From the May 5, 2023 issue of the Transformational Times - Wellness
We’ve Come a Long Way, but Have a Long Road Ahead: Addressing Systemic Problems That Affect Wellness and Burnout
Alicia Pilarski, DO
Dr. Pilarski, who has been actively involved in promoting on-campus wellness for several years, reflects on her first few days as the Froedtert & Medical College's first Chief-Well-Being Officer...
While the waves of excitement wash over me, I'm simultaneously pulled under the current with the reality that this new role is going to be incredibly overwhelming at times, very challenging. Our healthcare system needs an overhaul. It's not just our own organization, but others across the nation that need to restructure many aspects of how we collectively deliver safe and quality care to our patients, all while protecting those who deliver the care.
Depression among physicians is increasing
There are so many contributing factors to these alarming statistics: inefficiency of practice, administrative burdens, inadequate use of technology, excessive workload with inadequate staffing, moral distress, stigma coupled with barriers to receiving mental health care, lack of autonomy and control over work, misalignment of values and expectations, and so many others. 
When I first started to think about wellness (both on an individual level as well as in relation to my colleagues), I was an emergency medicine resident. I could see what was ahead of me and it was scary. I didn’t know how exactly I would be able to survive (let alone thrive) in a field that was riddled with burnout and cynicism towards societal burdens, job demands, and the emotional toll of seeing tragedy on a regular basis.
At first, I believed it was a "me" problem and that I would need to work on being more resilient; foster my own wellness. To some degree, that was true (exercise, sleep, etc. are always recommended.) But to be completely honest, my personal mindfulness practices have come and gone and have never really stuck.
But then, after a few years in practice, I realized it doesn’t matter how resilient or well you are as an individual. The system you work in will have the greatest impact on your work and personal well-being.
A night where I reached my breaking point
I’ll share a story. As a new mom with a four-month-old at home, I was working a night shift in the Emergency Department (ED). I was still very early in my career. My shift was scheduled to end at 2:00 AM, which left the ED with only one attending and two residents until 7:00 AM. At the end of my scheduled shift, I elected to stay longer because our patient volumes were incredibly high. I wanted to ensure the safety of our patients and didn't want to saddle my colleague with the 20+ patients in the waiting room, trauma victims, angry patients, etc. This, unfortunately, went on for several months. It became the norm to stay late to help out the rest of the ED staff.
However, my four-month-old daughter was also just waking up. I was getting text messages from my husband, asking when I would be home to nurse her, or whether he would have to dip into our milk supply in the freezer. I didn’t have the time or capacity to even respond. I realized I hadn’t even pumped yet. I remember thinking, “What kind of mother am I?”
I was tired, frustrated, stressed, anxious, and overall super burned out from the shift (and my job at that point).
That night, a page came across at 6:00 AM from our paramedic colleagues: “Stable vitals and complaint of chronic, whole body pain.” Why did this patient need an ambulance? Why were they coming to the ED for chronic pain? My frustration escalated and my compassion for this patient I had never met evaporated.
And then, without thinking, I forcefully threw my pager across the desk of the ED. It was an act of fury, frustration, guilt, sadness, and sleep deprivation.
I may have also said some choice words to color my actions. It was not my finest moment. In fact, my nursing colleagues and my resident working with me just stared at me with their jaws dropped. I quickly realized the impact of what I had just done and apologized to everyone for my words and actions. Luckily, my pager wasn’t beyond repair. I hoped the same was true for my relationships with those I worked with.
I first blamed myself and thought I needed to focus on my own personal well-being and resilience. I was broken. I questioned if I would come back to work the next night.
But after a few hours of sleep, I had a chance to think about what got me to that point.
- A schedule that keeps an overnight physician past a scheduled shift because there isn’t enough coverage to handle the patient load.
- No built-in break for me to go pump while on shift (let alone time to eat!).
- A broken system of healthcare where patients feel the only way they can obtain care -- even if it’s not emergent -- is through the ED.
- A culture that expects us to handle these emotions and challenges on our own, not reaching out for help, since that may make you look weak.
Yet, what ended up keeping me in this remarkable profession? It was a calling to compassionately care for my patients, even if it meant my own personal sacrifice at times. It was a commitment to my colleagues and team to be there for them so they would not have to do this work or endure suffering in isolation.
And so, it began. I needed to find a way to fix the things that were broken, all while emphasizing the things that were incredibly fulfilling in the profession of caring for other people.
Let's fix the system and not blame the individual
As Chief Well-Being officer, my overarching goal will be to help solve system-related issues that impede our ability to provide safe, quality care to our patients while enhancing the critical work of building relationships with our patients and colleagues that bring us true connection and purpose.
It will not be to add more yoga to our already busy schedules. Although, it is a goal to identify more time in our schedules to do things like yoga, or whatever else you love without having to feel guilty about it! Included in that work is simply improving basic needs while working in our clinical environment (i.e., eating, resting, pumping, emotionally processing, etc.). In healthcare, we have always operated in a very lean model, yet this strategy does not allow for the needed mental, physical, and emotional breaks that each of us deserves regularly.
Healthcare needs to be delivered more efficiently for both the caregiver and the patient, and this will ultimately impact our well-being and our patients’ outcomes. It’s time that we rethink how we work together across specialties and coordinate care better, eliminating our silos and breaking down the hierarchy.
I plan to work with others just as passionate as I am about eliminating the unnecessary burdens from the electronic health records (EHR), in addition to removing other administrative tasks that are not related to patient care. On a positive note, I am not alone in this effort, and some of this work has already begun!
It’s also my goal to find ways to make your job easier and more fun. If you have ever played “Trauma Ball” or “Chair Races” on a rare slow night in the Froedtert ED, you know 😉
With our challenging jobs, we need to cultivate connection with our colleagues. We all should feel supported and cared for by those we work alongside. The importance of psychological safety among teams is paramount, and this will be another area that we will continue to work on improving. If we treat one another with compassion and kindness, we ultimately strengthen our ability to work with one another and positively impact how we care for our patients.
We have the tools to make this work. Together.
At F&MCW, we have an incredible number of resources for support (mental, emotional, physical, etc.,), but these resources are underutilized and at times difficult to access. Another goal in the coming year is to ensure these valuable resources are highlighted and access to them becomes easier, in addition to allowing for time in our work schedules to utilize them.
I am inspired and motivated by those who have been involved in this work to date. Through the work of achieving the American Medical Association’s (AMA) Joy In Medicine” Bronze Award for our organization, the immense growth of our F&MCW Supporting our Staff (SOS) Peer Support Program, the various well-being committees working to coordinate efforts across our organization, and the individual champions and leaders who have dedicated their time to making well-being a priority for our entire healthcare team, we are positioned for success as we collectively take the next steps in improving the well-being of our entire healthcare team.
While the work will be overwhelming and challenging at times, I am certain I won’t be alone on this important journey and the meaning and purpose for this work will continue to be a guiding light.
Alicia Pilarski, DO, is the Froedtert & MCW Chief Well-Being Officer and an Associate Professor in the Department of Emergency Medicine at MCW. She is the Co-Director for the Graduate Medical Education (GME) Pillar for the Robert E. and Patricia D. Kern Institute for the Transformation of Medical Education, and the Medical Director for the F&MCW Supporting our Staff (SOS) Peer Support Program.