‘In Dialogue’ Episode 8: Dr. Jon Novick, OMA PHP Program
In episode eight of “In Dialogue,” CPSO Medical Advisor Dr. Vivian Sapirman speaks to Dr. Jon Novick, a psychiatrist, psychoanalyst, addiction medicine specialist and Medical Director for the Ontario Medical Association’s Physician Health Program (PHP), about the vital role the confidential program plays in physician health, physician burnout and the importance of understanding it as a system issue vs. an individual one, and the stigma around seeking care.
Dr. Novick runs a private practice in Oakville and is an assistant professor in the Department of Psychiatry at the University of Toronto with a focused interest in medical psychotherapy. He also served as the inaugural Career Exploration Faculty Lead and the first Director of the Career Advising System with the MD Program at U of T. In addition to assisting physicians struggling with mental health and addiction problems, he enjoys helping learners with career development and established physicians find the best work-life balance.
The PHP provides a range of services to physicians, residents and medical students across Ontario, as well as supportive services to family members. The services align with the belief that physician health matters and that education, early intervention and treatment are important in helping to sustain a healthy medical workforce. Services to members include timely connection to treatment and resources, such as treatment of substance use or mental health conditions, counselling, coaching, and more.
The Physician Support, Advocacy and Accountability Programs (PSAAP), formerly known as the monitoring program, provides evaluative services for physicians and trainees where mental health, substance use or behavioural issues are a concern. The program allows the PHP to gather information, with consent, about how the individual is managing their health and wellbeing prospectively, to provide advocacy and support in the workplace, including any necessary accommodations, and to provide progress notes to agreed upon parties. It supports them as they work, and helps identify early signs of a potential relapse or recurrence of health or behavioural issues. Participation is voluntary, but may be requested by the workplace, training program or regulatory body.
Related eDialogue Articles
- Reclaiming Herself
- Reaching Out for Help
- Pandemic and Mental Health
- Physician Burnout and COVID-19
- Patient Bias, Physician Burnout
- Pandemic-induced Mental Health Distress
- How to Treat Stigma
- ‘In Dialogue’ Episode 2: Dr. Janet van Vlymen
- ‘In Dialogue’ Episode 1: Dr. Mamta Gautam
- OMA PHP Program
- Canadian Medical Association’s Physician Wellness Hub
- A profession under pressure: results from the CMA’s 2021 National Physician Health Survey (August, 2022)
- Watch: Four physicians describe the causes and effects of burnout and ways to cope
CPSO presents “In Dialogue,” a podcast series where we speak to health system experts on issues related to medical regulation, the delivery of quality care, physician wellness, and initiatives to address bias and discrimination in health care.
Dr. Vivian Sapirman (VS):
Thank you for joining us “In Dialogue.” My name is Dr. Vivian Sapirman. I’m a psychiatrist at Women’s College Hospital, the Mental Health Physician Lead at the Workplace Safety and Insurance Board, and a medical advisor here at the College. I’m thrilled to host this important episode on mental health and physician burnout with Dr. Jon Novick, who is a psychiatrist, psychoanalyst and addiction medicine specialist. Dr. Novick is also the Medical Director for the Ontario Medical Association’s Physician Health Program [PHP], which makes him the perfect person to engage in this conversation.
Before we begin, I do want to make a listener note and emphasize that the subject matter of this episode may be distressing for some listeners, especially if they have or have in the past experienced mental health struggles of their own, or if somebody in their family is struggling. And we would like to let our listeners know that help is available for those who may need it. We will also include some information and support resources on the episode page. So, I encourage you to make use of these and pass them along if you know someone who is struggling.
Now let’s get to our discussion. Welcome, Jon. And thank you so much for speaking to us. You know, I’ve already mentioned some of the different things that you do. So, tell us a little bit more about the kind of work you’re involved in right now.
Dr. Jon Novick (JN):
First of all, thanks so much, Vivian, for inviting me. It’s a really great opportunity to not just speak with you and talk about this important topic, but also just to spend some additional time with you because I’ve enjoyed working with you increasingly over the past year. So, as you’ve already mentioned, I’m a psychiatrist, I also trained as a psychoanalyst, and I have a sub-specialization in addiction medicine. I’ve been in practice for about 20 years. I really enjoy the work that I do right now. Currently, the bulk of my work is with the Physician Health Program, and working with learners and physicians. Really though, the work that I’m doing is so much more as the Medical Director for the Physician Health Program, providing the confidential support and services to all of the physicians in Ontario, as well as medical students and residents who contact us or are in need of support services and assistance with respect to a variety of different issues, including mental health conditions, substance use disorders and behavioural problems.
VS: So, John, we always try to start each episode on a positive note. So, in your career in medicine, whether it be clinically or academically, tell me about some of the things that have sparked joy for you.
JN: Oh, I love that question. And in fact, I would say that this is a really great example of something that sparks joy — for me at least — this phase of my career. So, it’s talking about the work, talking about the great things that we do for physicians and learners, and collaborating with people. I really like to follow the things that get me excited about practicing medicine and building on all of that, in addition to the wonderful stuff about being a doctor, which is helping people. It’s always wonderful when you can see the successes of the work that you do and the interventions that you make, as well as that not so occasional “Thank you.” I mean, all it takes is one expression of gratitude a day, I think, to really spark joy. And I would add that my current job, which I love for so many reasons, and one of them being the amazing people that I get to work with and the excellent team. And so, it is always a joy to go into work.
VS: I can say for myself that I have had contact with your team. I have the privilege of getting to engage with you and your team periodically and I completely echo that they are an amazing, incredibly skilled group of people. And I’m delighted to hear that having this conversation is also something that brings joy. So, I am so thrilled that we were able to bring you here today and to launch into this discussion.
JN: Yeah, thanks.
VS: So, our listeners may not be familiar with the Physician Health Program, or the PHP, or even the role of a medical director. You’re new to that role. Can you spend just a couple of minutes telling us about what that involves, what is the PHP and what do you do as medical director?
JN: Okay, I’m really happy to talk about that. Let me answer that by first describing a little bit about what the Physician Health Program is and what we do. We’re one of the oldest, in fact one of the most respected programs, in North America. And just a couple of years ago, we celebrated the 25th anniversary of the program. The Physician Health Program provides assistance and services to all of the physicians in the province of Ontario, as well as learners. And that includes medical students and residents. We really like to think of ourselves as a central hub for all things having to do with physician health and well being.
Physician health programs initially started focusing on providing support and resources to physicians who were suffering with substance use disorders. And our program, as well as many others, have expanded to support physicians experiencing difficulties with mental health conditions, as well as behavioural problems. The Physician Health Program at the OMA is one of the more comprehensive programs, where in addition to providing the support, we also provide other services, such as assessments, what used to be called monitoring [now Physician Support, Advocacy and Accountability Program(PSAAP)], and we have a very robust intake service where people can call and receive resources or referrals for care out in the community. And the job of the medical director is to provide the clinical oversight for all of the work that we do, as well as program development. And I want to say that I also work hand-in-hand with [Laura Mattila,] the senior director of the program [administration and operations].
VS: The PHP clearly serves a very important purpose. And in order for physicians to really provide good care to patients and safe care to patients, they need to be well, as well. And it’s really important to have people taking care of our doctors who take care of others. So, what kinds of things are we seeing occurring with physicians? We’ve heard a lot of talk, both in the media and from the government within the medical system, about physician burnout and the way it impacts the health system. And we all know that pandemics only exacerbated this further. So, based on your experiences, your observations, what have you seen?
JN: A lot. But first of all, physicians are not automatically immune to all the illnesses and conditions that everybody gets. But with the increase in burnout among physicians, as well as other professionals, we have seen a dramatic increase in the request for services, whether it’s directly from physicians and learners, as well as third parties who are referring people because they’re showing signs of distress — and at times, even impairment. I’m not so good at remembering all of the numbers, but I would say that based on some of the recent surveys — it’s been clearly documented not just by the Canadian Medical Association, but also the Ontario Medical Association — that the number of people experiencing burnout has drastically increased. I think the data from the CMA’s physician health survey showed an increase from somewhere around 25 percent in 2017 to nearly 50 percent in 2021 when it was redone. The OMA did their own surveys and showed another marked increase from I think it was 2019 to 2021. So really, it’s a well documented problem.
And I would like to add that there are a lot of people in many areas of the organization, the association, the government, individuals, hospitals, that are working really hard to tackle this problem. Maybe another question is, how does this show up? And it shows up in a number of different ways. So, physicians experiencing burnout will experience exacerbations of underlying problems, they’re at greater risk for depression, for substance use, as well as suicide. It has an impact not just on the physicians and their home life, but it also has an impact on the system overall, whether you’re talking about a local system, or the larger healthcare system. It has an impact on patients, the kind of care that’s delivered, as well as patient satisfaction.
VS: It’s really clear that there’s a real ripple effect from this kind of problem. It doesn’t just affect the physician struggling, but those who come within that person’s circle. And as a doctor, when we’re doctors, there are a lot of people who potentially come within that circle of people that we’re responsible for and we need to provide care to. We’ve already talked about the PHP being a really excellent resource for these physicians. Is there anything else that you would you suggest to physicians who are struggling in terms of managing their health and well being, managing burnout, managing more kind of overt mental health or addiction problems?
JN: Okay, I love that question. It allows me an opportunity to get on my soapbox ever so briefly and say that there is a sort of a myth that is perpetuated a bit in that question, which is that burnout is not an individual issue. It’s not about a physician who isn’t taking good enough care of themselves or not doing enough exercise or focusing on their wellness. It’s not a question of resilience. Even as recently as just a year or two ago, people were presenting solutions as if what we had to do was build more resilient people. One could wonder, perhaps the issue with burnout is the fact that medicine already selects exceptionally resilient people, and that makes them more vulnerable.
So, I find that it’s a lot easier to think about burnout as an occupational injury. And we know that at least 80 percent or so of the contributors to burnout have to do with the practice and the work environment. So, I think as I may have said earlier, there are a lot of different people working on this issue of burnout. Now, physicians need to be heavily involved in coming up with solutions and addressing the problem, but it is not solely the responsibility of individual physicians to fix this problem. All levels of the healthcare system have to come together locally, and let’s say provincially or nationally, to tackle this. And there are a lot of people heavily involved in a number of initiatives. The OMA and the Ministry of Health currently have a joint task force working on addressing burnout. As you know, the CPSO as well is heavily invested in having a healthy population of doctors, and you’ve done a number of things, not to mention this current podcast.
VS: I’m really glad that you drew that distinction between the individual bearing the burden and bearing the responsibility, and the broader system within which we work and we exist really kind of driving a lot of this, and we really need to put a lot of focus into that side of things. You’ve already mentioned, you’ve alluded to, some of the things the College is doing — is there anything that you can suggest that the College as the regulator can do?
JN: Wow, had I known I was gonna be asked this question, I would’ve prepared my list of asks. But I want to mention one of the things that the College has already done, which is a changing the membership renewal questions. So, I think you know that every year physicians have to renew their licenses and they’re asked a set of questions. And historically there have been questions — two questions — asking people about their state of health and whether or not they have a condition that might impair their ability to provide care, practice medicine, as well as whether or not they have a substance use disorder. And that question has changed and, I think, consistent with and in response to a lot of efforts on a number of levels, to destigmatize mental health and substance use disorders among physicians, and to really facilitate care as opposed to scaring people away from seeking the care that they need. And so this gentler approach, I think, is a lot more welcoming and I believe that we have even seen that.
There are a lot of articles written about physicians, substance use disorders, licensing, et cetera, et cetera. And one of the recent articles that I read showed that there are a decreasing number of physicians who are having issues with their licensure or from the regulator due to substance use disorders. And one of the interpretations of this is that that is happening because physicians are seeking help sooner, possibly because there is a reduction in stigma and possibly related to these changes in the questions that were thought to previously have kept people away from seeking the help and the very good treatments that they need, and that they can benefit from. I don’t think I answered your question, which was what else can the CPSO do? I would say they’ll continue to be a part of the solution and continue to be a part of tackling burnout, ensuring that physicians are well cared for, and that they are supported in order to continue to provide the care that’s necessary for all the patients in Ontario.
VS: Sometimes change can be slow, especially when you’re dealing with organizations. So, I’m really delighted to hear that we’re seeing some of the benefits, like reaping some of the benefits of some of the positive change that’s already underway. In your answer, you alluded to a lot of different things that I want to go into in a bit more detail. You talked about substance, you talked about stigma, you talked about physicians seeking help. So, let’s unpack some of those a little bit.
Maybe let’s start with the idea of physicians contacting the PHP. There’s the stigma piece of it — and I will want you to tell me a little bit more about that — but there’s also the practical side of it. While the PHP is at arm’s length from the CMPA — I think that’s actually really important to make explicit, to note explicitly, and maybe you can speak to that a little bit so people understand — we do hear that physicians are sometimes hesitant to contact the PHP, because they’re worried about experiencing repercussions or consequences with the College if it is found out that they are seeking help for mental health or addiction issues. What would you say to that?
JN: I mean, I know it’s too easy to say one is at greater risk of being found out if you don’t seek help, because of the consequences of practicing impaired at some point, but people are still hesitant. There are challenges on many levels. First and foremost is basic denial. Whether you’re a physician or somebody else, whether you have some accountability or not, there’s a basic level of denial around having a condition and needing help. I think that has been perpetuated for decades, first by the sort of superhero depiction of physicians.
In answering that question, I would also just want to make clear to any of the listeners who might be, let’s say, suffering in silence, that you aren’t alone; you’re really in good company when you call the PHP or seek help on your own because there are a lot of physicians with many similar conditions, seeking help and getting help. Some of the data that we have suggests that physicians, particularly with substance use disorders… Historically, the physician health programs were created as an alternative to discipline. But as a support program for physicians with substance use disorders, we know that physicians with moderate to severe substance use disorders who connect with physician health programs and enroll in monitoring have an incredible recovery rate — somewhere around 80 percent or so, which is actually higher than other populations or people involved in recovery that aren’t being monitored. But also, along with that success and recovery, is physicians retain their licenses, and they have a lower likelihood of dying from their illness, which was a significant problem before there were physician health programs.
VS: That’s a really excellent point.
JN: So first and foremost, I think one of the challenges is that sometimes people mistakenly conflate the Physician Health Program with the CPSO. While we have an agreement with the CPSO as the provider of monitoring, if that’s necessary, people need to know that just like other physicians or other institutions, there are only a limited number of circumstances where somebody needs to be disclosed to the CPSO. And in fact, I think institutions have more conditions under which they need to report to the CMPA.
So then, the Physician Health Program — I also I think I mentioned this, but it’s worth repeating — that the services that the Physician Health Program provide are confidential, and folks can also reach out to us anonymously and get resources without having to tell us who they are. We also are able to provide referrals, as well as monitoring, without involving the College; people do not need to be known to the College as part of their undergoing monitoring, if that is something that they feel that they need to do and they choose to do. The services that we provide are confidential and that means with respect to the CPSO — except for specific circumstances — the information that we have, the records that we keep, they’re governed by the same principles that govern PHIPAA.
VS: What I’m hearing is that it’s really a fine balance that the PHP needs to achieve because we’re talking about physicians who provide care, and patient safety is paramount. And at the same time, we want to make sure that physicians are safe and healthy, and taken care of. And so striking that balance between ensuring that nobody’s working impaired, and also making sure that they’re getting the help and the support that they need can sometimes be a complicated one. But at the same time, it sounds like the PHP really does an amazing job of striking that balance, without involving the CPSO, being able to provide the care to physicians that they need to ensure that they really are able to provide safe care to patients.
JN: Yeah, and I would say it really isn’t as complicated as one might think because, first and foremost, we are a service to members — members being the physicians of Ontario, as well as residents and medical students. And so, our goal is to provide the support and services needed to physicians and learners who are currently suffering, are at risk of suffering from mental health conditions, substance use disorders and behavioural problems. By the way, we also can provide intake resources to family members.
VS: So, that’s actually really interesting. I’m not sure people know that. And despite being a psychiatrist, despite having lots of line of sight to the PHP, I was actually not aware that that was a service that was provided. So, can you tell us a little bit more about that? I think it’s very important.
JN: Yeah. So, family members of doctors, residents, medical students can call us and speak with the intake clinicians, and get resources and referrals. We’ll often get requests for a wide range of things, whether it’s psychiatric services, or couples counseling. The other thing to mention is that we also provide support and services to leaders — leaders at the university, the hospitals — when they have questions and concerns about students, residents, physicians on staff, and how to approach, address, manage and, if necessary, refer these folks for assistance.
VS: Again, a really, really important service. Thank you for telling us a little bit about that. I want to shift gears a little bit. We’ve been talking around the idea of substance use and of addiction, and you’ve had extensive experience in addiction medicine, even aside from your role at the PHP. Can you talk a little bit about some of the barriers to care that may prevent people struggling with addiction from seeking help, whether it be for addiction issues or other mental health issues? You’ve already talked about denial. Can you take us through a little bit more? What are some of the obstacles?
JN: Well, the first obstacle is the substance itself, because people get addicted to substances for a reason — certain substances are very addictive — so, you get caught in this cycle. And then there is the denial. It’s really hard for people to recognize that either their use has escalated to a level that is problematic. Again, there are many things — or they’re fearful of the consequences of seeking help, or they may not even know that help is available. And as I was mentioning before, particularly when it comes to physicians who engage in treatment that is geared towards physicians, and they work with the physician health programs, their chances of recovery are really very good.
So, I think accessing care is also a problem. And we could spend hours on accessing care, not just in Ontario, but around the world. But I would say that at the Physician Health Program, we’re really good at getting people connected with care and in a timely fashion. Sometimes it’s not knowing how to navigate the system. Or sometimes it’s being really afraid that you’re going to lose your family, your job, your income, all your supports. And I don’t want to paint too rosy a picture because, of course, there are people who do lose a lot of things, but I think most people end up, in the end, realizing that it’s a blessing that they’ve been able to seek care for their substance use disorder.
VS: You’ve already mentioned the really good outcomes and the likelihood of recovery is very, very high. So, it’s all the more reason to encourage physicians to reach out and you’ve already talked about — you’ve already kind of made the message to physicians listening — you are not alone and I really want to just come back to that because that is so important. And that really is the purpose behind having this conversation and exploring this content, to know that as you already said, physicians like anybody else, like laypeople, like our patients, can also struggle and become ill and have issues that need to be addressed. And we really need to dispense with this idea that we are superheroes, that we are invulnerable, that we’re not human, and that we need to always keep going. So, really important points that you are raising.
JN: Yeah, that’s right. Thanks for reiterating that — that’s a really important message to get across.
VS: Is there anything else that stands out for you? Like any other content, any other messaging that you think we should get across?
JN: I think one thing that I would like to add, considering the folks who may be listening to this podcast, is to reiterate the services that are available, but also to highlight the fact that the services can’t be available to our population of physicians and learners without physicians out there and other health care providers being interested in taking physicians in their care, taking them on as patients.
VS: That’s right. That’s right.
JN: So, if there’s one sort of request I can make, it’s that if anybody out there is interested in working with our population, that they just get in touch with us. I think that some people might be hesitant because having a safety sensitive worker, so to speak, in your care might make some people concerned — “Okay, what if this? What if that? Do I have to tell somebody because, you know, you’re treating a regulated professional?” And what I would say is, “Well, we’re there to support them as well.” So, if anybody has any questions or concerns, they can get that assistance from us regarding how they care for a safety sensitive worker, like a physician or a med student or a resident.
VS: You’ve already talked about some of the limitations in the system and the lack of resources. And it’s a really excellent point because in providing care for physicians, we face some of the same kind of lack of access and lack of resources that other people do within the broader system. And so, if there is a physician, or if there are physicians who are willing to step up and provide this care, I think that is so critically important. And again, it really is so important, because of the broader need to make sure that physicians are able to keep providing care to patients, that they stay well, that they’re able to get back to work both because it is so important to us in terms of our identity and our values and the importance of our roles in our lives, and also to be able to provide care to the people of Ontario because there is a bit of a shortage in care and access.
JN: Yeah, that’s right. And we are there to support people to support our people. So, going back to the licensing question and whether somebody is receiving the appropriate care for their condition, I think it reminded me of something that is really important to clarify, which is that the physician health program provides a lot of services. So, we have our intake service that provides the resources and referrals, we have our educational efforts, we have our assessment and monitoring services. We don’t provide treatment, I just want to make that clear. So, we refer for treatment and we have a lot of people who provide feedback to the treaters who provide feedback to us, let’s say, in the case of monitoring. While we are clinical service, we don’t provide direct care. And it’s important to make that distinction because there are physician health programs in other parts of the country where that’s what they do, and they don’t do the other things that we do. Some programs provide the treatment and don’t provide the monitoring or the assessment; we provide the assessments, the monitoring, the resourcing and referrals.
VS: I guess the point being that you refer, right? You connect physicians with providers who can provide treatments.
JN: Yes. And again, that is why it is so important that if there is anybody who is listening, who is interested in providing care and being a provider for physicians and learners, that they let us know.
VS: And I think the point that you’re making — that the care is provided by physicians out in the community who have been linked to these struggling physicians by the PHP, that information is confidential, the same as any of your health care information — is right. You’ve already talked about being bound by PHIPAA, the same as any doctor that any of us sees. You mentioned the regulatory question a couple of times, Jon, and in that question, it says, “Are you getting the appropriate treatment you need for whatever condition it is that you have?” and if you are being seen and engaging in care with one of the physicians to whom the PHP has directed you — if you are doing that, the College is happy. And you know what? As long as you’re engaging in care and taking care of yourself and doing what you need to do, I think that physicians can feel confident that there is nothing to fear.
JN: We used to get calls and we still do that we’re triggered by the licensure questions. And there are pluses and minuses to that. I think one of the advantages of the health questions is that sometimes it can nudge people to give us a call and to seek appropriate care for their conditions.
VS: It kind of shows the seeds, I guess. Reading about it kind of flags for people that, okay, this is something that I need to be responsive to.
JN: So, if we go back to the question that you asked before about do I have any suggestions for the College around how to continually work on approaches to physician health, wellness and impairment, and thinking about the medical licensure question, I want to reiterate that the change that took place is really excellent and timely. I think there’s still this mystery surrounding what happens and a degree of uncertainty that can contribute to people’s hesitation to really consider the question. And as an insider, let’s say, I know what flows from certain answers, oftentimes, it’s just a referral to the Physician Health Program.
VS: And in that way, I think it’s such an important partnership. While the information is confidential, while it’s at arm’s length, the College really does value and rely on the PHP to provide that scaffolding to physicians. And once we know, the physicians are connected to the PHP and being referred to the care that they need. That is very reassuring — that’s what we want to see happen. And not only are we concerned for the safety of patients, but we were very concerned for the well-being of our physician membership.
JN: And I would also like to add that the experience that we have, and I think that a lot of people who are engaging with us have with the College, is that the College is very responsive when people are seriously considering the recommendations. They’re taking care of themselves — that satisfies the College and it really is often a very smooth process.
VS: You’re in the frontlines of this, so that’s really great to hear that that’s your experience of it. And that you’ve seen that especially over the last number of years, the processes have improved, that it is smoother, that there is that responsiveness — that’s really great to hear.
JN: And I would say as a psychiatrist and as somebody who has been doing this for the last five years, I think that a lot of the challenges that people have, what it comes down to actually is a persistence of an internalized stigma.
VS: Tell me a little bit more about that. What do you mean by internalized stigma?
JN: People are still struggling to a certain degree to accept perhaps that they have a condition, to accept that the condition requires certain treatment, perhaps some times certain restrictions — they might see that or take it personally. But when it comes down to it, I think a large part of that has to do with either shame — again, internalized stigma, this false idea that a doctor should be this way and shouldn’t have a condition — and that when there are these asks, the resistance is often fueled by that underlying struggle.
VS: I think that underlying struggle really does drive so much of how we as physicians practice: our reluctance to take sick days, reluctance to cancel, feeling this incredible accountability and responsibility to our patients, very appropriately. But it’s a problem and it comes at the cost of physicians’ own well being. This idea that somehow a different set of rules apply to us. And we’re not even talking about other areas where this plays out.
JN: I’m so glad that you mentioned the hesitancy to take sick days. I’m not really sure where else the issue of presenteeism is a problem. Part of it is that if we’re talking about the occupational environment and issues of burnout, it isn’t so easy to call in sick, right? So, are the mechanisms in place as there would be in other areas? And we’re going to think, okay, well, if I call in sick, then so-and-so is going to have to cover for me and I feel bad about that, or I’m concerned about that, or my patient has waited six months for this appointment, I can’t possibly. And I think some of it is that we could work on supports in the system to allow that to happen a little bit more easily, right?
VS: Yeah, I think that’s the recurrent theme, right? That it’s not just about the individual, it’s about the system as well and they really kind of go hand-in-hand because it’s not enough to say to physicians, take sick days when you need them, take that time. You have to be healthy in order for patient’s to be healthy. There has to be supports, as you said, within the system to allow that and to facilitate that.
JN: Yeah. And I mean, I know we might be going a little bit off topic, but a lot of physicians feel that they can’t even take vacations.
VS: Yeah, absolutely.
JN: And for some people, it’s actually a lot of work. And it costs three or four times the price of a trip because they’ve got to find coverage. And that’s a capacity or human resource issue that I think needs to be managed.
VS: It is, because those system issues and those human resourcing issues fall on the backs of physicians. That even the idea of talking about physician vacation might be experienced as a little bit challenging. Because I know for myself, this internalized stigma, like, no, we need to be available to our patients at all times, right? They need us. There’s a shortage. People are waiting. The waitlist or long clinic days are full. How is that compatible with the idea of taking vacation and taking time to for yourself when we really bear so much responsibility and so much accountability?
JN: Yeah. And so, we need to remind ourselves that in order to be able to provide the best care that we can to our patients, we need to be taking care of ourselves as well. People like to use the metaphor of when you’re in an airplane and the oxygen masks drop from the ceiling, you need to put yours on before you put on or assist somebody else in putting theirs on.
VS: Without a doubt. And I think we’ve hit on the overarching kind of message and theme from today’s conversation, and that that idea of taking care of yourself, in whatever form that looks like, right? Whether that means reaching out for help if you’re struggling, if you’re suffering, if you’re ill; calling the PHP if there is a medical condition or a mental health condition or an addictions issue that needs to be addressed; all the way down to taking sick days when you need them, making sure you’re taking your vacation, making sure you’re caring for yourself as well as your patients.
JN: Yes. And again, it can sound like we’re saying, “Oh, well, part of the problem is doctors aren’t taking care of themselves.” And it’s very easy to say, “Take a vacation, take a sick day.” But if the supports aren’t there in order to allow that to happen, it’s very difficult, right? So, if you don’t release the oxygen mask, well, you can’t put it on. And all the other areas of this system have to take responsibility. So, hospitals, other areas of the system really need to take responsibility. I mean, every year we learn all the fire safety protocols and other things. I don’t know if we’re required to learn about how to keep ourselves well and healthy.
VS: I think this kind of comes full circle to the beginning part of the conversation, where to your earlier point, lots of different bodies, entities, organizations, are looking at that question. So, there has been a shift in the last number of years, there has been improvement. We still have a long way to go, but hopefully we’ll continue moving in that direction.
JN: Oh, yeah, we will. We have to. I think everybody realizes that.
JN: So, I know that we talked about a lot of different topics. And people may have differing opinions or not agree with some of the things that we said or that we discussed. And I think that is a great thing, particularly if additional conversations follow from that. But I was not being purposefully provocative. Yet, I know that people may either take issue with some of the things that have been said, perhaps some things have been simplified. We couldn’t really go into the full details of the complexity of the issue, for example, like burnout. But my hope would be that if people do have a reaction, that this simply furthers the conversation, because there’s a lot of work that is going on and needs to be done. And we need more people involved.
One of the things that I would also encourage, as well, following from what I was just saying, people shouldn’t hesitate to reach out to me directly. It’s so easy for somebody to just post their opinion, even if they’re not anonymous on some social media page, but just engage directly and become a part of the solution. People should not hesitate to reach out to the PHP or myself directly. And my contact information is readily available on our web pages.
VS: Jon, thank you so much for taking the time out of your busy schedule to talk with us today. We really appreciate your thoughtful insights. You’re bringing your experiences and your opinions to bear on this conversation, and we wish you all the best.
Thank you everyone for listening to this episode. More information and resources are available on the episode page. And if you are struggling, please reach out for help.
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