Oregon Wellness Program: A Statewide Approach for Addressing Licensee Burnout

The high demands of the medical profession are often associated with physician stress, mental health duress and isolation, which in turn correlate with increased career discontent, attrition from practice, illness and possibly suicide.

Earlier this year, Medscape published the “National Physician Burnout, Depression & Suicide Report 2020,”¹ an online survey of more than 15,000 physicians from 29 specialties. Of the physicians surveyed, 42% reported experiencing burnout, defined by the survey as “long-term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job, and lacking a sense of personal accomplishment.” Approximately 16% of those surveyed also indicated they experienced feelings of colloquial or clinical depression. A separate study conducted by the Harvard T.H. Chan School of Public Health et al. deemed burnout a “public health crisis that urgently demands action.”² 

In acknowledging the tremendous effect burnout and suicide have had on the medical profession and the attendant impact on patient safety, the Oregon Medical Board (OMB) added a goal to its Strategic Plan: “Promote and maintain the wellness of OMB applicants and licensees.” To achieve this goal, the OMB has partnered with a network of professional societies and health care institutions to establish the Oregon Wellness Program (OWP).

Health care professionals may experience remarkable stress dealing with work and personal demands. While many aspects of the profession are rewarding, other demands can be negative and may become disabling, leading to the need for assistance.

The OWP is a proactive, upstream approach to help licensees avoid impairment in their practice of medicine and to promote the well-being of Oregon health care professionals through education, research, and coordinated regional in-person counseling and statewide telemedicine services. It is the first statewide program in the nation to offer a collection of free, confidential wellness and counseling resources aimed at supporting the well-being of medical board licensees. To help guide the program and keep Oregon's health care providers at the center of its efforts, the OWP has established three core tenets:

• Provide voluntary, highly confidential, professional counseling and support services for Oregon's health care professionals when and how they need it

• Reduce barriers often associated with seeking essential counseling for medical professionals

• Encourage access to resources that foster enjoyment in the medical profession as well as in practitioners' professional lives

The OWP is similar to an employee assistance program, but it operates independently from any employer, health care system, or the licensing board. The program offers eight free counseling sessions per client, per year. Eligible health care providers can access these services through a centralized phone number or by visiting the OWP website. From there, licensees are matched with a qualified psychiatrist or psychologist in their area or via telemedicine.

Visits are generally available within 48 hours and appointments are confidential. Additionally, no diagnosis is reported to third parties, no insurance is billed, and no information is disclosed to others without written consent. The structure of the program makes it possible to make appointments quickly and easily at physician-friendly times.

The program has been developed and sanctioned by physician peers, who understand the complexities and dynamics of medical care. The clinicians who provide services are locally selected and are screened to ensure they have experience in providing care for health care professionals, and receive additional instruction to participate in the OWP. The biographies and professional credentials of clinicians participating in the OWP are provided on the program's website.

The OWP evolved out of “town hall” meetings from early 2014, attended by physician and non-physician leaders of medical societies in Oregon, along with other organizations. The program then developed into the Oregon Wellness Coalition (OWC), a group of leaders from health care professions and organizations dedicated to shedding light on the burden of professional burnout suffered by health care professionals and developing programs to help bring the wonder of medicine back into focus.

Over time, the coalition partnered with the Foundation for Medical Excellence, an Oregon foundation established in 1984 for the same purpose. An executive committee was elected to lead and develop the OWP, which was launched formally in early 2018.

Currently, the program is available to all licensed physicians, physician assistants, and advanced practice providers. There are four regional hubs — the Central Oregon Medical Society (COMS), the Marion-Polk County Medical Society (MPCMS), the Lane County Medical Society (LCMS) and the Medical Society of Metropolitan Portland (MSMP) — accessible to eligible health care professionals for in-person visits in nine Oregon counties (Clackamas, Crook, Deschutes, Jefferson, Lane, Marion, Multnomah, Polk and Washington). Plans are in place to expand to two additional regions, and future planning is underway for sites in other communities in the state. To date, the OWP has provided more than 1,200 in-person and telemedicine counseling sessions. On average, practitioners attend 3.5 sessions.

Collaborative agreements have been made with the current regional sites, and will be made with those currently under development. This allows them to operate independently while facilitating collaboration and the ability to share innovations, resources and problem resolutions.

Plans are also underway to provide similar services through collaborative agreements with the other regional medical societies and two statewide institutional programs. Membership in an Oregon medical society is encouraged but not required to access OWP services.

To ensure the continued success and evolution of the program, the OWP is governed by an Executive Committee made up of members from the OWC, as well as individuals from the Oregon community who have interest and expertise in physician wellness. The membership of the OWC includes representation from county medical societies, the Oregon State Medical Association, the Oregon Medical Board, Oregon Health and Science University (OHSU), Kaiser Permanente, and Providence Health and Services — as well as individual physicians and psychologists, trained in mental health, and other health care professionals.

The Executive Committee meets regularly to organize, advance and implement the program. The committee also conducts research to evaluate the services provided and explores ways to develop more sophisticated methods for both intervention and prevention.

Financial contributions to the OWP have helped the program expand since its launch. Donations to date have amounted to nearly $500,000. Donations have come from the state of Oregon's physician and physician assistant licensing fees, as well as from academic health centers, physician practices and health care professional organizations.

In addition to its counseling services, the OWP offers a Wellness Library, featuring personalized resources for health care professionals. Included are tools to help defuse stress, demonstrations of research-based innovations in the wellness arena and insights from the life experiences of health professionals that can be shared among colleagues to help as they seek to cope with stress.

The Wellness Library includes clickable infographics and direct links to an evolving collection of current articles, studies, videos and podcasts discussing physician burnout, stress, depression and general wellness. The library is designed to be accessed from anywhere, on the go or in the office.

Health care professionals are central to the safety and health of the community in which they practice. Though many of the aspects of a career in medicine are rewarding, every medical provider experiences remarkable, often overwhelming stress. The OMB strongly supports and encourages its licensees to take advantage of the services provided by the OWP and has prioritized the initiative by providing funding for the creation of the program's website, www.oregonwellnessprogram.org, as well as various marketing materials. Funding from the Board has also gone toward administrative support and a portion of the clinical services provided.

In the long term, the OMB hopes that the Oregon Wellness Program and the funds it has dedicated to its start-up and growth will help guide health care providers to a more positive and empowered place and renew their love for the profession.