Why Resilience Training Isn’t Working

[00:00:00] Welcome to the Direct Well-Being Podcast. I'm your host, Dr. Anders Apgar. With us today, I'm really excited to have our guest, Dr. Ridgley Salter, who is a board-certified family physician and has been the medical director for Well-Being at WellSpan Health since 2015, and the chair of the WellSpan Medical Group Council since 2018.

Ridgley oversees over 20,000 employees in their well-being journey. Ridgley, thank you very much for being here.

Thank you, Anders. I'm honored to have this discussion with you, and it's really great to reconnect after,

many years Yeah, let's put that in perspective too. I think it's been some 30 years since we were in medical school together, graduated medical school, so I appreciate that.

we hooked up in Washington DC at a leadership conference and, when I learned about your journey and where we were going

with this you know, and we're here today to talk about kind of the evolution between resilience and wellbeing. You posted something really great on your LinkedIn page, The title of it is called I Am Human, and it's a brilliant example of what people actually get in the way of good care when [00:01:00] people are distracted.

Tell me more about that.

Yeah, Anders, I think our colleagues at Stanford really did a nice job at capturing those elements that really drive burnout in our healthcare system through a number of different roles. they followed physicians and APPs and leaders and nurses and just, the hopes and dreams they have that they can, get back to experiencing the joys of what they thought they were gonna experience when they got into this medicine journey in the first place.

And I think it really highlights the necessity that organizations especially need to understand in our healthcare and professionals, that they got into this because they really care about taking care of their fellow men, women, and children. And there's many barriers that unfortunately keep that from happening.

and the sooner that we recognize that and put strategies in place to help us address those barriers, those things that lead to our burnout, that doesn't allow us to bring the best versions of ourselves to all of our [00:02:00] roles, but especially our roles of caring for people, that's

critically

important. Yeah. I couldn't agree more. You've said it very well that we come in with different versions of ourselves and the wellbeing projects that we do are really about, removing there are barriers to becoming that wellness or that best version of yourself when you walk into the operating room or you walk into the patient room so that you are fully present.

You've been doing this for a long time. WellSpan seems to be at the forefront of what was resilience and, doctor heal thyself and, deal with it and, into something that's really of a wellbeing program. This has been, from the math of it, and I'm not a great mathematician, but, it's been an 11-year journey.

Tell me about that.

Yeah. this my personal journey into getting to this work, comes about through my own burnout. And I wonder if I start there because that's really what drove this. And, you know, I was about 12 years into my career. I was engaged in the work, I was engaged with my organization, I was involved with, not only our medical group's board, but I was the chair of the board.

I was involved in a number of different [00:03:00] things to try to make things better. And, yet I was a full-time family physician. Had three kids that were getting increasingly busy and I wanted to make sure that I was everything to everybody. So I'd work a full day and see as many patients as I could, overbooking people.

Trying to be efficient, trying to get my notes done in real time. I would get as many as the urgent tasks done as I could, before I needed to get home because I wanted to be there for my family as well. I wanted to be present for them, we wanted to have a family dinner, but shortly after that it was off to practice 'cause I wanted to be engaged in my kids' life.

So whether it was softball practice or basketball practice, off to that. And then back home at the end of the night, shower and it's 9:00 PM and the kids are getting ready for bed, and dad's sitting down to do two more hours of tasks 'cause he didn't get to them during the day. And

At that point in my career I'm feeling like I'm not being impactful in any of my roles, you know? And I just couldn't see the good I was doing. I remember one night in particular, as I'm grinding through tasks, and [00:04:00] getting up and gonna have to wash, rinse, repeat and do it the next day again.

I remember some task that triggered me. It was something where I, needed to address an abnormal test result that was ordered by a specialist colleague of mine. And when they called to get the results, the specialist office couldn't give it to him because the physician was busy. And they said, "Just talk to your family doctor about that ."

And as you can imagine And I'm sitting there with my son, Nick, who was then 17 and wants to go into medicine, and I just remember slamming my laptop down, and I turned to Nick and I said, "Nick, don't go into medicine. And if you do go into medicine, for crying out loud, don't go into primary care because all the bleep rolls downhill to primary care."

And thankfully, I didn't do that very often. That's the one time that I remember discouraging him from going into medicine. But I knew at that time, I'm not in a good place. I'm not seeing any of the good that I'm doing. I'm just seeing that I'm falling short in all of my roles here. And I knew that I needed to do [00:05:00] something differently.

And lucky for me at that time, a medical director job came open. And the first time I applied, I didn't get it, but the second time I did. And the short part of it is that I was able to move into a position where I could start to have an impact and help my fellow colleagues in particular.

And, shortly after that, we started our first physician and APP wellbeing council, and I felt like, "Yeah, this is it. This is what I wanna do. I wanna make sure that my colleagues don't get to burn out like I was." And so that has since evolved to the point where now my whole, halftime role, still practicing halftime, is our medical director of wellbeing.

And I do that with a lot of passion and purpose with my colleague, Dr. Mike Diller. He's my psychologist dyad partner. Yeah. So that's been my journey to try to make lemonade out of lemons and make a difference in not only my own career and the purpose of my own career, but hopefully for that of my colleagues.

That's amazing. and two things that you brought up. One is, job [00:06:00] resilience. You didn't get the job you put in an application for and the other is impact, which I think any clinician, physician, whatever, APP goes into this impacting lives .

, And when you lose that sense of impact, that's where burnout comes from. But specifically resilience. So I think this all started as resilience, right? resilience training is what I think it used to be called a long time ago. And I think There was that untruth that... What was the biggest untruth physicians were told about resilience?

I don't know where along the way resilience got that bad that negative connotation, but I can tell you in the physician community it has it. And I can tell you even now when I hear the word, I'm kinda like, "

What do you mean resilient?" We're pretty darn resilient, and I've got some data to show that.

but it's interesting because there's lots of good things behind resilience science that actually does allow us to bring the best version of ourselves. I call it more these are wellbeing practices. and when we give our talks around wellbeing, we talk about, hey, we need to be doing these things to bring the best version of ourselves-

[00:07:00] to our role so that we can apply the discretionary effort when we see things that aren't working in our area, that we can say, "You know what? We can do that better. We can plan, do, study that better." But if we don't have that energy to apply that discretionary effort it's not gonna get better.

And so there's plenty of things that we have to do for our own self-care, for our own connection, to express gratitude, to be flexible, and practice mindfulness, and lead with hope and all of those things that are really rooted in good resilience, science, if you will. But that in and of itself is wholly insufficient.

And really, organizations didn't know what to do, but they wanted to make sure that their physicians, and APPs, and nurses were taking care of themself. And so that really was the... Early on, that was the initial approach. Hey, make sure you're taking care of yourself because this is hard work, and it's really important.

But there wasn't a recognition that there's a lot of system factors that are contributing to that. So it really went from this unawareness- To awareness that, hey, [00:08:00] there's things that are going on here unintentionally in our system that are impacting our physicians and APPs. So that resilience, got a negative connotation and I think when you use that word around physicians now,

we'll see our colleagues bristle. But I do wanna share one thing about resilience, and there's a good study that came out from a colleague of mine, Colin West, at Mayo Clinic, and He started the study before this pandemic, and it came out shortly after the pandemic hit in mid-2020.

And this is what they looked at. They did these resilience scores, and they looked at physicians and compared to other people in the population. And what they found out is really three things from this study. One, physicians have a higher resilience score than average, and so I don't think any of our colleagues would be surprised about that finding, right?

If you got through medical school and got through the rigors of residency, yeah, you've proven you're pretty darn resilient. The second thing they found was that those that had the lowest resilience score on this, like, Connor Davidson Resilience Score from zero to eight, those who scored, like, a zero to two or a three, they did have higher levels of burnout.

In fact, really high [00:09:00] levels of burnout, like 82%. So the least resilient physicians did have higher levels of burnout. And with every improvement in that resilience score, burnout scores went down. So resilience does work. However, what it also found as a third thing is that the most resilient physicians, those who scored an eight out of eight on that resilience score, still had burnout rates of 29%.

And so that tells us that, yes, improving our own well-being does help. However, it can't be the only solution, and because 30% of us are still burnt out despite being the most resilient per the resilience scores. And so you'll hear people in the well-being world saying, "Resilience is not our problem. We need to make sure we are addressing the system factors that lead to burnout."

And so it's a yes and. It's yes, we gotta be doing those things to take care of ourselves, and the system has to be recognizing what are the factors that are contributing [00:10:00] to, the burnout of our, healthcare professionals

Thanks for sharing that. It sounds to me like resilience is an individual solution, whereas well-being is more of a system solution.

And so I think if you're addressing it as a system, you stop characterizing a physician as resilient or not resilient, which then becomes a value statement

I think that's right on, Anders. I think probably one of the best ways to think about it is that we need to move from the focus on resilient individuals to resilient organizations, and that is organizations who recognize the often unintentionally the workings of their system and the impact that it has, and how can we create, you know, better culture and efficiency and build more efficient teams to take care of the very important work of caring for patients so that we can do what we were called to do and that is, you know, care for people, the way that we had hoped we wanted to way back when this journey started even-

before medical school.

what I look at is we got through medical school, right? And that required a lot of commitment, [00:11:00] but it also requires commitment to even stay in the system. you know, everybody, "The broken system, broken system, broken system," but we're not here necessarily to fix the system.

We're here to have the system recognize, and also have us recognize what we can do to really get through, not through a system necessarily, but really become a working part of a flowing system. How does being committed to medicine, in your opinion, differ from being committed to any other demanding specialty?

Because look at other high-powered people who are putting in, 80, 120, 160 hours a week, and they're, artists, performers, actors, professional athletes, CEOs of major companies. They're putting in the same amount of time. Why do we get to, why do we as physicians, quote un- quote unquote, "get to complain" about the time we put in?

What is different about being a physician?

a lot of us feel like when we pursued this as a career that this wasn't just a job that this really was... And it wasn't even just a career, it was more of a [00:12:00] calling. Like, we felt we were given incredible blessings and opportunities to be able to do this.

and then realize the ability to take care of our fellow men, women, and children is really a blessingand it's a calling. And you'll see this a lot in people in service industries, and you'll see them, when Christina Maslach started studying burnout, it truly started noticing it, or studying it in education.

Once you realize it's highly prevalent in these service industries, right? Teachers, educators, those as, in healthcare not-for-profit organizations. When you care very deeply about the work you're doing because it is very humanistic, that is a setup, unfortunately, for creating burnout and creating this moral injury where I just can't do what I want to do or what I was hoping to do.

And so you see that a lot in industries where people are very passionate about the work they do because of who they're serving, not necessarily [00:13:00] because of the status they obtain or the money they make. But it really is driven out of service to take care of our fellow, men, women, and children.

When we see those barriers in place it creates this burnout, moral injury, or just this incredible angst that makes us want to either push forward or withdraw depending on where we are in our life and how much energy we have to fight and keep

going forward

And pushing forward is not necessarily resilience. Pushing forward is in some cases it sounds like it's acceptance. Because even in a perfect system, you're talking about moral injury simply not being able to accomplish for patients what you want to accomplish for them: health, longevity, and things like that.

Unfortunately, patients die. And even in a perfect system- Mm-hmm ... perfect medicine, perfect everything- there's just things that are beyond our control. And so I think that becomes very difficult for anybody. Again, even in a perfect system, you're gonna have patients that die, and you deserve to have, I like the term deserve instead of have, would, or should.

But you [00:14:00] deserve to have a system in place that cares about that impact of even a perfect system when everything you've done right still doesn't work.

Yeah. You know, I just got a group of leaders together here at WellSpan and a lot of them physician and APP leaders, and we talked about, what are the things that we need to be aware of and continue to get better at as we look to improve the engagement and wellbeing of our people?

and one of the articles we read from JAMA in, March was thatsystems have a moral obligation to take care of their physicians, APPs, nurses. and the good news is in doing so, when they create this environment of culture of wellbeing and are committed to improving efficiency of practice so that the physicians, APPs, and nurses can work to the top of their license what they find out is they get better physicians and APPs.

They get people who are more engaged, who are more likely to do the right thing who apply that discretionary effort. And Anders what we found is that, with a lot of data [00:15:00] when we invest in the things that improve, the wellbeing of our healthcare workers because yes, it's the morally and ethically right thing to do, we've also found that it's the fiscally responsible right thing to do.

Because those healthcare and professionals now when they're not burnt out, are delivering better care, higher quality care, fewer errors greater patient safety, a greater patient- ... and family experience. And not to mention the own, physician and APP and nurse experience. And so when we do invest and recognize that, yeah, this is something we've gotta make sure is that we're taking care of, it's as, goodness, the quadruple aim, right, is having a healthy well care team that can execute on all the other things we care about.

High quality care, that is safe and evidence-based and creates great outcomes, and a great patient and family experience- . at a value. and when we put that on the same level as we value quality, safety, and patient experience, we'll be able to do those [00:16:00] things even better, and it'll be better for the organization as well as the patients we're caring for.

Love

that. I love that. Sounds like WellSpan is doing a heck of a job at realizing the return on investment. Let's talk about it in business terms, because the business of medicine- Yeah ... is kind of that ugly underbelly. But it sounds like, you know, WellSpan has recognized return on investment, which is not always a cash flow thing, but they understand the return on investment that occurs when you create systems that may be slightly more costly time and money-wise, but you will get that on the back end, i- in an excess, in profit of what you've got.

Because, what really drives this system is outcomes and experience, which is I'm just walking basically what you said backwards, which is you get to outcome experience by walking it backwards, taking care of your clinicians, taking care of the systems that take care of the clinicians. we both talked about excellent outcomes. So This is a tough question. How can a physician, and I haven't figured this out, but when a patient dies- And you've done the absolute best medicine you can.

And we all question, like, what could I have done that would have changed this [00:17:00] outcome? How can that be still a good or an excellent outcome? How can you put those two sentences, "This is an excellent outcome. The patient died." It's not like, you know, the surgery was a success, but the patient died.

That's not what I'm getting at. That's not right, right? That's not a funny joke. But patients do pass away but an excellent outcome to me sounds like a patient passing away with dignity

Yeah, to your point we got into this to, improve the lives of our people in our communities but bad things happen and they can happen on our watch even if we feel like we've done everything we could.

And so I think your question is, you know, how can we make good of that? I think when the patient is at point of death we can do everything we can to make sure that they at least don't suffer and we can certainly work with patients and families to do that. As far as how can we make that better, especially when there's an unexpected patient death, I think organizations need to have things in place so that we [00:18:00] can support our physicians, APPs, and nurses, and those who are impacted by those outcomes.

And one of the things that we've been a little bit harder for us to ramp up, is really putting into place what are called peer support programs. and other organizations have done this incredibly well, where they've trained colleagues, physicians, APPs, nurses, leaders in all different areas in psychological first aid.

Because a lot of times when that happens, yes, we know EAP is available. We can certainly go talk to them. We could get an appointment with a psychologist. A lot of our colleagues choose not to do that and they'll either suffer in silence, or when given the opportunity to talk about how that impacted them by talking to a colleague, they'll jump at that because talking to a colleague and sharing an experience like that, such as an unexpected patient death, a malpractice suit, a workplace violence event, you know, whatever it is, that for some reason is what our colleagues are interested in.

And so [00:19:00] one of the things we're doing here in WellSpan is we've done a pilot in our orthopedic service line in one of our hospitals to start to train people in psychological first aid so that when something like that happens to a colleague, we can be there for them on a peer-to-peer basis and just sit with them and hold space with them, let them know that, yeah- I know what it's like because I've been there as well.

This really hurts, and I'm so sorry you had to go through with that." But just being able to process that with a colleague creates incredible comfort and creates the sense that my system cares about me. They care about me enough that when I go through an adverse event like this, they have trained people that I can go talk to and feel supported even if it can't change, the outcome of that.

And so I think that's one of the ways an organization can really support especially their point-of-care healthcare professionals and some organizations have done that really well with peer support programs, and WellSpan's in the process of setting that up and spreading that system-wide.

That's fantastic. I often hear that, you know, patients like [00:20:00] to go to somebody who looks like them or sounds like them, and I think that's completely reasonable, and I think that same philosophy holds true for physicians who may go through some psychological harm through whatever.

Listen, taking care of patients is hard, so you're apt to at some point, uh, have some psychological harm come to you. so talking to somebody who not necessarily looks like you but has those same backgrounds and those same experiences I think are going to be something that helps people through those times.

you talked a lot about you know, what happens to somebody in an adverse event. an adverse event doesn't necessarily mean a mistake. An adverse event means just that you didn't get the patient where you need him to be. Life itself quite frankly is a terminal illness unfortunately, right?

So- ... but the term that they use, and you're probably more familiar with this than I am, but it's the term of second victim. So something happens to a patient that you don't want to happen, and you are primarily in control of whether that did or did not happen. There's that second victim, and that sounds like what you're describing to us.

Yeah, and there's a lot of, literature on that. And interestingly enough, orthopedic literature [00:21:00] has a lot on this, you know, how can we prevent that second victim syndrome? How can we prevent that guilt of, gosh, could I have done something differently? And keep that physician, APP, or nurse from carrying that with them because that'll invariably affect, them down the roadif they can't ever fully process that.

And it's gonna affect, the next time they're in a similar case, they may be thinking back of the last time they lost a patient and that doesn't help the current state of doing the best job at the time of that surgery or taking care of that patient. So that is one of the goals, to try to prevent that second victim syndrome so that we don't harbor that, ' cause it keeps us in the game.

You know, there's been many colleagues who, when an event like that has happened, they just can't do it anymore. They feel like, I can't move forward with medicine." And that's incredible loss, not only to that physician, APP, or nurse who decides, "I can't go on," but it's a loss to all the other people who that person would've been able to serve if we could've somehow kept them in the game of medicine.

And so there's a lot of personal and system benefits to creating these support structures [00:22:00] to avoid that second victim syndrome. And Anders, you may have experienced it. I have. I know I've experienced it. I still remember the name of the child that , Died on my watch when I was an intern

and I still carry that with me.

Could I have done something differently? And I wish I would've had the chance to process that better- Ah ...

Boy, we've gone a lot deeper in this than I thought we were going to, but I'm with you, Ridgley. I can remember the names- Yeah ... of where I was when stuff went haywire in the operating room, delivering a baby.

we've had situations where, people, because of religious preference, have refused blood products when they're bleeding to death, and there's a newborn baby there. And we've have had those conversations, subsequently with people prior to delivery, first, second visit obstetrically, and we talk about, taking on blood products if you're actively dying.

And patients, you know, to their own credit are committed to their religious preferences. Good for them, But we've had those conversations where I've said to patients when I've had a good relationship with them, 'cause it's a hard question.

"Do you wanna orphan [00:23:00] your child? Do you want your child to grow up without a mom?" And it's a really hard question and you get to that point where y- here's that moral injury. I have these blood products in my hands. I can save you or I can try and save you. Maybe it works, maybe it doesn't work, but I have a solution in my hands, and I can't use it.

Augie Garrido, who's one of the greatest, baseball coaches who had a very, colorful language, shall we say. I remember the video on him. I also happen to be good friends with a baseball player named Aaron Rowan, who played under him. I talked about his colorful language and how tough he was, on his players, but he said to his players, "You guys are gonna forget this in 15 minutes.

I've gotta live with this for the rest of my life." And he took wins and losses very seriously. and the game of medicine is not a game. It's not wins and losses. maybe it's little wins and little losses, but you're dealing with people's lives but you live with them for the rest of your life.

And I think that's a really good point and people deserve to recognize that. Physicians, and anybody caring for patients deserve to recognize the [00:24:00] fact that there is a psychological grind that piles up. Moral injury is permanent. It leaves scars, and it leaves something that's gonna fill up a cup of moral injury.

And When you can't increase the size of that cup and it fills over, there's burnout and you're done. So, you know, the best thing you can do is get into a system or recognize what's available to you when you do start to feel burnout. Are there any common signs that people listening may be asking, "Is that me?

Is that me?" in your experience, which is significant experience what should people realize or recognize about themselves, what they're saying it to themselves at night or when they're seeing a patient? When should they seek help?

Yeah. ,

because of the frustrations and stresses of our job that we're just, not as good as we used to be or good as we wanna be I think that in and of itself is something to give us pause and say, w- why is that?

What, what's driving this? Burnout is like I said, been studied for 40 years and it has official definitions. It has six drivers. But in short, it's not a [00:25:00] mental health condition. it has overlaps with things like anxiety and depression, but it's a workplace phenomenon.

You know, it's chronic workplace stress that's not adequately managed that results in emotional exhaustion, often due to work overload, depersonalization or cynicism where, you really start to objectify. And goodness, I remember that was even back in residency where I was like, "This isn't one more soul I need to take care of.

it's one more thing that I need to do so I can get home at the end of my 36-hour shift." and it results in decreased efficacy. You're just not as good as you used to be or as you wanna be. But I like a simpler definition of burnout, and that is, It comes from a colleague, of mine, Dr.

Bryan Sexton, who's studied this stuff a lot. He's at Duke. He's now Duke's, chief well-being officer. And burnout as it pertains to your work is the impaired ability to experience positive emotion You're doing good, you just can't see it. All you can see is that which is wrong and that which is negative.

and I like that definition because it helps us get to the wellbeing definition, which Bryan Sexton has also defined as the ability to see the good and the bad at the same time. [00:26:00] And so part of the work of burnout is to not only identify those things, those drivers of burnout, and create improved work cultures and, and workplace efficiencies.

But the other side of that is how are we cultivating what is good? Do we have processes in place so that we can see the good that we're doing, so that you can see the impact of our work? And because our brains aren't good at that, right? Evolutionarily, our brains are programmed to see the negative.

you know, Barbara Fredrickson, a psychologist in positive emotion at UNC, says, "The negative screams at you, but the positive only whispers." And so you have to be intentional about cultivating those goods and seeing the good, and that's where I was in my burnout, Anders. I was doing good .

I just couldn't see it. And I just did not have the tools where I could see the impact of my work or the impact that I was having, with the time I could spend, with my family. Yeah. and so I think that's part of the solution . And I don't know if you were gonna ask, like, the special sauce question about, how do we get from here?

Yeah. But, I don't know if we know the special sauce. One thing I will say is [00:27:00] it is many ingredients that make up the special sauce. but I can tell you what it's not. and it's not a one-size-fits-all. and so as much as possible we need to understand the drivers of burnout, of different roles, of different service lines, you know, because they're different.

The burnout for my colleagues in primary care is different for the burnout of our colleagues in surgery, for example. And we have to understand those differences. And so I would say if there's two main ingredients to the special sauce, this comes from another article from JAMA that was just written back in March as well, two of my colleagues, that have contributed to that, John Ripp at Mount Sinai and Kerry Palmera, and that was that when it comes to wellbeing, we have to not only improve comfort- Mm-hmm

or what's called hedonia. And that is, you know, improve workplace efficiencies and improve the culture and provide the resources, both human and otherwise, needed to take great care of people. those efforts allow us to sustain our work. But what's really meaningful that I think is sometimes overlooked [00:28:00] is the work that we do, we need to be able to tap into the meaning and the value and the purpose that we have in our work.

and the wellbeing feeling that we get from that is called eudaimonia. It's a new word that I learned. And so if I were answering the question is what is the secret sauce, I would say it's a combination of hedonia and providing comfort and improving workplace efficiencies, and eudaimonia where we tap into those- things and those opportunities to really connect with patients and where we can see the meaning and the value and the purpose in our work.

And I think that second portion is probably an underutilized- focus of wellbeing work, especially when it comes to those who are at the point of care and really driven to take great care of our fellow men, women and children.

Wow, that's an excellent explanation your expertise is clearly beyond anything I understand, and [00:29:00] that's why I'm here too. I'm here to learn about it as well. And I wanna walk back to your definition of wellbeing that you shared with us. still going through puberty, apparently . But, ability to see the good and the bad.

So wellbeing is not just rainbows and unicorns sound bowls, yoga. You know- Yeah ... take a couple of, happy pill, have a day off, play a little golf, and you'll be fine. It's like, look, bad stuff's gonna happen, but we've got a system in place so that you can process the, stuff that's suboptimal or even bad, and hold onto the stuff that's good.

I think you explained that really well. I really appreciate all these viewpoints. We have, just a few minutes in the program, and so where does wellbeing show up every day in a physician's life? Work-life or personal life , Where does that go, briefly?

Yeah.

You know, when we're firing on all cylinders and we're thriving and we're not only well, but we're thriving, I kinda think of wellbeing on a continuum. Like up here is thriving and down here is burnout. and when we're meeting our calling, we feel like we're making an impact [00:30:00] that,

that's where we wanna get to. that, that's where we're thriving. But we have to recognize what causes burnout and understand those drivers, and so I think that's an important thing. When you're experiencing that burnout, the way it shows up in our everyday life is both professional and personal consequences.

You know? There's a lot of data that, we're not as effective. We're more likely to make errors. We don't have as good a patient experience and that really impacts patients, and it impacts organizations because, it's very important for organizations that we provide that great, safe, quality care with a great experience, and we do it at the best value possible.

But it also has these incredible personal consequences that can lead to other things, that can lead to other dysfunctional things in our life, right? increased substance use and an increased, mental health problems- Yeah ... increased suicidality. Goodness- Wow ... we lose 400 physicians every year, Yeah

to suicide. And so it has incredible downstream consequences on ourselves and on our relationships. and I think one of your other questions was- Yeah ... [00:31:00] how does it show up at home?

Yeah ...

it impacts our home relationships. it impacts, even when we are home after working those long hours, sometimes we can't turn it off and we can't be present.

You know, we can't create that switch, like, okay, I'm taking my doctor hat off and now I'm yours. I'm spouse, I'm dad I'm mom. And so, that's where burnout can show up both professionally and personally.

It - has pretty significant impact on both-

Okay, we've gotten to that point where we had a great conversation, and I really appreciate the expertise, and I'd love to get some of the links to those great resources that you've shared with us, and thank you for that. When you think about this, someone who's listening right now what one action item could somebody who's listening to The Direct Well Being Podcast right now, what could those listeners do today to make this conversation stick with them?

I can think about it, - in two different ways. one is more what can you do individually, and one is more how can I maybe spread that at least my own local area? And so I'll start with the local area, is that there are certain things that we can do to kind of spread some wellbeing [00:32:00] practices within our own care area.

And, I'll give you a really, basic way of doing that. We could do that in our daily huddles in the morning, you know? Before we get started in the work of the day, we could say, "Hey, does anyone have any vitamin G? any gratitude that they'd like to share?" And you could quickly go around the room and you could say, "I'm grateful for my colleague because she covered for me last week, and isn't it great to have such a great team?"

And just build that camaraderie, we can share it at the end of our workday. You know, so one of the things that I'll do to try to spread this gratitude practice, and again, my colleague Bryan Sexton has this great three good things practice, whereas if you do three good things for 15 day straight, you have the benefits of improved wellbeing and work-life balance and even depression improves if you're doing three good things.

But we can take that three good things concept and at the end of our workday, at the end of clinic day, or at sign-out, we can say to our colleague, "Hey, what were three good things from today?" Because even if it was an awful day and we were running behind, there's always three good things. And so I'll say to my clinician, "All right, Brittany, [00:33:00] what were three good things from today?"

And we can always find those three things at least, that we made an impact on our colleagues today. Yeah. And then you can take it home, Anders. When you go home for dinner, when we sit down after our prayers for dinner, we do one crappy- ... and three happies.

Tell me about that.

we get that crappy off our chest, and then we go around the table and we talk about what was good today and what is meaningful to us.

And again, it helps us see the good. And so I would say if there were practices that you could do locally, it's to talk about those mission moments, and it's to have operational processes in place that we talk about the impact that we're having and the good that is in the work that we're doing.

'Cause we are. We're doing good. we are doing good things and taking care of us, of our fellow men, women, and children. So that's one thing we can do operationally. I would say one thing personally that our colleagues listening could try to do that as much as possible, One of the questions think we had talked about before we got on air was that what are we not talking about that we should be?

And that is creating those opportunities to provide meaning, value, and purpose. And one of the ways that we can do that is through what's called [00:34:00] job crafting. And so if you're early in your career and you haven't really set up that cadence, work with your employer to try to do something at least 20% of the time that is very meaningful to you.

It could be teaching, it could be mentoring, it could be doing research. 20% seems to be the magic number. Tait Shanafelt and his colleagues in Stanford he was in Mayo Clinic then, studied this, and the magic threshold is that if you're doing something 20% of your time, that you really enjoy and you're really passionate about, your professional fulfillment goes up and your burnout risk goes down.

So if there's one thing I would encourage our colleagues to do, try as much as possible to job craft that your workweek, at least 20% of time, is doing something that is really meaningful, valuable and purposeful to you. And Anders, I'll wrap it up that thought with this In that remember my son Nick- who I told not to go into medicine? I'm grateful to tell you that- ... he didn't listen.

which is I'm grateful for because it's a good fit for him. He did go into medicine. He went, after Drexel, he [00:35:00] went into family medicine at the Medical University of South Carolina, got a great education there.

And then he came back to WellSpan and he joined us, and he was able to create a job that is great for him. He sees patients three days a week. He teaches the family medicine residents two days a week, and he even does a week of teaching the inpatient medicine rotation about every eight weeks. And I can tell you, the reason I told Nick not to go into medicine is I didn't want him to have a career of disappointment, and that medicine wasn't what he-

hoped it was going to be. But when you job craft and you're doing something at least 20% of the time that you love, you're gonna make it. And so I'm grateful that my son has job crafted and has found that balance and loves teaching, and that's, a big part of his week. And, I'm grateful for that.

And I think he has a great chance of making it in medicine without getting burned out and finding that professional fulfillment. Wow. So that helps- Beautiful ... dad's heart. And that's why [00:36:00] I went into this, you know? I went into this 'cause I wanted to make it better for my colleagues, you know, we're very passionate about that,

My colleague Mike Diller and I there's two of us at WellSpan. The Office of Wellbeing is two of us, but we've got these great kindred spirits. We are very collaborative, and we've been able to sit in spaces to infuse wellbeing, at the levels of the organization. And thankfully, our leaders are talking about wellbeing.

one of the things we ask them to say is, during any initiative, what impact is this gonna have on the health and wellbeing of our people? And when an organization can ask that question regularly, they're gonna be in a good place.

there's a lot of great stuff here that everybody can take home and take with them.

Gratitudeobviously at the foremost of that. The vitamin G, let's take that with us. good for you, and good on Nick for sticking with it and you've created something that the ripple effect is gonna be significant because now you've got the next generation who's still working hard.

You know, they haven't dropped out. They're not doing less to create wellbeing, they're actually doing more meaningful stuff. you said it a lot better- Yeah ... than I did. But I really appreciate you being here, Ridge. [00:37:00] thanks again for connecting agreeing to be with us. and I hope, I can lure you back in, and we'll do some further episodes and capture some of that material you've shared with us and put it on the website, directwellbeingpodcast.com and put it up there so people have resources far and beyond just this podcast.

So, again, thanks to WellSpan for, letting you be here, and Dr. Ridgley Salter, national forerunner for, wellbeing for clinicians. Thank you for being here.

Thank you, Anders. Thank you for what you're doing, giving these discussions a platform. I really appreciate it, and that you thought of me, and we were able to have this conversation, and I encourage you to continue doing this work.

Transcripts are lightly edited for readability and may contain minor errors.