Logan Lutton

etter Together is a professional, structured coaching program designed by female physicians to address the burnout that is disproportionately experienced by women in medicine. What started out as a clinical trial has transformed into a full program that has coached more than 100 women, many of whom have found personal and professional success.

® spoke with Better Together cofounders Adrienne Mann, M.D., and Tyra Fainstad, M.D., via Zoom. The transcript below was edited for length and clarity.

Medical World News®: Can you describe the Better Together program?

 Better Together is a six-month online group coaching program that was designed for women residents. It was delivered to women residents at the University of Colorado in 2021. In our program, participants get invited to a members-only website, where they can engage with us in three different ways. We have weekly content over six months that covers a whole bunch of stuff, starting from vision and values, setting big goals, to dealing with perfectionism, impostor syndrome and envisioning your future self. We have weekly modules that people can work through on their own. They can also (be) coached by Tyra and I, or live on a Zoom call, where we host two calls a week. They can raise their hand and come up and say, “Hey, I would like coaching today on some bad feedback I got in the operating room,” and we’ll go back and forth with them on a Zoom call in front of a group of their peers, and then send them back when they’re done. We usually coach about four people per call. They can also engage in coaching on our website in a written way. They write to us, we respond, and it gets posted on a forum on the website for all the participants to read and benefit from. Throughout all this, our objective is to help show people what’s going on in their mind and get them curious about their thinking.


MWN: What makes today’s physician culture so toxic?

 Physician culture rests on this idea that a physician is a hero. With that comes an idea of pure altruism, which unfortunately has gotten translated into putting yourself last. It even creeps into martyrdom a little bit.

 This is a pattern I’ve seen get worse over my career. It’s been brought to light with recent events, especially the pandemic. People are starting to talk more about the toxic culture. Unfortunately, instead of talking about the culture itself, what ends up happening is this battle between the system and the individual, which leaves room for someone to be at fault and someone to blame. You’ve got the system on one side, blaming the individual employees or health care providers, saying, “Here, try a free yoga session. Are you happy now?” You can get physicians as resilient as possible, and there is still going to be this awful culture (and) this mindset of perfectionism.

MWN: Why does burnout disproportionately affect women?

 There are issues women deal with disproportionately in the workplace — outright sexism, macroaggressions and daily microaggressions. It’s creating this huge cognitive load to have to deal with the additional stress of not being taken seriously or constantly being asked what your age is. I get asked all the time, “Who’s taking care of your kids?” by my patients. Certainly, people (who) are underrepresented in medicine deal with that to a magnificently bigger degree. Adding to this is the fact that people who are socialized as women are often the ones (who) are the default caregiver outside of work. There isn’t a place for rest or to let your guard down. The pandemic brought that to a head, also. When kids couldn’t go to school anymore, data (have) shown the work fell disproportionately onto those (who) identify as women at home.

MWN: The demographics of this study were primarily White, cis-gendered women. Would you consider introducing this program to communities of color or nonbinary individuals?

 Those demographics are representative of the population we have here at the University of Colorado. We plan to expand this program in the fall of this year to 27 sites across the country, with a focus to serve many other populations.

 We’re hoping to get an adequate representation of all the people we’re serving — so all the trainees in medicine — and then find out (whether) there is a difference in those (who) are underrepresented. Do people of color get more out of this? Do nonbinary people get more out of coaching? Then also having the representation amongst coaches. We are still in the early planning stages of all that, but that’s a goal of this program.

MWN: Was there a specific moment when you decided this program needed to happen?

 For me, it was when I hired my first coach. I have experienced three waves of burnout over the course of my medical training. One little blip in medical school, one blip in residency, then another blip, (which was the most severe) when I was early faculty. I had just had my second kid and was trying to figure out how to come back to work in several leadership roles and just really struggled to find my feet, and I hired a coach to help me get some perspective.

 My story is the same. Adrienne and I sort of had these parallel experiences, which are not that rare. Medical training attracts people like us — people who get validation from the outside. I now identify as a reformed approval addict, but that’s sort of how I went through medical training. I was just doing the next best thing that other people told me to do. I didn’t stop to come up for air until I hit rock bottom.


MWN: What do you think led to the success of this program?

 At the base of it, physicians and physicians in training are just not OK right now. The data show many of us are burned out, many of us are barely keeping our heads above water. We, of course, didn’t plan the pandemic to coincide with the release of Better Together, but it really was right there when the residents needed it. It was easy to get into it in a socially distanced way. It addressed at the core, the reasons why we’re not OK. The reason we’re not OK is because we haven’t learned how to manage our feelings and our minds. [Participants] see Adrienne and I as medical educators they know and respect. We talk about this journey we’ve been through, and I think it’s accessible to them in a way that perhaps other mental health modalities are not. Coaching is not stigmatized in the way other mental health resources are.

 The tools we teach them are practical. They can apply these metacognitive tools immediately and see the traps they get themselves stuck in, in their thinking. The other thing that was powerful about our intervention was that they were not doing this alone. They’re able to see (they’re) not the only one who shows up to work, thinking people are going to find out (they) don’t know everything. We also offer three different ways for folks to engage. These are busy women, (and) their days are long. We’re able to offer a bunch of different ways to participate meaningfully in the program.

This article was published by our sister publication Medical Economics. 

Articles

Better Together is a professional, structured coaching program designed by female physicians to address the burnout that is disproportionately experienced by women in medicine.

Better Together program helps extinguish burnout for female physicians

Telehealth Access for America (TAFA) has published the results of a 

 in which 1000 participants were asked about their opinions of telehealth. Positive reviews were overwhelming, with more than 94% of individuals supporting continued access to telehealth services.

“Access to telehealth is vital to achieving better health outcomes, greater health equity, more patient choice, and a more efficient health care system,” said Telehealth Access for America spokesperson Julia Mirich, in a 

 “One of the unfortunate truths about the US health care system is that zip codes determine health outcomes and overall life expectancy.”

Telehealth has become increasingly popular among senior citizens and 87% report a positive experience. Further, 70% of these individuals have previously traveled more than 30 minutes on average to visit their healthcare provider.

“Voters who live long distances from their health care provider demonstrates how critical telehealth is to addressing disparities in the health care system,” Mirich said.

Telehealth protection is also a bipartisan issue. Eighty-eight percent of democrats are in favor as well as 66% of republicans.

Voters from underserved groups such as communities of color and voters who face financial insecurity also favor protections - specifically 86% of Black voters and 82% of Hispanic voters. In addition, 84% of voters in favor are worried about being able to pay health care costs support permanent solutions to protect access.

“Voters believe in the positive impact of telehealth and their broad-based support for permanent solutions to protect access is clear,” Mirich said. “Lawmakers should act swiftly to avert the telehealth cliff through permanent reform that safeguards coverage and flexibility for virtual care.”

More than 8 in 10 voters view the federal government’s decision to lift restrictions on telehealth services during the COVID-19 pandemic as positive (81%). Just 8% have a negative view.

93% of voters agree that patients and consumers should have the choice to see a licensed clinician virtually.

92% of voters believe that Americans should have the choice to access telehealth services after the pandemic ends, regardless of whether they live in a rural or urban area.

78% of voters support the passage of legislation to permanently protect access to telehealth services.

This article was originally published by sister publication Medical Economics.

Research shows that telemedicine bridges gaps in healthcare access despite party affiliations.

Support for protecting telemedicine access remains broad

Most state medical boards are seeing an increase in complaints against physicians for spreading false or misleading information about COVID-19, according to a new survey.

The Federation of State Medical Boards has released the results of their 2021 survey and found that COVID-19 misinformation has affected almost all state medical boards.

67% of boards have experienced an increase in 

 related to licensee dissemination of false or misleading information.

26% of medical boards have made or published statements about the dissemination of false or misleading information.

21% of medical board have taken a disciplinary action against a licensee for disseminating false or misleading information.

“The staggering number of state medical boards that have seen an increase in COVID-19 disinformation complaints is a sign of how widespread the issue has become,” said Humayun J. Chaudhry, DO, MACP, President and CEO of the FSMB, in a 

The FSMB Board of Directors released a statement in July saying that physicians risk disciplinary action if they spread COVID-19 misinformation. Since then, 27 boards have either reported 

 by licensees or taken disciplinary action.

“Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license,” the July statement read. “Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.”

In addition, the FSMB Board Ethics and Professionalism Community is currently constructing a policy document that will list the specific guidelines and recommendations when future disinformation is encountered. The FSMB’s House of Delegates is expected to vote on the document in April 2022.

“We are encouraged by the number of boards that have already taken action to combat COVID-19 disinformation by disciplining physicians who engage in that behavior and by reminding all physicians that their words and actions matter.” Chaudhry said. “They should think twice before spreading disinformation that may harm patients.”

This article was originally published by Medical Economics.

An alarming amount of COVID-19 disinformation is prevalent even from physicians.



Logan Lutton

Articles

Better Together program helps extinguish burnout for female physicians

Support for protecting telemedicine access remains broad

Increase in COVID-19 misinformation complaints against physicians reported by state medical boards