The Joy of Innovation in Diabetes Care

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Robert Gabbay, MD, PhD, kicked off the “Diabetes Innovative Models of Care: Taking Back Your Practice with Innovation” sessions at ENDO 2019 by instructing attendees how simply reconnecting with their original passion could possibly extinguish burnout. Incorporating new forms of innovation could be the answer. 

ENDO 2019, as always, provided attendees with numerous changes to get up to speed on the latest research and interesting cases from the clinic, but the annual meeting also featured a session taking back practices through innovative models of care, through an eight-expert panel chaired by Robert Gabbay, MD, PhD, chief medical officer, Joslin Diabetes Center in Boston. “There’s so much going on in healthcare and I think there’s an amazing opportunity for us as endocrinologists to think about new ways in which we can deliver care,” Gabbay said during the ENDO session in New Orleans.

Gabbay, who not only chaired this panel but is also chairing an Endocrine Society task force to look at innovative models of diabetes care, during his opening remarks talked about finding joy in in delivering care and how innovation can bring more joy to the work endocrinologists do, but he was also well aware of the potential questions from audience: Why are we relating joy in work to innovation?

And it’s here that Gabbay laid bare the stark truth affecting physicians across the U.S. – more and more physicians are getting burned out. Physician burnout impacts personal and professional lives alike. Doctors abuse alcohol and drugs; they are withdrawn, lonely, depressed. A physician commits suicide every day in the U.S.

And endocrinologists are not immune. “We’re relatively high on the list,” Gabbay says.

Finding the Joy in Work

One reason for more endocrinologists getting burned out is that the diabetes rate continues to climb, and the number of endocrinologists is not keeping pace, not even close. “So those people have long waiting lists and are struggling to manage that. Reimbursement hasn’t gotten any better and meanwhile their brethren in other specialties get reimbursed significantly better,” Gabbay says.

There’s no magic wand that can be waved to suddenly increase the number of endocrinologists, so until that time, according to Gabbay and the task force he’s heading, endocrinologists and physicians in general can think about how to reconnect to the joy they once found in their work, that passion that made them choose whatever specialty in the first place. “One of the things is finding meaning,” Gabbay said during his ENDO presentation. “When we find meaning in our work, we’re much less likely to be burned out.”

“First figure out what lights your fire, and then figure out a way that you can carve out at least 20% of your time doing that.” – Robert Gabbay, MD, PhD, chief medical officer, Joslin Diabetes Center, Boston, Mass.

At first blush, that can sound like a rosy platitude, but studies are looking at the relationship between how much meaning doctors find in their work and how burned out they are. “And it turns out that for every 1% increase in the amount of time you spend doing something meaningful, there was a corresponding improvement in burnout, but interestingly, up to 20%,” Gabbay says.

So, for every percent up to 20% physicians are doing something meaningful, there’s a benefit, but this phenomenon plateaus at 20%. “If you spent 50% of your time [doing something meaningful], you weren’t necessarily that different in terms of burnout. And the good part of that is then, really our quest should be to find out first for each of us, what is that 20%? What is the thing that really gives us the greatest satisfaction and meaning to our work?” Gabbay says.

Regaining Control

For clinicians, one of the main things that brings meaning to their work is having a sense of control over their practices, the feeling that they have choices when it comes to how they care for their patients. “If you look at the way endocrinology has been practiced over the last several years, the pace has increased dramatically,” Gabbay says. “The amount of paperwork has increased dramatically. The feeling of lack of control over what they do, and control is often a hot button issue. Some control over your world is an important part. Meaning is another part. Equity or fairness, feeling that things are fair where you are. Those are major themes.”

Gabbay points to an essay that appeared in The New York Times this past June by Danielle Ofri, MD, PhD, an internist who practices in New York City, titled “The Business of Health Care Depends on Exploiting Doctors and Nurses,” which touched on how the traditional response of physicians, when there’s more to do, is just keep adding more and more work until it somehow all gets done. “And that’s really the way it’s been over the last 20 years, and electronic health records certainly have not helped,” Gabbay says.

“Embracing innovative models of diabetes care not only can give you better patient care and better outcomes, but it can really help recharge your batteries and reconnect you to joy at work.” – Robert Gabbay, MD, PhD, chief medical officer, Joslin Diabetes Center, Boston, Mass.

And again, this problem won’t simply go away, which is why Gabbay and the Endocrine Society task force are asking endocrinologists to think about what really “lights their fire” when it comes to caring for patients. “What we’re going to be doing today is the beginning of a movement, we hope,” Gabbay said in New Orleans. “A national movement for us to work to take back our practice and to do that through innovative models of care.”

For now, Gabbay says clinicians should start thinking about new programs they can implement in their practices, about doing something differently, about doing something innovative.

“What we shared with the audience [at ENDO 2019] was, first figure out what lights your fire, and then figure out a way that you can carve out at least 20% of your time doing that,” he says. “Embracing innovative models of diabetes care not only can give you better patient care and better outcomes, but it can really help recharge your batteries and reconnect you to joy at work.”

— Bagley is the senior editor of Endocrine News. He wrote about caring for transgender patients in the October issue.

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