The Foundation For Medical Excellencepresents

Physician Well-Being: Recovery and Resilience

Friday & Saturday, October 4-5, 2013Skamania Lodge, Stevenson, Washington

In cooperation with:Group Health Physicians

Virginia Mason Medical Center

Portland Clinic

UWMedicineGraduateMedical Education

NW Kaiser Permanente, P.C.

Providence Health & Services

Legacy Health System

Salem Health

OHSUIntegrativeSelfCareInitiative(ISIS)

John Alsever, M.D., Family Lectureship

William B. Webber Lectureship

a Northwest Regional Symposium

Statement of Need:This regional symposium is part of a series of educational experiences presented by the Foundation’s Northwest Center for Physician Well-Being. This conference is dedicated to providing physicians with the skills to manage change in their personal and professional lives. It is also an opportunity to interact with others who are doing similar work, to exchange program and curriculum ideas and to begin to study and develop positive methods of re-engineering the work settings of northwest physicians to promote their well-being and personal growth.

Who should attend: This program will benefit physicians, healthcare staff, representatives from hospital medical staff well-beingcommittees, representatives from staff model HMOs, representatives from physician group practices, residency and medical school well-being coordinators, and all those who are interested in issues related to physician well-being.

Program ObjectivesUpon completion of this activity, participants should be able to:

• Defineandrecognizeburnout

• Understandtheleadingcauseformentalhealthissuesintheworkplace

• Discusstherelationshipchallengesofspousesandphysicians

• Defineresilience

• ProvidepracticaltoolsforusingAppreciativeInquirytechniques

• Describetheeffectsofmindfulness-basedinterventionsonphysicians

• Applyyourvaluestohowyouspendtimeandmoney

• Thinkabouthowyouallocateyourtime

• Discusstheessentialsofabasicfinancialplan

• Defineemotionalintelligence

• Learnsomaticcenteringasaresiliencypractice

Distinguished FacultyMamta Gautam, M.D., MBA, FRCPC, CCPE, is a psychiatrist from Ottawa, a Clinical Professor in the DepartmentofPsychiatry,UniversityofOttawa,acertifiedcoach,andPresidentandCEOofPEAKMD.Sheisapioneer intheareaofPhysicianHealthandWell-being,andishailedas“TheDoctor’sDoctor.”SheisthefoundingdirectoroftheUniversityofOttawaFacultyofMedicineWellnessProgram.Thisprogramservedas the template for the Canadian Medical Association Centre for Physician Health and Wellbeing, where she served as the Chair of the Expert Advisory Group. She created the Canadian Psychiatric Association Section on Physician Health. In 2008, she founded the International Alliance on Physician Health, bringing together experts worldwide to collaborate on work in this area. Dr. Gautam is an internationally known consultant and speaker on Physician Health and Leadership in Medicine. She writes a regular column, Helping Hand, in the Medical Post on Physician Health, as well as Coach’s Corner, a column in the newsletter for the Canadian Society for Physician Executives. She has written two bestsellers – Irondoc: Practical Stress Management Tools for Physicians, and The Tarzan Rule: Tips for a Healthy Life in Medicine. She founded PEAK MD in 2009, expanding the concept of Physician Health to focus on wellness, and the proactive primary prevention of health of professionals. She has received numerous awards for her innovative work in Physician Health, including Distinguished Fellowships in both the Canadian and American Psychiatric Associations, and was the inaugural recipient of the Canadian Medical Association’s Physician Misericordia Award.

Dr. Gautam is the 2013 William B. Webber Lecturer.

Lt. Col (retired) Stephane Grenier, MSC, CD, served in the Canadian military for 29 years and workedinvariousconflictandpostconflictzonessuchasRwanda,Cambodia,Kuwait,theArabianGulfonship,Lebanon, Haiti and Kandahar, Afghanistan. Faced with his own undiagnosed PTSD and depression upon return from Rwanda, he took a personal interest in the way the Canadian Forces were dealing with mental health issues.In2001hecoinedtheterm“OperationalStressInjury(OSI)andconceived,developed,implementedand managed a government-based national peer support program for the Canadian military known as the Operational Stress Injury Social Support (OSISS) program. His work led to the launch of a second highly successfulnon-clinicalmentalhealthprogramwithinhisworkplacespecificallydesigned to increasementalhealth literacy and reduce stigma. His work was recognized by many including the Governor General of Canada who awarded him the Meritorious Service Cross. In 2010 he was seconded to the Mental Health Commission of Canada and entrusted with the role of leading and overseeing the development of National Guidelines of such non-clinical interventions. In 2012 he retired from the Canadian military and became the founding PresidentandChairof theBoardofPeerSupportAccreditationandCertificationCanadaandalso foundedMentalHealthInnovations,acompanydedicatedtohelplargeorganizationsinnovateinthefieldofmentalhealth disability management.

Peter S. Moskowitz, M.D., is the Founder and Executive Director of the Center for Professional & Personal Renewal in Palo Alto, California, providing career and life coaching to physicians nationwide since 1998.He is also Clinical Professor of Radiology, Emeritus, at StanfordUniversity School ofMedicine.Heiswidelyrecognizedasa leader inthefieldofphysiciancareerand lifemanagement,wellnesseducation,andcareertransitionplanning.AskilledcareerandlifecoachtrainedandcertifiedattheprestigiousHudsonInstitute of Santa Barbara, he has coached several thousand physicians individually and in workshop settings since 1998. He was a founding member of the Physician Wellness Committee of the Medical Board of California, and served for more than a decade on the Physician Well Being Committee at Stanford Hospitals and Clinics. He is particularly interested in issues of career and life balance, medical career transitions, stress and burnout management, the disruptive physician, and career planning for physicians-in-training. He is a nationally recognized author, coach, and workshop facilitator. He is a frequent contributor to healthcare trade journals on topics relating to physicians lives and careers, and is co-author of Medical Practice Divorce, a primer on medical career transitions published by the American Medical Association Press.

Dr. Moskowitz is the 2013 John Alsever, M.D., Lecturer.

Workshop FacultyLisa Goren, MS, is the Program Director for Physician Engagement at Legacy Health, a five-hospital health system in Portland, Oregon. In her role, she isresponsible for ensuring physicians are strategic partners in organizational decision-making as it relates to their practices. Lisa also oversees Legacy’s physician leadership development program, which focuses on building physician leaders who can adeptly lead amidst healthcare transformation.In her prior role as a senior organizational development consultant, Lisa helped leaders and teams improve processes, manage change, plan strategically and communicate more effectively.Lisa teaches in the Masters of Healthcare Administration program at PacificUniversity and spent 10 years teaching undergraduate courses at other Oregonuniversities.ShehasaB.A. inAdvertising fromMichiganStateUniversityandaM.S.inCommunicationStudiesfromPortlandStateUniversity.

David J. Kearney, M.D., is an Associate Professor in the Department of Medicine at the University of Washington, Gastroenterology Division, and theDirector, Mindfulness-Based Stress Reduction (MBSR) Program at VA Puget Sound Health Care System, Seattle, Washington. He is a physician at the VA Puget Sound Health Care System affiliated with University of Washington. He has a specificinterest in the influence of stress-reduction on health. He has ongoing studiesthat assess the effect of mindfulness meditation and loving-kindness meditation on PTSD symptoms, quality of life, self-compassion, compassion for others, and psychological well-being.

Julia Smith, M.D.,isanassistantClinicalProfessorofMedicineattheUniversityof Washington. She practiced primary care internal medicine in downtown Seattle from 1981-2001. Her focus during her practice years was to help patients discover the inner resources of mind and body to address the disease at the root of their suffering. Her current work integrates what is understood in neuroscience with study in adult development, ontologic and somatic (body-centered) coaching, and traditions that derive wisdom through embodied practice: meditation, yoga and the martial art of aikido. Dr. Smith offers coaching and workshops in somatic awareness and embodiment as means to recover vitality, resilience, wisdom and discernment in our lives, work and relationships.

Susan DeWitt Smith, D.M.A., holds a Doctor of Musical Arts degree from the Eastman School of Music, where she studied with Nelita True. Her many musical accolades include a second prize in the Young Keyboard Artists’ International Competition, semi-finalist standing at the International StravinskyAwards Competition, several performance awards from Dartmouth College and a performer’scertificateandteachingawardfromEastman.Dr.SmithhasperformedthroughouttheUnitedStatesandNewZealand.Anavidchambermusician,shehasplayed at the Hot Springs Music Festival, the Grand Teton Music Festival, the Nelson Music Festival and the Olympic Music Festival. Dr. Smith has appeared as a soloist with the Dartmouth Symphony Orchestra, San Diego Chamber Orchestra, Palomar Symphony, San Diego Symphony, and several times with the Oregon Symphony. She is a member of the Oregon-based Third Angle New Music Ensemble, and lives in Portland, Oregon where she teaches at Lewis and Clark, Reed College, Marylhurst University,andmaintainsanactiveperformingschedule.

Physician Well-Being: Recovery and Resilience

Program Events Friday, October 4, 2013

Optional Workshop —Separate Registration1:00 - 5:00 pm — Rainier RoomMaximizing Your Personal and Relationship Effectiveness: A Workshop for Couples — Peter Moskowitz, M.D.Objectives: •ClarifyYourPersonalPurposeandRelationshipPurpose • ImprovetheEffectivenessofYourPersonalTimeAllocation • SustainYourHealth:TheSixDomainsofWork-LifeBalance • ImproveYourWorkEffectiveness:YourPhone,Email,andWorkflow • ManageYourCareermoreEffectively:UsetheCareerCycletoYourAdvantageTheMedicalMilieuinwhichwefindourselvesasphysicianscreatesincessantdemandsonourtime,our resilience, and the emotional and physical energy we have left to bring to the relationship table and to our children. Often the many demands on our resources seem not only reasonable, but important. Ourscientificandclinicaltrainingrarelypreparesustodealwiththesecompetingdemands.Thisfour-hour workshop for physicians and their spouses/partners will utilize a combination of didactic lecture, experiential learning, and small group discussion to approach topics which provide hope, new ideas, and new practical tools with which to improve your personal and couple effectiveness. Each participant will receive a bound workbook containing the exercises and references, and will leave with a personalized plan to increase effectiveness.

Saturday, October 5, 20137:30 - 8:15 am Registration/Continental Breakfast – Stevenson C/D8:15 - 8:30 am Welcome and Introductions

8:30 - 9:15 am Plenary 1 – Stevenson C/DPreventing Burnout — Mamta Gautam, M.D., MBA, FRCPE, CCPEObjectives: • Defineandrecognizeburnout • Understandthebio-psychosocialfactorsthatleadtostressandburnout in physicians • Knowthenumberonecauseofstress,andnumberoneskillindealing with stress • ImplementpersonalizedstrategiestopreventburnoutStress is inherent in medicine, and can lead to burnout. This presentation is designed to assist physicians inidentifyingtheirownsourcesofstress,andlearninghowtopreventburnout.Usingabio-psychologicalapproach, the main causes of stress will be discussed. The psychology of the professional will be outlined tohelpusunderstandwhywebehaveandreactthewaywedo,andwhywehavedifficultymakingpositivechanges.Earlywarningsignsoftroublewillbeidentified.Thenumberonecauseofstressisrevealed, as well as the number one solution. A general approach to burnout prevention is outlined.

9:15 - 10:00 am Plenary 2Mental Health in the Workplace – A new way to look at an old problem: Illness or Injury — Leadership or Clinical Matter?Lt. Col (retired) Stephane Grenier, MSC, CDObjectives: • Developanewnon-clinicallenstoperceivementalhealthproblems • Understandtheimportanceofsocialsupportasadeterminantof mental health • Redefineandchallengeentrenchedparadigmsregardingworkplace mental health • Learn ways to begin systemic wellnessMental health has now become the leading cause of both short and long-term disability claims and together they account for the majority of workplace disability management costs in North America. Traditionally, mental health difficulties in the workplaces have been principally viewed through twolenses. The performance lens and the clinical one. Clinicians treat symptoms and leaders manage behaviors. Has this approach served us well?Anchored in over a decade of experience in dealing with mental ill health issues in the Canadian Military and having worked with several large employers since his retirement, this presentation will challenge traditionalviewsregardingmentalhealthinworkplaces.Newparadigmswillbeintroducedanddefined.Simple and pragmatic ways of starting down the path of systemic wellness will be covered allowing the start of a process to re-humanize the modern workplace and erode stigma. With trends such as social distancing and productivity demands ever increasing in our brain-based economy, going back to some simple and natural societal coping strategies long forgotten will be brought back to the forefront as inspiration to move us forward.10:00 - 10:15 am Refreshment Break

10:20 - 11:35 am Interactive Breakout Session #1 (select a session)Breakout Session 1 — Rainier RoomThe Medical Marriage: The Things Physicians and Spouses Argue About — Peter Moskowitz, M.D.Objectives: • Discussthecommonfeaturesofthemedicalmarriage • Discussthemarriagechallengesofspousesandphysicians • Presentsolutionstothechallenges • CreateasafeforumfordiscussionbetweenspousesA successful marriage is the ultimate spiritual challenge. This is particularly true for physicians and their spouses due to the unique demands of their relationship. This breakout session should be attended by couples who would like to spend an hour thinking critically and openly with each other about their relationship, their challenges, the things they argue about, and finding effective solutions. Writtenexercises will lead each couple to an individualized plan to improve their marriage.Breakout Session 2 — Baker RoomEnhancing Physician Resiliency — Mamta Gautam, M.D., MBA, FRCPE, CCPEObjectives: • Defineresilience • Knowthe5componentsofresiliency • IdentifyspecificstrategiestopromoteandmaintainresiliencyPhysicians are vulnerable to stress in their daily lives. Resiliency is the ability to bounce back after such stress and being psychologically challenged. It depends on your ability to manage your personal emotional reactions, and to respond effectively to others when they are stressed. This presentation is designed to assist professionals in understanding their own sources of stress, and learning how to enhance their resiliency tobettermanage it.Thefivekeycomponentsof resiliencywillbeoutlined.Methods are outlined for implementation of strategies that address each component. Multiple clinical vignettes are given throughout.Breakout Session 3 — Summit 7Appreciative Inquiry: Moving from Problems to Possibilities — Lisa Goren, MSObjectives: •ProvidepracticaltoolsforusingAppreciativeInquiry techniques to current challenges • ExplorehowfocusingonstrengthsandsuccessescanhelpyouattainsuccessThe pressures of today’s healthcare climate put overwhelming stress on the entire care delivery team. These challenges can seem insurmountable without a clear path steeped in possibility, as opposed to problems. In this session, participants will learn practical tools for using Appreciative Inquiry as an approach for managing change in the immediate work environment. Explore how focusing on strengths and successes can move individuals and teams to a place that had never before seemed attainable.Breakout Session 4 — Summit 6Mindfulness in the Workplace – Practical Applications — David Kearney, M.D.Objectives: • Describetheeffectsofmindfulness-basedinterventionsonphysicianswell-being and relational capacity • LearntechniquesforbreathingmeditationIn this interactive session, Dr. Kearney will explore simple and accessible mindfulness meditation practices. Beginning with a simple exercise in which participants eat a single raisin mindfully, the session will explore practices that develop the ability to let go of ruminative tendencies and live more in the present moment. The session will also include a session of breathing meditation. The theoretical frameworkwithinmodernpsychology for thehealthbenefitsofmindfulnessmeditationwill alsobediscussed.11:35 - 12:45 pm TFME Hosted Lunch – Stevenson C/D Foyer

12:45 - 1:30 pm Plenary 3 – Stevenson C/DValues-Based Use of Your Time and Money — Peter Moskowitz, M.D.Objectives: • Discusstheimportanceofpurposeandvalues • Applyyourvaluestohowyouspendtimeandmoney • Thinkabouthowyouallocateyourtime • Discusstheessentialsofabasicfinancialplan • Illustrateprincipleswithafewexamplesfrommycoachingpractice“Battlingasacoach in the trenchesofphysicianburnout for thepast14yearshasetched intomymind the importance of poor personal resource management to the etiology of physician stress and professionalburnout.”—PeterMoskowitz,M.D. continued on next page

Physician Well-Being 2013 Conference InformationFriday & Saturday, October 4-5, 2013

Saturday, October 5, 2013 (8:00 am - 4:00 pm) Recovery and Resilience registration is $275 Friday, October 4, 2013 (1:00 - 5:00 pm) Maximizing Your Personal & Relationship Effectiveness:

A Workshop for couples – separate registration for $275 per couple

To register: Registration online at www.tfme.org. Hotel arrangements are made directly with the Skamania Lodge Hotel at (509) 427-2531.

If you have questions, call the Foundation at (503) 222-1960. Space is limited, we encourage you to register early.

In consideration of your fellow attendees and the faculty, the Foundation would respectfully ask that participants not bring infants or children to any of the sessions or lunch. Please contact Skamania Lodge to arrange child care. Spouses and guests are welcome to register for the conference at a reduced registration fee of $150.

Registration Fee: Physician Well-Being $275 ($150 rate for spouses or residents) (October 5, 2013)

Workshop for Couples Session: $275 per couple (Half-day October 4, 2013)

Refund Policy: Refunds prior to September 13th will be charged a $50 fee. No refunds after September 13, 2013.

Venue and Accommodations: Skamania Lodge, 1131 SW Skamania Lodge Way Stevenson, Washington 98648, (509) 427-2531

For a limited time, a block of rooms is being reserved for seminar registrants. Please call early for reservations and be sure to mention that you are attending the Foundation’s Wellness Symposium. You may also reserve a guest room online by visiting www.skamanialodge.com — please click on book-now.

Special Needs: The Foundation For Medical Excellence fully complies with the legal requirements of the Americans with Disabilities Act. If any participant attending this educational activity is in need of accommodation, please contact the Foundation.

Accreditation: The Foundation For Medical Excellence is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit: The Foundation For Medical Excellence designates this live activity for a maximum of 5.5 AMA PRA Category 1 credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Our two most vital personal resources are our time and our money. Professional Burnout is almost always associated with poor allocation of time and/or money. In this 45 minute didactic presentation, Dr. Moskowitz will emphasize the importance of living with and within our own purpose and values, as part of our own inner guidance system. Applying your personal values surrounding your time and your money won’t prevent stress or burnout. However with effective use of these two vital resources as a foundation, physicians will be well prepared to enter the battle, and much more likely to sustain resilience and enjoy the practice of medicine.1:30 - 1:40 pm Transitional Break1:40 -2:55 pm Interactive Breakout Session #2 (select a session)Breakout Session 5 — Rainier RoomTime and Money Management: Create Your Own Plan — Peter Moskowitz, M.D.Objectives: • Determineyourcurrentandyourpreferredweeklytimeallocation • Considerhowtomovetowardsyourpreferredallocationplan for improved balance • Makesomecriticaldecisionsaboutthestateofyourfinancialplanning • CreateapersonalplantoimproveyourtimeandmoneymanagementTheplenarysessiononthistopicpresentedfundamentalconceptsunderlyingtheeffectiveandefficientuse of your two precious resources, your time and your money. This 75 minute breakout session will be a mini-workshop to focus on the practical applications of the principles discussed in the plenary. Dr. Moskowitz will lead a discussion of how to create a personalized plan. Each participant will receive a workbook with written exercises, and will leave the session with a personalized time and money management plan.Breakout Session 6 — Baker RoomMental Health in the Workplace: Peer Support Programs – From Implementation to Research — Lt. Col (retired) Stephane Grenier, MSC, CDObjectives: • Understandthebuildingblocksofasuccessfulpeersupportprogram • Discoverhowpeersupportactsasacatalystfororganizationalwellness • Understandhowpeersupportdovetailswithotherexistingwellnessprograms • BecomefamiliarwithCanadianNationalStandardsofPracticeforpeersupportThisworkshopwillspecificallyfocusontheprocessesandprotocolsrequiredtoimplementaworkplacepeer support program that can be evaluated and where outcomes can be measured. In hopes of rehumanizing the workplace, and challenging society’s traditional outlook regarding mental health, Grenierhas spentmuchofhis career redefininghowworkplacesand individuals should care forandsupport those affected by mental health problems. By developing, implementing, and managing peer-basedprogramsaimedatreducingstigma,Grenierprovidesleadersandmanagersafirmunderstandingof how to deal with the fast-growing realities hindering today’s brain-based economy. His non-clinical approach offers simple and pragmatic ways of giving purpose to the lived experiences of members of the workplaces and allows organizations to start down the path of systemic wellness and re-humanized workplaces where mental health stigma is no longer a barrier to recovery.

Breakout Session 7 — Summit 7Emotional Intelligence: Aligning Intent and Impact — Lisa Goren, MSObjectives: •DefineEmotionalIntelligence •Understandthelinkbetween(awareness)andimpact(behavior)inpersonal and professional interactions • Learnstrategiesforimprovingwell-beingthroughleveraging Emotional Intelligence • HelpotherscultivatehigherdegreesofEmotionalIntelligenceA great deal of emphasis is placed on the value of cognitive intelligence and the relationship between IQ and success. However, there is increasing evidence suggesting that Emotional Intelligence (EI) is the strongest indicator of professional success by as much as 90%. EI is not simply about recognizing or controlling ones’ emotions, rather it is about learning to align thoughts with actions. Once individuals can successfully manage the space between intent and impact they have the opportunity to increase personal, relational and professional well-being.Breakout Session 8 — Summit 6Somatic Centering: Your Inner Resource for Resilience — Julia Smith, M.D.Objectives: • Experiencetheinterplayofbodyposture,muscletoneandbreathtoinfluence your perceptions, cognition, emotion and behavior • Reviewtheneuro-scientificunderpinningsofthisdynamicprocesswithinthe human body-mind • Learn“SomaticCentering”,aresiliencypracticethatenablesyoutopushthe ‘reset’ button as you go through the demands of your day • Exploretheapplicationofthispracticeinyourinteractionswithpatients,soyou can ‘take in’ their concerns without ‘taking them on’Neuroscience research has confirmed what yogis, martial and other movement artists have knownfor millennia – that body and mind are not separate; what we call ‘mind’ is a function of a dynamic interplay between body, brain and relationships. The implications of this understanding for medical professionals and their patients have barely begun to be explored. In this workshop we will introduce howattendingtothestateofthebodycaninfluenceourstateofmind,refinethequalityofourpresenceand afford greater resiliency as we encounter the daily complexities and challenges of life and work.

2:55 - 3:10 pm Refreshment Break – Stevenson C/D3:10 - 3:20 pm Commitment to Change – Dr. Ed Keenan3:20 - 4:00 pm Musical Interlude – Susan DeWitt Smith, D.M.A.4:00 pm Adjourn