I am continually awed by SGIM’s story. We were established as the Society for Research and Education in Primary Care Internal Medicine (SREPCIM) in 1978 with a grant from the Robert Wood Johnson (RWJ) Foundation and an affiliation with the American College of Physicians (ACP). Our founders were responding to a perceived need to focus on academic primary care, intent on building an environment and space for such members to professionally develop and network. The concept of burnout in clinical medicine was nascent in medicine at that time but the structure of the Society unintentionally seemed focused on combating collective burnout.1, 2
The Society was created as a forum to highlight clinical care, education, and research in primary care. Over the years, we maintained a laser focus on generalism through SGIM’s mission which states the need to cultivate “innovative educators, researchers, and clinicians in academic general internal medicine, leading the way to better health for everyone.”3 Our Commissions highlight the continuum of generalist care across transitions (Academic Hospitalist; Geriatrics) as well as our commitment to equity (Health Equity, Women and Medicine).
I reiterate our history, mission, and vision for it is the True North that Jean Kutner, Eric Bass, and Kay Ovington navigated with many others to ensure the stability of our organization over the past year. During the pandemic, all our worlds have been and continue to be shaken. Generalists are at the crossroads of justice and equity in our boardrooms, examination rooms, and hospital rooms. Daily, those interactions demonstrate the stark realities of differential access to societal assets and the health outcomes of those disparities.
All levels of inpatient and outpatient clinical infrastructure, in which many of our members are practicing, have experienced upheaval. Our hospitalists and trainees have been on the front lines of care, adeptly jumping from one crisis to another—managing a novel disease in the context of limited treatment options with limited or inadequate PPE, managing or operating with limited staffing support and/or prolonged work shifts, and doing this while also being away from family for work and/or out of fear. Our outpatient clinicians have navigated financial shortfalls, changing clinical paradigms for COVID-19 testing, creating partnership with patients who might demand unproven therapies, and converting instantaneously to telehealth as a means of delivering care. These clinical realities are also situated in a time of societal outcries, violence, and economic uncertainty that are agitating for change. Our trainees at the postgraduate level have felt to brunt of the pandemic, quite literally putting their lives on the line to serve the higher calling of the profession. This was also done while fighting in the streets for social justice and often without additional time off, compensation, or adequate behavioral health support in the moment.
For primary care physician-researchers, an additional reality is that competition for funding to pursue lines of inquiry and discovery is more fierce than ever; at the same time, research funding has been redirected to issues related to the pandemic. It is not clear how the current funding environment will react to our style of discovery. Health services and primary care research championed by our members has longed forged the way for substantial policy changes that improve the health for all.
One can look at our present situation through the lens of collective burnout, the condition in which we are left with depersonalization as an adverse coping skill for emotional exhaustion. I illustrated in this column many of the identified systemic issues that lead to collective burnout. But I do not want to leave us on a sour note. Gagné and Deci were among the first to articulate the factors needed to ensure wellbeing, self-determination and intrinsic motivation in the workforce. In medicine, we have combined wellbeing, self-determination, and intrinsic motivation into one concept of “well-being.” Gagne and Deci further articulate that “well-being” is affected by competence, autonomy, and relatedness which are also key factors in addressing our collective burnout: competence (effectiveness in dealing with the work environment), autonomy (control over the course of lives), and relatedness (close affectionate relationships with others).4, 5 For anyone who reads this month’s SGIM Forum, SGIM provides the antidote to collective burnout.
Competence. Our annual meeting provided the context and tools needed for continuous professional development. The program and the daily work of our members ensure that we all are better prepared to handle the complexity of equity as it relates to climate change, vaccine distribution, or access to care.
Autonomy. As an organization, SGIM acted, instead of bemoaning the state of primary care decline due to the pandemic. In the Q&A with the SGIM CEO, Eric Bass, he announces our organization’s co-sponsorship of the National Academy of Science Engineering and Medicine (NASEM) report on “Implementing High-Quality Primary Care.” This call for an intensive re-dedication to high-value, high-quality primary care, will undoubtedly lead to investments that enhance our patients’ experiences, care quality outcomes, and clinicians’ and trainees’ satisfaction. In another example of autonomy, the SGIM Health Policy Committee responded to a National Institutes of Health (NIH) “Request for Information (RFI): Inviting Comments and Suggestions to Advance and Strengthen Racial Equity, Diversity, and Inclusion in the Biomedical Research Workforce and Advance Health Disparities and Health Equity Research” with clear tenets for the NIH to adopt to advance these aims.
Relatedness. We have expressed our love and commitment to SGIM through the generosity of our members and supporters. To date, we have 2,899 members who paid their annual dues and the Philanthropy Committee raised $261,830 in donations and pledges since it was established in Fall 2020. As I consider the value of 525,600 minutes of my SGIM annual membership for $1.11 a day, I have the answer: it is the season of love.
- Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30:159–165.
- Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2:99–113.
- Society of General Internal Medicine. Vision and values. https://www.sgim.org/about-us/vision—values. Accessed on May 15, 2021.
- Gagné M, Deci EL. Self-determination theory and work motivation. J Organiz Behav. 2005;26:331-362.
- Hartzband P, Groopman J. Physician burnout, interrupted. N Engl J Med. 2020 Jun 25;382(26):2485-2487. doi: 10.1056/NEJMp2003149. Epub 2020 May
Health Equity, Leadership, Administration, & Career Planning, Medical Education, SGIM, Social Justice, Wellness
“During the pandemic, all our worlds have been and continue to be shaken. Generalists are at the crossroads of justice and equity in our boardrooms, examination rooms, and hospital rooms. Daily, those interactions demonstrate the stark realities of differential access to societal assets and the health outcomes of those disparities.”
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