Supporting Physicians Who Work in Challenging Contexts: A Role for the Academic Health Center

摘要

id="p1">Physicians who work in challenging contexts such as remote rural locations or with special populations may need support in persevering in their positions and also may suffer vicarious trauma through their work. Academic health centers may be in a position to provide much needed support to these physicians through focused continuing medical education, faculty development, practice-based research networks, and other means. id="p-2">Caring for patients may exact a toll on the caregiver and certainly requires a level of resilience. Physicians and other healthcare providers come face to face with suffering on a daily basis that might be singularly life-changing and traumatic events for another sort of witness. The toll expresses itself in a number of ways and under a variety of different names, such as vicarious or secondary trauma,id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1id="xref-ref-2-1" class="xref-down-link" href="#ref-2">>?–id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3 occupational stress,id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 burnout,id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5 or compassion fatigue.id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1,id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 Although all healthcare providers may experience these phenomena as occupational hazards, those who serve in identifiably more difficult contexts have the difficulty compounded by geographic (rural) or organizational isolation, relatively low compensation, poor or unsafe working conditions, or more draining patient interactions.id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2,id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7 id="p-3">Fortunately, physicians tend to be resilient individuals. As Reedid="xref-ref-8-1" class="xref-bibr" href="#ref-8">8 and colleagues demonstrate, primary care and specialist physicians, in both rural and nonrural settings, demonstrate similar levels of grit,id="xref-ref-8-2" class="xref-bibr" href="#ref-8">8id="xref-ref-9-1" class="xref-down-link" href="#ref-9">>?–id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10 defined as “perseverance and passion for long-term goals, working strenuously toward challenges, and maintaining effort and interest over years despite failure, adversity, and plateaus in progress.” However, primary care physicians (PCPs) appear to differ from specialists in the grit subscales related to perseverance of effort and overall ambition, and this difference is more pronounced when comparing rural primary care physicians with either their rural specialist colleagues or either primary or specialty care physicians in nonrural areas.id="xref-ref-10-2" class="xref-bibr" href="#ref-10">10 It may be that individuals with higher intrinsic levels of perseverance and ambition may partially self-select into the longer training period and eventual higher compensation that goes with specialization; yet, it is also probably true that some aspects of grit, particularly perseverance, may be required for the challenges of rural practice. id="p-4">Woolhouse and colleaguesid="xref-ref-2-3" class="xref-bibr" href="#ref-2">2 examined vicarious trauma in a different subpopulation of PCPs: Canadian PCPs who treat female drug users as a large portion of their patient panel. Although these PCPs report suffering from vicarious trauma through the hopelessness, self-defeating behaviors, and social injustices they witness through practice, they also report developing “vicarious resilience” over the course of time. In Woolhouse's sample, this appears to be a self-taught, self-preservative learned behavior. id="p-5">What might we take from the various studies cited, including the most recent reports by Reed and Woolhouse? Clearly, PCPs operating in especially challenging circumstances would benefit from external support. In such especially challenging circumstances, however, the resources to provide such support are generally scarce, whether due to geography (eg, rurality), patient type (eg, drug users), or organizational structure (eg, a community health center). id="p-6">There exist both demonstrated mechanisms for providing such support and a potential means for delivery. Although the efficacy and long-term effects of Balint groups have been questioned, no doubt many PCPs have come in contact with this mechanism of support in residency and may be useful in providing support over the course of a career.id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11 Aside from the explicit goals of Balint groups, the facilitation of such groups may create implicit secondary benefits for PCPs treating special populations in that it may create networks that