Family Docs Need Love Too

Senator Josh Newman (D-Fullerton) introduced a resolution in the California Senate to declare March 26, 2023, to April 2, 2023, Family Physician Week. Although its adoption was all but certain, I detected a faint flutter in my stomach as roll call commenced.

It turned out my apprehension was unwarranted. In an era of vitriolic political division, it was remarkable to see every single senator, Republican and Democrat, support the resolution. It seemed that Family Medicine was something that all sides could agree on.

As you may be aware, the CAFP adopted a strategic goal of “Raising the profile of Family Medicine.” It is one pillar in the strategy to reestablish our broken health care system on a sounder foundation built on primary care. This is only possible if the world knows our value; how, for example, we—the specialists in primary care— increase the life expectancy of communities over 2.5 times more than other specialties (Basu et al., JAMA Internal Med, 2019).

However, we must also recognize the benefit of raising family medicine’s profile extends beyond reputation. Fellow family physicians benefit when they see the value of their own work affirmed. Our overworked and stressed colleagues are helped by knowing they are seen, because being recognized signifies that others see our work as meaningful and has worth.

Family physicians need a little love right now.

A Medscape Physician Lifestyle & Happiness Report (2023) found that compared to prior to the COVID-19 pandemic, the proportion of physicians reporting being at least somewhat happy with their jobs dropped from 75% to 48%. In the 2022 Medscape Physician Burnout & Depression Report, 51% of Family Physicians reported burnout, and we were the fifth-most burned out among all specialties, and the most burned out amongst outpatient specialties.

Dr. Christina Maslach, professor emeritus at University of California at Berkeley, and a pioneer in the understanding of burnout described it as a three-legged stool that depended on a sense of decreased accomplishment, depersonalization, and exhaustion.

Other researchers have found that the concept of selfefficacy—the belief in one’s competence to cope with stressful or challenging demands—may be protective against burnout. Indeed, Shoji et al. (2016) in Anxiety Stress Coping showed that self-efficacy has an inverse relationship with burnout: higher self-efficacy is associated with lower rates of burnout. Supporting this finding, Bernales-Turpo et al., (2022) in the Journal of Primary Care and Community Health, found that a higher sense of self-efficacy improved work performance.

It logically follows that higher self-efficacy, or a belief in one’s capacity to face challenges, should correlate with a higher sense of accomplishment. Taking these findings together, one can see how self-efficacy can destabilize one leg of Maslach’s three-legged stool, the sense of decreased accomplishment.

After the vote, my state senator rushed over to speak with me. First, I have ever only approached my representatives, never the other way around. Second, if in my wildest dreams one of them had come to me, it would have been at no more than the most languid pace. My senator had taken note of my practice, a community health center in her district, and she wanted to thank me for the work that my organization did for her constituents. She told me that we provided an important service and that we played a vital role in the community.

To express how her affirmation of my work’s value lifted my spirits could only be an understatement.

Returning to clinic after my visit to the State Capitol, I noticed one of the family doctors, who was newer to practice, seemed to be struggling that day. I went to go check in with her and we commiserated a bit about inbox and the brokenness of health care for the medically underserved. It was clear that work weighed visibly on her. I decided to tell her about my visit to Sacramento.

“She really said that about us?” she exclaimed in astonishment as she turned her attention back to her patients.

I was surprised by how much she brightened up.

I do not think any of us expects to be thanked for the work we do as Family Physicians. Even so, receiving that appreciation can mean the world when one of us hits a rough day, or week, or when it feels like things can never be better. Never should we acquiesce to what is broken in health care, but we must always remember to give ourselves reminders that, even in this system, we matter.

Lauren Simon, MD, MPH, FAAFP, CAFP Immediate Past President