A couple of weeks ago the AMA send out a newsletter addressing bullying in healthcare focusing on the results from special task force in 2020. In looking over the results of this task force, I noticed a copyright dated 1995 to 2020. This means the AMA had at least some of this information going all the way back to 1995. This was very upsetting to me. Now, don’t get me wrong, I’m quite pleased that the email is addressing bullying in healthcare. Bullying is a strong driver a burnout, and burnout is at crisis levels. In fact, burn out was a crisis levels prior to the pandemic, when it affected 50% of all healthcare workers. It now affects at least 67% of all healthcare workers.
I’m simply saying, the AMA should’ve done something about this back in 1995. Or, at least prior to this becoming a crisis. I also believe that they should come right out and state that bullying is a driver of burn out. They haven’t done that. What they have done is offer us the definition of workplace bullying. That’s helpful. They’ve come up with a program for healthcare organizations with 100 providers or more. There are a lot of organizations out there that don’t have 100 providers and for those, all they’ve come up with is that you can sign a statement saying you’re going to work on it. I’m not sure if that’s helpful at all.
The AMA program is called Joy in Medicine, and has bronze, silver, and gold medal levels. It recommends baseline testing of providers to see their levels of burnout, and does this with four different forms of testing. It recommends putting in place measurements for teamwork, support, and leadership. It also defines contributors to workplace bullying, including the following: a bullying culture, poor staffing levels, excessive workload, power and balances, or management skills, role conflict or ambiguity, stress, and lack of autonomy. It also defines contributors to workplace bullying, including the following: a bullying culture, poor staffing levels, excessive workload, power and balances, or management skills, role conflict or ambiguity, stress, and lack of autonomy. There is a little other information on the program.
My concern here is that the AMA is well-intentioned, but isn’t doing enough. Medicine is facing a crisis. Healthcare is facing a crisis. 67% of our providers are burnt out. 400 physicians a year are committing suicide. And all we have is a program for organizations with more than 100 physicians, and a promise from organizations with less than 100 providers. Not a promise to the smaller organizations, but a promise from the small organizations. None of this is very well-defined, and I’m not sure where they’re going with us. More importantly, I’m not sure the AMA knows where they’re going with this. We need answers today. And we need answers that are implementable. We don’t need physicians dying, particularly by their own hand. We need things to change and we need them to change soon. We know that 80% of what causes burnout happens at the organizational level, and people who will run organizations are generally not physicians. Will take them to task?
I don’t have the answer to this question I don’t know who will take them to task. However, I do know that this is why physicians are fighting back. They’re fighting not only for their livelihood, but for their very lives. In rural America, during the pandemic, hospitalist physicians were not getting off work until after grocery stores closed. They were being expected to work 12 to 24 hour shifts without food. The only meal they got during the day might be the one meal a day that might be provided by the hospital. Yes, this affected the nursing staff too, but the nurses are only working 12 hour shifts. The nurse is also only work three days a week, but the hospitalists 12 to 24 hour shifts, 10 to 14 days in a row. I found myself bringing them meals from home. Or, having them stop at my house for a meal on their way home from the hospital. It wasn’t exactly pandemic safe, but it was still the right thing to do.
Why are hospitals and organizations taking care of their physician staff anymore? Do they think we’re invincible? Do they think there’s an endless supply of us? Do they think they can endlessly abuse us, and we will keep coming back for more? Something has to give. Unfortunately, what’s giving are the physicians, and we’re burning out. And it’s not changing. This is the crisis of the American healthcare system. What do we do now as physicians? Do we get behind this AMA program that seems poorly defined? Do we demand further information? Or a better program?