This is a really important symposium on physician burnout, and it's the first time we've ever done this in the AOFAS, and frankly, I think we're a little late to the game. So I hope you find this very helpful and interesting. We've got a couple internationally renowned speakers and leaders about clinician wellness who will be sharing some of their insight today. One of them is Alan Friedman, a good friend of mine who is founder and CEO of J3P Healthcare Solutions, and another is Dr. Karen Weiner, who, amongst the many hats she's worn, is the former CEO of Oregon Medical Group. And I suspect all of us from time to time have probably experienced the symptoms of burnout, just trying to keep our balance amongst all of our very busy professional careers and our other personal interests and family life. The world we live in is a challenging and complicated one. You all know that. But I will say that, at least in my opinion, I suspect many of you share it, is that it has never been vogue to talk about burnout, particularly as a surgeon, right? It sort of is considered a form of weakness to talk about burnout, and we definitely need to change that. And I will tell you on a personal note, while I've had a great past few years, my wife and I are about to take a sabbatical, if you can call it that, for about six weeks in Italy. And frankly, I've never done this. We've never done this in our professional careers, and we're really looking forward to it. And I think that's all part of this, too. So Casey, Daniel, and I, I will tell you that we really thought this was a great idea, and along with these speakers, and Elaine, who's going to share some AOFAS insight, we're hoping that this helps us understand a little bit more what burnout is, why it matters, how it fits into our own environments and our own behaviors, and perhaps most importantly, what we in AOFAS can do about it. So with that, I'm going to call up our speakers and turn this over to Tanya Dixon and say I'm very grateful for them to be here and share their insights. So thank you very much. Good morning, everybody. Thank you for attending. I think this topic is very timely and important because I guarantee All of us have suffered from burnout. I think we need to talk about it more And you know when I remember being a young eager, you know We're going to go to medical school. I had talked to my you know, Obi-Gyn and my PCP and they're like don't do it You know and I was like what and I think I understand why you know They were telling me not to go into medicine because of all the stuff that we you know, can't do That burns us out. And so I think this is a very timely topic Alan Friedman and dr. Karen Weiner who's actually a pediatrician by her training I've Spent the last hour, you know talking with and I could probably talk hours with them about this this topic. I personally went through Alan's program at our institution at University of Cincinnati and I think it definitely, you know allowed me to see inside myself Various things to improve so that I can be a better person so that I can you know Take better patient care and I think that's what we're all here Trying to learn and to talk about more because as surgeons I think we don't want to talk about You know the this aspect and I think it is it is important But Alan is the founder and CEO of J3P And here are his numerous, you know accolades, but I truly can attest to you know his his expertise and I'm hoping you can you know, get some good insight info and Open up the discussion, you know later on we're gonna have some time to discuss and I you know Think of the questions that you want to ask of them I'm also going to talk Karen introduce Karen now because they're a dynamic duo. They're gonna tag-team their talk and roll right into it But she is like Chris said is a former CEO of Oregon Medical Group But what I found was most impressive is she's taken a step back And is going back to school to get her master's in organizational psychology. So she's putting her mouth What you know, she's she's leading by example, and I think that is truly important to you know Hear what she has to say and and getting that extra expertise to Change us to make things better for us So that we can continue to give good patient care so now I will turn it over to Alan So, thank you so much for that kind introduction, Tanya. I appreciate it. It's a privilege for me to be here. I appreciate Christy Giovanni and Casey and Daniel's invitation to be here to share with you information that hopefully will be helpful to you personally and professionally. These are my disclosures. I'm an owner and an employee of J3P Healthcare Solutions, and I also sit on the editorial board for the American Journal of Medical Quality. We had sent this out in the Know Before You Go email, but there was a short assessment. If you did not have an opportunity to complete it and would like to complete it, it will take about six minutes. I'm going to move forward, but this is just a quick QR code for you to take advantage of that. And as I said, if you don't want to access that today, we'll keep the link open until Monday for you to access this. This will have probably more context as we progress. So, the bottom line is you're all here because you care about other people. But the bottom line is, ultimately, who's caring for you? And really, as an organization, these are the conversations that we really have every day. You all matter as human beings to us, first and foremost, with all due respect to your surgical prowess or the role that you play within the clinics at home. This is our footprint. These are the organizations that we work with. We only work in healthcare, predominantly within the surgical and procedural specialties, and we have a special connection with orthopedic surgery. I was just at the AAOS NOLC meeting in D.C., and came up here from there. When we think about your environment, it in some ways resembles this. And the challenge is that we haven't really done a good job as a field of providing the tools for you to understand how to navigate this. Today is basically a toe in the water, pun intended for all of you, in the sense of we want to help provide somewhat of a toolkit for you to understand yourself a little more so that you can understand how to more efficiently navigate what you have to deal with. When we think about the concept of self-awareness, it seems a very esoteric phrase, but really it's foundational. And it's foundational in the same way that when a building or a house is being built, the foundation is so critically important because anything that comes on top of that will be, bless you, will be determinant on how stable that base is. So what we want to do today is just give you a little bit more information in terms of that. So when we think about strategic self-awareness, this really ties into how can you use yourself as an instrument in order to understand yourself in a way that you may not have before, and then also understand how you can leverage that in understanding what your strengths are and what your limitations or challenges are. Notice I didn't use the word weaknesses with a bunch of people in orthopedic surgery here, but to really leverage this as a strength to help you get more of what you want. So we can't change our personality, but we can change how we think. We had a little auto-advance here. But for those of you who are here Wednesday, you already have this, but if you don't, there's going to be a pop-up that comes up on your app where you can text your response to this question. So let's just take about 10 seconds and answer this question. The question is, there's a difference between my personality or my tendencies and how I actually behave at work. So in essence, is there a difference between kind of how you think and what you do and what you say? OK, so that's a good confirmatory diagnosis. Oh, interesting. I still go with my original statement. So we'll move on from this, but the reality is that there is a difference, and we'll talk a little more about that. So when we think about the different versions of ourself, this isn't about a clinical diagnosis from a psychological perspective, but this is about understanding that there's a difference between who we are at home in the bathroom when we're getting ready to go to work and face the world, and there's a difference between that person and who we are at home with our families and other people who we're, quote unquote, intimate with in our lives, and then ultimately, how that intersects with how we have to show up. So if we look at that green stick figure in the center, that's the person in the bathroom. If we look at the light blue in that next ring, that's the person that you are at home with your loved ones. And if we look at that navy ring, what this is really about is this is about how you have to show up. So the more that we go from who we really are in terms of that inner sanctum to who we have to be at work, it is going to be the determinant factor of how much energy that we have to expend. And so when we think about this formula, this formula is going to come up again. So our behavior is actually the terminal output of a lot of different variables. Our thought process, which is really a function of our personality, our tendencies, our environment, we'll call that our baggage, good and bad, and then what is important to us. So when we think about it this way, when you all look at me in front of you, I'm positioned based upon the introductions as a subject matter expert and as a professional. Those of you in the audience who know me personally know that I am actually a two-year-old and I am not the person that you see in front of you. So what that means is that I am projecting to you who I want you to see. Doesn't mean I'm inauthentic. It doesn't mean that I'm disingenuous. It just means that the version of who I really want to be is what I am presenting to you personally. Who I really am is very different. And so there's that formula again. And why that formula matters is that if we understand those variables that are not equally weighted and are contextually dependent, that's going to help us actually get more of the things that we want in our lives. So think about burnout. Think about wellness. Part of that conversation, and Dr. Weiner will speak more about this, is that we're not getting enough of what we want and makes us fulfilled. So hold on to that formula. I promise I'm not going to get too technically psychobabble, if you will, very technical term here. But there is a theory called self-determination theory. And this came out of the University of Rochester in the 1970s. And in simplified form, what this means, it's about feelings. We don't talk a lot about feelings. We're going to talk a lot about feelings this morning. This is about making sure that you feel competent in the work that you do. It's about feeling autonomous as it relates to having influence over what is going on around you. And it's about feeling connected to other people and something bigger than yourself. These are feelings. So as human beings, as professionals, our goal, our aspiration, is to make sure that we try and feel these three things as much as we possibly can. So why that matters is because we want to make sure that our battery is as full as it possibly can be. Part of this is your responsibility. When we think about the conversation around burnout, and as I said earlier, Dr. Weiner will address this in more detail. But it's a systemic issue, not an individual issue. But there are things that we can be doing at the individual level to really influence how we feel. And that is within the purview of our control. So you have a choice. Do you stay in the way you're thinking now? And the way you're thinking now may be very appropriate. And you may feel very fulfilled, not burned out, not fatigued. Or do you change the narrative in your head and figure out maybe there's a different way? We want to challenge you to think. Maybe there's a different way. And the reason why this is connected to burnout is because when we think about our tendencies and we think about our energy, the more extreme our personality is, the more we have to manage ourselves in the pursuit of who we need to be publicly, professionally. So based on that iceberg slide, I have to work really hard to manage myself in order to show up professionally. I've worked at it a long time. I still struggle with certain aspects of that. But it's a worthwhile endeavor because the return on that investment is that I have more energy for me as a human being. So the idea at the bottom right is that's who you may be in terms of that inner sanctum self. And on the top right is who you have to be and want to be at work. So the more extreme that personality piece is, the more energy you have to expend to manage. So why have this conversation? How is it all connected with burnout? The idea here is that if you understand yourself, then you're going to understand how to be more effective at influencing. Influencing is the key skill for really everything that you do. But unfortunately, because of the environment that many of you are working in, we feel as though we don't have that influence that maybe we once thought we had. So this is in relationship to our patients, our colleagues, our staff, our family members. But then there's a phrase here that is intrapersonal skills, not interpersonal. So I want you to hold on to that for a second. What we're here today to do is really prime your pump, so to speak, to understand yourself, which is really where that intra piece comes in. Why that matters is that if we understand ourselves as a foundational element, back to that self-awareness slide with the building foundation, that is going to allow us to be more effective in terms of our interpersonal skills and our interpersonal connectivity. And if we can do that, then we actually increase our level of influence at the system level. And the system level is where it gets exciting, because then you can really have an influence on changing policy and changing how things are done. But the work to be done is on ourselves first, then connecting with others, and then applying that to how we can actually change the narrative so that we take a systemic problem and we start to really apply our skills to change that narrative. Very important. So how do we do this really practically? What can we do coming out of today? There's three behaviors that are critically important if you want to engage other people interpersonally and avoid conflict, regardless of what our personality is or is not. And the first is really we have to be humble. Humility is a must. The second, we have to ask questions. Tell me more. I don't understand your perspective. I really care about our professional relationship. Please explain that to me differently, because I really want to understand you. And then the final piece is really to exhibit what we call primal empathy, to put yourself in someone else's shoes. So those three behaviors are something tangibly that you can take from our time together today and actually act on. So you have your tools. We have our tools. And our tools are a little different, if you will. And the reality is that we have an assessment that, for many of you, you completed that took on average about six minutes to complete. It's 90 questions. And this allows us to understand that personality piece of that formula that I had explained earlier, as well as provides the motivational piece in terms of concretizing what we believe to be important for us. So the assessment that many of you completed is really a development assessment. And it's a developmental platform. And so these are the scales here that, and I think we have, it's on auto advance here, but we'll hopefully pull it back. So these are the different dichotomous scales that people were assessed on. And it's everything from candid to considerate. So as an example, I score much more candid than considerate. For many of you in the room who know me, you know that to be true, that my tendency matches my behavior. But I have to be really mindful that that candidness does not get me into trouble. Because what's important to me is helping people. So if I'm not careful, my candid approach, my frankness, and my directness can actually work against what is important to me. So that's just an example of how this works. We pulled the data late yesterday. And we had about 27 people who had completed it. Again, this link will be open until Monday. It took about six minutes for people to complete. And this is just one representation of the data, if we look at this in the sense of a cohort. And you can see that it shows the distribution, and it shows basically the scores in the average. So if we look at it differently, and we were to think of all of you as a team, if you will, really what this is about is understanding that as a tendency, we have people who are very disciplined, and very candid, very pragmatic. People who are less flexible, who are less laid back, a little more driven. So this probably resonates with many of you. But again, these are personality tendencies. So that's one way to look at it. Here's another way to look at it. So you can see that there's no one size fits all to this. And we're all really diverse. And we want that. We all care about people. We all share many of the same values. But how we approach that conversation is what's different. This is just represented differently. And so you can see here, in a much different lens, the candid and the stability piece come out, which means that self-awareness is not natural for many of you. How does this apply in our remaining moments here? We have someone who's highly considerate. There's someone in the clinic who's not behaving nicely. So that person who's highly considerate won't address that person with challenging behavior, because they're naturally very considerate. When we look at a candid and passionate physician, and none of us work with those people, we have someone who's really candid, really passionate. That's the person who's in the OR throwing instruments. And no one has the comfort to speak to that person. And therefore, people don't want to work in that operating So here's a final poll question before I hand it off to Karen. I want to view myself differently in order to increase my level of influence to achieve the outcomes that I want. So please go ahead and answer that. Take about 10 seconds, and then I'm going to have Karen. Well, thank you. It's a pleasure and an honor to be here. I think of this work as psychological and social proprioception. So what happens when your proprioception is not functioning properly? Someone will walk into things, twist their ankles, hurt themselves repeatedly. And without your psychological and social proprioception, you're at a disadvantage to be able to influence your environment. And before I tie this into this concept of how do I connect this to burnout in my experience at work, I want to take a moment to just level set about burnout. Because I think the term is bandied around quite a bit. And it's a lot in lay media. And it's become sort of a buzzword. So the definition of burnout was really highlighted and researched in the 70s. And this concept of emotional exhaustion, cynicism, and a loss of sense of personal accomplishment. So essentially, a chronic emotional exhaustion and depletion, which leads to a cynicism and a depersonalization around the care that you provide the people that you are intending to help. And then over time, with that depletion. And this is not a binary kind of either I'm burnt out or I'm not. We all know that there are days and weeks where we feel this way, particularly difficult call or difficult string of days where we'll feel this way. But burnout is really a chronic state of being. And the research showed that the domains of work life are what really impact our experience of burnout. And so as Alan was saying, burnout can be experienced by the individual, but it's not an individual's problem. It is a manifestation of a mismatch between the individual and the work environment. And so the domains of work life that were highlighted were a person's workload, which seems kind of the most intuitive and obvious, their sense of community in their workspace, their autonomy and sense of control in how their day unfolds, the fairness with which they're treated or the sense of fairness. And finally, their values. So are the individual's core values honored in their work life? So when we think about burnout this way, we kind of understand why focusing on meditation and mindfulness and yoga, while important, and I don't want to diminish that, really kind of misses the mark when we're talking about what really impacts people's experience of their work. And why it's important to develop self-awareness or your psychological proprioception is because this is where we need to be able to influence our workspace in order to decrease burnout. This is a conceptual model to just highlight that it's not binary, that it's not, well, if I'm not burned out, I'm OK, and so I can just soldier on. To understand that there are people that are highly engaged and highly satisfied, and it's a spectrum. And then there are people that are burnt out and are thinking every day about leaving the profession. And again, this is a conceptual slide. What we do know is that since COVID, that bell curve has really shifted to the left. So the incidence and prevalence of burnout is really much higher now. Another way to think about this is this concept of satisfaction versus engagement. So we know that highly satisfied, highly engaged physicians and clinicians exist somewhere, but they're like unicorns. They're harder to find these days. Our colleagues who are highly engaged and highly dissatisfied, you'll recognize them. They'll show up to meetings, and they will be full of them and vigor and expressing themselves about what's not working. You're highly satisfied but highly disengaged colleagues. Then finally, your highly dissatisfied, highly disengaged colleagues are really where we start to worry about, is this person just burnt out? The problem is, in both the highly engaged but dissatisfied and in the highly satisfied but disengaged, there's a gravitational pull towards this space because if you can imagine somebody who's showing up to those meetings, expressing And somebody who seems really satisfied but isn't showing up over time is going to feel like these changes are being done to them. And I would imagine that that those in the somewhat and not at all Columns would would like to be able to influence their environment more effectively And and have a sense that if they were able to do that not only would their patients benefit, but their work life around this, but this is essentially the anatomy of an organization. So I get it's like throwing up an MRI in front of a non-clinician. But this is the anatomy of the system in which you live. And again, back to proprioception, if you need to understand your environment and where you sit in that environment in order to be able to influence. I think most physicians would like to think, and ideally this would be the model, that the physician and the patient sit at the center of every system because that's what healthcare is for, and that all of the rest of the system is built around us to be able to support that interaction. But you probably sense from your work that that's not really the case. And so I'm not saying that this is the best setup, but this is the anatomy of your organization. This is not just in healthcare. So understanding that there is always an external environment. There is a leadership component that's developing the mission and the strategy and creating the organizational culture, or at least ideally representing what they want that organizational culture to be. There's management practices around you. There's structure, org charts and so forth, systems and policies in place to carry out all of this. And then you are located down here in the individual performance, the individual needs and values, the individual skills and abilities. And what you bring to work is all of that and your motivation. And where you experience work is here in your work unit climate. So your experience of work is the interface between the organization and the individual. So if this is the anatomy of an organization, this is a cartoon sort of physiology of the organization. leadership will create goals and from those goals feed our current performance and back into our goals. It also, over a longer period of time, actually changes the organizational reality. So this is how administrators, leaders, kind of senior C-suite people look at the organization. And for a little map, like, you are here. So whether you're aware of what's going on, Great. This is very encouraging, because this is really where the answer lies. We know that change is hard. We want change. Fewer people want to change, and even fewer people want to lead the change. And I think in healthcare and in medicine, that's even more so. It's very difficult for a physician to stand up and volunteer to lead their peers. Not just because that's extra work, beyond the work of caring for patients, but there's a culture in medicine that we are all equal, that to step up and lead your peers might create a target on your back. So with a show of hands, we saw the percentage of leaders. How many of you in this room So it's an interesting concept we we don't we don't highlight followership the same way that we highlight leadership I don't think we value followership and certainly not in our society. We don't and in our profession. We really don't But I want to take a minute and talk about the role of upper right-hand corner, which of those birds is leading that flock? The point being that leadership is a function, always a function of the leader, the follower, and the context, that there is no leadership. There are leaders, but there is no leadership without followership, and that followership has its own role in being able to influence the environment. that either undermine or support your success as a leader. And I think it's an area in medicine that's ripe for evaluation, because we can't abdicate our responsibility when one of our peers steps up and says they're going to lead, that we say great, you're in charge, you're leading, and I'm checking out. Because that can be interpreted as passive resistance. There can be actually passive resistance, passive aggressiveness to just not really supporting the leadership, and by doing so, you actually undermine your ability to influence. When we think about what are the characteristics that got you here as a physician, as a surgeon, as a clinician, the important characteristics, traits, competencies that you developed through medical school, residency, and fellowship. These are all very important. Competitiveness, self-reliance, perfection, knowing it all, doing it all, being a take-charge individual, making decisions and acting on them. But these are not necessarily traits that make you either an effective leader, an effective follower, or a patient. just a small sample, but that there are flip sides. of all of this is that we can move in the direction Now I'm going to introduce, we actually should not need any introduction, is Ms. Elaine Layton, our Executive Director extraordinaire, who's going to talk to us about what the AOFAS can do for us, the resources that are available, and just, you know, being an ally for us in the field. Good morning, thank you. So I was asked to speak about AOFAS resources, and I admit at first it took me a little bit to put my head around how this connects to the talk, because so much of what was presented today relates to your work environment. I think a lot of what AOFAS has to offer does that, but I hope more importantly it provides a mechanism for you to increase the meaning of what you're doing in your profession in serving others. I have nothing to disclose other than I guess being paid by AOFAS might mean that I am biasing you toward AOFAS. When people think about AOFAS, I think the first thing most people think of is education, and that's probably where we have the most formal resources, if you will. In 2020, the AOFAS annual meeting chaired by Dr. Scott Ellis really focused on physician burnout, and the guest speaker that year was Dr. Pamela Weibel, and her address was on physician suicide prevention, and we also had some other sessions related to work-life balance. Those recordings are in the member physician resource center under a section for mental health and burnout. In that section, there are the recordings from the 2020 annual meeting. We also partnered that year with the Ruth Jackson Orthopedic Society on a wellness series related to other topics such as second victim syndrome and, again, work-life balance. And then finally in there, we also have resources from the AMA because this issue of physician burnout and also physician suicide has really come to the forefront in the last few years. Another way that I think AOFAS helps members is in providing tools to hopefully reduce some of the pain points in your practice. We partner with the AAOS, with the AMA, with the American College of Surgeons on a lot of legislative and regulatory issues to help reduce those burdens, fight those reimbursement cuts, and, again, we pass on those resources where we can. We also focus on practice management education tools to help with practice efficiencies and to represent the AOFAS and the subspecialty to the CPT and RUC committees. And then finally, we offer some other tools related to patient and public education resources. But at the end of the day, AOFAS is a community, it's a living entity, and it's made up of all of you, and that's really where the greatest value is from AOFAS. I think it's the connections. Everyone always says foot and ankle is the most collegial subspecialty in this orthopedic space, and you can see it here. You can see how happy everybody is to see each other. But I think more importantly, when people struggle, I really do believe that all of you are there for each other and are certainly willing to be there for each other if you don't realize that. This group is great at mentoring young trainees and bringing them in. It's not a competitive subspecialty, it's a very cooperative subspecialty. We also offer a lot of formal professional advancement opportunities for people looking to advance their CV to get to that next rung on their academic career ladder with research grant support, with opportunities for teaching, and leadership. The committee and board members, cumulatively, I can't even tell you, it would be at least five digits of hours every year that people commit to helping each of you and the patients that you all serve. So most importantly is the service, and that's getting to the idea of meaning, and not just looking at what you do day to day in your work life, but really helping you replenish and find value and meaning in what you do. And that's where I think AOFAS has the most to offer. It's an opportunity for you to contribute, to give back, whether it's volunteering on a mission trip, whether it's being part of a committee, it's really to be there for you, and I just think that's the strongest part of what AOFAS is. Yesterday, Dr. Brian Den Hartog was installed as president, and his goal for the coming year is to focus on member value and engagement, and so I hope that you will share with us what AOFAS can do better, and what other activities, support, opportunities we can provide you. We are adding a women's leadership scholarship this year. The DEI committee is really focused on helping people come into the subspecialty, and making sure that they're successful when they join foot and ankle, and I just really hope Well, now is the time for, you know, getting your questions answered, so please come up to the mic. We're going to hang out afterwards for those who may be a little bit shy to, you know, talk to us one-on-one, but feel free to, you know, ask this panel of expertise, you know, what can they do, what can, you know, what can we do at our institutions to make things better? Yes. Hi, James Calder from London. I'd like to thank all of you and AFAS for putting this session on. It's fascinating and it's very insightful, some of the things you've discussed, because it isn't discussed publicly. I had a very, a great colleague, surgical colleague of mine who had a burnout session very publicly, and it was disappointing, but we brought him back from the edge, but it was a bit worrying for a while. I would just like to ask, what you've put here, are there changes within an organisation that may be needed to prevent burnout? As surgeons, we're always going to be under huge amounts of pressure, and it's actually very encouraging when Chris is going to take a time-out period after the pressures of being, and I think more of us should do that and recognise that. But is there something else we should be doing, recognising those who are resilient as we bring them into the training scheme, as well as just recognising that they may have a burnout, and is there a way of building resilience within the organisation? Because in the NHS, it's going to be really difficult to turn that big tanker, and trying to get changes there is very difficult, but is there a way we can build resilience and encourage that psychologically within our trainees? Well, I'd like to think that burnout occurs when the demands of work outstrip the resources required to meet those demands. So that's a really broad statement, but when you think of that model, that burnout is occurring when the demands outstrip the resources, it helps to identify what may be going on in your organisation. So hard work, as you said, the stress of being a surgeon and the hard work is not what will create the burnout, that's the demand. Are there the resources in place to support delivering on those demands? So for some surgeons, they'll talk about the reason why they're feeling burnt out is because the way the OR is run, and how they can't do what they need to do, because operationally things are just not in place. So it's not the workload itself, it's the resources needed to support that workload. When it comes to other forms of building resiliency, it may be a completely different issue. So the OR may be working just fine, but the culture in the organisation is cutthroat. So the community is not there, the quality of the relationships between surgeons is not enough to support that. There's a lot that is happening in our environment that we cannot control. But there are things that we can control. And so it's a paradigm shift to take our thinking away from what we can't control and figure out what we can influence, as small as it may be. That is not as systemic or at the enterprise level or the NHS level, but it's really at the individual level combined with the things that Karen had brought up. Gary? Gary Stewart from Atlanta. You know, I think this was an excellent session, very important to do. What I have noticed is that some of these kind of wellness things that happen in the hospital or that you may think are well-meaning just seem to add to the physician's day. If it's possible, maybe you could talk about some options that are maybe more voluntary instead of it almost is punitive when you are having a busy day and the hospital says, oh, at noon we're having a wellness session, everyone's required to go. So maybe you could talk about that a little bit. So I'll take that on. Every day we hear that. They're wellness Wednesdays, by the way. That's I think the popularized terminology. But there's a deeper kind of answer to that question in the sense that if we think about there's a physician wellness program, that might be good for people who are not surgeons or proceduralists for that Wednesday at noon session, or the best is when we have a wellness program that's mandatory on a Saturday, right? So the point is, is when we were thinking about the idea about how we can influence, take that self-knowledge that we are kind of at least giving you the foundation of today, go to the people in positions of authority and say, I really would love to take advantage of some of this great programming that you have, but the time in which it's being offered is really not, it's not working for me because I have to be in the operating room and I have my RVU requirements, so where's the rub, right? So. Yeah. Those personal resources are a real and important ingredient in personal resiliency. There's no doubt about that. But that's not what you're asking from your organization. And for your organization to come in and say, here's how we're going to deal with burnout, we're going to help you build your personal resilience. Hi there, I just finished a leadership position I was the provincial head of orthopedics for five years slightly different foot and ankle role and what I found Made me quite burnt out in that leadership position Who's being up against organizations that had missions and values but blatantly failed to follow them You know our own hospital is a Catholic hospital They say they care about the disadvantage yet every time we go and talk to them about the diabetic foot They say they're not interested. I mean what more disadvantaged population could they possibly look after than that? And so you listen to the missions and values and just say from where I sit. I don't see it The doctors of the province the doctors of British Columbia, so they'll say that we're better together Yet when we went to them about our concerns about ours work for orthopedics and other issues like Getting maternity leave and stuff We just couldn't start a conversation So, I don't know how we get around those barriers, you know, maybe I'm not patient enough Maybe I'm not persistent enough, but I'd like to hear your thoughts about how you change that culture From you know, like you're actually sort of below it and how do we how do we how do we when we lead? How do we actually change the things that are above us? So I'll take that question first and I'll hand it to Karen. So it's about influence. We've been speaking a lot of an influence But how we influence? There's a lot of ways that we can go up an influence We can take our baseball bat and try and hit someone over the head Repeatedly, you know, or we can basically express how we feel about something to the to the people who are in positions of influence number one number to ask Those individuals what is important to them how they feel about something and then the final piece is to say So I've expressed how I feel on behalf of my constituency now I have a better understanding of of what your perspective is How do we partner and compromise so that our needs can be addressed while making sure that you know? What your initiative is is being met as well Sometimes you can't get people to the table to make a conversation. We spent five years trying to talk to the health minister I mean we you know, we went to the press we got, you know Literally hundreds of stories about access to care and we the health minister simply would not talk to us You know the only health minister across the entire country that wouldn't talk to orthopedics, you know So if you can't if you can't get a conversation going it becomes extremely frustrating Well, I think that to that point that that's kind of goes back to what we spoke about earlier to your point Obviously someone has to be one to have a conversation with you to have the conversations that we're speaking about But then that goes back to what we said earlier, which is if you can't get someone at the table What can we influence within the paradigm of what's in the sphere of our control and what is not? So it might be that 90% of what we're trying to accomplish. We have absolutely no ability to control but there's 10% Start there that'll at least able you to gain some bandwidth back to at least approach that 90% hill that you have to go up against I'll add to that There's a continuum here. So I think the work of and self and when you're interacting with an organization to be able to. The headlines were, physicians sound the alarm on safety at the hospital. And it just was a bomb that went off in our community. And that is the nuclear option. But it starts from really understanding yourself, understanding who you are as a human being. Jitmangwani, Leicester, UK. Well, thank you first up for an excellent session and including in the main program. So I'm in a leadership position at the moment with 45 consultant colleagues who have, there's no hierarchical system in the UK and you want to influence a change with your colleagues who obviously have been in that position previously, either leading or being led by somebody else. To introduce a change in that scenario where there is no professional gap, you're completely non-hierarchical, i.e. everybody's got the same stake at everything that we have. That can be particularly challenging. If you want to obviously introduce a change of behavior in colleagues, there's a unanimous agreement and something to be done. The whole group agrees that this needs to be put in place. There's no doubt about that, but to bring about that change in the behavior for that particular change to happen in the service. And it starts with having that humility. it as something that is beneficial and moves, you know, them in the direction they want to go, and it's never clean and 100%, right? There's always that, we call it the force field analysis, things that are pushing towards change and really things that are pushing against change. But calling those dynamics out and really tying the change to what's important to your colleagues. I'll just add to that very quickly. We're working with a department in New York City now, and what we're doing as our first step is basically doing stakeholder interviews to find out what matters to people from their perspective first, and then to Karen's point, once we have that data, there's two or three themes that we can coalesce people around, then whatever the change that we're trying to get them to work on together becomes, we're working on this to help you achieve your goals. The byproduct of the exhaust of that exercise is that the organization or the quote unquote enterprise or the health system actually gets that benefit, but we have to change an arrow about focusing on what individuals' needs are and then working backwards.

physician burnout

symposium

clinician wellness

balancing careers

perception of weakness

self-care

causes of burnout

AOFAS

interpersonal relationships