Promoting the wellness and resilience of his residents and colleagues is a passion for Dr. Michael Epter. He has become a leading spokesperson on the topic within the residency leadership community. With over a decade of experience as a program director, as well as the challenges he worked through caring for twins born at 24 weeks, he has plenty of wisdom and insight to share on how we can help promote wellness in EM!

NameMichael Epter, DOmichael epter
LocationMaricopa Medical Center (Phoenix, AZ)
Current Job(s)Program Director & Vice Chair of Education (formerly Program Director & Vice Chair of Education, University of Nevada)

How did you become interested in Wellness and Resilience?

My interest in wellness and resilience began after first becoming a Program Director 11 years ago. While there are very defined things a PD is responsible for, I would place the concept of connectedness to one’s residents on a level more important than semiannual evaluations or even success on a self-study visit. How do I define connectedness? Knowing a resident on a granular level. What are their goals and their struggles? What/who is personally meaningful to them? How do they maintain balance outside of the hospital? Do they reward themselves when they are not a work?

My opinion is that residents (and faculty alike) have to engage in the deliberate practice of having “escapes” and thus, reward themselves with activities that allow them to have a mental release where they are free from daily stressors. For some, this may be going to the gym, hiking, biking, or the mental activities of reading a book, journaling, and mindful meditation. For others, it may be travel. Setting these escapes for yourself just as one would set a reminder on their device for a meeting is critical to its success because putting it on your smartphone means that it is a priority in your day. Priorities happen – they aren’t left to chance. Given the demands that are placed on residents and ED physicians alike, you have to make yourself just as much a priority as completing a PBLI log. I am often reminded of being on an airplane when you are instructed regarding the placement of the oxygen mask “if traveling with children, place your own mask on first…” This is similarly good advice for us – if we don’t take care of ourselves first then how can we be of any benefit/help to our patients, spouses, friends, children and community?

My own personal connection to physician wellness and resilience was challenged on every level with the birth of our twins. Like many other couples, you are hopeful your wife has an uneventful pregnancy and bears healthy children. While May is traditionally a time when programs are putting the finishing touches on preparing for the upcoming graduation in June of their seniors and celebrating that momentous time, I found myself in a NICU with the birth of twins at 24 weeks and weighing in at a few hundred grams rather than what one normally expects to talk about with friends and family, namely: pounds. The next 6 months allowed me to learn many a life’s lessons and reshape who I am today. Wellness and resilience have now become a passion to promote and I have been fortunate and honored to lecture nationally on this topic, engage in focus groups, and publish on this as well. Having been through what I have, if I can help someone else in getting through a period of losing their willingness and ability to share feelings and experiences, or someone becoming progressively more emotionally withdrawn by drawing on the lessons I learned, then perfect – I have reached a goal of paying it forward and assisting others.

What resilience and wellness initiative have you started?

When I was in Las Vegas, we developed a residency wellness curriculum which had at its core a resident-driven, resident wellness committee. This committee developed the aforementioned curriculum that was EM and resident-centric. Residents face an additional complexity beyond what already challenges us as EM physicians causing professional exhaustion. Namely, ensuring one’s choice in residency was the right one, attempting to carve out and protect time off, ego gratification, and perhaps the most threatening, imposter syndrome – the fear of exposure of weaknesses.

Here at Maricopa this has been duplicated but also has been layered by having a psychologist speak with the residents each month, leading a discussion on an important wellness/resilience topic but also creating a forum for the residents to discuss harm, medical errors, inadequacy, and loss of control. Unfortunately, these forums are very uncommon in medical culture. It is the exchange of views and experiences with colleagues that is a central resource for reduction of professional insecurity and reinforces the core concept of connectivity.

Where have you found support?

Most importantly, I have had support from the residents. We have a resident in our program, Cristian Patterson, who is our resident wellness champion. All programs and departments should have a wellness champion. Resident ownership is important to the overall vitality of the wellness initiative. If there were only a top-down approach to wellness, the buy-in from the residents would be appreciably less than it is. I firmly believe that as a PD, I must delegate certain powers because I lack the bandwidth to decide and know everything. As noted above, we have been fortunate to have a psychologist participate, so reaching out to the community or looking elsewhere within your University is something to investigate. I have found that not directly having someone who is connected to the program centrally, or peripherally is important since the residents then feel that those forums are “safe spaces”.

What are the most important concepts for promoting wellness in your program?

Awareness. The statistics are frightening (and under-reported) regarding the number of physician suicides that occur annually. We have an obligation not only to teach the latest evidence based literature that applies to our patient population but also about all facets that fall under the umbrella of threats to wellness/resilience as well as strategies to prevent and if need be, overcome them. We will all face challenges that threaten our wellness as our careers unfold (and perhaps multiple times), so properly preparing can prevent poor performance and help prevent burnout. Wellness/resilience are meaningful, so let’s be mindful of that and optimize our strategy.

What are some important, practical steps that individuals at other institutions could take?

Step 1:

If you have not already, make wellness a central initiative in your department. Have both a resident champion and a faculty champion. Even though I have emphasized resident wellness/resilience within this article, we have the unfortunate distinction as EM physicians of being at the top of nearly every survey on physician burnout. We must change this. Ignorance is bliss. Every one of us should dig deeper to find solutions to this problem and make changes within your department and institution. Simple things like having physician wellness/resilience as a standing agenda item at your faculty/departmental meeting is a first step toward ensuring that this is a priority. As noted above, establishment of forums for your providers and putting together resources for outreach so that when things begin to go astray, one knows where and to whom to turn without endless navigation.

Step 2:

Next, assess. Assess for burnout frequently – while introspection may be the key difference for those in balance vs. those at risk – it is catching people who are not burned out but at risk that cannot be overstated. It is in this group that one can make significant strides with smaller interventions.

Step 3:

Lastly, intervene. One of the more pleasing things about EM is the embodiment of the team. Sitting on the sideline when you see warning signs in individual residents/faculty is not the culture of EM.

To close, over-thank, appreciate, and mentor. A little recognition for the conditions under which we all perform our jobs goes a long way, while mentoring facilitates your connection to your residents and colleagues so they can navigate the wonderful future that is emergency medicine.

Christina Shenvi, MD PhD
Associate Professor
University of North Carolina
Christina Shenvi, MD PhD


Emergency Medicine and Geriatrics trained, Educator, Professional nerd, mother of 4, excited about #educationaltheory, #MedEd, #EM, #Geriatrics, #FOAMed.
Christina Shenvi, MD PhD

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