A CMA for Physicians

Living our Values and Ensuring our Sustainability to Contribute

The Triple Aim framework seeks to optimize health system performance by improving three key elements: the health of the population, the patient experience and cost-effectiveness. To achieve these three outcomes, it is essential that the system supports a 4th Aim. The Triple Aim must become the Quadruple Aim (1), adding a commitment to improving the work life of physicians. Ensuring the health of physicians must be appreciated as key to achieving the health of the population as a whole. In an optimal caring patient–doctor relationship the well–being of both partners is paramount. Doctors are humans caring for fellow humans.

The demands on the healthcare system, and on physicians in particular, seem to be ever-increasing. The growing gap between the expectations for our services and our ability to provide the quality of care we want to deliver is leading to significant burnout. Many have lost enthusiasm for their work; have become cynical and are no longer experiencing a sense of personal accomplishment. Some are questioning why they went into our profession in the first place. But physician frustration, dissatisfaction and ultimately burnout are really the canaries in the coalmine. They are the early warning signs of a healthcare system creating barriers to high quality practice – a system leading to both physician burnout and patient dissatisfaction.  How can doctors’ professional lives be made better? What can be done to help physicians deliver the quality of care we know we’re capable of providing and that people living in Canada need and deserve? What can the CMA do?

Governments, hospitals, residency programs, our regulatory colleges and the general public have failed to fully appreciate the link between physician well-being and patient health and wellbeing. Even though physician well-being should be a goal we seek to achieve in and of itself, the fact that it is linked to the clinical outcomes and health of our patients is essential for all stakeholders to understand if they are going to provide the support needed to improve the context and culture of the environment in which physicians work.

Over the past several years the CMA has done an excellent job in advocating for physician health and well-being and has raised awareness about the importance of resilience and how to achieve it. But the focus has been mainly on the symptoms experienced by physicians and not the underlying cause of the disease. To achieve the Quadruple Aim requires an increased emphasis on the system supports that physicians need. There are many specific areas to be addressed that are currently contributing to physician burnout and many potential solutions that can be considered. These include:

    • The need to address administrative burdens in office practice
    • Provide better support for effective electronic record systems and data sharing
    • Interprofessional team-based models of practice
    • Developing more readily accessible electronic, financial, and practice management tools
    • Programs to help physicians recognize the signs of burnout
    • Provide physicians with both online and face to face contacts to help them work their way through their problems and challenges

Together we can achieve the Quadruple Aim by following the essential principles of collaboration, consultation and inclusion to identify key gaps that matter most to our profession with actions such as:

    • Building on the existing work of the CMA including:
      • Support for the new Charter of Shared Values – a critically important document to guide our professionalism
      • Revising the CMA Code of Ethics (created in 2004) – an initiative now well underway
    • Creating a task force dedicated to reducing stress and burnout rates that represents physicians across all disciplines and specialties that will:
      • Consult with other health professions to understand their work on these issues and discover the intersections of our mutual interests.
      •  Learn from domestic and international think tanks that are successfully addressing these issues
      • Map the needs of our members according to their geographic location and the range of supports available and unavailable to them.
      • Develop systems supports and tools for physicians to manage their stress and support their success
    • Create the “space” and process for physician innovators to come together and collaborate with other interested partners to catalyze and foster the development of new and disruptive ways to address the health system challenges of the 21st century

As CMA President, I would commit to working with all stakeholders including governments, educators and the public to help Canada achieve the Quadruple Aim: Better health of our population, an enhanced patient experience, greater cost-effectiveness and improved physician wellness and career satisfaction.

      1. Bodenheimer T, Sinsky C. From Triple Aim to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. WWW.ANNFAMMED.ORG. VOL. 12, No. 6. November/December 2014. 573-575.


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