[Interview] Luis Garcia, MD, President, Sanford Clinics

This spring, Dr. Luis Garcia, Sanford Health's president of clinic, joined executives from the nation's top health systems as a panelist at the Becker's Annual Meeting in Chicago. Garcia spoke on a subject about which he has become passionate, and one which a growing number of healthcare institutions are beginning to prioritize - the mental health and well-being of healthcare employees. We spoke with Dr. Garcia for insight on the issue. 

MED: Let's put aside the obvious strain of the pandemic for a moment. Is there something about people who work in healthcare that makes them especially vulnerable to stress or burnout?

LG: For many people in healthcare, their career really was a calling. People who feel called into this field want to give our best and pursue excellence for our patients. So healthcare is full of overachievers. That alone creates a lot of internal stress. 

So as a baseline, the industry brings an environment of high stress situations. And trust between patients and physicians is being questioned, whereas before it was more absolute. But now there are so many more sources of information and they are influencing how patients are making decisions about their healthcare. 

Add to that the events of the last couple of years, just like any human being, there is a tipping point. There is a time when you go wow this is more than I can handle. 

What we are seeing if you look at the stats in the industry, problems that were prevalent before are much more accentuated right now. Burnout - 50 to 80 percent. Twenty percent of physicians polled have considered suicide in the last year. The prevalence of that is much higher among women than men (about 130 percent higher).

One in four workers in healthcare have considered leaving healthcare because of what's been going on in the last couple of years. 

By design, by the way in which our demographics work, we were already looking at a shortage of physicians and nurses. We were already looking at how are we going to deliver healthcare into the future with the expected shortage? Then you have everything that the pandemic brought…

The result is that a lot of people considering going into healthcare are deciding not to. 

MED: What can employers do to help their workers get through this?

LG: One thing that we advocate a lot is awareness. Whether you are in healthcare or not, we need to recognize that things like mental health issues DO exist. 

People tend to hide mental health issues because they are afraid of the stigma. It is safe to talk about it. If we don't know about it, we cannot help you. 

So you have to create a safe environment where someone can say I'm human, I don't feel good today, I'm having a bad day. And then build the resources to be able to offer solutions to employees. 

We don't see our employees just as employees. Our commitment to them does not stop on Friday when they go home. If we see them as just office hour workers we are failing them. Instead, we see them as family members. 

We need to see them as human beings, support them and their families, and support them not only at work but outside of work, as well. We see this as an investment in our most valuable asset. 

When we look at our workforce, we ask what can we do to support our workforce? Those strategies are different for women than men and different for a brand new doctor from the doctor who is nearing retirement. It would be a failure for us to treat them all the same. When you are in an independent setting, that is very difficult to do. 

Thankfully, we are well-[positioned as a well integrated healthcare system to address this, but the rural setting adds another layer of complexity. The delivery of healthcare is much more complex in terms of both cost and infrastructure than it is in an urban setting.  

One thing that the last couple of years have done to the existing workforce, when we approach this topic we think about healthcare workers first as clinicians then as human beings. As clinicians, they have been dealing with a couple of years of uncertainty. Healthcare workers are people who want to be able to give you uncertainty, that you are in a safe place and that your problem is going to be resolved. 

The uncertainty that we have seen over the last several years creates a lot of stress in our workers. 

As human beings, they were dealing with exactly the same problems as everyone else - are their kids going to be able to go to school, dealing with a sick family member or losing a loved one, or a spouse losing a job. They were not only dealing with what was going on inside of work, but also outside of the workplace. Right now, they feel tired, devalued, and burned out. 

We are very grateful for the people who have chosen to stay. Healthcare is about a calling, helping those in need, in their most vulnerable time. There are many people who are very grateful for this. But there is only so much we can ask of them. 

One of the things we have put a lot of emphasis on is how do we continue to support those that are continuing in the healthcare industry and those who want to be able to go into healthcare. These are tough times but it continues to be great, we want them to know how great it is. 

We cannot completely decouple what is happening in healthcare from what happened in the last couple of years. As a result of the pandemic, a lot of things are surfacing. 

For a lot of our patients, because they wanted to protect themselves, they delayed their care. What we are seeing now, is that the complexity of care that is needed for both inpatients and outpatients is higher. So that is one challenge.

One thing that we continue to advocate is to come back and get your preventative healthcare. 

In Sanford, prior to the pandemic, we were diagnosing 1 breast cancer a day. Now we are diagnosing breast cancer every 7 days. It is not because breast cancer rates have decreased. 

MED: What advice do you have for current workers or for those considering a career in healthcare?

LG: They need to not try to be a hero all the time. As human beings, we also need to pay attention to our own wellbeing. We tend to neglect our own wellbeing. I would tell individuals that if they are feeling the signs of depression, anxiety or burnout is to pay attention before it is too late to act on it. That will look different for different people. But just the acceptance that you need help and that you are not going to be stigmatized. 

A burned out physician is three times more likely to make a medical error. That is why it is so important. Their own wellbeing needs to be as high a priority as the wellbeing of others. 

I go and exercise, I spend time with my family. Some people say I disconnect and put my cell phone down. Identify what brings happiness to your life and fill your cup and intentionally make time for those things. We are so busy with the pace of life, we are constantly going, going, going, and it's just an accident when we find ourselves with 20 minutes to take care of ourselves. 

If it fills my cup to be a father, I'm going to spend time with my children. 

Being in healthcare is a privilege and an honor and those who are still interested in getting into healthcare, I would not discourage them. It is rewarding and satisfying. You have a real impact on people. 

We really want to send a message of gratitude for all those who have chosen to stay. These have not been easy times. They showed up in times of uncertainty. They did and they continue to show up. We are extremely grateful for those who are here on the front line.