New Case Studies Offer Actionable Insights to Reduce Clinician Burnout and Improve Well-Being

Clinicians of all kinds, across all specialties and care settings, are experiencing alarming rates of burnout. New case studies from the National Academy of Medicine’s (NAM) Action Collaborative on Clinician Well-Being and Resilience provide an overview of initiatives that reduce clinician burnout and support clinician well-being at organizations across the country.

The Educational Commission for Foreign Medical Graduates (ECFMG®) is a member of the NAM Action Collaborative. Every year, ECFMG sponsors more than 11,000 foreign national physicians in J-1 visa status to participate in U.S. clinical training programs. These residents and fellows face the stresses of living and working in a foreign country in addition to the significant demands of their training programs. ECFMG and its Exchange Visitor Sponsorship Program (EVSP) are refining several initiatives to support these physicians and meet their unique needs.

“Our mission at ECFMG/FAIMER is to advance medical education and help improve health care worldwide,” said Dr. William W. Pinsky, President and CEO of ECFMG and Board Chair of FAIMER. “These case studies are important examples of how we can attend to the needs of clinicians, so they can attend to the needs of their patients.”

The NAM hopes that each case study serves as an idea-generating resource for leaders to implement programs and policies at their own organizations that address systemic factors that contribute to clinician burnout. Each case study is designed to help readers more fully understand the successes that organizations have had in implementing well-being programs.

Ohio State University Case Study

At Ohio State University, initiatives to address burnout and promote the well-being of medical, nursing, and health sciences students, trainees, and practicing clinicians are supported by the highest levels of leadership, including the university president. This case study explores the central coordination and alignment of well-being initiatives that span the university, as well as focused examples of programs and policies within the College of Nursing, College of Medicine, Department of Emergency Medicine Residency Program, and the Wexner Medical Center. The Ohio State University case study also explores the role of the University Chief Wellness Officer in advancing the professional fulfillment and well-being of the entire university community. Ohio State calculates a cumulative productivity net savings of over $15 million from wellness programming as well as a $3.65 return-on-investment for every dollar invested in wellness. Additional impact includes decreased anxiety, depression, stress, and suicidal intent among students, faculty, and staff as well as increased academic performance and levels of healthy lifestyle behaviors. University Chief Wellness Officer Dr. Bernadette Melnyk notes, “Leaders, faculty, and managers must ‘walk the talk’ and provide needed wellness resources as well as support for ‘grassroots’ initiatives. The return on and value of investment—including faculty, staff, and students who are happy, healthy, and engaged—will be well worth it.”

Virginia Mason Kirkland Medical Center Case Study

The Virginia Mason Kirkland Medical Center, an outpatient clinic located outside of Seattle in Kirkland, WA, utilizes an innovative, system-wide management method to improve patient care and safety by eliminating waste and inefficiencies. This management method is used to streamline repetitive aspects of care delivery, standardize clinical roles, and engage in continuous learning activities. Two pillars play a central role in improving wellbeing at the medical center: (1) Workflow optimization and (2) Promoting a culture of collegiality, respect, and innovation. Kirkland Medical Center relies heavily on the integration of clinical pharmacists into the care team to free up time for physicians, physician assistants, and advanced registered nurse practitioners to see patients with more complex conditions. Medical assistants help reduce clinician workload and manage administrative tasks, such as confirming patient medications, processing orders, and replying to patient portal messages. Mandatory “pauses” after every 3-5 patient visits allow clinicians to address documentation needs throughout the day, ensuring that all clinicians can leave for home within one hour of seeing their last patient. Surveys from the medical center show that 90% of Kirkland Medical Center’s non-clinician staff and 93% of clinicians are “content” or “engaged.”

The development of each case study was informed by expert interviews with professionals from each organization. The NAM conducted preliminary interviews, in-person site visits, extensive follow-up interviews, and document review for each case study. Additional case studies are forthcoming.

Read the full case studies: nam.edu/clinicianwellbeing/case-studies.

For questions, please contact the National Academy of Medicine at ClinicianWellBeing@nas.edu.

Hahnemann Closure: Release of Residents/Fellows from Contracts

At the July 19 bankruptcy court hearing on the closure of Hahnemann University Hospital, Hahnemann’s representatives reported that it would release residents and fellows from their contracts over the next few weeks. The anticipated release of trainees from their Hahnemann contracts represents tangible progress for trainees in transferring to new training programs.

ECFMG is following this developing situation closely and is continuing its outreach to other organizations, including the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME), to exchange information and to ensure timely and meaningful updates for Hahnemann’s trainees. Please monitor this webpage for updates. Residents and fellows training at Hahnemann under ECFMG J-1 visa sponsorship should contact their ECFMG case manager with any questions or concerns.

Additional information on Hahnemann’s closure is available on this website.

(published July 20, 2019, updated August 7, 2019)

Hahnemann Closure: Information on GME Funding for Hahnemann Residents and Fellows

As plans for the closure of Hahnemann University Hospital in Philadelphia unfold, one important issue that must be resolved is the transfer of graduate medical education (GME) funding for physicians in training from Hahnemann to the other hospitals that accept these trainees. Since the issue of funding has received much attention in recent days, ECFMG is sharing the following basic information that may be helpful to Hahnemann residents and fellows as they seek to transition to training programs at other hospitals.

U.S. hospitals are reimbursed for the educational costs of training physicians by the U.S. Government, specifically by the Centers for Medicare & Medicaid Services (CMS). Hospitals are reimbursed by CMS for each resident/fellow that they train, and each hospital is subject to a limit or “cap” on the number of trainees for which it receives reimbursement. Reimbursement for fellows is valued at 50% of the amount for residents.

When a hospital closes and its trainees are displaced, the trainees may continue their training at another hospital. In this case, the hospital that accepts a displaced resident or fellow is eligible to receive the entire CMS reimbursement for his/her position. At this time, Drexel University College of Medicine and Hahnemann University Hospital are negotiating the release of GME funding for Hahnemann’s residents and fellows. Once released, these funds will be available to move with trainees to their new training hospitals.

During these negotiations, Hahnemann residents and fellows should continue to look for positions in other training programs. They also should be aware of the following facts about GME funding for their positions:

  • Funds from CMS for the training of physicians are owned by the training hospital (in this case, Hahnemann), not by any affiliated medical school(s).
  • When a hospital closes and a trainee moves to another hospital, the funding for the trainee’s position moves with the trainee to the new training hospital.
  • When a trainee moves to a new training hospital, the funds that move with the trainee are for all remaining years in the trainee’s program.
  • A hospital is eligible to accept a displaced trainee and to receive his/her funding, even if the hospital is at or over its number of capped positions.

Please monitor this website for updates on this developing situation.

Additional information on Hahnemann’s closure is available on this website.

(published July 5, 2019, updated August 7, 2019)

ECFMG Statement on Closure of Hahnemann University Hospital

The Educational Commission for Foreign Medical Graduates (ECFMG) is expressing its support for the Hahnemann University Hospital community in light of the announced closure of this long-standing member of the graduate medical education (GME) and health care communities. The closure of this large academic medical center will have broad and significant implications.

As a leader in medical education worldwide, and particularly as part of the Philadelphia community, ECFMG is concerned for Hahnemann’s patients, house staff, physicians, and other employees, as well as the Drexel University medical students who receive clinical education at Hahnemann. We are most concerned for the city of Philadelphia and its many patients who depend on Hahnemann for care.

ECFMG also is the sole J-1 visa sponsor of foreign national physicians to participate in GME at U.S. hospitals. Each year, we sponsor more than 11,000 physicians in J-1 visa status to participate in GME programs across the nation, where they receive medical specialty and subspecialty training and provide supervised patient care. Some of these physicians currently are in training at Hahnemann. Because of the closing of Hahnemann, they must seek other training venues.

Currently, we are focusing our efforts to assist the international physicians in training at Hahnemann under ECFMG J-1 visa sponsorship. ECFMG is reaching out to each of these physicians to provide support and assistance, as they seek to transition to other GME training programs. If they are unable to enter other U.S. training programs, they will need to return to their home countries.

As is the case in cities across our nation, international physicians in training at Hahnemann in Philadelphia make invaluable contributions to our clinical training environments and patient care. The loss of these physicians and their expertise, innovation, and international perspectives would be a loss to us all.

We offer our sincere best wishes to all who are impacted by this unfortunate situation. We look forward to working with national and local partners to help ensure the continued training of the many talented international physicians who have called Hahnemann home.

Please also see the ACGME statement, Hahnemann University Hospital Closure.

Additional information on Hahnemann’s closure is available on this website.

(published June 28, 2019, updated August 7, 2019)

Liz Ingraham Interviewed for The Premed Years Podcast

Liz Ingraham, Assistant Vice President for Communications and External Affairs at ECFMG, was interviewed for The Premed Years podcast about the process for international medical graduates who want to pursue graduate medical education in the U.S. She also talked about the role of ECFMG in the process, and the recently launched Guidance on Medical School Selection resources on the ECFMG website. You can hear the interview in its entirety at http://traffic.libsyn.com/medicalschoolhq/PMY325.mp3.

The Premed Years podcast, hosted by Dr. Ryan Gray, helps students learn more about how to get into medical school. It is an initiative of Medical School Headquarters.

ECFMG President Dr. William W. Pinsky Featured in NBC10 Philadelphia Story on IMGs

NBC10 Philadelphia on Monday aired a story on the importance of international medical graduates (IMGs) to the U.S. health care system featuring ECFMG President and CEO William W. Pinsky, M.D. You can see the story at https://bit.ly/2ClGCH0. NBC10 correspondent Matt DeLucia also interviewed Dr. Arturo Rios-Diaz, an ECFMG-certified physician currently under ECFMG J-1 visa sponsorship as a third-year general surgery resident at Thomas Jefferson University Hospital in Philadelphia.

ECFMG Launches New Blog, Journeys in Medicine

ECFMG serves as the sole sponsor for nearly 11,000 foreign national physicians participating in the U.S. Department of State’s Exchange Visitor (J-1 Visa) Program to train in U.S. programs of graduate medical education. During their time in the United States, exchange visitor physicians engage in medical specialty and subspecialty training at institutions accredited by the Accreditation Council for Graduate Medical Education (ACGME) and have opportunities to both share their cultures and learn about the people and places of the United States.

ECFMG has developed Journeys in Medicine as a forum for these current and alumni exchange visitor physicians to share their experiences in their own words. In addition, Journeys in Medicine will highlight training programs that host exchange visitor physicians. By sharing these stories, ECFMG hopes that readers will gain insight into the important impact exchange visitor physicians have on health care both in the United States and in their home countries.

We encourage you to explore the stories now available on Journeys in Medicine at www.ecfmg.org/journeysinmedicine/. Follow @ECFMG_J1 on Twitter to find out when new stories publish and about upcoming content. Please share this information with your friends and colleagues who are interested in graduate medical education.

ECFMG’s Perspective on Immigration Developments Published in Modern Healthcare

International medical graduates (IMGs) are essential to the U.S. health care system. In the September 10 issue of Modern Healthcare, ECFMG President and CEO, William W. Pinsky, MD, shares ECFMG’s perspective that restrictions on immigration for physicians could have unintended negative consequences on the delivery of quality health care in the United States.

“Immigration is directly connected to the physician shortage because meeting the health care needs of our population would be impossible without the continued contributions of doctors educated abroad,” he writes.

Read the full article.

Dr. Pinsky Pens Opinion Piece on Impact of Travel Restrictions for STAT News

ECFMG President and CEO, William W. Pinsky, MD, recently wrote an opinion piece for STAT News on the U.S. health care ramifications of the Trump administration’s travel restrictions. “Millions of Americans, particularly those in underserved communities, depend on foreign doctors, thousands of whom hail from countries affected by the restrictions,” he says. Read the full article here.

ECFMG Statement on Supreme Court Decision to Uphold Visa Restrictions in Presidential Proclamation

Today, the U.S. Supreme Court rendered its decision to uphold the visa restrictions in the Presidential Proclamation issued in September of last year. While the Court’s decision does not change the visa restrictions currently in force, it does represent the latest in a series of immigration developments that are shaping the environment in the United States, the environment that many from around the world, including talented health care professionals, aspire to join.

The Court’s decision comes just days before the traditional start of the academic year for U.S. programs of graduate medical education—those medical specialty and subspecialty training programs that transform medical school graduates into practicing physicians. Each year, thousands of foreign national physicians are selected for such training programs, and their qualifications are vetted thoroughly by the Educational Commission for Foreign Medical Graduates. These physicians provide much-needed health care services, enrich the clinical learning environment with their international perspectives, and add diversity to the U.S. physician workforce.

In the United States, where one-quarter of our physicians have received their medical degree outside the United States and Canada, the ability to provide accessible, high-quality health care depends on our ability to continue to attract highly qualified physicians from around the world. Anything that disrupts the flow of these talented and qualified professionals into the United States will have a negative and potentially long-term impact on patient care.

We urge immigration policymakers to consider the many contributions that foreign national physicians make to our health care system and our economy, and to ensure that United States remains an attractive option for the best and brightest minds from around the world.