How to Support Clinicians Reluctant to Seek Support

Free Peer Support Offering for Healthcare Workers Gains Global Traction

By Megan Headley

New York insurer EmPRO Insurance Co. has long been providing peer support and other management tools to help healthcare workers deal with chronic stress and other burnout-related issues. It is, after all, good business for a medical malpractice insurance company to keep the physicians it insures in excellent shape.

However, since March 2020, the company has opened its support groups to healthcare employees around the world who may need help managing the mental and emotional stress of the COVID-19 pandemic. To date, more than 1,000 professionals from all 50 states and other countries, including India, Israel, and Canada, have taken the company up on these free, anonymous resources.

Gerri Donohue, vGerri has a accountice president of education at EmPRO, who developed the company’s physician peer support program, calls this popularity more evidence of the need to better support frontline workers’ emotional needs.

“A peer support program, especially of the complexity of the level that EmPRO offers, is not really something that we’ve seen in the industry,” Donohue says. “Why not offer it to as many healthcare workers as we possibly can?”

As Donohue remarks, EmPRO isn’t actively seeking to collect information about the diverse group of physicians who are tuning in, although some clinicians have volunteered the information that they’ve set their alarm clock to Eastern time to tune into a group discussion session. This group is less about marketing and entirely about removing isolation—which is a key contributor to physician burnout and has only intensified since the beginning of the pandemic.

In the roughly 10 years since EmPRO began offering emotional support tools, the company has recognized, perhaps paradoxically, that as an insurance company they’re able to provide a unique level of support to clinicians suffering from burnout and chronic stress.

“It’s very difficult for hospitals and healthcare organizations to try to implement something like this within their organization because of disclosure issues and fear,” says Tristan Mueck, DO, assistant medical director at EmPRO. “We know that there are hospitals telling people what to say and what not to say outside of their organization, and that [clinicians] are worried about termination related to things that they have said in relation to the pandemic. In that environment, having an honest, open discourse is very difficult.”

Because the healthcare workers taking part in these programs come from so many health systems, EmPRO’s leaders hope there’s greater trust in the anonymity their program offers. It’s a model that could prove useful to other third-party support groups or health systems working together to drive greater adoption of their burnout prevention offerings.

Permission to seek help

Donohue notes that the pandemic seems to have given physicians more “permission” to admit that they need help, and that could be contributing to the uptick in people registering for support sessions.

“Physicians are terrible at assessing their own level of stress,” Mueck adds, citing a 2014 study published in Annals of Surgery. A survey of 1,150 U.S. surgeons asked to assess their own well-being relative to their colleagues found a majority (89%) believed their well-being to be at or above average—including 71% of surgeons with scores in the bottom 30% relative to national norms.

“It just shows how physicians are disposed to minimize their own suffering psychologically and to bear down and take whatever load is placed upon them,” Mueck says. “That’s what we’ve seen with the pandemic.”

That’s one reason Donohue sees burnout-prevention programs as critical to implement today: These programs may now be more likely to encourage healthcare workers to care for their own emotional needs and build habits that could improve their health in the future.

“When the vaccine comes and everything starts to fall back into some sense of order and normalcy, there may be a tendency for physicians to retreat rather than to go for help,” she cautions. “It’s in the nature of physicians. They want to give and they want to help.”

Support that deemphasizes stigma

While EmPRO’s physician wellness program includes individual and group peer support elements, it also relies on programming that does not emphasize providing help, but instead focuses on building community. In many ways, the stigma around support has shaped the programs the company offers.

“Most of our groups are not called support groups,” Donohue explains.

One recent example is the company’s Writer’s Studio, run by narrative medicine specialist and endocrinologist Barbara Hirsch, MD, MS. In these recent sessions, Donohue says, “[Hirsch] will bring a story or poem, everybody will take a look at it together, and it usually leads them back to COVID, even though the story or poem had nothing to do with COVID.”

Narrative medicine uses reflective writing or literary analysis to help humanize healthcare. It increasingly helps physicians connect with patients at a human level, pushing them to use storytelling to look more fully at the patient. In these programs, however, stories also provide a cathartic release for the stressors that clinicians face. What’s more, Donohue says, a program can provide this release without being advertised as a support group.

“If you ever asked those physicians if they went for support that night, they would say, ‘No, my insurance company is offering something that reminds me of my college days in literature that I loved.’ In fact, they’re expressing their fears of getting sick themselves, bringing sickness to their families, and the stresses that they face on a day-to-day basis,” she explains.

The company’s mindfulness offerings are promoted in much the same way, as is its newest offering, Women in Medicine.

“When you look at that title, nothing comes to mind initially. It could be women in medicine getting the same pay or women in medicine becoming CEOs of hospitals,” Donohue says. “We wanted to do that intentionally to let it take its own form.”

The goal, however, was to create a place where women could form supportive connections and begin to turn the increasing tide of risks uniquely impacting female physicians. The program was built with a 2020 JAMA study in mind, which had found that while male physicians are 33% less likely to die by suicide than men in the general population, female physicians are 46% more likely to die by suicide than women in general.

Ultimately, Donohue says, this was the heart of this targeted group’s earliest meetings. “We wanted to have a place for them so that when the group is over that they have a connection with each other, another woman physician going through something very similar,” she says. “We are hopeful that we’re going to be able to reach those who have been a little bit more silent in their suffering and give them a life preserver.”

An important trend

The Medscape National Physician Burnout and Suicide Report 2021 released this January found that, percentage-wise, physician burnout remains at the same critical level as before the pandemic, with 42% of physicians reporting burnout. However, the pandemic has changed the specialties hit hardest, with critical care, rheumatology, and infectious disease specialists ranking among the highest in reporting burnout for the first time. Nearly 80% of the 12,000 physicians surveyed said they had felt burned out before the pandemic began, and only 8% named the stress of treating COVID-19 patients as the primary cause of burnout (most cited bureaucratic demands).

If Donohue’s and Mueck’s observations are correct, healthcare workers who have been dealing with burnout for some time are finally, as a result of the pandemic, seeking critical support and self-care. Putting more such tools and support in place now could help make this a growing trend in the months and years ahead.

For more information on EmPRO’s peer support offerings, visit https://www.myempro.com/how-we-help/new-york-physicians-peer-support-group-for-malpractice-litigation.

Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at megan@clearstorypublications.com.