Podcast Episode 19 | Physicians Foundation Combatting Mental Health

With Dr. Gary Price

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Gary Price:                    00:00                And it goes to this idea of physicians adapting and there's an inherent assumption there that somehow, physicians are troglodytes who don't want to use new technology.

Intro:                            00:14                From Spaugh Dameron Tenney, it's the Prosperous Doc podcast, real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Penny.

Shane Tenny:                00:32                Welcome to today's episode of The Prosperous Doc podcast. If you're a new listener, welcome. We're glad that you've joined us and if you're a regular subscriber, you'll notice that we've got a new name today, and I wanted to take just a minute and talk about that before we jump into today's interview. Since our podcast launched almost a year ago, our mission has remained unchanged. Part of that is to break through some of the isolation and loneliness that are part of the journey through medicine and dentistry. As we live our lives on social media, it's easy to see everybody else and the highlight reel of their lives that's evident and miss the real story of what's going on. So, we've worked diligently to bring real conversations with folks around topics like physician burnout and financial infidelity. We've done interviews talking about thriving in the midst of the struggle of running a private practice and healthcare entrepreneurship and we've gotten great feedback.

Shane Tenny:                01:35                In the midst of that, we want to continue to pursue that, but without creating any confusion around the word wellness. There's part of us that kind of feels like it's become a little bit of a buzzword or is a little overused and we want to continue to focus on conversations that are focused on helping you flourish. We want you, through your time with us in this podcast, to grow emotionally, relationally, financially, intellectually and professionally. So we believe that the name Prosperous Doc really reflects what our goal and our mission is around that to help you flourish and find prosperity. So with that said, we're going to continue to focus on real stories, real inspiration, real growth. With that, I'll leave you to today's interview.

Shane Tenny:                02:30                Welcome back to another episode of White Coat Wellness. I'm Shane Tenny, glad to have you with us today where we're going to be highlighting an organization doing tremendous advocacy work for physicians and medical providers around the country. In 2003, a class action lawsuit brought about by physicians and 19 state medical societies and three county medical societies against private third-party payers resulted in a significant monetary settlement. The settlement led to the establishment of The Physicians Foundation, an organization that's grown to become a leading voice for physicians across the country.

Shane Tenny:                03:12                Since its inception, The Physicians Foundation has awarded now over $49 million in grants to support causes around physician leadership training, raising the bar for health information technology and tackling really vital issues such as physicians shortage and burnout and suicide. I'm joined today by the president of The Physicians Foundation, Dr. Gary Price. He's a board certified plastic surgeon, serving as attending surgeon and clinical assistant professor of surgery at Yale New Haven Hospital in Connecticut. He's affiliated with numerous local and national medical associations and societies and has been the president of The Physicians Foundation for about the last two years. Dr. Price, thanks so much for being with us this morning.

Gary Price:                    04:02                Thank you, Shane. It's a pleasure to be here.

Shane Tenny:                04:05                I'll toss out a softball out here first and just ask if you can add a little color commentary to what I was just describing. What is The Physicians Foundation and kind of the scope of the mission?

Gary Price:                    04:16                Sure, The Foundation, as it currently consists, is governed by a board of 21 physicians and executives and medical societies from around the country. They represent the organizations that originally filed the class action suit. Our mission, in a very simple sense, is to improve the quality of healthcare that Americans receive and to improve the environment that physicians deliver that care to their patients. As far as how we accomplish that, we're currently focused in four different areas. One, improving the leadership skills that physicians have so that they can better lead their organizations and better lend the physician's voice to the current debate over healthcare reform.

Gary Price:                    05:05                We're very interested and we're one of the first organizations to sort of shine a spotlight on the impact that what I'll call social determinants of health have on the quality of patients' outcomes in healthcare, and also on the cost that that healthcare involves. We fund research into anything that shows promise of improving the environment that physicians practice and deliver care to their patients. We, fundamentally, from the beginning, recognize that many of the changes that are taking place in healthcare were creating an environment that really was toxic for the physicians who were practicing in that and ironically was negatively impacting the way care is delivered. In addition to that, our fourth area of concern is physician wellness, which has become an increasingly important topic over them the past several years. So we fund the projects and meetings and educational sessions impact all of those areas.

Shane Tenny:                06:16                I'm not sure we have time to get through all of them, but I sure would like to tackle it because I know there's good work going on in all of those. Help me understand, were you a part of the original lawsuit back in 2003? How and when did you begin to get involved in The Physicians Foundation?

Gary Price:                    06:32                I was not part of the original lawsuit or settlement back then. I came on the board in 2006, so now, 13 years ago. I had been president of the Connecticut State Medical Society at that point and Connecticut was one of the societies involved in the initial lawsuit. I actually replaced our first board member who became the CEO of the Foundation and I came onto the board at that time. We still have a number of members of the board who were involved in the original lawsuit who keep us grounded to the original mission and purpose.

Shane Tenny:                07:11                Pretty impressive to have that legacy and that continuity among the leadership. In your tenure as the president of the organization these last couple of years, as you highlighted there, there's a lot of good work and focus being done. What are the projects or the programs that are currently underway that you're proudest of?

Gary Price:                    07:33                Well, currently we have several that I'm very proud of. I think the foundation's biggest accomplishment to date is shining a spotlight on the impact of those social determinants of health I mentioned earlier. Over 10 years ago, we funded a book by Dr. Buzz Cooper who looked into the economics of healthcare and showed how there was a direct correlation between a patient's economic educational housing standards that had a direct impact on both the quality of their healthcare and ironically, made their healthcare much more expensive. The prevailing view at that time was that those differences in costs between different populations in different geographic areas were somehow due to the physicians who were providing the care. That really didn't make much sense to us because care was much more expensive in areas with real problems as far as poverty, education, transportation.

Gary Price:                    08:33                Buzz, very nicely in this book looked, in a very rigorous scientific way, at the correlation between zip codes and the cost of care and showed conclusively that actually that was much more expensive in economically-disadvantaged areas as opposed to more affluent areas. It took a long time, but the Foundation was one of the moving forces behind bringing that into the public discourse and very pleased to see in the current debate over healthcare that it's really becoming an important topic and that's something we're definitely continuing to pursue. We've funded an organization and worked with them at this time called The Health Initiative, which has some very expert policy and economics consultants within it. They've worked with us around the country to start looking at how we can practically bring about change within healthcare financing and government policy to include a consideration of these factors and begin to address some of them as we try to make our healthcare system better.

Gary Price:                    09:42                So that's one of our current projects with social determinants of health. In the physician wellness arena, of course, we're terribly concerned about that. I know you've drawn attention to this in your previous podcast, for which I'm very grateful on behalf of all the physicians and their families, but we have a real problem with physician suicide in the country that it's not only just a horrible tragedy for the individuals and their families, but it has a terrific impact on patients. Roughly 400 physicians every year commit suicide. Overall, it's almost twice the rate of any other profession. That means that roughly 1 million patients every year, lose their doctor to suicide. So, we think this is a critically important topic. There are a number of reasons I think this has happened and there are a number of reasons that make physicians reluctant to seek help when they're in emotional trouble, which I'd be happy to talk about, but we've funded several initiatives to take a look at this and to start trying to improve all the factors that lead to it.

Gary Price:                    10:54                One of them is our recent Vital Signs Campaign, which is designed not only to raise awareness among physicians and their families to start to get them talking about it, and also to provide a very simple set of tools to begin to address it and try to get individuals help. In addition to that, we funded a national campaign in conjunction with the AMA to take a hard look at physician wellness in the setting of practicing physicians. That initiative involves a study involving a number of practices in the states of Washington, New Jersey and North Carolina. What we're trying to do there is look at the state of wellness through a rigorous scientific assessment, go into the practices and introduce a number of tools that have been shown to improve the wellness of the physicians and then look at those practices after that intervention and see if it's really made a difference. That's an ongoing project. It'll take place over two years. We're in the middle of it right now. So I'm very proud of our efforts to actually step in and do something about that.

Shane Tenny:                12:05                It seems to me that, I guess, the prevalence of the conversation around burnout and the spotlight that is now being directed at the suicide issue are beginning to move the needle, at least from my perspective and I'm curious about yours to the point you're making where perhaps in the past, it's been fairly taboo to talk about or raise issues around anxiety, stress, depression, burnout, indifference. Do you feel like there's at least an opening now within the medical community, within hospital systems, that sort of thing to begin to address these, or if I can tack on a followup to this is, within larger systems, is it just lip service to burnout and suicide, or do you see larger healthcare systems actually putting dollars and beginning to implement programs?

Gary Price:                    12:56                Shane, I think we're just beginning to see the door open to shed some light on this area. I think a number of things have begun to happen that will make this effort little bit more successful, if you will. I think in the past, there has been lip service, but not a lot of attention through efforts from organizations like The Physicians Foundation. I think people are talking about it a lot more now. Some data has become available that reveals the financial impact of having to replace a physician to a large hospital system. I think this has drawn their attention a little more seriously to the problem. Those are really positive steps, I think. At the national level, when I talk about this now, I've been talking about it for several years and it definitely gets more attention now. I think people are ready to hear about it and they're motivated to do something about it because at this point, everyone does have a colleague whom they've lost to a physician suicide.

Gary Price:                    14:01                Of course, it only takes one of those to make us all realize it's a very serious problem. There are a number of reasons why physicians won't talk about it. I think that's part of the problem. They're afraid that it'll be perceived as a sign of weakness or lack of effectiveness by their colleagues and their patients. They're worried that if it's brought to the attention of a medical board, the approach will be punitive and they could lose their entire career. So instead of seeking help for something that is treatable and there are definitely things that can be done, they won't talk about it and of course things get worse. That's probably the most classic feature of it that in my personal experiences, no one had any idea that our colleagues we're in trouble until suicide occurred.

Shane Tenny:                14:58                Until there's something really visible that manifests at an acute level. If I might follow up with a question, I know there's been conversation across the community and research being done on the topic you raised around disclosing past mental health to the state medical boards and the fear around that. That strikes me as a complicated topic where on the one hand, if states probe or ask about a history of mental health, and there's a fear of disclosing that and so I can see on the one hand, there's an argument to say, "Look, state, stop asking about information that you're not going to do anything with other than create unnecessary noise." On the other hand, there's an argument that seems to me that it's kind of reasonable to ask, "Are mental health issues in your past?" But let's be realistic about it, that doesn't mean it's a career changer. It's just something that needs to be disclosed. Talk a little bit about the complexity of the issue.

Gary Price:                    15:53                Sure. Well, you brought up one of the important and complex questions about it? One of the barriers definitely is this perception of physicians that there are state medical boards who control their licenses, of course, will view any mention or history of treatment for mental health issues as a reason to take their license away and then it will be a permanent blot on the record. So you can imagine anyone who thought disclosing something that would ruin their entire career would definitely think twice about doing that, let alone a physician. You're absolutely right. There are many states who either currently or in the past did have a question on their licensing applications about a history of mental health issues. Yet, there were very few, if any, who took any action on that.

Gary Price:                    16:47                Physicians across the country who looked at this in detail, and have come to the conclusion that asking that question actually does more harm than good, especially when no action is taken on that basis. There have been several states who have successfully gotten that question taken off of their license applications. I think that is a positive step. It's to remove the stigma that's associated with it and that perceived barrier. The medical boards, from their perspective, recognize that they're there to make sure that the professionals they license are safe to take care of their state's patients.

Gary Price:                    17:25                I totally understand that. However, ironically, by stigmatizing mental illness, by taking a totally punitive approach, they make physicians go underground with these problems, not seek treatment and I think there is a growing consensus that actually makes care less safe. So I think these steps to take those questions off the licensing applications are positive ones. I think they reflect a growing recognition that there has to be more openness about these issues to keep our physicians well and to make sure our patients get good care.

Shane Tenny:                18:04                Well, I want to touch on another hot topic, at least every time I'm in conversations with docs, and that is a that's electronic medical records. So when we come right back from this break, I want to open up that can of worms with you.

Gary Price:                    18:18                Great.

Will Koster:                   18:23                I'm Will Koster, bringing you this episode's financial wellness tip. I am extremely passionate about seeing money at work. However, we have all been reminded with the recent pandemic that every financial plan needs to have a certain amount of liquid cash as the foundation. An emergency fund, while not exciting, is an essential backstop to make sure your personal finances stay in order, even when the greater economy is not flourishing. Some medical professionals have been hit extremely hard with the economic shutdown due to COVID-19. Luckily, if planning properly, an emergency fund can help smooth out the volatility in production and income. Most financial professionals agree that three to six months of living expenses is an adequate amount to have in cash reserves.

Will Koster:                   19:11                Understanding that in emergency, such as losing the ability to perform surgeries is at hand, a family can also adjust items within their personal finances to make their emergency fund stretch longer. Some examples of this are taking advantage of forbearance options if they have student loans or discontinuing automatic investments into the market. As life begins to return to normal, it is important to rebuild your emergency fund as quickly as possible. Oftentimes, we suggest redirecting savings that would have ordinarily been invested to be saved into cash in order to expedite the process of replenishing those cash reserves. The key takeaway, don't overlook the importance of having an emergency fund. For this episode's financial wellness tip, I'm Will Koster.

Shane Tenny:                20:00                Dr. Price, you have written about the vast love for electronic medical records in a number of articles, including one that I came across in Forbes from last year and you had several good quotes. So I'll commend you for your authorship on this and I just want to read them here. The first quote that really jumped out to me is this one that I know our listeners will appreciate. You wrote, "When the canaries in the coal mine start dying, one generally doesn't respond by starting to look for tougher canaries," which, of course, seems to be the initial response from at least many large hospital systems, is, "Just suck it up and toughen up and start to deal with this." But your line, at the end of, at least the piece I was referring to from last year, you wrote, "It's time for the entire house of medicine to address the EMR itself." I wonder what you mean by that, what you see. Are physicians beginning into adapt to life with EMR and see the benefits, or is it still just the thorn in the side?

Gary Price:                    21:03                Well, Shane, that's a great question and it's probably my favorite topic, so I'd be happy to talk about it. I think in the initial introduction of EMRs and the problems that occurred with it, that there was a fundamental paradigm assumption that was completely wrong, and it goes to this idea of physicians adapting. There's an inherent assumption there, but somehow, physicians or troglodytes who don't want to use new technology. Initially, it was very obvious that a lot of people implementing the EMRs thought the whole problem was just with particularly older physicians who didn't want to adopt new technology. I think that assumption was completely wrong. Physicians log some aspects of the EMRs. The ability to get data immediately and to look at trends in data and to gather it from many different places, I've never heard a physician who didn't think that was just wonderful. It saves time and it makes care safer.

Gary Price:                    22:11                We still have a long way to go with that part of it. The interoperability of EMRs is still a big problem and I don't think it's been adequately addressed by government or hospital systems. There's still a lot of compartmentalization, but even the data currently shows that this notion that somehow it's just older physicians who don't want to adapt, it's not true. Frustrations with EMRs cut evenly across age groups in physicians as well as the frustration levels. I think that all stems from the fact that like it or not, the real fundamental purpose of the original introduction of EMRs was as a billing instrument. I don't think there's another billing system that's been introduced anywhere in the history of man, that's been as wildly successful as EMRs have been for hospital systems and perhaps insurance companies. However, because it was designed as an accounting instrument, it really not only ignored the physician using it at the bedside, but it actually made that harder and much, much less efficient.

Gary Price:                    23:29                The whole idea of technology is supposed to make care more efficient, to make it better and physicians were right in the trenches experiencing this and it was easy for them to speak up right away. It wasn't popular for them to speak up. The EMRs, I think, were tremendous assets to hospital systems' bottom lines. Unfortunately, I think the government played a role in this. Federally, there were huge incentives and even financial pressures to introduce EMRs back in the late '90s and early in the century, but they were forcing the introduction of systems that weren't really ready and they hadn't shown themselves in the marketplace. I think if they had come in to the marketplace with more pressure to make it easier for the end user, we probably would see better systems today.

Gary Price:                    24:26                They still are the number one source of frustration to physicians. Seventy-eight percent of physicians in our most recent position survey reported experienced feelings of burnout and the number one cause that they cited was frustrations with dealing with the electronic medical records system. So I think a couple of things have to happen. We all have to step back and realize that this tool has not been optimized for the people who are being asked to use it. Then we have to start looking at practical ways of making it better and I think we also have to develop ways assessing how well it works to be able to give grades and ratings, if you will, to different systems and to how systems work in different hospitals so that the physicians using them can look at that ,as well as where the hospital physically is and making decisions about where they want to work and also make decisions about what systems they want to use, because there's got to be some pressure on the people who develop and sell these systems and the administrators who introduce them from the top down to be responsive to that.

Shane Tenny:                25:43                Do you see, as hospital systems respond, at least hopefully, or theoretically to the frustrations of the providers and as the Apex and the Cerners and the different EMR creators respond, albeit slowly, but respond, do you feel there's still a lot of frustration? Is the pendulum getting to swing at all? Are the benefits beginning to outweigh the costs or are we're still at the beginning of that implementation and a long way to go?

Gary Price:                    26:14                I think we're at the beginning of it, Shane, but we're in a good place. I think it's now at least in the consciousness of everybody, that it isn't working as well as it should be. I think, perhaps, our voices have slowed the swing of that pendulum in the wrong direction. I believe it's maybe has stopped moving in the wrong direction. It's lot easier to convince a hospital system and an EMR provider that they need to do something when the data's there, that it's actually costing money and I think that data's now available. I think many large hospital systems now realize that the frustration with is inefficient.

Gary Price:                    26:59                We've certainly played a big role in bringing attention to the fact that that frustration is playing a large role in burnout and burnout is not only a problem for our physicians, but it's a problem for the health system that is asking that physician to provide care and not only for their personal wellbeing, but their financial bottom line. There's good data now, but it costs money to be inefficient and it costs a lot of money to replace a physician. So I think we're at the point that everyone realizes we have to do something. Now we need to work on practical solutions.

Shane Tenny:                27:35                Can we talk for a minute about physician staffing and shortage? I know the foundation has developed tools and forecasting and research. To the point you're making, there's certainly plenty of frustration and headwinds now between the regulatory environment, between the technology, between the system and payer pressures. I know a lot of the forecasts are anticipating shortage of physicians over the next decade. What are you seeing as some of the primary causes there, or maybe the universe is. Are there any solutions that are presenting themselves to your organization?

Gary Price:                    28:11                Sure. Well historically, over 20 years ago, much to amazement of people in organized medicine and the foundation, the people who were influencing social policy insisted that there would be no shortage of positions. It was very obvious to us with a relatively level number of physicians graduating and what was happening with our patient population, people on average, were getting older. But as they got older, of course, they were living longer and had much more complicated medical problems, which all predicted a greater need for physicians. I think that debate finally was ended probably in the early 2000s and there was a lot of spending put into developing new medical schools. That's still going on.

Gary Price:                    28:58                So I think we have realized now, we admit there will be a shortage, which an organization like ours think is a victory. We got the message across. The problem is there's a tremendous lag time between opening a medical school and physicians actually entering practice and caring for patients. If you have four years of college, four years in medical school and then somewhere between four and as long as eight to 10 years of postgraduate training before that physician's actually out there helping patients. So the question is, what else besides putting more physicians in the pipeline can we do? We feel that that frustration we were talking about needs to be addressed because it leads to physicians retiring earlier than they normally would. We do surveys of physicians every other year.

Gary Price:                    29:48                We have one about to be done for the coming year. But that survey, since we've been doing it now, over the past eight years has consistently shown that a large number of physicians anticipate retiring earlier than they would have otherwise, because of those frustrations. So addressing those, we think, is very important. On a public policy level, the funding in our country for our residency positions, which is where young doctors go after they graduate medical school to complete their training, that has remained stagnant and now we actually don't have enough training positions for the students who graduate medical school in the U.S., let alone students from outside medical schools who would like to come here and train. So that's a choke point in the pipeline.

Gary Price:                    30:40                We think that making the environment that physicians practice in less toxic and more rewarding on a personal level will greatly help in, not only keeping physicians practicing, but also, making them more efficient, able to deliver more care to more patients. Taking away some of the regulatory barriers that make care so inefficient and frustrating, I think, we'll make physicians more efficient. Of course, there are other strategies put forward alternative providers, such as physician's assistants and nurse practitioners. I think that's only a partial solution. In the end, at the level of care there just are circumstances where you need that end up and more concentrated training that only a physician gets.

Shane Tenny:                31:36                Right. I know there are other studies and articles and things written as well. Another topic that is certainly at the forefront of conversations that I'm in is just the cost of becoming a physician. When you have the high burden of the cost of medical school and the student loans that come along, and then there's a lot of publicity now around the quagmire of the public service loan forgiveness program and how inept the Department of Education is it managing that. Just from conversations with folks in undergraduate and thinking about their career and it's, "Well, you know, that's going to be really expensive and a long time to train and the student loan environment is, is going to require me to pay a high burden for a decade or more while all my friends pass me by." These are just very real considerations too, or considerations and creating a hindrance to people entering one of the oldest and most noble professions, truly.

Gary Price:                    32:36                Well, you bring up a good point. Of course, that delay in entering the workforce and the financial burden of that has really historically always been part of becoming a physician. I think that's something most people don't even think about or realize, but it's just exponentially magnified over the last 20 years. It's probably one of the unique financial conundrums that face physicians compared to other professions in that the magnitude of that now, as you're probably aware, on average, a medical student, once they finished medical school training comes out with a debt of somewhere between $200,000 and $300,000, sometimes even more. But then they enter postgraduate training where they do receive a salary, but it's not on a par with other professionals at that level.

Gary Price:                    33:25                It's certainly not enough to start off paying off debt and by the time they're actually entering practice this they have this huge debt that's the equivalent of a house before they've even started working. That becomes a more complex problem because it influences where they might choose to practice, makes them less likely to go to an area that really needs a doctor. It also, we think, influences the specialties they get because they've got real pressure to pick a specialty or practice that might supply a higher salary and help them pay off those loans, which potentially drives them away from primary care professions like pediatrics, family medicine and even general surgery, areas that we have a real need to increase the number of doctors. So it's a very real problem and it sticks its tentacles into healthcare in many different directions.

Shane Tenny:                34:21                Yeah. Well, as we wrap up here, we've talked about a lot of the challenges facing the profession today, but I want to close, if we can, and let me ask you what makes you feel hopeful about the future of medicine?

Gary Price:                    34:37                I probably experience that every day. I think the reason most physicians went in, if not all of us, went into medicine and made the time, financial and personal sacrifices to do it is we just want to feel like we've helped someone else feel better. I think every day, all of us experienced that hopefully, at least once. The frustrations can make us go home upset about that, but I think the opportunity to do that as a physician, is what keeps all of us going. I'm hopeful because I think these issues that we've been talking about today are now being discussed. They're at least part of the discussion and The Foundation is very proud to have helped create that environment and we really want to continue to provide research and data and practical solutions that will help move that forward for our physicians and our patients.

Shane Tenny:                35:37                Excellent. Dr. Price, thanks so much for being with us this morning for highlighting really important topics and in some ways, most importantly, just highlighting the good work that The Physicians Foundation is doing and the available resources that you have to the medical community. So thanks again.

Gary Price:                    35:53                Thank you, Shane. We're really grateful for the opportunity to share that with you.

Shane Tenny:                35:57                Thanks so much for joining us today for our interview with The Physicians Foundation president, Dr. Gary Price. Again, he mentioned their Vital Signs Program around physician burnout and suicide and they've got a great piece that you can download for free. We'll include the links to it in the show notes at the bottom of the podcast here. We've got a number of other great interviews that I've been doing over the last couple of weeks that will be coming out every other week. If you haven't noticed, we try to release an episode every other Monday. If you subscribe, then you'll be sure to get an alert when that comes out as well as the topic and who the guest is so that you can listen in there. We're available also through most of the social media platform. If you have questions, ideas or suggestions, you can feel free to email me directly, shane@whitecoatwell.com. Thanks so much for being with us today and we'll see you back here next time. Bye-bye.

Speaker 2:                    36:50                This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.