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Let me tell you a little about my personal journey from naive optimism to cynicism to burnout to realistic optimism. I promise I will answer @KJFMartin's question. If I don't, you can get a refund for what you paid to read this.
I was one of the last group of residents to do a rotating internship @RoyalColumbian Had a blast. Delivered babies alongside @KevSclater. Assisted in the OR with @peterblair50. Did a few intubations too. I don't think I slept very much.
I had this sense that we were all colleagues and all equals. Everything we did was in the service of patients. There was no distinction amongst the residents on the basis of specialty. We all looked the same in our greens. The 'system' looked shiny and bright.
In the midst of all this I decided to get my GP license (you could do that in those days). I had my first taste of the 'real world' when I moonlighted in a random assortment of places. A detox centre, a Down Syndrome clinic, a mental health team. I started to see the cracks.
When I graduated from my specialty residency in psychiatry I got a dream gig @BCChildrensHosp I started a telehealth program, worked with fantastic colleagues, felt 'in the zone'. However within a few years things started gnawing at me.
I encountered bureaucratic hurdles. I saw regulation trump patient-care. We deployed an EMR that got between me and my patients. I felt powerless to make changes. I left the hospital not because of the people or leadership, but because the system ground me down.
So I tried to take on the world on my own. I joined with like-minded colleagues and tried to make a difference. Some family physicians and I even started a clinic in Maple Ridge that won a @DoctorsOfBC award. (I think they deserved it more than me).
But I got totally burnt out. Spent. Seeing all those patients. Responding to everyone's emails and phone calls. Working until 2 in the morning every night. Trying to do everything on my own.
There were bright spots during those dark times. My colleagues surrounded me and helped me. They gave me advice. They relieved me of my guilt of not serving patients well enough. They came up with ways to share the burden.
Also, and this will start to answer @KJFMartin's question, a few years back I took some courses through what was then called Physician Management Institute (now @Joule_CMA). Just some random courses such as 'Engaging others' and 'Leading Change'
I met some amazing people like @SteinJanice @PeterKulingMD @DrShelleyRoss and many others. They showed me how I could make a difference outside my clinical work.
@DoctorsOfBC regularly puts out calls for people to join committees. After my experience with bureaucracy I wasn't exactly enthralled with the idea. But the people I met at those courses inspired me. I managed to get a seat at Specialist Services Committee!
For the next three years I sat on the committee and learned how the healthcare system really works. I served under consummate physician-leaders like @DktrV. I realized that this is a really complicated enterprise with a lot of moving parts.
I also met people from 'the other side'--- physicians in administration like @DayanMuthayan (and ran into @peterblair50 again!). I also met lots of top people from the Ministry of Health. Through it all I realized a number of things.
1. The problems in health care developed over a long period of time and through no fault of any one particular individual or organization. No one sat on a committee and decided to screw the GPs or marginalize mental health and substance use.
At worst these antagnostic and unsupportive elements develop out of neglect, or ignorance, but not out of malice. Most people are good people. (including docs!) It really helped me to remember that when I was feeling underappreciated and unsupported out in the clinical world.
2. When faced with incontrovertible facts and rational argument, most people, being good, will want to do the right thing. This is especially true for doctors as we are purportedly an evidence-based bunch. No one wants to stand out as going against the evidence. However,
3. Anything you do in healthcare will affect a lot of people. Why don't we put everything into primary care? Because our Cancer Agency is buckling under increasing demand. Why not boost mental health services? Because women are suffering in labour for want of anesthetists.
4. If you put all the good people (which is most people) in a room together and equip them with the tools to make incremental changes (and once in awhile a really big change) you can make a difference.
That's why groups like Specialist Services Committee fund doctors to attend committees, contribute to health authority initiatives, attend leadership courses, and to re-engage with one another as colleagues. We sometimes even co-host things like a #SpecialistSymposium
All the other Joint Collaborative Committees do it too. GPSC, JSC, SCC. doctorsofbc.ca/working-change BC is a leader in supporting these activities. Unfortunately many people do not know about what we do, and sometimes people even get money from us not knowing where it came from.
One of my most astounding experiences was when a colleague told me that it was good that I was involved in all this work, and that I shouldn't feel guilty for reducing my clinical work to do so. That led to lesson #5
5. If you want to make small changes, you can do it off the side of your desk. If you want to do big things, you will have to make some choices. In my case I had to significantly reduce my clinical workload. That of course has financial implications in an FFS model
but we are working to make sure that physicians are not taking as large a hit as in the past. It's one of the reasons why I wish that systems change was a part of our job, and paid appropriately, but until that happens we will try to create time and financial space for our docs
I will take anyone out for lunch that reads this to the end. No cheating! To summarize: @DoctorsofBC and its committees like GPSC, SSC, SCC, and JSC do create opportunities for physicians to get involved in systems change
The committees and working groups can seem opaque and confusing. Sometimes they are. But they are populated by very smart and dedicated people who want to do good. We are constrained by a system where any movement can cause severe and immediate impacts to other participants.
Sometimes you can start small by attending a few courses (and get sponsored!), responding to a call-out for a time-limited working group, or even just by joining your generalist or specialist society. This gets you into contact with the movers and shakers within the system
It can be a hassle if you live in a rural or remote area, or have other commitments like a family 😍 That's why I have so much respect for people like @awruddiman @DrLarsenSoles @gavery10 who do this work and put in a lot of miles as well as time away from home
That being said this is the 21st century so we have teleconference, videoconference, and Slack to keep everyone involved. A lot of stuff does still happen @DoctorsOfBC in Vancouver or with government in Victoria. Its just the nature of the beast but we try to be more inclusive
You can also talk to people like me! Be forewarned however: don't have any patients booked or be on-call. I tend to go on-and-on-and-on---like this tweetstorm. I'm just very passionate about this stuff, and I hate to see people getting burned out and giving up. I've been there.
Final thought. I remember I used to get really frustrated about how there was so much secrecy about things like negotiations or special committees like the Medical Services Commission. I thought it was some kind of medical illuminati deciding our futures.
Now I've come to realize that it's a lot like patient-doctor confidentiality. It's there because you have to develop a relationship of trust, and only in that relationship can you discuss---sometimes in confidence at first--- really big issues that can make a big difference.
