Operation Stress Removal Oregon Medical...3 Healthcare Professional Wellness Peer- Reviewed Publications, 2017 Thursday, November 2 Childcare Available 5:00-6:15 pm Simultaneous Meet

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Operation Stress Removal

Pease/Pariser Symposium for Healthcare Professionals and Spouses

Reclaim the joy of being a provider, and reconnect with your family

November 2-3, 2017 Thursday Evening and Friday Morning

St. Charles Medical Center - Bend, Oregon

Table of Contents & Page Numbers on Page 3

Up to 4.5 Hours CDE Credit

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This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of St. Charles Health System and Central Oregon Medical Society. St. Charles Health System is accredited by the Oregon Medical Association to provide continuing medical education for physicians.

St. Charles Health System designates this live activity for a maximum of 4.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Up to 4.5 Hours CME Credit

Stacy Lynne Pariser Died at Age 21, after 16

years of Acute Lymphoblastic

Leukemia 1971-1993

Pease/Pariser Symposium Bradford N. Pease, MD BA, Stanford MD, Harvard Surgeon and Co-founder of the Bend Memorial Clinic

1912-2004

Provider approved by the California Board of Registered Nursing, Provider Number 8050 for 1.0 or 1.5 contact hours. depending on session(s) attended. Must attend full session to receive continuing nursing education contact hours.

Archie Bleyer, Clin. Res. Prof, OHSU Lisa Dobey, Director, St. Charles Foundation David Zulauf, MD, Chair, SCHS Wellness Comm. Ripdeep Mangat, MD, COMS President Linda Leffel, MD, COMS Past President Gary Dehm, DDS, President, CODS Mike Henderson, MD, Topic Originator Michael Mastrangelo, MD, OMB Peter Palacio, MD, OMA

Planning Committee

CNE Credit

Objectives

• To grasp the magnitude of the healthcare provider burnout problem, nationally and in Central Oregon

• To appreciate its effects on spouse/partner, children, and other family members

• To understand its history and contributing factors

• To learn methods of detection, realization, prevention, treatment, and cure

• To realize how to assist each other in stress removal

• To recognize, support ,and participate as appropriate and early, in the Central Oregon Healthcare Professional Wellness Program

*MDs, DOs, PAs, NPs, can join COMS for 2017-2018 programs

for $150 as a new member (www.comedsoc.org) and

receive free attendance at all dinner meetings and summer

and holiday festivities, for spouse , childcare, and

participation in the wellness

program (8 1-hour sessions per 12-

months)

Dentists and orthodontists must only claim credit commensurate with the extent of their participation.

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Healthcare Professional Wellness Peer-Reviewed Publications, 2017

Thursday, November 2 Childcare Available 5:00-6:15 pm Simultaneous Meet-The-Expert Small Groups 1. Elaine Cox, MD Prof. Clinical Pediatrics, Indiana University

A Deadly Silence: My Pledge to Combat Physician Suicide 2. Bill O'Neill, MBA CPEP, Raleigh, NC

Avoiding Communication Pitfalls 3. Barry J. Taylor, DMD Asst. Prof., OHSU School Dentistry

Healthy Mental Health for the Dental Professional

6:15 pm Reception 6:45 pm Dinner 7:05 Special Announcement: Donald E. Girard, MD

Vice Chair, Oregon Medical Board Oregon Coalition for Healthcare Provider Enhancement 7:15-8:45 pm *Keynote Presentation*: Dike Drummond, MD, Seattle Author, Stop Physician Burnout www.TheHappyMD.com 'Burnout Proof' LIVE Workshop for Healthcare Professionals and Spouses/Partners Dr. Drummond’s book and Lines of Life smartphone ID card holder provided to all attendees

Friday, November 3

7:00-8:00 am St. Charles Grand Rounds, including breakfast

Sonny Nguyen, JD,RRT,CPHRM Sr. Director, Patient Safety & Risk Management, NW Region, The Doctors Company Challenges of the EHR, including Liability Claims Roger McKimmy, MD Oregon Urology Institute, Eugene; Past Vice Chair, Oregon Medical Board Coping with the Electronic Health Record (EHR)

8:00-9:15 am Simultaneous Meet-The-Expert Small Groups A. Karen Weiner, MD, MMM, CPE CEO, Oregon Med. Group, Eugene

Burnout: What We Can Do About it as Leaders For healthcare administrators/leaders/officers

B. Emily Dalton, MD Pediatrician, Eureka CA and Eugene Is It Really Quality Improvement (QI)?

B. Join Luh, MD Russel Pardoe Radiation Oncology Center, St Joseph Hosp., Eureka, CA MACRA Regulatory Burdens The Burnout Threat

Dean David Bangsberg Patty Buehler

Moderators

Gary Dehm, DMD Linda Leffel

Peter Palacio

Lisa Dobey

Fran McCabe

Archie Bleyer Mike Mastrangelo

Archie Bleyer

Mike Newman, Wash DC

Conference Rooms A & B

Location*

Conference Rooms C & D

Board Room (2nd Floor)

Conference Room C

Conference Room D

Conference Rooms ABCD

Conference Rooms ABCD

Map of Conference Rooms

Central Oregon Medical Society Wellness Program

The Bulletin Editorial by Mike Henderson, DO October 21, 2017

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*Map on page 4

History, Description

39 Mike Henderson

Ripdeep Mangat

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For Board Room, take these stairs to 2nd floor and take hallway to 1st room on left

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Burned Out (%)

Pathology

Radiology

General Internal Medicine

Urologic Surgery

Family Medicine

Emergency Medicine

Physical Med & Rehab.

Orthopedic Surgery Neurology

Dermatology

Anesthesiology

Obstetrics/Gynecology

Psychiatry Other

Preventive/Occupational Medicine

General Pediatrics

Radiation Oncology

Pediatric Subspecialty Ophthalmology

General Surg. Subspecialty

General Surgery

Neurosurgery General Medicine Subspecialty

Otolaryngology

Average Burnout

Average Satisfaction with Clinical Burden

Satis

fact

ion

with

Clin

ical

Bur

den

(%)

60

55

50

45

40

35

30

25

20

75 70 65 60 55 50 45 40 35

West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.

Lancet. 2016 Nov 5;388(10057):2272-2281.

How vulnerable is your practice? … and you? Which specialties especially need to look out for each other?

6 Small Group Session 1. Elaine Cox, MD Prof. Clinical Pediatrics, Indiana University

A Deadly Silence: My Pledge to Combat Physician Suicide Presentation Materials


A Deadly Silence: My Pledge to Combat Physician Suicide Presentation Materials (continued)









12 Small Group Session 2. Bill O'Neill, MBA CPEP, Raleigh, NC Avoiding Communication Pitfalls

Presentation Materials


Presentation Materials (continued)





16 Small Group Session 3. Barry J. Taylor, DMD Asst. Prof., OHSU School Dentistry Healthy Mental Health for the Dental Professional






19 Small Group Session 3.

Barry J. Taylor, DMD Asst. Prof., OHSU School Dentistry

Healthy Mental Health for the Dental Professional


20 Dinner Announcement Donald E. Girard, MD

Vice Chair, Oregon Medical Board Oregon Coalition for Healthcare Provider Enhancement

Materials

Selected Publications on topic by Donald Girard, MD: 1999-2015 The effects of electronic health record implementation on medical student educators. Spencer DC, Choi D, English C, Girard D. Teach Learn Med. 2012;24(2):106-10. A comparison between physicians and demographically similar peers in accessing personal health care. Cedfeldt AS, Bower EA, Grady-Weliky TA, Flores C, Girard DE, Choi D. Acad Med. 2012 Mar;87(3):327-31. A novel approach to increase residents' involvement in reporting adverse events. Scott DR, Weimer M, English C, Shaker L, Ward W, Choi D, Cedfeldt A, Girard D. Acad Med. 2011 Jun;86(6):742-6. Education to return nonpracticing physicians to clinical activity: a case study in physician reentry. Bower EA, English C, Choi D, Cedfeldt AS, Girard DE. J Contin Educ Health Prof. 2010 Spring;30(2):89-94. Barriers to innovation in continuing medical education. Bower EA, Girard DE, Wessel K, Becker TM, Choi D. J Contin Educ Health Prof. 2008 Summer;28(3):148-56. Awareness of and participation in maintenance of professional certification: a prospective study. Bower EA, Choi D, Becker TM, Girard DE. J Contin Educ Health Prof. 2007 Summer;27(3):164-72. Comparison of career satisfaction and emotional states in residents and faculty at one academic medical center. Girard DE, Choi D, Dickey J, Wessel K, Austin D. BMC Med Educ. 2006 Jul 7;6:36. A comparison study of career satisfaction and emotional states between primary care and speciaity residents. Girard DE, Choi D, Dickey J, Dickerson D, Bloom JD. Med Educ. 2006 Jan;40(1):79-86.

http://www.ncbi.nlm.nih.gov/pubmed/22490089














21 Keynote Presentation Dike Drummond, MD, Seattle

Author, Stop Physician Burnout www.TheHappyMD.com 'Burnout Proof' LIVE Workshop for

Healthcare Professionals and Spouses/Partners Presentation Materials

22 Keynote Presentation Dike Drummond, MD, Seattle Author, Stop Physician Burnout www.TheHappyMD.com

'Burnout Proof' LIVE Workshop for Healthcare Professionals and Spouses/Partners Presentation Materials





25 Grand Rounds Sonny Nguyen, JD,RRT,CPHRM Sr. Director, Patient Safety

& Risk Management, NW Region, The Doctors Company Challenges of the EHR, including Liability Claims


26 Grand Rounds Sonny Nguyen, JD,RRT,CPHRM Sr. Director, Patient Safety

& Risk Management, NW Region, The Doctors Company Challenges of the EHR, including Liability Claims

Presentation Materials (Continued)

27 Grand Rounds Roger McKimmy, MD Oregon Urology Institute, Eugene;

Past Vice Chair, Oregon Medical Board Coping with the Electronic Health Record (EHR)








30 Small Group Session A. Karen Weiner, MD, MMM, CPE CEO, Oregon Med. Group, Eugene

Burnout: What We Can Do About it as Leaders For healthcare administrators/leaders/officers followed by

special session with Dike Drummond, MD Presentation Materials


Burnout: What We Can Do About it as Leaders Presentation Materials (continued)









36 Small Group Session B.

Emily Dalton, MD Pediatrician, Eugene Is It Really Quality Improvement (QI)?

37 Small Group Session B. Emily Dalton, MD Pediatrician, Eugene Is It Really Quality Improvement (QI)?


38 Small Group Session B. Emily Dalton, MD Pediatrician, Eugene Is It Really Quality Improvement (QI)?


39 Small Group Session C. Join Luh, MD Russel Pardoe Radiation Oncology Center, St Joseph Hosp.,

Eureka, CA; Oregon Health & Science University MACRA Regulatory Burdens & Burnout Threat


Luh JY. MACRA Regulatory Burdens and the

Threat of Physician Burnout. Mayo Clin Proc.

2016 Nov;91(11):1671-1672.

40 Small Group Session C. Join Luh, MD Russel Pardoe Radiation Oncology Center, St Joseph Hosp., Eureka, CA

Oregon Health & Science University MACRA Regulatory Burdens & Burnout Threat Presentation Materials (continued)













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Other Resources

Healthcare Professional Wellness Peer-Reviewed Publications, 2017

Central Oregon Medical Society Wellness Program

The Bulletin Editorial by Mike Henderson, DO October 21, 2017

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55

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History, Description

Operation Stress Removal

Pease/Pariser Symposium for Healthcare Professionals and Spouses

Reclaim the joy of being a provider, and reconnect with your family

48 The Central Oregon Medical Society (COMS) Healthcare Professional Wellness Program (HPWP)

for Physicians (MDs, DOs), Physician Assistants (PAs), Dentists (DDDs, DMDs), Nurse Practitioners (NPs) and Other Advanced Practice Providers

October 1, 2017

Background Note: 208 publications on the topic have been published in peer-reviewed

medical journals thus far this year (2017); see References on page 50

As summarized by Donald E. Girard, MD in The Oregon Physicians’ Initiative: The Coalition for Professional Enhancement (Oregon Medical Board Report. 2016;128(2):3-7), Professor Emeritus and Associate Dean for Graduate and Continuing Medical Education, OHSU and Vice Chair of Oregon Medical Board, the United States has nearly one million practicing physicians, approximately half of whom are men and half women. The average debt burden of today’s medical school graduates is about $225,000 and the average career length is 29 years. The distribution of physicians is increasingly specialty medicine. Forty years ago, the majority of physicians remained generalists and today less than 20% are generalists. In contrast to 40 years ago, more than half of physicians work for large business networks, have little or no oversight authority, and are purely resources for “patient care output.” All employed doctors are required to meet productivity standards for reimbursement. In the early 1970s, the majority of physicians were represented by medical societies, local, regional and national. Through them physicians negotiated with payers, established their codes of ethics, and developed networks where doctors worked together to care for patients. Beginning in the early 1980s the “world of Wall Street” began to realize the capital value of medicine and since that time the profession has become increasingly industrialized. It is now huge business, with buying and selling large healthcare institutions occurring continually to the highest set of bidders, without physicians or other health care professionals involved in their own destiny.

The magnitude of the healthcare professional burnout challenge must be understood. In a survey by investigators at the Mayo Clinic of 6,880 U.S. physicians, 3,680 (54.4%) of the physicians reported at least one symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). In contrast to the trends in physicians, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working US adults, resulting in an increasing disparity in burnout and satisfaction with work-life balance in physicians relative to the general US working population. After pooled multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians remained at an increased risk of burnout (odds ratio, 1.97; 95% CI, 1.80-2.16; P<.001) and were less likely to be satisfied with work-life balance (odds ratio, 0.68; 95% CI, 0.62-0.75; P<.001). Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. The investigators concluded that more than half of US physicians are now experiencing professional burnout.

The problem is worsening. In a recent study of physicians in four U.S. states (Sinsky C, et al. Ann Intern Med. 2016;165(11):753-760), electronic health record systems designed to speed patient referrals and improve treatment are contributing to doctor burnout and taking away from patient care. “For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day,” researchers wrote. “Outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work.” In a report earlier this year (Tai-Seale M, et al. Health Aff. 2017;369(4):655-662), data on 471 primary care physicians’ time allocation patterns captured by over 31 million EHR transactions in the period 2011–2014, who collectively worked on 765,129 patients’ EHRs, showed that physicians split time evenly between seeing patients and desktop medicine, logging an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine.

49 As described by Dr. Girard, impairment is the final step of a continuum, the presence of which adversely affects the physician’s abilities to carry out the sacred duties of medicine. Impairment includes the domain of substance use disorder but also comes in many forms and is just as capable of obstructing the physician’s work and resulting in patient harm. A disorganized practice, cognitive dysfunction, mental health disorders, falling behind in knowledge or skills, not maintaining professional boundaries, poor interpersonal skills, social isolation, and myriad personal issues, including spousal discord, financial concerns, malpractice threats, family illness and dysfunction are all examples of themes that impair but are rarely given the attention that comes with the addiction illnesses. Unaddressed, these are often more subtle but just as devastating. But if the sacred covenant among physicians is to first do no harm and ultimately protect those for whom they have care responsibilities, impairment must be prevented, or at the very least identified and treated at its earliest appearance.

Suicide is the most visibly tragic failure among physicians. More than twice as many physicians, men and women, commit suicide than age- and demographically-matched peer groups. In Eugene, five physicians committed suicide over a 2-year period (Wible P. When doctors commit suicide, it’s often hushed up. Washington Post. July 14, 2014). But for every physician who has committed suicide, there is a myriad of physicians with impaired professional roles that lead to spiraling events ending careers, families, friends, self-esteem and premature death. Substance use disorders are prevalent in physicians, and Central Oregon is no exception.

Physicians enter a career that is a calling; one in which there is little role for failure. They chose their professions to be there for others and defer personal rewards and needs. This includes timely personal health care and counseling. Physicians have fewer personal physicians and see fewer health and mental health professionals, instead usually opting to treat themselves and, as Dr. Girard has emphasized, badly.

As Dr. Girard summarizes, “today’s physicians are in debt, overcommitted and have little authority in their professional lives. They are made to believe that they are healers with no need for personal healing. Instead, they learn to follow the path of their mentors for whom medicine was the only marriage in life.“

Central Oregon Physician Wellness History and Status

East of the Cascades in Oregon, three physicians have committed suicide and several physicians and dentists have retired from medical practice or were forced to retire from practice prematurely due to stress-related behavior. Central Oregon has one of the highest physician turnover rates in the state despite the attractiveness of living here, and compared to the national rate of 12% annual relocation rate for all physicians (Source: SK&A Healthcare Provider Move Rates, August 2015). The largest specialty clinic east of the Cascades, in Bend, has averaged more than twice the industry standard of physician turnover during recent years (www.bendbulletin.com/slideshows/1474888-151/a-high-turnover-at-bmc). The most recent publicly-available information about medical professional burnout in Central Oregon is the August 2017 removal of an orthodontist’s license after alleged opioid abuse, including cocaine and heroin (www.bendbulletin.com/localstate/5488682-151/board-bend-orthodontist-worked-while-impaired). The practitioner wrote an emotional, humbling close-of-practice letter-to-patents that the Bend Bulletin published. Of concern, the Oregon Board of Dentistry divulged the practitioners’ attendance at the Health Professionals’ Service Program and yet did not inform the public about potential danger to the practitioners’ patients (www.bendbulletin.com/opinion/5496189-151/editorial-dentistry-board-needs-to-protect-the-public). Multiple Central Oregon physicians and advanced practice providers having to quit healthcare because of substance use disorder, some as young as in their late 20s.

We also quite aware of Central Oregon physicians and other healthcare professionals who have lost their licenses to practice in Oregon because of psychological distress, substance use disorder, and unacceptable behavior related to patient care. The Oregon Medical and Dental Boards are struggling with a record-high rate of mental health referrals, licenses revocations, and practice suspensions and monitoring. We are also aware that Oregon lags behind other states, including Washington, in providing preventive resources for health professional burnout, malpractice, and patient care disruption.

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These examples are tip of the iceberg of our burnout healthcare professional problem, and the future appears to be more ominous. One reason is the new EHR system in the St. Charles Healthcare System that will be implemented on January 1, 2018. According to reports from the aforementioned specialty practice, the new system implemented there in 2015 “dealt a significant setback” to the clinic’s financial and functional status (http://www.bendbulletin.com/localstate/5590762-151/bmc-hires-nj-firm-to-improve-finances). According to the New England Journal of Medicine’s Catalyst 4-hour program on Leading Physicians|Physicians Leading on July 12, 2018 (http://catalyst.nejm.org/events/physicians-leading-leading-physicians/), EHR is not only a primary reason for physician burnout, as described above, the new EHR systems will create more distress. Surgeon Brent C. James, MD, MStat, Executive Director, Institute for Healthcare Delivery Research and Vice President and Chief Quality Officer, Intermountain Healthcare, stated that the two newest EHR platforms, one of which is the new St. Charles’ platform, are “dead” on arrival because they were not developed by the healthcare professionals who are now required to use them.

Lane County Medical Society Physician Wellness Program (LCPWP)

Coupled with the mass exodus of physicians in Lane County in 2011 and 2012 and the suicides mentioned above, the Lane County Medical Society initiated their Physician Wellness Program (LCPWP) (http://lcmedsociety.com/index.php/providerwellness/). Under the leadership of Candace Barr, LCPWP engaged Thomas Fauria, PhD, psychologist at Cascade Behavioral Health (http://lcmedsociety.com/ index.php/providerwellness/) and Nicholas Telew, MD (www.peacehealth.org/findadoc/care-providers/ 319/nicholas-w-telew-md) of PeaceHealth to create a partnership to meet their concerning trend in physician level of stress and burn-out. LWPWP has since been on the forefront of a national trend in Physician Wellness, providing free and confidential specialized counseling to medical providers in their community. The program was designed to address changes and challenges and help develop physician resilience to the myriad of challenges and stressors in health care. The demonstrated success of the LCPWP has allowed for expansion to include services to PAs and NPs. Kari Liddy, Ph.D., psychologist (http:// lcmedsociety. com/index.php/providerwellness/) joined the program to assist Drs. Fauria and Telew.

Since inception in April 2012 through April 2017, the LCPWP has served a total of 77 physicians. As the first service of its type in Oregon, the program, not surprisingly, started slowly:

• 2012-2015: 52 (1.16 physicians per month) • 2016: 16 (1.33 physicians per month) • 2017 (1st 6 months): 9 (2.25 physicians per month) • The most frequent presenting issues are relationship conflicts & burnout. • 37% of physicians were seen for self-identified burnout. • 35% of the presenting problems were co-worker and couple/marital conflict. • Average sessions per case : 3.77

The LCPWP provides clients with a safe, private, protected place to think through and seek solutions to the myriad of complex personal and professional challenges of practicing medicine. LCPWP enables easy access to resources for clients to help take care of themselves. Common barriers to wellness are reduced through privacy assurances by eliminating insurance billing and concerns regarding reporting to the medical board. MDs, DOs, PAs, and NPs schedule Wellness appointments by making one phone call. Appointments are scheduled for a secure tele-health consultation or in-office session arranged in the local community. Tele-health or in-office appointments are scheduled as requested.

51 Medical Society of Metropolitan Portland Wellness Program (MSMPWP)

In 2015, the Medical Society of Metropolitan Portland (MSMP), serving Multnomah, Clackamas, and Washington counties, started their wellness program (MSMPWP, www.msmp.org/Wellness-Program), modeled after the LCPWP and the Oregon Health and Science University (OHSU) started by Dr. Girard. in 1999 (references appended). As Chair of Oregon Medical Board and current Vice Chair, he is intimately familiar with physician behavior review, regulation and reprimand by the Oregon Medical Board and its Health Professionals’ Services Program (HPHS). The MSMPWP is based in the MSMP office, and directed by Amanda Borgess, their executive director. In contrast to the LWPWP, the MSMPWP healthcare professionals seeking help are seen in the MSMP office. The psychologists and psychotherapist who travel from their offices or homes to the MSMP facility are Beth Kaplan Westbrook, PsyD, Dan Rubin, PsyD, and Rebecca Martin-Gerhards, EdD (www.msmp.org/Meet-Our-Psychologists).

Towards the end of 2016, the expanded their program to include PAs and NPs. For the first 10.5 months of 2016 (January 1-November 15, 2016) the MSMPWP provided service to 29 clients, of which one was a PA, having just started to serve PAs and NPs: The Oregon Coalition for Healthcare Provider Wellness Complex problems can often be solved by simple solutions if they are understood. The central challenging issues for physicians are twofold. First, physicians are products of endless support from others and now are expected to be endless support to others. Second, the culture into which they are expected to assimilate discounts – in fact rejects – the role of peer or professional help in addressing life’s challenges. Now is the time for a culture change to reinvigorate a plagued and unhappy profession. Now is the time to establish the balanced work-life that is critical for personal wellness in today’s complex world.

Dr. Girard reminds us not to forget our promise in the Physician’s Oath to treat our colleagues as our sisters and brothers. So who better to facilitate the transition than a group of our peers? By establishing a community of resources that are easily accessible, non-judgmental, and freely used by physicians, we can address the spectrum of issues ranging from personal to professional.

Oregon has the reputation for wellness innovation. The roots of the state’s involvement with physician health goes back more than 30 years when a flurry of suicides among Oregon physicians became the nidus for the formal establishment of a medical association and later a state program. The Health Professionals Program, established in the late 1980s to intervene on the behalf of physicians with substance abuse disorders, became a notable success. During its tenure, more than 78% of those who entered returned to full-time successful practice after five years. In addition, many of those who succeeded in the program became mentors for those just entering, and the program maintained the confidentiality of the practitioner to a great degree.

Total Wellness Clients: 29 Client’s Credentials: 22 MD Completed Appointments: 113 4 DO No-show Appointments: 2 1 PA Urgent Appointments: 5 2 Resident Clients with EAP* 13 3 Other Average Age: 48 years Counties Represented: 17 Multnomah Gender: 13 males 16 female 8 Washington Total Amount Raised: Over $100,000 2 Clackamas Total Wellness Clients: 29 Clients with EAP* 13 Completed Appointments: 113 Average Age: 48 years No-show Appointments: 2 Gender: 13 males 16 female Urgent Appointments: 5 Total Amount Raised: Over $100,000

*Employee Assistance Program

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In the later part of the first decade of 2000, legislation reassigned participants in the HPP to the Health Professionals’ Services Program (HPSP), which exists to this time. The current program is committed to mirroring the success of the earlier program. Random urine monitoring is the centerpiece of the program. Treatment is available as an adjunct to the program. During the 2013 legislative session, changes were made to the law to allow for treatment arms as well as monitoring. That is good news.

Through organizational partnerships, a Coalition has formed among the Oregon Medical Association (OMA), the Oregon Medical Board (OMB), the Oregon Psychiatry Association (OPA), MSMP, LCMS, OHSU Resident and Faculty Wellness Program, Oregon Kaiser Permanente, and most recently, COMS, . This Coalition has met several times to share experiences in program development. Principles that Coalition members agree are essential to the ultimate success of a program include:

1. Common protocols for entry, evaluation and treatment; 2. Common protocols for entry, evaluation and treatment; 3. Standard qualifications for health care professionals who provide the treatment; 4. Financial support that is provided by umbrella groups rather than the individual health care

professional; 5. Supportive peer professionals to provide counseling; 6. Increasingly sophisticated resources for the evaluation of physicians to help with better

understanding of challenges and recommendations for their remediation; 7. Ability to address any variety of issues, including personal (relationships, marital discord,

children, finances, etc.), professional (organization, charting, malpractice, interpersonal skills, disruptive behavior, etc.), substance abuse, and mental health; and

8. Core tenets: confidentiality and professionalism in all relationships.

Oregon has the exceptional ability to gather myriad experienced and thoughtful peers, consultants, advanced degrees in social work, psychology, counseling, mental health, addiction medicine, psychiatry, and education and retraining to provide the professional resources necessary. The Coalition will create a network using the individual members’ established resources and strengths, building upon the successes of the individual organizations to create a unified program.

Entry to the program is confidential but carries no stigma because the services offered are vast and entry is open to all, both those needing help and those wanting to serve. The individual physician bears no costs; those are underwritten by the partner organizations and the health care systems in which the physicians work. These health care systems provide critical support and understand that healthy healthcare providers are key to best practices and outcomes.

The Oregon Coalition leaders believe that physicians have long been denied the access to and learning from the vast curricula of opportunities available to the general population that affords improved coping skills and resilience and markedly diminishes the risks of burnout, career loss, and most tragically suicide. The long standing belief that physicians are a singular professional group who can “march through” the personal tragedies of their own and their patients is just not reality. We need at least the same if not more help, advice, and resilience training in dealing with the inordinate stresses of the profession than perhaps any other group. To leave these treatable concerns unaddressed and untreated is not acceptable to our health care professionals or the patients they serve.

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The Central Oregon Medical Society (COMS) Healthcare Professional Wellness Program (HPWP)

In February 2017, Dr. Girard and Ms. Borgess presented the genesis and status of MSMPWP to the COMS membership. Since then, COMS has been represented on the Oregon Wellness Coalition as an ex officio member of its Executive Committee.

Dr. Fauria has met with the COMS Executive Board to review his participation and those of his colleagues, including Dr. Telew, with COHPWP. He will be first contact for any healthcare professional from Central or Eastern Oregon desiring COMS HPWP assistance.

The plan is for all members of the COMS (MDs, DOs, PAs, NPs) to be provided with a round-the-clock 24/7 direct-line phone number to Cascade Health (541-345-2800) or email ([email protected]). The COMS member or designate would call Cascade day or night . Cascade reception staff or exchange service will verify if the caller wishes a local, face-to-face appointment or prefers a telehealth appointment. If the caller selects telehealth, Cascade’s receptionist schedules the telehealth session and sends the appropriate intake and consent forms to be completed and returned prior to the initial session. A trained receptionist at Cascade will record the request and have Dr. Fauria contact the caller and determine whether he or she would prefer to initiate care via telehealth with Dr. Fauria or be referred to a local care consultant in central Oregon of their choice (one psychologist and three psychiatrists have offered to serve the program). If the caller does not have a preference, Dr. Fauria would recommend a consultant based on the nature of the concern. If the former, a consent form would be provided to the caller and after received by Cascade, Dr. Fauria would begin the wellness evaluation and assistance the other telehealth service, as he has done for Lane County since 2012. If the latter, the caller would be provided with the appropriate contact information of the local care consultant in Central Oregon.

If the caller chooses a local, face-to-face appointment, Cascade reception will immediately contact the identified COMS staff person to arrange the local appointment with Bend area PWP providers, coordinated by the office managers of the aforementioned consultant providers.

Alternative mechanisms of referral to consultants are under consideration by the Oregon Coalition, including allowing anyone, whether of not a medical society member, to request help via the Coalition, select a consultant from biosketches on the Coalition’s website, self refer to the consultant, and to undergo one session without charge. Thereafter the caller would need to join a medical society, either paying for membership him/herself or having his/her practice pay for membership. Either way, this process would be conducted without any indication why the membership was initiated and be non-discoverable.

After-Hours Crisis Call Coverage: One of two options will be applied:

Local Coverage: After-hours will be provided locally; any call received by Cascade after hours, on weekends or holiday will be referred to the 24-7 local (Bend) contact.

Cascade Coverage: If COMS elects to provide after-hours crisis call coverage through Cascade Behavioral Health, Cascade Behavioral Health will provide crisis stabilization and referral to the clinically appropriate follow-up services, either locally or through tele-health. Cascade provides on-call services to physicians from 5 PM to 9 AM. The on-call clinician receives a call from the answering service and responds within 10 minutes to the answering service. If the answering service does not receive a call back from the on-call clinician in 10 minutes, backup systems are implemented to contact the next clinician on the on-call list. The clinician taking the call will return phone call to the client within 15 minutes or less of request receipt. A Cascade LCPWP clinician will respond to the request for assistance, with acuity assessment, risk of self and/or harm to others, and telephone counseling to stabilize the crisis either locally or through tele-health.

54

Cascade psychologists, clinical social workers and licensed professional counselors are familiar with stressors in health care and have worked extensively with physicians and mid-level providers. In additional to extensive experience working with health professionals, Cascade LCPWP staff receive two forms of specialized training to ensure quality care: 1) On-site classroom training to stay up to date with the unique factors affecting the health care industry, and 2) Ongoing case consultation to review cases to ensure continuity of care and evidence based practice. Cascade clinicians will follow crisis counseling procedures to identify themselves as a Cascade Behavioral Health LCPWP clinician responding to the request for assistance. Clinical screening will include acuity assessment, risk of self and/or harm to others, as well as telephone counseling to stabilize the crisis.

Telehealth Services The reason for the more remote provision of wellness services is to acknowledge the potential for local discrimination, embarrassment, or other sensitivities that healthcare professionals may have by working psychotherapists and associated in their local community. Telehealth allows for services to be rendered which ease transportation, accessibility or privacy challenges which previously were barriers to accessing care. This potential may be particularly applicable to Central Oregon because we are a smaller, more confined, and knowledgeable population than that of Lane or Portland region counties. We expect that a sizable proportion of local healthcare professionals will prefer a more remote source for their assistance, not only to avoid local disclosure but also to be able be assisted wherever they prefer, at home, in their office, or another preferred location, and thereby avoiding the need to travel to a psychiatrist’s or psychologist’s office or place of practice.

Telehealth service is embedded in Cascade Health’s EHR system and therefore insures HIPAA compliance, assurance of protection of health information, as well as total privacy for the client engaged in care. The telehealth program has been tested and, in at least the early phase, has been effective in evaluating the need and providing the appropriate assistance. Telehealth services are available through secure communication via computer, laptop, or mobile device. Although most psychiatrists still prefer face-to-face interactions with their clientele, the Cascade telehealth process has been functional with those care providers who have learned to utilize it. Cascade Health is prepared to expand telehealth services to COMS members.

Local (Central Oregon) Support For those preferring local support, COMS HPWP will be staffed with psychiatrists, psychologists, clinical social workers and licensed professional counselors, all of whom are familiar with stressors in health care and have worked extensively with physicians and mid-level providers. These professionals are available to provide safe, confidential, and expert consultation to address the challenges health care providers face in their personal and professional life. Thus far, Bend Psychiatry Group’s three psychiatrists (Lawrence Campbell, MD, Joseph Barrett, MD, Anthony Monteverdi, MD). Timothy Hofeldt, MD, another Bend psychiatrist, and Andrew Barram, PsyD, psycholo gist , have met with COMS and agreed to participate in the COHPWP. Several other psychologists and mindfulness experts have indicated plans to participate.

Given the interest also expressed by the Central Oregon Dental Society, COMS is considering having dentists and orthodontists access the COMS HPWP via membership in COMS. Dentists have been known to have an even higher rate of practice-related suicide, attributed in part to their ready access to opioids barbiturates, and other life-ending medications. The recent orthodontist situation described above is relevant to the dental need.

October 21, 2017

55

1. Job satisfaction among academic family physicians. Agana DF, Porter M, Hatch R, Rubin D, Carek P. Fam Med. 2017 Sep;49(8):622-625. 2. Descriptive study of association between quality of care and empathy and burnout in primary care. Yuguero O, Marsal JR, Buti M, Esquerda M,

Soler-González J. BMC Med Ethics. 2017 Sep 26;18(1):54.. 3. Physician burnout: Can we prevent or reduce it? Krishnan V, Sarkar S. Natl Med J India. 2017 May-Jun;30(3):149-150. 4. Physician burnout: are we treating the symptoms instead of the disease? Squiers JJ, Lobdell KW, Fann JI, DiMaio JM. Ann Thorac Surg. 2017

Oct;104(4):1117-1122.. 5. Effects of Job burnout and emotional labor on objective structured clinical examination performance among interns and residents in Taiwan.

Wang CY, Chen JD, Wang CH, Wang JY, Tai CJ, Hsieh TY, Chen DY. Eval Health Prof. 2017 Jan 1:163278717729732. 8. Empathy and burnout of emergency professionals of a health region: A cross-sectional study. Yuguero O, Forné C, Esquerda M, Pifarré J,

Abadías MJ, Viñas J. Medicine (Baltimore). 2017 Sep;96(37):e8030 9. Complications: acknowledging, managing, and coping with human error. Helo S, Moulton CE. Transl Androl Urol. 2017 Aug;6(4):773-782.

10. Causes and adverse impact of physician burnout: a systematic analysis. Azam K, Khan A, Alam MT. J Coll Physicians Surg Pak. 2017 Aug;27(8):495-501.

11. Satisfaction, burnout, and turnover among nurse practitioners and physician assistants: A Review of the Empirical Literature. Hoff T, Carabetta S, Collinson GE. Med Care Res Rev. 2017 Sep 1:1077558717730157.

12. A study of otolaryngology resident quality of life and sleepiness. Garcia-Rodriguez LR, Sanchez DL, Ko AB, Williams AM, Peterson E, Yaremchuk KL. Laryngoscope Investig Otolaryngol. 2017 Mar 10;2(3):113-118.

13. CMA must address physician burnout, pharmacare, say doctors. Vogel L. CMAJ. 2017 Sep 11;189(36):E1171-E1172. 14. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Gidwani R, Nguyen C,

Kofoed A, Carragee C, Rydel T, Nelligan I, Sattler A, Mahoney M, Lin S. Ann Fam Med. 2017 Sep;15(5):427-433. 15. Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Arndt BG, Beasley

JW, Watkinson MD, Temte JL, Tuan WJ, Sinsky CA, Gilchrist VJ. Ann Fam Med. 2017 Sep;15(5):419-426. 16. Oncologist burnout and compassion fatigue: investigating time pressure at work as a predictor and the mediating role of work-family conflict.

Kleiner S, Wallace JE. BMC Health Serv Res. 2017 Sep 11;17(1):639. 17. (Almost) forgetting to care: an unanticipated source of empathy loss in clerkship. Holmes CL, Miller H, Regehr G. Med Educ. 2017

Jul;51(7):732-739. 18. Wellness and burnout in burn care providers: professionalism, the social covenant, and the 7 habits of highly effective teams. Hultman CS,

Neumeister MW. Clin Plast Surg. 2017 Oct;44(4):943-948. 19. Emotional intelligence and burnout in academic radiation oncology chairs. Holliday EB, Bonner JA, Formenti SC, Hahn SM, Kalnicki S, Liu FF,

Movsas B, Fuller CD, Thomas CR Jr. J Healthc Manag. 2017 Sep/Oct;62(5):302-313. 20. They did not start the fire: reviewing and resolving the issue of physician stress and burnout. Babyar JC. J Health Organ Manag. 2017 Jun

19;31(4):410-417. 21. Factors associated with burnout syndrome in medical residents of a university hospital. Gouveia PADC, Ribeiro MHC Neta, Aschoff CAM,

Gomes DP, Silva NAFD, Cavalcanti HAF. Rev Assoc Med Bras (1992). 2017;63(6):504-511. 22. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Pacheco JP, Giacomin HT, Tam WW, Ribeiro

TB, Arab C, Bezerra IM, Pinasco GC. Rev Bras Psiquiatr. 2017 Aug 31:0. \ 23. In reply-defining physician burnout, and differentiating between burnout and depression. Melnick ER, Powsner SM, Shanafelt TD. Mayo Clin

Proc. 2017 Sep;92(9):1456-1458. 24. Defining physician burnout, and differentiating between burnout and depression-II. Schears RM. Mayo Clin Proc. 2017 Sep;92(9):1455-1456. 25. Defining physician burnout, and differentiating between burnout and depression-I. Bianchi R, Schonfeld IS. Mayo Clin Proc. 2017

Sep;92(9):1455. 26. Development of the SOSS-D: a scale to measure stigma of occupational stress and burnout in medical doctors. Clough BA, Ireland MJ, March S.

J Ment Health. 2017 Sep 4:1-8. 27. The impact of a required longitudinal stress management and resilience training course for first-year medical students. Dyrbye LN, Shanafelt

TD, Werner L, Sood A, Satele D, Wolanskyj AP. J Gen Intern Med. 2017 Aug 31. 28. The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals' reactions. Gandino G, Di Fini G, Bernaudo A,

Paltrinieri M, Castiglioni M, Veglia F. J Health Psychol. 2017 Aug 1:1359105317727841. 29. Physician burnout. Moore DM. Del Med J. 2016 Jul;88(7):201-202. . 30. Exploring perceptions of health caregivers on the causes of caregivers' occupational burnout in institutes of children with cerebral palsy: A

qualitative study. Dehghan A, Hosseini SA, Rassfiani M, Dalvand H. Electron Physician. 2017 Jun 25;9(6):4516-4523. 31. Resident perspectives on work-life policies and implications for burnout. Westercamp N, Wang RS, Fassiotto M. Acad Psychiatry. 2017 Aug 25 32. Severe burnout is common among critical care physician assistants. Bhatt M, Lizano D, Carlese A, Kvetan V, Gershengorn HB. Crit Care Med.

2017 Aug 23. 33. Electronic health record effects on work-life balance and burnout within the 3Population Collaborative. Robertson SL, Robinson MD, Reid A. J

Grad Med Educ. 2017 Aug;9(4):479-484. 34. Improving communication with surrogate decision-makers: a pilot initiative. Meltzer EC, Shi Z, Suppes A, Hersh JE, Orlander JD, Calhoun AW,

Tung J, Logio L, Manna R, Bialer PA, Acres CA, Fins JJ. J Grad Med Educ. 2017 Aug;9(4):461-466. 35. Associations between the Application of Signature Character Strengths, Health and Well-being of Health Professionals. Hausler M, Strecker C,

Huber A, Brenner M, Höge T, Höfer S. Front Psychol. 2017 Jul 31;8:1307. 36. The problems with burnout research. Eckleberry-Hunt J, Kirkpatrick H, Barbera T. Acad Med. 2017 Aug 16. 37. Sources of distress for physicians and nurses working in Swiss neonatal intensive care units. Klein SD, Bucher HU, Hendriks MJ, Baumann-Hölzle

R, Streuli JC, Berger TM, Fauchère JC, On Behalf Of The Swiss Neonatal End-Of-Life Study Group. Swiss Med Wkly. 2017 Aug 14;147:w14477. 38. In Pursuit of the Fourth Aim in Health Care: The Joy of Practice. Gergen Barnett KA. Med Clin North Am. 2017 Sep;101(5):1031-1040. 39. Work stress associated cool down reactions among nurses and hospital physicians and their relation to burnout symptoms. Büssing A,

Falkenberg Z, Schoppe C, Recchia DR, Poier D. BMC Health Serv Res. 2017 Aug 10;17(1):551. 40. The Academy of Master Clinicians: Recognition of Clinical Excellence Within an Academic Medical Center. Glick JH, Mulhern V, Olthoff KM,

Ende J. Acad Med. 2017 Aug 8. 41. Encouraging Mindfulness in Medical House Staff via Smartphone App: A Pilot Study. Wen L, Sweeney TE, Welton L, Trockel M, Katznelson L.

Acad Psychiatry. 2017 Aug 9. 42. The Privilege of Being a Physician and the Immutable Values of the Medical Profession. Heudebert GR. Trans Am Clin Climatol Assoc.

2017;128:234-242. 43. Strategies to Combat Physician Burnout in Gastroenterology. Anderson JC, Pfeil S, Surawicz C. Am J Gastroenterol. 2017 Sep;112(9):1356-1359.

56 Two Hundred Eight (208 ) Peer-Reviewed Publications on Medical Professional Burnout in 2017 as of September 30

Number of reference is PubMed number

43. Managing diagnostic uncertainty in primary care: a systematic critical Alam R, Cheraghi-Sohi S, Panagioti M, Esmail A, Campbell S, Panagopoulou E. BMC Fam Pract. 2017 Aug 7;18(1):79.

45. In Reply-Physicians in the 21st Century: Between Identification With Medicine as a Calling and Self-Diagnosing Burnout, Depression, and Anxiety. Kao AC. Mayo Clin Proc. 2017 Aug;92(8):1315.

46. Physicians in the 21st Century: Between Identification With Medicine as a Calling and Self-Diagnosing Burnout, Depression, and Anxiety. Mousa OY, Dhamoon MS, Dhamoon AS. Mayo Clin Proc. 2017 Aug;92(8):1314-1315.

47. Finding the sweet spot: Developing, implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees. Tucker T, Bouvette M, Daly S, Grassau P. Eval Program Plann. 2017 Dec;65:106-112.

48. An index to characterize female career promotion in academic medicine. Brüggmann D, Groneberg DA. J Occup Med Toxicol. 2017 Jul 21;12:18. 49. Provider Health and Wellness. Nanda A, Wasan A, Sussman J. J Allergy Clin Immunol Pract. 2017 Jul 19. pii: S2213-2198(17)30388-4. 50. Addressing Physician Burnout Among Practicing Physicians. Balzora S, Weinshel E. Clin Gastroenterol Hepatol. 2017 Jul 19. pii: S1542-

3565(17)30852-2. 51. Pathology: A Satisfying Medical Profession. Xu H, Remick DG. Acad Pathol. 2016 Aug 7;3:2374289516661559. 52. Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues. Ames SE, Cowan JB, Kenter K, Emery

S, Halsey D. J Bone Joint Surg Am. 2017 Jul 19;99(14):e78. 53. Empathy, burnout, and antibiotic prescribing for acute respiratory infections: a cross-sectional primary care study in the US. Sun BZ, Chaitoff A,

Hu B, Neuendorf K, Manne M, Rothberg MB. Br J Gen Pract. 2017 Aug;67(661):e565-71. 54. How to prevent burnout in cardiologists? A review of the current evidence, gaps, and future directions. Panagioti M, Geraghty K, Johnson J.

Trends Cardiovasc Med. 2017 Jul 4. pii: S1050-1738(17)30103-2. 55. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic Clough BA, March S, Chan RJ,

Casey LM, Phillips R, Ireland MJ. Syst Rev. 2017 Jul 17;6(1):144. 56. Professional burnout syndrome in doctors of surgical specialties in Ukraine: causes, consequences, labor optimization ways. Skurupii DA,

Kholod DA, Sonnik EG. Wiad Lek. 2017;70(3 pt 1):508-511. 57. Prevalence of burnout in health professionals working in palliative care: a systematic Parola V, Coelho A, Cardoso D, Sandgren A, Apóstolo J.

JBI Database System Rev Implement Rep. 2017 Jul;15(7):1905-1933. 58. [Admission to intensive care of palliative care patients : the stakes and factors influencing the decision]. Escher M, Nendaz M, Ricou B. Rev

Med Suisse. 2017 Feb 1;13(548):323-325. French. 59. What Ails Thee? The Myth of the Holy Grail and Physician Burnout. Restauri N. J Am Coll Radiol. 2017 Jul 8. pii: S1546-1440(17)30578-1. 60. Patients with challenging behaviors: Communication strategies. Schuermeyer IN, Sieke E, Dickstein L, Falcone T, Franco K. Cleve Clin J Med.

2017 Jul;84(7):535-542. 61. Disenfranchised Grief and Physician Burnout. Lathrop D. Ann Fam Med. 2017 Jul;15(4):375-378. 62. Sustaining a career in surgery. Brandt ML. Am J Surg. 2017 Oct;214(4):707-714. 63. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Gregory ME, Russo E, Singh H. Appl Clin

Inform. 2017 Jul 5;8(3):686-697. 64. Effect of emergency physician burnout on patient waiting times. De Stefano C, Philippon AL, Krastinova E, Hausfater P, Riou B, Adnet F, Freund

Y. Intern Emerg Med. 2017 Jul 4. 65. Electronic health record innovations: Helping physicians - One less click at a time. Guo U, Chen L, Mehta PH. HIM J. 2017 Sep;46(3):140-144. 66. Physician burnout: the hidden health care crisis. Lacy BE, Chan JL. Clin Gastroenterol Hepatol. 2017 Jun 30. pii: S1542-3565(17)30790-5. 67. Code Lavender: Cultivating intentional acts of kindness in response to stressful work situations. Davidson JE, Graham P, Montross-Thomas L,

Norcross W, Zerbi G. Explore (NY). 2017 May - Jun;13(3):181-185. 68. Burnout, career satisfaction, and well-being among US neurology residents and fellows in 2016. Levin KH, Shanafelt TD, Keran CM, Busis NA,

Foster LA, Molano JRV, O'Donovan CA, Ratliff JB, Schwarz HB, Sloan JA, Cascino TL. Neurology. 2017 Aug 1;89(5):492-501. 69. Getting by with a little help from friends and colleagues: Testing how residents' social support networks affect loneliness and burnout. Rogers

E, Polonijo AN, Carpiano RM. Can Fam Physician. 2016 Nov;62(11):e677-e683. 70. Stress and burnout in health-care workers after the 2009 L'Aquila earthquake: A Cross-Sectional Observational Study. Mattei A, Fiasca F,

Mazzei M, Necozione S, Bianchini V. Front Psychiatry. 2017 Jun 12;8:98. 71. The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: A decision analysis. Turner TB, Dilley SE,

Smith HJ, Huh WK, Modesitt SC, Rose SL, Rice LW, Fowler JM, Straughn JM Jr. Gynecol Oncol. 2017 Sep;146(3):642-646. 72. Resident burnout: not just for the "long hours" specialties. Kasten J. Acad Med. 2017 Jul;92(7):904-905. 73. Leadership and physician burnout: using the annual review to reduce burnout and promote engagement. Shanafelt T, Swensen S. Am J Med

Qual. 2017 Sep/Oct;32(5):563-565. 74. Association between level of exposure to death and dying and professional quality of life among palliative care workers. Samson T, Shvartzman

P. Palliat Support Care. 2017 Jun 23:1-10. 75. Burnout: Prevalence and Associated Factors Among Radiology Residents in New England With Comparison Against United States Resident Physicians in Other Specialties. Guenette JP, Smith SE. AJR Am J Roentgenol. 2017 Jul;209:136-141.

76. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Fumis RRL, Junqueira Amarante GA, de Fátima Nascimento A, Vieira Junior JM. Ann Intensive Care. 2017 Dec;7(1):71.

77. Writing well: the long-term effect on empathy, observation, and physician writing through a residency writers' workshop. Lemay M, Encandela J, Sanders L, Reisman A. J Grad Med Educ. 2017 Jun;9(3):357-360. 78. Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Busireddy KR, Miller JA, Ellison K, Ren V, Qayyum R, Panda M. J Grad Med Educ. 2017 Jun;9(3):294-301.

79. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic Dewa CS, Loong D, Bonato S, Trojanowski L. BMJ Open. 2017 Jun 21;7(6):e015141.

80. Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in health care professionals. Thimmapuram J, Pargament R, Sibliss K, Grim R, Risques R, Toorens E. J Community Hosp Intern Med Perspect. 2017 Mar 31;7(1):21-27.

81. Factors influencing professional life satisfaction among neurologists. Teixeira-Poit SM, Halpern MT, Kane HL, Keating M, Olmsted M. BMC Health Serv Res. 2017 Jun 19;17(1):409.

82. Decreasing patient stress and physician/medical workforce burnout through health care environments: uncovering the serious leisure perspective at Mayo Clinic's campus in Rochester, Minnesota. Dieser RB, Edginton CR, Ziemer R. Mayo Clin Proc. 2017 Jul;92(7):1080-1087.

83. How physicians draw satisfaction and overcome barriers in their practices: "It sustains me". Branch WT Jr, Weil AB, Gilligan MC, Litzelman DK, Hafler JP, Plews-Ogan M, Rider EA, Osterberg LG, Dunne D, Derse AR, Pittman JR, Frankel RM. Patient Educ Couns. 2017 Jun 8. pii: S0738-3991(17)30348-8.

84. Burnout among workers in emergency Departments in Palestinian hospitals: prevalence and associated factors. Hamdan M, Hamra AA. BMC Health Serv Res. 2017 Jun 15;17(1):407.

85. Burnout-there's an app for that: helping physicians deal with job-related stress. Holoshitz N, Wann S. JAMA Cardiol. 2017 Jun 14.



86. Emotional distress among physician residents and fellows: an observational study of trainees seeking counseling visits. Golob A, Beste LA, Stern M, Johnson K. Acad Psychiatry. 2017 Jun 12.

87. Moral distress in PICU and neonatal ICU practitioners: a cross-sectional evaluation. Larson CP, Dryden-Palmer KD, Gibbons C, Parshuram CS. Pediatr Crit Care Med. 2017 Aug;18(8):e318-e326.

88. Burnout syndrome in health-care professionals in a university hospital. de Paiva LC, Canário ACG, de Paiva China ELC, Gonçalves AK. Clinics (Sao Paulo). 2017 May;72(5):305-309.

89. [Syndrome of emotional burnout among women-physicians elderly]. Myakotnykh VS, Borovkova TA. Adv Gerontol. 2017;30(2):208-214. Russian.

90. Changes in the health professions: a commentary. Schoenbaum SC. J Ambul Care Manage. 2017;40(3):199-203. 91. For our patients, for ourselves: the value of personal reflection in oncology. Schapira L, Meisel JL, Srivastava R. Am Soc Clin Oncol Educ Book.

2017;37:765-770. 92. Factors associated with provider burnout in the NICU. Tawfik DS, Phibbs CS, Sexton JB, Kan P, Sharek PJ, Nisbet CC, Rigdon J, Trockel M, Profit J.

Pediatrics. 2017 May;139(5). pii: e20164134. 93. Grief and Burnout in the PICU. Crowe S, Sullivant S, Miller-Smith L, Lantos JD. Pediatrics. 2017 May;139(5). pii: e20164041. 94. Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study. Adriaenssens J, Hamelink A,

Bogaert PV. Int J Nurs Stud. 2017 May 12;73:85-92. 95. Editorial: work-life balance: essential or ephemeral? Schwingshackl A, Anand KJS. Front Pediatr. 2017 May 10;5:108. 96. Exhausting physicians employed in hospitals in Japan assessed by a health questionnaire. Suzuki S. Sangyo Eiseigaku Zasshi. 2017 Aug

18;59(4):107-118. 97. Engaging all employees in efforts to achieve high reliability. Benedicto AM. Front Health Serv Manage. 2017 Summer;33(4):33-40. 98. [Burnout in physicians]. Kurzthaler I, Kemmler G, Fleischhacker WW. Neuropsychiatr. 2017 Jun;31(2):56-62. German. 99. The implications of psychological symptoms for length of sick leave. Schneider A, Hilbert S, Hamann J, Skadsem S, Glaser J, Löwe B, Bühner M.

Dtsch Arztebl Int. 2017 Apr 28;114(17):291-297. 100. The emergence of personal growth amongst healthcare professionals who care for dying children. Beaune L, Muskat B, Anthony SJ. Palliat

Support Care. 2017 May 22:1-10. 101. Physician burnout, work engagement and the quality of patient care. Loerbroks A, Glaser J, Vu-Eickmann P, Angerer P. Occup Med (Lond). 2017

Jul 1;67(5):356-362. 102. Occupational burnout and empathy influence blood pressure control in primary care physicians. Yuguero O, Marsal JR, Esquerda M, Soler-

González J. BMC Fam Pract. 2017 May 12;18(1):63. 103. Workplace factors associated with burnout of family physicians. Rassolian M, Peterson LE, Fang B, Knight HC Jr, Peabody MR, Baxley EG,

Mainous AG 3rd. JAMA Intern Med. 2017 Jul 1;177(7):1036-1038. 104. EHRs attributed to physician burnout. Hey J 3rd. J Miss State Med Assoc. 2016 Jul;57(7):242. . 105. Are burnout prevention programs for hospital physicians needed? Amanullah S, McNally K, Zelin J, Cole J, Cernovsky Z. Asian J Psychiatr. 2017

Apr;26:66-69. 104. Physician burnout and well-being: a systematic review and framework for action. Rothenberger DA. Dis Colon Rectum. 2017 Jun;60(6):567-576. 107. Factors for and against establishing and working in private practice correlated with work-related behavior and experience patterns of Ferman

physicians in Schleswig-Holstein: A 2-year longitudinal study. Voltmer E, Spahn C, Frank E. Int J Occup Med Environ Health. 2017; 8;30:485-498. 108. Well-being in graduate medical education: A Call for Action. Ripp JA, Privitera MR, West CP, Leiter R, Logio L, Shapiro J, Bazari H. Acad Med.

2017 Jul;92(7):914-917. 109. Physician order entry clerical support improves physician satisfaction and productivity. Contratto E, Romp K, Estrada CA, Agne A, Willett LL.

South Med J. 2017 May;110(5):363-368. 110. The determinants and engagement patterns of chaperones and chauffeurs by Australian doctors in after-hours house-call services. Ifediora

CO. PeerJ. 2017 Apr 26;5:e3218. 111. Our intellectuals have failed us - System of a Down. Mishra S. Indian Heart J. 2017 Mar - Apr;69(2):133-135. 112. Coping with staff burnout and work-related posttraumatic stress in intensive care. Colville GA, Smith JG, Brierley J, Citron K, Nguru NM,

Shaunak PD, Tam O, Perkins-Porras L. Pediatr Crit Care Med. 2017 Jul;18(7):e267-e273. 113. Expanding the rubric of "patient-centered care" (PCC) to "patient and professional centered care" (PPCC) to enhance provider well-being. Post

SG, Roess M. HEC Forum. 2017 Apr 29. 114. [Environmental medical syndromes]. Wiesmüller GA, Hornberg C. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017

Jun;60(6):597-604. German 115. Changes in personal relationships during residency and their effects on resident wellness: a qualitative study. Law M, Lam M, Wu D, Veinot P,

Mylopoulos M. Acad Med. 2017 Apr 25. 116. "Back to Bedside": Residents' and fellows' perspectives on finding meaning in work. Hipp DM, Rialon KL, Nevel K, Kothari AN, Jardine LDA. J

Grad Med Educ. 2017 Apr;9(2):269-273. 117. Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals.

Fernández-Sánchez JC, Pérez-Mármol JM, Blásquez A, Santos-Ruiz AM, Peralta-Ramírez MI. Palliat Support Care. 2017 Apr 24:1-12. 118. Roles of physicians and health care systems in "difficult" clinical encounters. Goldsmith ES, Krebs EE. AMA J Ethics. 2017 Apr 1;19(4):381-390. 119. A successful debrief program for house staff. Leff V, Klement A, Galanos A. J Soc Work End Life Palliat Care. 2017 Apr 20:1-4. 120. Development of a research agenda to identify evidence-based strategies to improve physician wellness and reduce burnout. Dyrbye LN,

Trockel M, Frank E, Olson K, Linzer M, Lemaire J, Swensen S, Shanafelt T, Sinsky CA. Ann Intern Med. 2017 May 16;166(10):743-744. 122. Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational,

multicenter, cross-sectional study. Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V. Intensive Crit Care Nurs. 2017 Aug;41:11-17.

123. Experiences in an Italian Rehabilitation Hospital-Two Stories. Crisci C, Arnone B. Perm J. 2017;21. 124. Physician burnout is better conceptualised as depression. Bianchi R, Schonfeld IS, Laurent E. Lancet. 2017 Apr 8;389(10077):1397-1398. 126. Physician burnout: let's talk. Lancet. 2017 Apr 8;389(10077):1370. 127. Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology

Study Group (KROSG). Mampuya WA, Matsuo Y, Nakamura A, Hiraoka M. J Radiat Res. 2017 Mar 1;58(2):217-224. 128. Factors associated with professional satisfaction in primary care: Results from EUprimecare project. Sanchez-Piedra CA, Jaruseviciene L, Prado-

Galbarro FJ, Liseckiene I, Sánchez-Alonso F, García-Pérez S, Sarria Santamera A. Eur J Gen Pract. 2017 Dec;23(1):114-120. 129. Burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists. Zhou X, Pu J, Zhong X, Zhu D, Yin D, Yang L, Zhang Y,

Fu Y, Wang H, Xie P; China Neurologist Association. Neurology. 2017 May 2;88(18):1727-1735.



130. Building a sustainable primary care workforce: where do we go from here? Linzer M, Poplau S. J Am Board Fam Med. 2017;30:127-129. 131. Prevalence of burnout in board certified family physicians. Puffer JC, Knight HC, O'Neill TR, Rassolian M, Bazemore AW, Peterson LE, Baxley EG.

J Am Board Fam Med. 2017 Mar-Apr;30(2):125-126. 132. Improving family medicine with thoughtful research. Neale AV, Bowman MA, Seehusen DA. J Am Board Fam Med. 2017 Mar-Apr;30(2):117-

120. 133. Self-report study of predictors of physician wellness, burnout, and quality of patient care. Eckleberry-Hunt J, Kirkpatrick H, Taku K, Hunt R.

South Med J. 2017 Apr;110(4):244-248. 134 .Are We the walking dead? Burnout as Zombie Apocalypse. Doolittle BR. Ann Fam Med. 2016 Nov;14(6):578-580. 135. Practical considerations in addressing physician burnout. deb a. continuum (Minneap Minn). 2017 Apr;23(2, Selected Topics in Outpatient

Neurology):557-562. 136. Simulation of a novel schedule for intensivist staffing to improve continuity of patient care and reduce physician burnout. Geva A, Landrigan

CP, van der Velden MG, Randolph AG. Crit Care Med. 2017 Jul;45(7):1138-1144. 137. Changes in resident well-being at one institution across a decade of progressive work hours limitations. Krug MF, Golob AL, Wander PL, Wipf

JE. Acad Med. 2017 Oct;92(10):1480-1484. 138. What's the opposite of burnout? Epstein RM. J Gen Intern Med. 2017 Jul;32(7):723-724. 139. Minimising compassion fatigue in obstetrics/gynaecology doctors: exploring an intervention for an occupational hazard. Allen R, Watt F, Jansen

B, Coghlan E, Nathan EA. Australas Psychiatry. 2017 Aug;25(4):403-406. 140. Compassion fatigue among palliative care clinicians. O'Mahony S, Ziadni M, Hoerger M, Levine S, Baron A, Gerhart J. Am J Hosp Palliat Care.

2017 Jan 1:1049909117701695. 141. Relationships of work-related psychosocial risks, stress, individual factors and burnout - Questionnaire survey among emergency physicians

and nurses. Ilić IM, Arandjelović MŽ, Jovanović JM, Nešić MM. Med Pr. 2017 Mar 24;68(2):167-178. 142. An analysis of the relationship between burnout, socio-demographic and workplace factors and job satisfaction among emergency

department health professionals. Tarcan M, Hikmet N, Schooley B, Top M, Tarcan GY. Appl Nurs Res. 2017 Apr;34:40-47. 143. Breaking the stigma - a physician's perspective on self-care and recovery. Hill AB. N Engl J Med. 2017 Mar 23;376(12):1103-1105. 144. Improving communication between physicians and their patients through mindfulness and compassion-based strategies: A narrative Amutio-

Kareaga A, García-Campayo J, Delgado LC, Hermosilla D, Martínez-Taboada C. J Clin Med. 2017 Mar 17;6(3). pii: E33. 145. Joint analyses of open comments and quantitative data: Added value in a job satisfaction survey of hospital professionals. Gilles I, Mayer M,

Courvoisier N, Peytremann-Bridevaux I. PLoS One. 2017 Mar 15;12(3):e0173950. 146. Resilience training for healthcare providers: an Asian perspective. Hamou-Jennings FA, Dong C. Mhealth. 2016 15;2:25. 147. Predictors of job satisfaction among academic family medicine faculty: Findings from a faculty work-life and leadership survey. Krueger P,

White D, Meaney C, Kwong J, Antao V, Kim F. Can Fam Physician. 2017 Mar;63(3):e177-e185. 148. Effect of call organization on burnout and quality of life in psychiatry residents. Scarella TM, Nelligan J, Roberts J, Boland RJ. Asian J Psychiatr.

2017 Feb;25:27-30. 149. Cardiorespiratory fitness in internal medicine residents: are future physicians becoming deconditioned? Daneshvar F, Weinreich M, Daneshvar

D, Sperling M, Salmane C, Yacoub H, Gabriels J, McGinn T, Smith MC. J Grad Med Educ. 2017 Feb;9(1):97-101. 150. Reframing physician burnout as an organizational problem: a novel pragmatic approach to physician burnout. MacKinnon M, Murray S. Acad

Psychiatry. 2017 Feb 28. 151. Physicians' perceptions of volunteer service at safety-net clinics. Mcgeehan L, Takehara MA, Daroszewski E. Perm J. 2017;21. pii: 16-003. 152. A picture of burnout: case studies and solutions toward improving radiologists' well-being. Restauri N, Flug JA, Mcarthur TA. Curr Probl Diagn

Radiol. 2017 Sep - Oct;46(5):365-368. 153. Correlation between weekly working time and burnout syndrome among anesthesiologists of Maceió-AL. Barbosa FT, Eloi RJ, Santos LM, Leão

BA, Lima FJ, Sousa-Rodrigues CF. Braz J Anesthesiol. 2017 Mar - Apr;67(2):115-121. 154. A survey on the current status of rehabilitation services and burnout of rehabilitation professionals in Shanghai. Lu W, Zhou P, Zheng S, Xue D.

Work. 2017;56(2):319-325. 155. The association of team-specific workload and staffing with odds of burnout among VA primary care team members. Helfrich CD, Simonetti JA,

Clinton WL, Wood GB, Taylor L, Schectman G, Stark R, Rubenstein LV, Fihn SD, Nelson KM. J Gen Intern Med. 2017 Jul;32(7):760-766. 156. Personal life and working conditions of trainees and young specialists in clinical microbiology and infectious diseases in Europe: a

questionnaire survey. Maraolo AE, Ong DSY, Cortez J, Dedić K, Dušek D, Martin-Quiros A, Maver PJ, Skevaki C, Yusuf E, Poljak M, Sanguinetti M, Tacconelli E; Trainee Association of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Eur J Clin Microbiol Infect Dis. 2017 Jul;36(7):1287-1295.

157. Pediatric resident burnout and attitudes toward patients. Baer TE, Feraco AM, Tuysuzoglu Sagalowsky S, Williams D, Litman HJ, Vinci RJ. Pediatrics. 2017 Mar;139(3). pii: e20162163.

158. Burnout in pediatric residents and physicians: a call to action. Mahan JD. Pediatrics. 2017 Mar;139(3). pii: e20164233. 159. Work satisfaction, burnout and gender-based inequalities among ophthalmologists in India: A survey. Nair AG, Jain P, Agarwal A, Jain V. Work.

2017;56(2):221-228. 160. Burnout in the plastic surgeon: Implications and Interventions. Prendergast C, Ketteler E, Evans G. Aesthet Surg J. 2017 Mar 1;37(3):363-368. 161. Commentary on: burnout in the plastic surgeon: implications and interventions. noone rb. aesthet surg j. 2017 mar 1;37(3):369-371. 162. The effect of personality on occupational stress in veterinary surgeons. Dawson BF, Thompson NJ. J Vet Med Educ. Spring 2017;44(1):72-83. 163. Development of a new scale to measure ambiguity tolerance in veterinary students. Hammond JA, Hancock J, Martin MS, Jamieson S, Mellor

DJ. J Vet Med Educ. Spring 2017;44(1):38-49. 164. Addressing physician burnout: the way forward. Shanafelt TD, Dyrbye LN, West CP. JAMA. 2017 Mar 7;317(9):901-902. 165. Formal mentorship in a surgical residency training program: a prospective interventional study. Zhang H, Isaac A, Wright ED, Alrajhi Y, Seikaly

H. J Otolaryngol Head Neck Surg. 2017 Feb 13;46(1):13. 166. Association between physician burnout and identification with medicine as a calling. Jager AJ, Tutty MA, Kao AC. Mayo Clin Proc. 2017

Mar;92(3):415-422. 167. Professional interpersonal dynamics and burnout in European transplant surgeons. Jesse MT, Abouljoud M, Eshelman A, De Reyck C, Lerut J.

Clin Transplant. 2017 Apr;31(4). 169. Association of Intrinsic motivating factors and markers of physician well-being: a national physician survey. Tak HJ, Curlin FA, Yoon JD. J Gen

Intern Med. 2017 Jul;32(7):739-746. 173. Trainee wellness: why it matters, and how to promote It. Sharp M, Burkart KM. Ann Am Thorac Soc. 2017 Apr;14(4):505-512. 174. Prevalence of burnout among musculoskeletal radiologists. Chew FS, Mulcahy MJ, Porrino JA, Mulcahy H, Relyea-Chew A. Skeletal Radiol.

2017 Apr;46(4):497-506.



175. Striking a better integration of work and life: challenges and solutions. Cheesborough JE, Gray SS, Bajaj AK. Plast Reconstr Surg. 2017 Feb;139(2):495-500.

176. Burnout, career satisfaction, and well-being among US neurologists in 2016. Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB, Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, Cascino TL. Neurology. 2017 Feb 21;88(8):797-808.

177. The impact of administrative burden on academic physicians: results of a hospital-wide physician survey. Rao SK, Kimball AB, Lehrhoff SR, Hidrue MK, Colton DG, Ferris TG, Torchiana DF. Acad Med. 2017 Feb;92(2):237-243.

178. Strategies to promote resilience, empathy and well-being in the health professions: Insights from the 2015 CENTILE Conference. Haramati A, Cotton S, Padmore JS, Wald HS, Weissinger PA. Med Teach. 2017 Feb;39(2):118-119.

179. An observational study of provider perspectives on alternative payment models. Harris D, Puskarz K. Popul Health Manag. 2017(5):402-410. 180. Physician burnout in physical medicine and rehabilitation: Should we focus more on physiatrists' mission? Silver JK, Bhatnagar S. Am J Phys

Med Rehabil. 2017 Aug;96(8):e159-e161 182. Burnout among cardiologists. Michel JB, Sangha DM, Erwin JP 3rd. Am J Cardiol. 2017 Mar 15;119(6):938-940. 183. "It Is like heart failure. it is chronic … and it will kill you": A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians.

Kavalieratos D, Siconolfi DE, Steinhauser KE, Bull J, Arnold RM, Swetz KM, Kamal AH. J Pain Symptom Manage. 2017 May;53(5):901-910. 185. The relationship between burnout syndrome among the medical staff and work conditions in the Polish healthcare system. Głębocka A. Adv

Exp Med Biol. 2017;968:61-70. 186. Risk and resilience factors associated with resident burnout. Chaukos D, Chad-Friedman E, Mehta DH, Byerly L, Celik A, McCoy TH Jr, Denninger

JW. Acad Psychiatry. 2017 Apr;41(2):189-194. 191. The impaired and/or disabled anesthesiologist. Katz JD. Curr Opin Anaesthesiol. 2017 Apr;30(2):217-222. 193. Medical student resilience strategies: A content analysis of medical students' portfolios. Prayson RA, Bierer SB, Dannefer EF. Perspect Med

Educ. 2017 Feb;6(1):29-35. 194. Pressure and disenchantment in physicians-Part II: Lessons for physicians from the Tao Te Ching. Cockerell CJ. Clin Dermatol. 2017 Jan -

Feb;35(1):100-104. 195. Clinical faceoff: physician burnout-fact, fantasy, or the fourth component of the Triple Aim? Wuest TK, Goldberg MJ, Kelly JD 4th. Clin Orthop

Relat Res. 2017 May;475(5):1309-1314. 197. The physician at risk: disruptive behaviour, burnout, addiction, and suicide. Grocott HP, Bryson GL. Can J Anaesth. 2017 Feb;64(2):119-121. 199. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. Panagioti M, Panagopoulou E, Bower P,

Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. JAMA Intern Med. 2017 Feb 1;177(2):195-205. 200. Self-care as a professional imperative: physician burnout, depression, and suicide. Kuhn CM, Flanagan EM. Can J Anaesth. 2017;(2):158-168. 202. Ready for change? The role of physician and staff engagement, burnout, and workplace attributes. Hung D, Chen PH. J Ambul Care Manage.

2017 Apr/Jun;40(2):150-157. 204. Are we at risk of losing the soul of medicine? Botha D. Can J Anaesth. 2017 Feb;64(2):122-127. 205. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Shanafelt TD,

Noseworthy JH. Mayo Clin Proc. 2017 Jan;92(1):129-146. 206. Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections. Tawfik DS, Sexton JB, Kan P, Sharek PJ, Nisbet

CC, Rigdon J, Lee HC, Profit J. J Perinatol. 2017 Mar;37(3):315-320. 208. Anesthesiology resident wellness program at the University of Saskatchewan: curriculum content and delivery. Chakravarti A, Raazi M, O'Brien

J, Balaton B. Can J Anaesth. 2017 Feb;64(2):199-210. 209. New insights into burnout and health care: Strategies for improving civility and alleviating burnout. Maslach C, Leiter MP. Med Teach. 2017

Feb;39(2):160-163. 216. Whose problem is it? the priority of physician wellness in residency training. Winkel AF, Nguyen AT, Morgan HK, Valantsevich D, Woodland

MB. J Surg Educ. 2017 May - Jun;74(3):378-383. 218. Measuring pediatric hematology-oncology fellows' skills in humanism and professionalism: A novel assessment instrument. Kesselheim JC,

Agrawal AK, Bhatia N, Cronin A, Jubran R, Kent P, Kersun L, Rao AN, Rose M, Savelli S, Sharma M, Shereck E, Twist CJ, Wang M. Pediatr Blood Cancer. 2017 May;64(5).

219. Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Austin CL, Saylor R, Finley PJ. Psychol Trauma. 2017 Jul;9(4):399-406.

223. Perceived nonbeneficial treatment of patients, burnout, and intention to leave the job among ICU nurses and junior and senior physicians. Schwarzkopf D, Rüddel H, Thomas-Rüddel D, Felfe J, Poidinger B, Matthäus-Krämer CT, Hartog CS, Bloos F. Crit Care Med. 2017;45(3):e265-273.

226. Defining team effort involved in patient care from the primary care physician's perspective. Hwang AS, Atlas SJ, Hong J, Ashburner JM, Zai AH, Grant RW, Hong CS. J Gen Intern Med. 2017 Mar;32(3):269-276.

239. Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain. Yuguero O, Ramon Marsal J, Esquerda M, Vivanco L, Soler-González J. Eur J Gen Pract. 2017 Dec;23(1):4-10.

241. Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies. Lapa TA, Madeira FM, Viana JS, Pinto-Gouveia J. Minerva Anestesiol. 2017 Feb;83(2):191-199.

248. Burnout syndrome in critical care team members: A monocentric cross sectional survey. Malaquin S, Mahjoub Y, Musi A, Zogheib E, Salomon A, Guilbart M, Dupont H. Anaesth Crit Care Pain Med. 2017 Aug;36(4):223-228.

250. Mindfulness practice: A promising approach to reducing the effects of clinician implicit bias on patients. Burgess DJ, Beach MC, Saha S. Patient Educ Couns. 2017 Feb;100(2):372-376.

254. Healthcare provider perceptions of causes and consequences of ICU capacity strain in a large publicly funded integrated health region: a qualitative study. Bagshaw SM, Opgenorth D, Potestio M, Hastings SE, Hepp SL, Gilfoyle E, McKinlay D, Boucher P, Meier M, Parsons-Leigh J, Gibney RT, Zygun DA, Stelfox HT. Crit Care Med. 2017 Apr;45(4):e347-e356.

258. Do work condition interventions affect quality and errors in primary care? Results from the healthy work place study. Linzer M, Poplau S, Brown R, Grossman E, Varkey A, Yale S, Williams ES, Hicks L, Wallock J, Kohnhorst D, Barbouche M. J Gen Intern Med. 2017 Jan;32(1):56-61.

266. Associations of work characteristics, employee strain and self-perceived quality of care in Emergency Departments: A cross-sectional study. Weigl M, Schneider A. Int Emerg Nurs. 2017 Jan;30:20-24.

273. Project on the good physician: a proposal for a moral intuitionist model of virtuous caring. Michael Leffel G, Oakes Mueller RA, Ham SA, Curlin FA, Yoon JD. Teach Learn Med. 2017 Jan-Mar;29(1):75-84.

279. Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions. Holmes E, Connolly A, Putnam K, Penaskovic K, Denniston C, Clark H, Rubinow D, Meltzer-Brody S. Acad Psychiatry. 2017;41(2):159-166.



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Operation Stress Removal Oregon Medical...3 Healthcare Professional Wellness Peer- Reviewed Publications, 2017 Thursday, November 2 Childcare Available 5:00-6:15 pm Simultaneous Meet