working to expand this, not just from physicians, but now we're moving into our nursing and our advanced practice provider healthcare workforce because we recognize that, though our nurses and APPs might experience some of those traumas differently than physicians do, that too is traumatic for them. And they too need some of the psychologic first aid that we provide with peer support.
Melanie Cole: So important. I'm glad you made that point. So, how do they connect with one another? Tell us a little bit about how it works.

Angela Chaudhari, MD: Oh, the details, the nitty gritties. Once we get a referral into our peer support program, it goes through me and our Office of Well-Being to really better understand what the situation was that they're being referred in for. And those referrals can come from a variety of sources. We see people actually self-refer after an event. We have peer referrals. I get calls from colleagues that maybe recognize that their colleague is struggling after an event. We also partner with risk management, our legal department, Employee Health, Employee Assistance Services, really to get referrals from a variety of places when our docs really think that they might benefit from connecting with a peer. And we hope to continue those relationships as we expand to nursing and advanced practice providers.

So once those referrals come into our Office of Well-Being, we aim to really put our healthcare providers with a colleague who also maybe has experienced something similar. So, our peer supporters, we have now almost 80 across the system — all physicians so far. We have our first nursing trainings scheduled in February. And we're really, really looking to understand the situations maybe those healthcare providers have been in and what they really feel comfortable supporting around when they go about supporting our colleagues.

So, once we get a referral in, we assign them a peer supporter who's been trained in psychological first aid, and then they often meet. Sometimes it's over coffee, sometimes it's by phone, sometimes it's by Zoom. But really a place to come together and create a psychologically safe space for our colleagues to really work through some of the trauma that they've experienced and be able to express their feelings about that issue. This isn't really meant to be a debrief session about the clinical work that they did. It's instead really a session designed to ensure that they're coping after that event, so that they can really be at their best when they move forward into caring for new patients in the future or similar situations in the future.

Melanie Cole: What important work you are doing, Dr. Chaudhari, across the healthcare spectrum. And you've scaled your program at Northwestern Medicine to become a network across multiple hospital organizations. Tell us how that came about.

Angela Chaudhari, MD: Well, I think physicians are burned out everywhere. And, unfortunately, we know that all these traumas that people experience in their everyday work in the healthcare system happens everywhere. But we actually felt really strongly as we went to expand to our system level that, really, each of our hospitals is an individual unit. We all function together as a team, as a system, but we also have our individual personalities.

And so, we thought it's really important to bring in leaders from each of those institutions to help us design the program such that it met the needs of our individual hospitals and our individual physicians. You know, here at the academic medical center, we have a mix of a large group of faculty, a smaller group of private practice. But actually, at our outside institutions, we have a smaller group of employed physicians and sometimes a larger group of private practice physicians. And we want to make sure we're meeting the needs of all those different colleagues when we think about peer support. We've been able to bring in a lot of volunteer peer supporters from across specialties, both employed and private practice, to better have the peer supporters that we really need to support our docs as they go through some of this work.

Melanie Cole: Wow. So important. And really, I love that the nurses' part, that they're coming in now because we learned so much during the pandemic about really all across the board for healthcare providers, but the nurses really stepped up. I mean, just amazing. So, this is such a great program. And through the creation of this P2P Network, Dr. Chaudhari, you’ve learned that the infrastructure can be expanded to create specialized support teams. Can you expand on that a little bit for us now? 
 
Angela Chaudhari, MD: Absolutely. Well, we're still in the process of creating, and we're looking to our nursing leadership and our nursing peer supporters to help us really design the program that they need for nursing and advanced practice providers. So, it's really exciting. We have advanced practice leaders in all of our regions right now as part of the Scholars of Wellness Program, helping us design how we see that and how we best roll that out for advanced practice providers. We have a number of nursing leaders within the academic medical center, as well as across our system, that are really helping us figure out how to design this best for our nursing staff.

With the differences in the way our schedules work and the different arenas that our nurses work in, you know, I think you're absolutely right, our nurses have really been the backbone of our health system, I mean, forever, but really have been recognized over this last three to five years. I really couldn't work without my nurse and APP support systems that I have in place. And so, recognizing that and recognizing that they also go through some of the same trials and tribulations in their job, the same traumas that physicians experience. And ensuring that we get them the support structures that they need as well has become such a priority here at Northwestern. 

Melanie Cole: My favorite question I get to ask you today, Dr. Chaudhari, is what's been the most rewarding part for you in starting this peer-to-peer network? It's really an amazing platform that you've got, and you're helping in an area that we didn't used to think about burnout and physician burnout, and it's probably been around a lot longer than most of us have really realized. But what's been the most rewarding part for you, reaching out to your colleagues and helping them to reach out to each other?

Angela Chaudhari, MD: You know, I think one of the things, when we think about all the different drivers of physician burnout, when I talk about physician burnout, I talk about the meaning in my work and my purpose being sort of what drives us to go. And, you know, for everyone at our institution, patient care, quality, safe patient care is our No. one priority all the time for our nurses, our APPs, our physicians. But for me, I find that, in addition to that work that I love with my patients, caring for my patients, doing surgery on my patients, what I really also find is that what brings me a lot of meaning and purpose to my work is really helping care for my colleagues. And I think I've always been someone who's, you know, been the person that maybe people talk to after a bad day. But now to be in a position where we can impact so many people and really have such an amazing team of both the people I work with in the Office of Well-Being as well as our amazing peer supporters that have come together; we now have a well-being council downtown, they've all come together. Everyone's doing this amazing well-being work at their individual levels. For so many people to come together and recognize this is what's important to us, this is what really drives our meaning at work so we don't get burned out as individuals, I think is one of the most important things.

I often quote one particular doctor who, when we've reached out to him, a senior physician, he experienced an adverse event and, you know, he's a seasoned surgeon. And he said to my peer supporter, "Wow. I'm just so surprised anyone cared that I had a bad day today." And honestly, it broke my heart, but also brought me so much warmth in recognizing that that's the impact that my peer supporters are having on our colleagues every day.

Melanie Cole: I can see that about you, not only your passion for this network and the peer support that you've helped to create, but also your compassion. And I imagine that that comes out with your patients, with your nurses and your advanced practice, you know, practitioners and all of your colleagues, Dr. Chaudhari. You're just so lovely. If a physician listening is interested in expanding the P2P Network for their own health organizations, how do they start? And for physicians who are listening, share examples of how both organizations and individuals can create that environment that supports wellness for physicians. It's so important.

Angela Chaudhari, MD: You know, I often tell people, so many people ask me this question when I go and talk about our program, and I say, I recognize in smaller institutions that maybe peer support isn't something that you can start at a big level like we've been able to do here at Northwestern. But so much of the time, I think all of us as healthcare providers can walk into an elevator and see someone crying or, you know, removing their tears in the elevator. And almost always that's because they've either heard something terrible about a patient or something's happened to them personally in their family. And the easy thing to do is turn the other way and walk off the elevator at your spot.

The hard thing to do is to turn around and say, "Hey, you doing okay? Do you need anything? Can I help? Do you need someone to talk to?" And I know that sounds crazy in an elevator, right? That you might say that to somebody, and it's uncomfortable, right? But I think that if we don't start recognizing those small moments when people are really hurting, that's when they most need that helping hand, that kind voice, that potential shoulder to cry on.

You know, we've created some physician lounges here at Northwestern, and often I find that's the biggest benefit of our physician lounges is I can walk in there and I can see someone typing away on their computer and being frustrated on the phone and I can say, "Hey, are you doing okay? It sounds like you're really frustrated today." And oftentimes, they'll go into a whole story, not per se, about the individual thing they're frustrated about, but a difficult patient situation they just experienced that's really leading to that frustration. And sometimes just talking about it is really all that people need to get through it and be able to move on with their day in a better mood and in a better place.

Melanie Cole: You just smile with your eyes, and they're so lucky to have you because, I can tell that people want to talk to you and that you offer so much comfort to your colleagues. As we wrap up, Dr. Chaudhari, is there anything else you'd like physicians to know about this program and the resources that are available through that P2P Network at Northwestern Medicine? For the physicians that are feeling that extra stretch and pressure, how can they reach out to you?

Angela Chaudhari, MD: You know, we currently have a P2P Network email. If you're in the Northwestern system, if you type in P2P on your email system, we pop up. Send us a note. If you're looking for a peer supporter to help you through a difficult time, we are available. We also, you know, are able to really direct people to other resources that maybe they're just having, you know, generalized difficulties in their work and looking for somebody to talk to on a more long-term basis. We're able to connect you with our Employee Assistance Services, therapists that are both within and outside the system to protect your privacy. There's so many different avenues here at Northwestern Medicine for support. And you know, I even mentioned if we have non-clinicians listening right now, some of our scientists, you know, Dr. Gaurava Agarwal, our chief wellness executive, also serves as our faculty liaison for wellness for the university, and I know he has some amazing resources for our non-clinician faculty as well. So, there are just so, so many resources available.
And the biggest thing I can really leave with is please, please, please, if you're feeling this way, reach out for help. You are not alone. So many people here at our institution and outside have felt what you are feeling, and we're really here to support you.

Melanie Cole: What a comprehensive program and so important. As you say, the need is huge. And thank you, Dr. Chaudhari, so much for joining us today and telling us about this incredible program that really does help physicians and providers and really across the healthcare provider spectrum. Such a need that we may not have realized before, but now we really are. It's a great program. Thank you again for joining us.

And, to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org to get connected with one of our providers or to find out more about the P2P Network. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.