What We Do
Burned-out, emotionally exhausted, disengaged physicians
are a major hidden factor in the high cost of health care
Despite studies showing a growing epidemic of physician burnout--with data supporting incidences of 40- to 60-percent of those practicing and a significantly higher-than-norm suicide rate--most health system executives are looking the other way. Even many physician leaders, themselves products of the prevailing macho culture of medicine, tend to dismiss the subject as "soft stuff" focused on those "who shouldn't be in medicine anyway."
Part of the problem is the absence of hard data quantifying the many ways the problem raises costs. Health leaders are only now becoming truly aware of the high costs of burnout-related medical errors and how misalignment and inefficiencies arise from exhaustion, cynicism and mistrust of administration. In addition, a lack of emotional intelligence in interpersonal dealings with staff and patients are also costly characteristics of burnout.
An outside review of Dr. Paolini’s Florida Hospital program, conducted by Jeffrey T. Jernigan, PhD during September and October of 2012 and published in February 2013, provided hard data on just one cost dimension of physician burnout--the cost to the hospital or health system of replacing physicians. That one cost-avoidance factor alone showed a 10-dollar return for every dollar spent on Dr. Paolini's program.
The calculation was based on a real cost to Florida Hospital of $200,000 to $300,000 to recruit a new or replacement physician. The study identified 25 interventions in 2011–2012 with physicians who remained in practice at Florida Hospital in 2013, but who would not be on staff if not for the work of her Physician Support Services (PSS) program. The associated savings to the hospital in just replacement expense was found to be more than $5.1 million for the preceding two years alone.
During the period studied, 1,266 total contacts with physician and physician family members were recorded. More than 50 physicians were helped through major negative life or career events. The published report noted: “An extrapolation of the data conservatively suggests that more than 100 physicians are practicing medicine today who otherwise would not be so employed if not for PSS interventions over the past 10 years. A much greater number of physicians are practicing safer, more relational and higher quality medicine to the benefit of their patients and the health system. Both the human and financial implications of this work over the past 10 years are stunning.”
The report also noted: “Counseling, psychotherapy and coaching are anchors of the program. However, the whole-person leadership development programs and holistic life balance and mental wellness activities offered to all members of the medical staff are what make PSS truly effective. The impact of PSS is reflected in more positive relationships between administration and medical staff members, healthier physicians, better working relationships among care team members, improved patient satisfaction and fewer medical errors.”
Physician Well-Being Programs
Dr. Paolini is probably the one non-MD in practice today with the deepest insight into the physician psyche. She specializes exclusively in physicians and their families. For the past 17 years she has logged thousands of hours of in-depth therapy sessions with physicians of all specialties. She is author of Inside theMind of a Physician, published in 2009, a book focused on understanding physicians and their world through the lenses of their personality characteristics, their training and the current culture and environment of medical practice.
Dr. Paolini designed the first-of-its-kind hospital-based program to address the development, integration and emotional wellness of physicians by embedding herself in their world. She rounded with hospitalists, scrubbed-in with surgeons, shadowed primary care physicians in their offices. She joined the medical staff and took call as a clinical psychologist in the emergency department, being there—sometimes in the middle of the night—working alongside physicians as they responded to emergencies.
She learned how the culture of medicine mitigates against self-care and about the reluctance of physicians to seek help no matter how severe the psychological pain and stress they experience. She was determined to be visible in as many venues as possible so physicians would come to know her as a human being and so that she could come to know them, their world and their language.
Through this embedded relationship, the medical staff came to trust that they were listened to and understood and also to trust that what was discussed would in fact remain confidential.
Today the program she started continues to operate from both a therapeutic and a prevention perspective, influencing both individual as well as organizational change through a continuing medical education curriculum, leadership development, and creative programming, as well as psychotherapy
Dr. Paolini subsequently founded a Physician Leadership Coaching service that provides support for physicians — for both their personal well-being and professional development — and the Institute for Physician Integration with a mission of fostering physician support programs for medical staffs and healthcare systems across North and South America.
In addition to her physician clients, Dr. Paolini is currently working with two health systems and has been previously engaged by several health systems for consultations, including the Mayo Health System, Wisconsin; Centura Health, Colorado; Loma Linda Medical Center, California; St. Helena (Adventist Central California) Napa Valley, California; Tampa General Hospital, Florida; and Baylor, Scott & White, Texas. Dr. Paolini has established an office at 613 N. Wymore Rd., Winter Park, FL 32789. She may be reached at firstname.lastname@example.org.
Physician Leadership Programs
Herdley O. Paolini, PhD, LP, director of Physician Support Services at Florida Hospital for 12 years, founded the Institute for Physician Integration in 2015 as a physician leadership development, well-being and integration consulting service for hospital medical staffs and health systems across the nation. She also opened a physician leadership development coaching service that
serves individual physicians.
Dr. Paolini cites recent studies showing more than 50 percent of practicing physicians are exhibiting symptoms of burnout, coupled with her belief in the essential role of physicians in achieving clinical integration, as her reasons for founding the Institute for Physician Integration.
She understands effective physician visionary leadership is essential for success in achieving the triple aim of transformative improvements in cost, quality and the patient experience.
A common assumption is physicians generally can move into leadership roles based on their education and experience,” says Dr. Paolini. “Health systems are learning—often the hard way—that just isn’t true. Even a MD combined with a MBA doesn’t address the impact of the default managerial style physicians learn through their training. Neither medical education nor MBA
programs address the soft skills and emotional well-be necessary for effective leadership.”
She also notes that the new wave of physician leadership training programs being started across the country often lack the basic foundations for leadership development. “You can cognitively train and coach to develop managerial tools, but that has little to do with creating leaders. Leadership has to come from within and developing it requires a holistic mind-body-spirit approach focused on personal well-being and interpersonal skills,” she says. “It’s not a quick fix.”
Crisis Intervention and Personal Development