In a panel at Becker's 12th Annual CEO + CFO Roundtable, Jim Gilligan, vice president of health system partnerships at the American Medical Association, facilitated a discussion on creating joy in medicine within rural integrated health systems. The session featured perspectives from Heather Spies, MD, physician director of clinician experience and well-being at Sanford Health (Sioux Falls, S.D.), and Makrina Shanbour, MD, director of provider experience at Confluence Health (Wenatchee, Wash.).
The panelists described their organizations' participation in the , which offers a roadmap for improving organizational well-being, especially for physicians and clinicians, and recognizes health systems meeting specific criteria across six domains. Dr. Spies and Dr. Shanbour shared their experiences and strategies for enhancing the clinician experience, reducing burnout and improving retention, highlighting the unique challenges and opportunities in rural care delivery.
Key initiatives include leadership development programs, reducing administrative burdens and leveraging data to support well-being efforts. Both health systems have seen substantial improvements in physician satisfaction and reduced burnout rates, demonstrating the effectiveness of a comprehensive approach to fostering a supportive work environment.
Three key takeaways:
1. Commitment from leadership is crucial for driving organizational well-being.
Panelists said the Joy in Medicine roadmap has offered clear guidance on where to start in their efforts to improve physician well-being. The structured guidance has also supported what Dr. Spies describes as "the beginning stages of this work" — which depends heavily on leadership commitment, she said.
Dr. Shanbour agreed, adding that data has played a key role in this stage of program building.
"The roadmap laid out not just the commitment, but actually how to look at the data we're gathering when we do surveys and how to implement change," Dr. Shanbour said. "It also helped us gather the support from leadership, and we found that we had lots of people doing well-being work throughout our organization. Pulling those people together so we were all moving in the same direction — that was really helpful."
2. Targeted retention strategies can significantly impact physician and clinician satisfaction.
The discussion highlighted industry workforce trends and how rural health systems compare. Mr. Gilligan shared that, at the end of 2023, 33% of physicians and 40% of advanced practice providers reported an intent to leave practice altogether in the next 2.5 years, per the AMA's national comparison report. For rural systems, these rates are even higher.
Sanford Health and Confluence Health, however, are seeing lower averages, crediting their well-being initiatives, which include intentional onboarding and engagement.
"We start our retention once our clinician has signed. We try to get them pulled in and connected to the community before they even move to our communities," Dr. Shanbour said. "And then we have a new physician orientation and mentoring process that goes on for about four months for all of our new clinicians."
At Sanford, the "lifespan of engagement" is a top area of focus for physician and clinician retention, Dr. Spies said. The health system engages physicians from day one through mid-career and beyond, and more recently, has deployed AI as part of a pilot program to identify physicians at risk of leaving.
"We were able to use some of our data analytics team members to help us develop a tool to identify who's at risk of leaving six months, 12 months, 18 months from now," Dr. Spies said. The pilot, built in one of Sanford's rural markets, enables the appropriate leaders to reach out to "at-risk" staff members to talk through patterns identified in the data (e.g., numbers of patients seen, cutting down on hours or working extra hours, etc.).
"It gives us the opportunity to acknowledge we're concerned, and that we care about them, value them and want to keep them here — and what can we do to talk through that," Dr. Spies said.
3. There are myriad, high-impact pathways for reducing administrative burdens.
Reducing administrative burdens is a widespread aim for clinical and operational leaders alike. Confluence Health has taken a multifaceted approach, Dr. Shanbour said, which started with improved training in the EHR, particularly on MyChart messaging. This effort stemmed from a department complaining they were getting a lot of MyChart messages from patients.
"Only 15% of their messages were being answered by staff, whereas our overall rate for our organization was about 60%," Dr. Shanbour said. "We also had departments where 90% of messages are handled by staff. So looking at the numbers, we're able to think about best practices, and we found that the people doing well had a great flow sheet they were using and training their staff on — and so we were able to spread that flow sheet to the rest of the organization, which has made a huge difference."
This effort, as well as reassessing other policies and procedures related to in-basket messages, have paid off. Dr. Shanbour said the health system has decreased the total number of minutes in the EHR for primary care physicians by 34 minutes per day.
Sanford Health also revisited policies, such as outdated regulations for discharge summaries, to see where they could remove unnecessary burdens. They also reassessed the need for various computer-based training.
"I got almost a standing ovation at the leadership meeting when we finally, after months and months of work, reduced multiple hours of computer-based training off of our clinicians' required learning," Dr. Spies said. "People were very burdened with that. At the end of their very busy day of seeing patients, they would still have computer-based learning modules to complete."
Removing hours of clinicians' work was a huge win, Dr. Spies said, and one that should be celebrated. "Make sure you absolutely advertise the win," she advised.