Who Benefits from Physician Wellness?

In their recent Position Paper for the CPA’s Professional Standards and Practice Committee, Myers and Freeland state that there is a “clear relationship between physician wellness and competence to practice medicine.” This grounding assumption, and other questionable claims about the dangers posed by physicians with burnout and the effectiveness of physician health programs, is not helpful to physicianemployees with or without mental health disorders. Physician wellness policies and initiatives in general seem more likely to help hospital management. Myers and Freeland’s statement about physician wellness and competence is similar to statements in the new Accreditation Council for Graduate Medical Education program requirements on resident well-being. The requirements claim that programs “have the same responsibility to address well-being as other aspects of resident competence.” The American Psychiatric Association Publishing Textbook of Psychiatry also states that “Psychiatrists will play an increasingly important role as leaders in medicine in the future and can help to emphasize the links among physician well-being, clinical competence, and the importance of well-being as an ethical imperative. . . . ” “[P]hysician wellness [is a term] used interchangeably with physician well-being” that loosely refers to health. The effect of defining physicians’ competence in terms of well-being is to refocus appraisals of physicians’ abilities not on their performance, but on their health. Another problem with physician wellness is that studies suggest physician wellness initiatives are not effective. Even if they were, it is doubtful that even effective treatments could overcome the harm done to physicians with mental health disorders by such stigmatizing links between wellness and competence. In addition, what might be framed a “voluntary” physician-initiated participation in a wellness program may often be more accurately characterized as an employerinitiated requirement for assessment of potential impairment. Imagine a physician who checks a box on his initial employment paperwork asking, “Would you like to sign up for our free mindfulness and relaxation classes?” or “Would you like to work with wellness counselors and hospital management to evaluate and improve your mental health and work performance?” Follow-up contact from the wellness program and subsequent participation may be appropriately characterized as voluntary. But what if a resident is called into a meeting with program leadership, who to her surprise, express concerns about her performance and say they want to provide their residents with every available resource they need to succeed: “Do you feel that psychological testing— which we can offer right here at the hospital wellness program—might be helpful?” I would argue that the resident’s subsequent participation and any “voluntary” waiver of confidentiality in this setting would not actually be voluntary. Furthermore, the authors’ medicalization of disruptive behavior and their references to “stigma” as essentially akin to “resistance” or as a problematic belief on the part of physician-employees may coerce compliance with these assessments. This is a problem with psychiatry in general that may be even more problematic in the already coercive environment of employment. The unintended consequence of these and other wellness policies and practices is that they grant physicians’ employers greater control over physicians’ private lives. Anything physician-employees do outside or inside the hospital can be said to interfere with, impair, or affect their well-being—and, by extension, harm patients. Linking physician well-being to competence opens the door to employers with strong personal opinions about certain therapies and lifestyle practices imposing those preferences on their physician-employees through implied threats that they will be labeled incompetent should they resist. These physician wellness policies are unlikely to actually help physician-employees. And they are even less likely to help physicians with mental health disorders or disabilities.