Hi everybody, this is Deb Myers from PCAA. Today's webinar is Trauma Team Burnout. Be sure you have your, you have dialed in the PIN number. This will allow you to answer questions at the very end. One registration includes one phone line and one access per hospital. Please check your email for any handouts. They were sent out last night. They're also available via the webinar. Towards the end, please use your question tab in the control panel to submit a question. You can either raise your hand to verbally ask a question, or you can write in the question. At the very end of the program, we're going to ask you to please do the evaluation of this webinar. Below is the link. You will also receive an email from me right after the webinar. There are no disclosures on today's presentation. The objective today is to analyze the history of medical economics in the United States, understand the reasons for the present turmoil in healthcare, recap for physicians how many attempts at healthcare reforms have taken place over the last 120 years, review ways that trauma team members can recenter themselves to weather the current storm of healthcare change, and suggest remedies for the present state of physician burnout by reclaiming our purpose. Today's presentation is given by Dr. Craig Ryan out of Texas. He is a regional chief medical officer at Covington Health. He obtained his pre-med degree in the University of Texas and then went on to the University of Texas for his medical degree. His residency included internal medicine, general surgery, and also a research fellow in surgical immunology. He does have a passion for trauma, trauma in history, and has rose to the ranks to reach the current status of a CMO. I'd like to welcome Dr. Craig for the presentation today. Thank you very much. Many of you know that you almost can't go to a medical conference anywhere in the United States today and not hear at least one topic on physician burnout. This is a huge issue. It is affecting all branches of medicine, but it can be particularly damaging to our trauma and trauma teams because we have traditionally asked actually more of our trauma teams than most medical specialties have asked. In light of all of the healthcare changes and all of the regulation and the high visibility of healthcare, there is a lot of dissatisfaction with the status of all of our healthcare providers nationwide. Deb, I don't have my buttons again. Can you send me control back? Sure. There we go. Still don't have a button that works. Many of you saw this article in Mayo Clinic Proceedings, and basically what it says is that the percentage of physicians reporting burnout in virtually every specialty is higher than it was three years before in 2011. If you look at the work-life satisfaction, I went too far, work-life satisfaction with everyone, everyone is saying that they have a worse personal life, a worse family life than they had three years ago. If you look at the breakdown by specialties, and this slide is almost ubiquitous in everybody's burnout talk, it shows that many of our specialties, orthopedic surgery, urology, radiology, and even general surgery, have a lower satisfaction with their work-life balance and tremendous issues with burnout. If you look at the burnout percentage as opposed to the general population, the general population is fairly static, but physicians are reporting a significant and steady increase in burnout. Their satisfaction with work-life balance has also actually risen a slight amount with the general population, but has fallen with our physicians. We're in a situation where it's kind of the best of times, the worst of times. The best situation we can imagine would be our physicians being involved, engaged, having patience and compassion, and feeling like they're being part of something worthwhile. This is what led me to trauma. As Deb said when we started, I do have a passion for trauma. I was a trauma medical director for 17 years, and even as a chief medical officer, I'm still active with our trauma program in that I'm the interim pediatric trauma medical director because I do have such passion for this work. Unfortunately, that's not where we are right now. At this point in time, we have physicians that are exhausted, they're cynical, they've become indifferent in several specialties, they're suffering from anger, bitterness and frustration, alienation and isolation in almost all aspects, and this includes our trauma teams. Why is this happening? We've already talked a little bit about the regulatory changes, the bundle payments, the MACRA, the MIPS, the eroding real income because physicians' income, even if it hasn't gone down yet, it is probably going to, and even if it hasn't gone down, it's less purchasing power as compared to inflation. So there are a lot of productivity pressures, the shortage in the workforce. A lot of people are just simply bailing out of medicine and retiring early. All of the mandates, including the use of EHR, the quality and cost of care mandates, and the feeling of loss of autonomy and control is creating a situation that our physicians are really suffering from. I found this on a T-shirt on a trip, and I think it says it all. We really did reach a point where we felt like we were no longer making progress, we were actually regressing. The causes of burnout, again, all of the things on this slide, the bureaucratic tasks, data entry, the EMR, compassion fatigue, difficult relationships with other members of the medical staff, all of these things that are felt to be new or perceived new inhibitions on our physicians or impositions on our physicians is what I'm trying to say, is really affecting their morale. So we have to really think about what burnout is. In a nutshell, that's on this slide, it's the loss of professional fulfillment, their emotional exhaustion, negativity, disempowerment, feeling like everything that's going on around them is completely outside of their control. And the one thing that, especially in trauma, we cannot lose is our connection to purpose. If we are not there to care for the injured members of our community, there will not be anybody there to provide that service. A chronic condition of perceived demands outweighing perceived resources is the definition of burnout. If you add secondary traumatization to that, that is tremendously impactful for our trauma teams. So the question is, to understand where we are today, we really need to look at how did we get here? How did we get into this dire situation that we seem to be in? I will tell you right now, it's all about the cost of care. And the most reassuring thing I can tell you is, it is not our fault. I'm going to go back through some of the history of health care reform in this country and show you what the issues are. If you take a 200-year look at federal expenditures, this is what it looks like. The total federal government expenditures are in the red. The health care expenditures are in the blue. So you can see that for 200 years, almost nothing changed until about the 1940s to 1960s. And only really in the 1980s did health care become a huge issue in terms of health care expenditures. If you dial in even closer and go to the last 120 years, you start to see this even more pronounced. And if you look at just the last 70 years, you can see how health care expenditures as a portion of the federal government budget has become tremendously impacted. So the federal government has basically written a lot of checks that it can no longer cash. There is a true panic in Washington to try to maintain some of the promises that the federal government has made to the populace of the United States, and they simply don't have the money to do this any longer. It's just that simple. I love this cartoon because it really talks about the change in the attitude about what it means to be a physician today. It's no longer about the doctor and the patient. It's about the doctor and the government, and it's really telling. If you look at the timelines of change, I think it really makes an impact. You really need to look at what happened in the early part of the last century, and if you take a good look, one of the things that happened in the 1900s were doctors were no longer expected to provide free services to all hospital patients. That one kind of blew me away. I did not realize that there was a point in time that if your patients were in the hospital, the doctors were actually expected to provide free services to all hospitalized patients. Furthermore, back in the 1900s, the railroads started to develop extensive employee medical programs. This is the first time we really saw any hesitant steps into employer-provided health care. If you look into the 1910s, the American Association for Labor Legislation had a first national conference on what's called social insurance. This was actually the first real discussions about health care being organized and funded nationally. Back in the 1920s, General Motors, when it was still making what we would consider antique cars, began to sign contracts with Metropolitan Life to insure about 180,000 of their workers, and it was really controversial when this first happened. In the 1930s, the Social Security Act was passed. The only way it was passed was by omitting health care from that bill. The push for health insurance was there, but the politics got influenced, and they realized that they couldn't pass Social Security with a health care provision in it, so it was stripped and kept separate from the Social Security Act. Against the advice of many, many insurance professionals, Blue Cross began in the 1930s, less than 100 years ago, and they began offering private coverage for hospital care in dozens of states. That was the first time that the insurance companies really started writing policies that we've had to deal with ever since. It was really during the Second World War, and after wage and price controls were placed on American employers, they could not recruit. They could not get new employees to come into their companies because they had wage and price controls. They couldn't compete on the marketplace, so they had to compete by offering their new employees or potential new employees benefits that they had never offered before, and one of those benefits was the employer-based health care benefits that we now all take for granted today, but this was not always the case. It really didn't come about until it was forced into the system by the wage and price controls of World War II. President Truman, back in the late 40s, offered a national health care program proposal, a single system that would include all of American society. This was basically denounced as a communist plot, and it was never passed into legislation, but as far back as the 1950s or 70 years ago, there was actually consideration of federal initiatives for nationalized health care. I was sitting in a restaurant in Dana Point, California, eating dinner with my wife one night two or three years ago and looked up and saw this copy of Life magazine on the wall, and what caught my attention was the second heading, Why Medical Care Costs So Much, and if you look down at the date at the very bottom of the magazine, it shows that this publication was issued on November 2, 1959. Health care costs are not out of control because of what our generation has done. It simply has a national trend that's been going on for the last 120 years. In the 1960s, we know what happened there. President Lyndon Johnson signed Medicare and Medicaid into law, and this was really a landmark bill. This was the first time the federal government ever started really saying, We own a part of health care. This was tightly contested, and a lot of doctors really felt like this was the first domino to fall, and it would actually ultimately result in a national health care or single-payer system, and it ultimately may. It was President Richard Nixon who actually coined the phrase health maintenance organizations, which was the first managed care attempt, and under President Reagan, who was one of the ultra-conservative presidents of our generations, they actually shifted Medicare payments to the DRGs rather than fee-for-service medicine. Private plans quickly followed suit because they couldn't keep doling out the amounts of money that it was costing them to pay for health care. That was the first real attempt to put cost controls back on the hospitals and back on the doctors and nurses that provided the care. In the 1990s, we knew that health care costs began rising at double the rate of inflation, and by the end of that decade, there were actually 44 million Americans, or 16% of the nation, that had no health care insurance at all, and everyone that works in a trauma center knows how impactful that is on our populations that we're asked to deal with. Medicare in the 2000s became viewed as unsustainable under the present structure and felt that it must be rescued. I went to a Texas Hospital Association meeting two or three years ago and listened to the Undersecretary of Health and Human Services, Under President George W. Bush, and he very politely explained that there was absolutely no sustainable formula in which Medicare in its present form can continue beyond the next several years. He said either the age will change to a higher age, greater than 65, it may go to 70, 68, 72, somewhere in there for eligibility, and the benefits may have to drop because the bottom line is the federal government simply cannot continue to pay what they promised to pay back in the 1960s. The second big piece of health care cost that is completely out of control is pharmaceuticals. In our health care system alone, we have witnessed a 32% rise in the cost of pharmaceuticals across the board in the last two years. If you can imagine your car payments or your house mortgage going up 32% in two years, you would recognize that as an absolutely unsustainable eventuality. Our patients can't afford their medicines when they're discharged from the hospital. They end up going home trying to tough it out, and they're getting readmitted to our hospitals because they couldn't afford their medications if they were prescribed at the time of discharge, and all because they cannot afford those medications. This one pretty much says it all. Everybody's got to be on the budget, and Jeremy says, no, it's fine. I think it's a good thing for my family to cut back on expenses as long as it doesn't affect me. And Spike says, of course, well, yeah, they have to be reasonable. Well, this is unfortunately everybody's philosophy. The doctors want health care costs and inflation to be cut. The hospitals want it to happen. The federal government knows that it has to happen, but everybody wants to put it on the back of someone else. The big bill, and the one that everyone really talks about in these days, is the Affordable Care Act, which is anything but affordable. Most of us know in health care it has actually created a situation where a lot of our patients that have what they think of as insurance really have disaster-only policies, that their deductibles are in the $5,000 and $7,000 range, and that our ability to collect those deductibles when those patients come in is almost negligible to the point that the effective net is that our patients really don't have insurance until they get past that $7,000 deductible. So the question is this, is there hope? Is there something that we can do as a collection of trauma centers and trauma teams that can support our doctors and nurses to help get us through this storm? That's really what we've got to do. There's a lot of information out there. There are many, many books available. This is one that I particularly like, and I have absolutely no financial interest in this whatsoever, but I will tell you it is a great and easy read, and it's by Starla Fitch, who is a physician, and she talks about the ways for us to deal with burnout. One of the things that's in the book is as we learn to heal others, we neglected ourselves. We forgot to heal our own selves. We do know that one thing that we can do to address the burnout issues with our physicians and nurses is we need to remind them that why they got into medicine in the first place is a safe place. It can soften the edges of long, difficult days if we remember why we went into medicine to start with. We need to build resilience. We need to build some emotional Kevlar to protect ourselves in tough times because what we do is incredibly important. On a normal day, resilience may look something as simple as taking a little bit of extra time with a patient that has a very difficult diagnosis, and then taking a deep breath, steeling ourselves for going into the next patient who is angry over something as trivial as you running a few minutes late because you had a very difficult issue to deal with. In trauma teams, this is particularly important because when we have elective practices, we can schedule a little better. When we have trauma teams that have to jump and run on a moment's notice, our trauma teams have to be able to go from zero to 60 faster than a Tesla. So we've got to be able to build some type of resilience into our trauma teams or they will burn out. We've got to take some downtime for ourselves. This is fundamentally important for us to do, and I think this is something that we need to build into our schedules as we start thinking about our trauma teams. I want to talk just a minute about practicing faith. I don't really mean religious faith, although that can certainly be a big part of this. Faith is the knowledge within your heart and beyond the reach of proof. That is what we practice every day. It, again, can be our relationship with God, but it's also trust and belief in what we were trained to do, trusting that our medications are actually doing what we were told that they do, trusting a pathology report, trusting a radiology report, knowing that what we were taught, knowing that what we were trained to do as both medical students, residents, and fellows is still the right thing to do, knowing that what we read in journal articles in the last week or the last six months is really fundamentally good medicine and that by applying those principles we can stay in touch with our patients and we can practice faith and know that what we're doing is the right thing for our patients. I had the occasion to be in Chicago in August last year. This is a picture of Wrigley Field with the Cubs playing a home game, and I want you to notice that the stands are absolutely full. I showed this to someone and they said, yeah, that's a picture from the World Series, and I said, no, it was a picture on a Saturday afternoon when these fans had been waiting since 1908 to see the Cubs win a pennant and win a World Series. This was before they won the World Series. So this is what faith looks like in reality. Believing that we have made the right choice to do what we do as physicians and nurses. This is what we do. Not everybody can do it. The fact that not everybody that applied to medical school got in is evidence that not everybody can do what we do. Not everybody would even want to do what we do, especially on our trauma teams, but our trauma teams should have the heart and the dedication to know that we are providing a service that no one else can provide. It's just that simple. We are offering our society and our citizens something that is absolutely invaluable for them, and we need to take a great deal of pride in what we do for our patients because it is something that no one else can do for them. Voltaire said that faith consists of believing when it is beyond the power of reason to believe, and that is an absolutely true statement. We have to cultivate our self-worth. We do see ourselves incorrectly. One of the reasons I went back through all of that history of federal expenditures and the 120-year history on federalization of health care is to recognize that we need to stop blaming ourselves for the health care crisis. We also need to remember that perfection is the enemy of good. Our patients need us. They expect us to be secure. They expect us to be secure in our knowledge, our faith, and not arrogant in our approach, but knowing that what we offer them is in their best interest. This picture went through the Internet. It became a viral picture. This was a physician from an emergency room, I believe somewhere in Southern California, and he had just lost a patient that he didn't expect to lose. This is the absolute epitome of burnout in doctors, but it affects not only doctors but it affects his nurses, the trauma team. It affects them. It affects the quality of their treatment, and it affects the care that their patients perceive. For those of you who are not on the webinar, I'm actually going to read this slide verbatim because I think this is one of the most powerful statements in the deck. When it comes to our work, nothing is harder, and I mean nothing, than telling a loved one that their family member is dead. Give me a bloody airway to intubate. Give me the heroin addict who needed IV access yesterday but no one can get an IV. Give me the child with anaphylaxis, but don't give me the unexpected death. We can only do so much, and we can only hope to do our best, but it's that moment when you stop resuscitation and you look around. You look down at your shoes to make sure there's no blood on them before going out and talking with the family. You put your white coat back on, and you take a deep breath because you know that you have to tell a family that literally the worst thing imaginable has happened, and it's in that moment that I feel, and I feel like the guy in this picture. That is what burnout really looks like. There was an outstanding article written by Marjorie Stigler, who is an anesthesiologist at the University of North Carolina at Chapel Hill, and it was a great article in JAMA in 2015 about what she learned from the events on the miracle on the Hudson, and she said it's not what you think. Post-traumatic stress disorder can affect everyone. Folks say that the key difference between aviation and medicine is that the pilot goes down with the plane, and she made a very different argument. She said, I beg to differ. The well-being of our trauma team is directly tied to the well-being of their patients. In post-traumatic stress disorder for Sully and the crew, there was no error, no misstep. They didn't make any mistakes, despite what you may have seen in the movie Sully. By all accounts, this was an incredible save, but they still experienced post-traumatic stress for at least three months after the event. If they did everything right and very quickly, why couldn't they sleep? Why couldn't they concentrate for the next three months? In aviation, no one would have considered pulling Sully and Skiles, the flight crew, out of that river, putting them in a taxi and taking them back to LaGuardia and asking them to get in another jet and immediately take off and fly another leg. We do this in medicine every single day. We expect our physicians and nurses that just had an absolutely awful outcome to go back and care for more patients without even a brief time of period to reflect or regroup. We know that trauma team post-traumatic stress disorder can affect us in this way, and our health care professionals are called second victims. The patients who they have to treat subsequently can be third victims if their mental health and spiritual health is not sufficient to provide the best of care for those third victims. A decade and a half later, we're still failing our second and third victims because we don't adequately support our teams, and we identify physicians as being weak if they can't continue to function in this environment. Unfortunately, the stigma about a doctor, a nurse, or anybody else in health care asking for help still lingers. One of the worst things that we can do to continue to make burnout bad is to continue the downward spiral by staying around the ain't-it-awful crowd on a daily basis. We all know who these people are. They sit in our doctor's lounges and our OR rest areas, and they bemoan the fact that the world has turned against them and that everybody's out to get them, and the hospital administration is terrible, and the government is terrible, and the state government is terrible, and everybody's out to get them. Everybody knows that's not true, but the continual bombardment of the negativity is something that will just destroy us if we don't get away from it and have a very different conversation. We have got to support the culture in our organizations, and we have got to get the culture in our organizations to say, we're going to stop the negative conversations. We're going to concentrate on the positive. We're going to concentrate on those things that we can control, and we're going to spend our time with those that do love us, those that love us not only when the condition is right for them. I love this slide because it really says it all. I do have a few members of my medical staff that constantly create turmoil and disaster. I call them the chicken littles. The sky is always falling with them, and then they get upset when it rains. They actually are creating their own environment that makes it virtually impossible for them to live in a beneficial environment. They are their own worst enemies. We need to be encouraging. We need to lift and strengthen each other for the positive energy that we do spread will be felt by everybody. We can change the conversation. We just have to get started. We are all connected, every last one of us, and everybody that has a trauma team needs to understand that because of the constraints and the demands on your trauma team, burnout in your team can be higher in that team than in any other team because there are demands that we make. But there are also rewards of being on a trauma team because you get to do things and see things that nobody else gets to do and see. Compassion is where we've got to go back to. We have to have love and compassion. These are necessities. These are not luxuries. Without them, humanity cannot survive, and we have got to recognize that we have got to bring compassion back into health care. Our connection is important. Our patient's connection with us is important. But one of the most important connections has really been ignored, connections between our trauma team members and the way they support one another in difficult times. Only our trauma team members know what trauma team members go through. I have a lot of members of my medical staff that have never been participants in my trauma team. They don't really understand the fact that some people are willing to step up and assume that burden because that's what makes their career worthwhile, and that's what we've got to explain, and that's what we've got to support with our trauma team members. They've got to understand that it is the one thing that can make them really feel like they are still part of a very, very meaningful, worthwhile profession. And it is in the sharing of these stories of our lives where we can find glimpses and clues about purpose and peace. Our world is unique. We have things in medicine that nobody else does. The bad things are these. We don't get to sleep through the night very often. We don't get to enjoy recreation, go to the movie, go to a barbecue when we're on call because we know what's going to happen. We know we're going to get paged out, and we're going to have to race to the hospital for whatever emergency that may take place. We don't even make appointments for our own health. We are the worst in the world about taking care of ourselves. What we do get to do is wear pajamas at work. Every doctor I know, every surgeon I know wears scrubs because they're comfortable, and nobody else would consider going to their job in the bank or the insurance company with a pair of pajamas on every day. We do receive trust from our patients. They trust us just to walk in our office. That is an incredible plus and perk for being a physician or a nurse. We get to relieve pain. We get to reduce fear. We get to reassure our patients when things are uncertain for them. We become the first to know both the good and the bad news about our patients' health, and we get to witness miracles. We really, truly do get to witness miracles from time to time. Where do we go from here, and how do we build that emotional Kevlar with our trauma teams? We need to trust each other. We need to support each other and find that resilience as a group. We need to celebrate our successes. If we fail, we fail together, and we need to support each other in that. We can regain the faith in the meaning of medicine if we strive to do so. We know in Corinthians it says, and now these three remain, faith, hope, and love, but the greatest of these is love, and this is something that we have got to go back to to support our trauma teams because without it we will surely fail. One thing that I wanted to mention because this was kind of the real aha moment for me. About two years ago, the week before Christmas, my wife and I were walking through a grocery store, and nothing out of the ordinary. I looked up and saw a woman down the aisle staring at me, and I thought it was a little unusual because there were signs of recognition on her face, but I'll be honest with you. I did not remember her. She walked up to me, and she said, Aren't you Dr. Ryan? I said, Yes, ma'am, and I still had no recollection of her whatsoever. She looked at me and said, I will never forget you. Twenty years ago in 1995, you came to the hospital at 2 o'clock in the morning. My son had been in a car wreck, and he was horribly injured. You took him to the operating room, and you saved his life. I will never forget you for that. That hit me like a ton of bricks because even with the story being told, I couldn't place the woman. I didn't remember ever meeting her. But it was at that moment in time that I realized that our patients leave footprints in our lives, but they're rapidly gone because of the wind, the waves, or even the next set of patient and family footprints that come along. But we leave footprints in our patients' lives as well. But the footprints we leave in our patients' and families' lives are poured in cement. The things that we do for them are at such a time of crisis in their life that they are going to remember for the rest of their lives what we did for them, what we said to them, and how we made them feel. So it is absolutely fundamentally important for everyone on the health care team and everyone on your trauma teams to remember that what we do, what we say, and how we respond is going to create an eternal memory in the lives of our patients and our patients' families, much more so than what we remember. If we don't stop and allow ourselves to experience both joy and love, we will definitely miss out on filling our reservoir up with what we need when hard things happen, and that is absolutely true. The woman in the grocery store made a tremendous difference in my life because she made it all worthwhile. Everything for the last 25 years has been worthwhile because she remembered what I did for her and her son. Together and with each other's support, we can do this. We can change the culture. We can focus back on the things that really matter. We can get back to a sense of pride and accomplishment, and we can remember why we became physicians, nurses, or any other health care worker because it does make a difference in people's lives, and we can. We can go down this road into the future. So that's what I wanted to share with you this morning. We have a few minutes left for questions if anyone has any, and I sincerely appreciate your attention this morning. Deb, I'm going to turn it back over to you. If anybody has a question, go ahead and raise your hand or go ahead and type it out. I think you've left everybody speechless. There are no questions. Deb, this is Craig again. I would love to ask the group that's listening, are they experiencing these symptoms of burnout with their trauma teams? Does anybody have a story they'd like to tell about how this has affected their teams as a whole? Go ahead, Janet. Go ahead and ask your question and tell your story. Hi. Can you hear me? Yes. Go ahead, Janet. Okay. Hi. I'm at the University of Utah in Salt Lake City, and we have recently initiated a debriefing program where any staff member can request a debrief on a specific trauma case. We've had some physician response. I'm curious to know how we could encourage more physician response when your schedules are already so busy, and having physicians actually acknowledge that they want to participate, but they don't have the time. What are your recommendations for a situation like that? One of the things that I would recommend is something that I've heard, because I've been really focusing in on physician burnout, and one of the problems that we have is physician schedules are so busy that they feel like they don't have time to stop and take care of themselves. One of the best solutions for this came from one of the Chicago system offices. In their hospital, what they did was this. They started what they called a journal club, and they met after hours. They meet 6.30, 7.00, 7.30 at night in a physician's home, and they met ostensibly when they started a journal club. What's interesting is that these issues about physician burnout and physician disengagement were so powerful that that's what the conversation turned to, and it became a support group. It actually became a group of physicians coming together to share their experiences and to share what was bothering them about healthcare as a whole, and it became a huge support group. The speaker told us that they hadn't actually discussed an article in the last 18 months, but the physical act of getting physicians together in a setting like that, and you have to call. You have to hand deliver the invitations. You have to make that personal plea for them to show up, because if they think it's just another meeting, they won't come, but if they realize that there's going to be something in it for them, something in it that makes them whole again, they will flock to a meeting like this. I will tell you, I came home from that discussion about the group in Chicago, and I started that group with some of my key physicians. I handpicked a group of about 12 physicians, invited everyone over to my home to just simply talk about physician culture in our building, and one of the things that we talked about at that nightly meeting was physician burnout, physician disengagement, and primarily about the culture of the physicians in our building, and when we got them talking about the culture, what became absolutely apparent was they were sick and tired of the negativity in the conversations. They want to change the conversations. They want to build on strengths. They want to get back to a place of joy in medicine, because they felt like that's been robbed from them. They don't get that at work. They won't get that in their offices, but if you can get them into a social setting at night, you can get them talking, and when they start talking, they start realizing that every one of them feels the same way, and they start supporting each other. That would be what I would recommend. Thank you so much. I appreciate your presentation. Next question is, how do you impress this onto hospital administrators in order to lessen some of these constraints that affect burnout? One of the things that I would say is that every health care journal, every administrator's journal, I'm looking at one right now called Health Leaders, and it's got Karen Weiner, the chief medical officer from the Oregon Medical Group in Eugene, Oregon, on the cover, and the title on the cover of that Health Leaders article is Beating Clinician Burnout. Every journal article that I have noticed in all of the health care economics, all of the health care leaders, all of them have some article about physician burnout, because this is starting to unravel the threads of our medical staff. Every physician leader, every administrator needs to understand that if they don't do something to try to get out in front of this and correct the trend that's already occurred and to prevent the further burnout from their medical staffs, they're ultimately going to be the losers. I think every hospital administrator is starting to recognize that this is a huge trend, and everywhere you go, there are articles, there are presentations on physician burnout, and I think they're starting to get the message. I have two comments to finish off. Great presentation, Dr. Ryan. Very inspiring for many of us that have been doing this for years. Second comment, thanks, Dr. Ryan, for helping me fill up my cup this morning. Many of us work in our programs with little outside support, but nonetheless with a lot of heart for our patients. Thank you. I'm going to go ahead and close today's presentation. I would like to thank Dr. Ryan for a great, inspiring presentation and the wealth of information he provided to us today. As you digest this information, if you have any questions, please email or call the office, and we will forward this on to Dr. Ryan. Please don't forget to complete the evaluation following the program so we may continue to improve our offerings. Thank you again for participating in the webinar, and remember to go out and take care of yourself and your team. Thank you. Thank you all.

burnout

trauma teams

healthcare

history of healthcare economics

physician burnout

resilience

support groups

hospital administrators