Academic medical centers around the country are creating groundbreaking jobs to help solve a long-standing problem among physicians in training and practice: burnout and stress. Stanford University took the lead in 2017, when it hired Tait Shanafelt, an expert in physicians’ well-being, as its first chief wellness officer.
Since then, about two dozen universities have placed people in similar roles, says Jonathan Ripp, chief wellness officer at the Icahn School of Medicine at Mount Sinai. He believes he was the fourth chief wellness officer in the country when he took on that role about a year and a half ago. Now, he says, “we’re seeing them all over the place.”
Part of his job involves fostering personal resilience and mental health among clinicians, students, and trainees. But the real focus is on workplace efficiency and culture. “We feel that if we get a handle on that, and enable them to do their work, be the most engaged in their studies and training,” Ripp says, “then that’s going to address the bulk of the problem, as opposed to making them more resilient for the stressors that are experienced in systems that could be improved.”
Ripp, who reports to the dean of the school, says he has spent his first year and a half “developing, putting the office together, recruiting a team, creating our model, raising awareness that we even exist.” He is also senior associate dean of well-being and resilience and an internal-medicine physician, joined Mount Sinai 15 years ago. Around that time, he also started doing research on burnout among medical residents. “I kind of picked a winner, in terms of a topic that not too many people were looking at when I was starting to look at it, and now it feels like everybody’s looking at it.”
To create a workspace that enables people to do meaningful work, Ripp studies problems that might be driving stress. The rise of electronic health records, for example, is often blamed as a contributor to burnout. “But it really is probably just one piece in a complex puzzle,” says Ripp, and his job is to evaluate the impact of electronic record-keeping on various medical practices and deliver that information to the employees who can make changes in the system.
Ripp sees four general arguments for why an institution should have a chief wellness officer. There’s the moral imperative; the tragic case, like a physician suicide; the regulatory case, with the Accreditation Council for Graduate Medical Education requiring that the programs it accredits pay attention to residents’ well-being; and the business case. “The more well your work force,” Ripp says, “the more optimal your health system functions.”
At the Keck School of Medicine at the University of Southern California, Kathleen Nelson, associate dean for leadership and wellness, has a similar focus on systemic issues. She says the school’s new dean, Laura Mosqueda, wanted to improve low morale after a scandal involving the previous dean, Carmen Puliafito. Puliafito resigned as dean in 2016, and left the university the next year after the Los Angeles Times revealed that he had been involved in illicit drug use while he was dean.
Focusing on the wellness of faculty and staff, especially as it relates to Keck’s leadership, was a top priority for the school, Nelson says. Mosqueda hired her just over a year ago to help refocus on “integrity and respect, the kind of values that were not quite obvious in the previous administration,” Nelson says.
Mosqueda’s decision to tie wellness and leadership together in the associate dean’s role seemed like a logical pairing to Nelson. “Leadership is not only about being in charge, but it’s taking care of those who are in your charge,” says Nelson. “A large amount of faculty well-being is predicated on how they feel about who their leader is.”
Seven years ago, Nelson came to the USC-affiliated Children’s Hospital of Los Angeles from the School of Medicine at the University of Alabama at Birmingham, and she has been in the associate dean’s role for just over one year. About 60 percent of her work time is devoted to her role as associate dean, she estimates. She continues to be a clinical professor of pediatrics and brings her experience as a pediatrician and administrator to her role. “The personal attention that I like to give to my patients I try to give to the people coming to my office, be they faculty or trainees and staff,” she says.
Nelson works with a council that represents the relevant groups at Keck: faculty, students, and staff. The council developed a vision for wellness that guides Nelson’s work: “Keck and our Health Sciences Campus is a place that faculty, staff, and learners — students, residents, and postdoctoral trainees — will want to work and to train because it’s a physically and emotionally healthy environment that supports opportunities for them to find joy in their activities.”
Through programming that includes mindfulness training, yoga classes, and weekly farmers markets, Nelson says, her office has been able to work on the “low-hanging fruit” of individual wellness. Some of those efforts, like the Mindful USC program, already existed. “Most people who go to medical school and go through residency and training are pretty resilient individuals. So that’s part of it, but the rest has to do with the culture that you’re living in and the things that are put upon you by the practice of medicine,” says Nelson.
Cultural changes take longer, and Nelson’s plans include gathering data on satisfaction with the leadership and environment at Keck and measuring the effectiveness of existing wellness programs. “As we see what the needs are, the office is absolutely likely to grow.” The Children’s Hospital of Los Angeles is hiring a faculty wellness officer of its own, and the person in that position would work in partnership with Nelson.
As more colleges follow Keck and Icahn in their dedication to wellness, the people in these new roles have joined forces. The Collaborative for Healing and Renewal in Medicine, or Charm, which was co-founded by Ripp in 2015, published its Charter on Physician Well-Being in the Journal of the American Medical Association. The charter, written by Ripp and two co-authors, is part of an American Medical Association effort to get institutions to sign on to a commitment to physician wellness. Charm has also recently started a network for administrators in roles like Ripp’s.
“We have a group that meets virtually or by phone and includes many, if not most, of this growing group of chief wellness officers,” says Ripp. “Whenever I hear about a new one, I try to reach out and invite them in. And it’s meant to be a way for us to springboard ideas and just be aware of who’s doing what and resources that exist to help each other.”
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