P.T. Koenig, M.D. 

Focus On… is a Q&A style interview that highlights a member, a conversation with an authoritative expert, spotlights an innovative program, or profiles a trend. If you have a suggestion for a person or topic we should consider as a future Focus On… subject, please email CANP at admin@canpweb.org.

P.T. Koenig is a family medicine physician for Sutter Medical Group in Dixon, where he has practiced for the last 20 years. He is the Lead Well-Being Champion and Co-Lead Clinician Communication Coach for Sutter Medical Group, and the Valley Pacesetter for the Sutter Health Joy of Work Initiative. He lives in Davis with his wife and their two sons.

Connections: 
How did you get involved with clinician wellbeing work?

P.T.: 
I started doing patient experience work about 10 years ago. That effort grew, and then I realized that it was hard to do patient experience work if you had burned out colleagues. Happy cows make happy milk. Clinicians can fake it for a little while, but in the long run, if they aren’t having a great experience in their environment, their patients are probably not going to have a great experience, either. About the same time, the Sutter Medical Group Board of Directors asked me to come up with a program for a wellbeing program for the group, and I led the team for that.

Connections: 
You’re also involved with a program called the Joy of Work Initiative. Tell us about that.

P.T.: 
The wellbeing work with Sutter Medical Group is designed specifically for our clinicians in the Sacramento area, and the Joy of Work is a Sutter Health-wide program for which I am the “Valley Pacesetter.” I represent the voice of the Central Valley clinicians at Sutter Health. There is a lot of overlap between the two programs. The Joy of Work team is focused on fostering an environment where the wellbeing of healthcare workers is connected and supported. The idea is to build the foundation for care that is safe, personal, affordable and accessible. We run a resource site with links to numerous helplines and great sources for self-care, including mindfulness, meditation, self-compassion and exercise.

Connections: 
Why are these efforts especially important for clinicians?

P.T.:  
It’s true, there are a lot of positive things about being a clinician. We have job security. We are well paid. We get to help people get better. That should bring us great joy. But there are other things that can get in the way, and other stresses can come in. Being a clinician is also really hard. There are problems you can’t fix. Sometimes a condition doesn’t have a cure or treatment, or the patient can’t access the treatment. Or there may be things that are non-medical we struggle to help patients with. Then there’s just life. We have families, relationships, illnesses. We are trained not to think about that stuff, not to feel things sometimes – but that bites us in the rear end in the long run. Ours is a culture of self-sacrifice and suppressing emotions. But you don’t want someone on the edge of emotional collapse taking out your gallbladder. This affects patient outcomes. A burned-out clinician makes more mistakes.

Connections: 
The wellness work must have been especially important at the height of the pandemic. How did you engage with clinicians?

P.T.: 
With the pandemic, the wellbeing work with Sutter Medical Group really pivoted. We had been doing a lot of in-person get-togethers and talking about our experiences, and putting on workshops, and that stopped. We began to focus on sending out communications to colleagues with the message that they are not alone. Everyone is scared. Everyone is struggling. It is normal to feel really weird right now. The update went out every day, and I began a “Daily Dose of Wellbeing” message with a link, a piece I had written, or a video. I try to mix shorter and longer pieces, some that might speak to me as a 50-year-old parent of two with something that might reach a younger colleague, for example. We have included readings about social justice, racial inequality and other related topics, as well, given everything that has happened in our country over the last year, particularly with George Floyd’s death, and increased attention to health equity issues.

Sutter-wide, we started a monthly Joy of Work webinar about self-care and caring for one another. With the pandemic, these webinars gave people a chance to get together, share their experiences and frustrations. When there is uncertainty, sharing the experience is really important. It’s not something that clinicians are good at. We’re not always good team players. 

For both programs, we offer practical tools. For individuals we talk about exercise, eating right, paying attention to your relationships and friendships, and not just focusing on work. Make sure you take time to be with your family. Incorporate some of that during the day. Take a deep breath before going into the exam room. We try to make it user-friendly; it’s not an academic approach, but a very down-to-earth approach. 

Connections: 
What role have NPs and other advanced practice clinicians played in these efforts?

P.T.: 
APCs are very much part of the Sutter Health culture. Historically they have been more open to patient experience training, and we have a higher percentage of APCs attending the wellbeing events than we do physicians. Most of us who do this kind of training believe APCs are more engaged, more emotionally intelligent on the whole, but our approach is that we are all in this together. We are all just taking care of patients and playing the clinician role, so we have more in common than differences. COVID doesn’t care what you have after your name. Let’s band together from the wellbeing standpoint. 

Connections: 
What is the role for the organization in all of this, and will organizational engagement be sustainable?

P.T.: 
I like to think of the role of the organization in terms of what I call “Do the trains run on time?” In other words, do I have a medical assistant today? Do I have a computer that works? Do I have an electronic health record that is not yesterday’s technology? If I need something and I ask for it, can I get it? Do I have any control over my schedule? Do I have enough PPE? If you are in a work environment that is dysfunctional, you can’t have a great experience of work. There is increased organizational support this work. It has been very well-received. Linking our well-being efforts with our operational efforts to make sure that our leaders listen to our clinicians and provide them with what they need to be well and to have a good work experience will have the biggest impact in the long run.

Connections: 
Wearing your wellbeing leadership hat, what are the greatest learnings from the past 14 months?

P.T.: 
If you have gotten through this year and you still feel you don’t need wellbeing stuff, there is probably something wrong. Most people recognize they have limits. They need help sometimes. People are far more open to the idea of the importance of emotional health and treating each other well. They feel a greater sense of purpose in their work, and they are really thinking about what it is that they do that is the most important. Life is short, and where do they have the greatest impact? And what speaks to them the most? We will see a lot of people focused on the purpose of and meaning in their life.