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A Word From the President: Resilience Will Drive Academic Medicine Forward

AAMC Reporter: November/December 2014

One of the great honors I have as AAMC president is visiting your campuses and personally seeing all the great work you are doing. In the last 12 months, I have had the privilege of making more than 60 of these visits. I am heartened and inspired by your progress on so many fronts. But I also hear your concerns. The pointed questions you and your colleagues ask reflect deep concern about the current and future state of academic medicine. You pose questions like:

• NIH funding is stagnant. Are we about to lose a whole generation of new scientists?
• Beyond NIH, all our funding streams are threatened. Is our basic business model still viable?
• We seem to be forming new clinical partnerships every day. Are we abandoning our core academic mission? As we partner with community doctors and hospitals, what does it mean to be a “faculty member?”
• Between Supreme Court decisions and state ballot initiatives rolling back affirmative action, how can we continue to make progress on our commitment to diversity?

Our students ask tough questions, too:

• Will I ever be able to pay off my debt? Can anything be done to reduce the cost of medical education?
• Competition for residency training slots is more intense than ever. What will I do if I do not get a residency position?
• Is a career as an academic physician even a viable option for me?

As a psychiatrist, I find myself wondering how these deep concerns affect our overall well-being. More and more in my conversations with our colleagues, issues of stress and burnout come up. A 2012 paper published in The Journal of the American Medical Association documents this distress. Surveying 7,000 physicians, Tait Shanafelt, M.D., and colleagues found that nearly half—46 percent—reported at least one symptom of burnout, a significantly higher rate than in the general population. Even more concerning is that more than 40 percent of the physicians who responded screened positive for symptoms of depression, and 7 percent reported having suicidal ideation in the last year.

While most of us would say that medicine is the most gratifying, stimulating, and noble career a person can pursue, many of our colleagues are in genuine distress. When we allow ourselves to acknowledge this and talk about what is causing this distress, we almost always point to the changes occurring in health care. An AAMC report described academic medicine’s struggles to keep pace with this change:

• “The future will see more health care demanded and provided than ever before. More physicians must be trained, and as quickly as possible.”
• “A clear trend of recent decades—and a virtually certain trend in the future—is the continuous rise in costs. All components of health care costs have risen. The cost of educating physicians has grown.”
• “The rise of specialization has resulted in the increasing trend toward team practice involving the contribution of a spectrum of specialists.”

While these sentences may sound as if they were written today, they actually come from the Coggeshall report, published in 1965. To cynics, it might seem that we continue to fight the same battles. But that is not how I see it. I see the amazing progress academic medicine has made in improving health over the last 50 years. I attribute our progress to an essential quality shared by many physicians and others who choose careers in health care—a quality that makes it possible for us to work on problems that often require decades to solve. That quality is resilience.

Resilient people share a sense of mission and work together to achieve it. Outside times of traumatic stress, we demonstrate resilience as optimism, self-confidence, and a willingness to embrace change. I see signs of resilience at work when I visit your institutions and speak to your leadership, your faculty, and your students and residents. On the individual level, I see scores of scientists demonstrating resilience through their continued perseverance in spite of historically low NIH grantacceptance rates. On the institutional level, academic medical centers are exhibiting resilience when they seize changes around them as opportunities to reinvent themselves and create more sustainable models for the future. As an academic medicine community, there is no better sign of our resilience than the commitment we are making to create a more positive environment for our learners and the patients they will serve.

So why are the rates of burnout and signs of depression so high among physicians? I do not believe it is because we have lost our resilience. I think it is because some of us have lost sight of our shared commitment to our mission, and that many of us have become isolated and are not creating networks of support. AAMC data show that two of the most significant drivers of faculty satisfaction are connection to institutional mission and interaction with colleagues. Unfortunately, it seems to be a short path to burnout and depression if we allow ourselves to lose these connections.

That is why it is so important to come together as a community. Together, we draw renewed strength from one another and use that strength to face the challenges we share and the obstacles we must overcome. Collectively, we are able to see how, time after time, we have risen above these obstacles to fulfill our shared commitment to educate tomorrow’s doctors, discover tomorrow’s cures, and provide our patients today with the best medical care possible. That is our resilience at work.

As a community, now is the time to draw on our resilience by remembering our shared purpose and committing to support one another more strongly than ever. Over the years, academic medicine has epitomized resilience, and I am more convinced than ever we will continue to thrive if we rise together to meet the challenges ahead.

Darrell G. Kirch, MD

Darrell G. Kirch, MD