Both groups spent the past year amassing information. IU Health’s group found emergency physicians believe they lack the tools—mostly staffing—to work efficiently. The school's group joined similar committees from peer institutions working toward the same end. "Wellness is a vague term,” said Kelker, who serves on both committees. “We need tools that can help us define it."
Pang's department has already rolled out tangible policy changes.
During the first and third trimesters of pregnancy, residents can opt out of night shifts. When the child is born, the resident gets six additional weeks of flexible scheduling. There’s now financial support for wireless equipment for lactating mothers, and bereavement leave: the department foots the cost when a resident picks up a shift for a grieving colleague. A peer support group for physicians facing malpractice claims has also been created.
Some research shows that working at an academic medical center provides a buffer. Physicians at medical schools like IU devote more work hours to non-clinical duties like teaching and research, which can boost feelings of personal accomplishment. Some studies—albeit with small sample sizes—also report lower burnout rates.
It's not without tradeoffs.
Academic faculty make less money than physicians in a community practice. Yet they experience a shared commitment to training physicians, scholarship, and innovation.
A GLIMPSE of this dynamic is visible at Eskenazi, where the ER handles more than 100,000 patient visits a year–a new patient every five minutes. Many are uninsured. They might be dealing with the acute consequences of a chronic condition. Or the results of street violence.
Two years ago, Eskenazi felt the tug of the trends pulling on emergency medicine. Nurses were fed up with the abuse from patients. Managers told them to jot down incidents on a form and drop them in a box. Eventually, those reports made their way to Marla Doehring, MD, who practices at Eskenazi and serves as one of the leaders of committee for residency safety.
"The incidents didn't shock me," said Doehring, an associate professor of clinical emergency medicine. "The sheer volume did. I thought we needed to do something."
The result: a study on workplace violence. It found offenders were often men who came to the ER voluntarily. Usually, an incident—most often reported by nurses—involved swearing or threats of legal action. But sometimes the lack of civility extended well beyond vulgarity and threats. Despite that, most healers default to their ethical code.
Esknazi took the data to heart. It increased security, tweaked no-tolerance policies to include non-violent harassment, and posted QR codes to streamline incident reporting. Even so, those efforts can't erase lousy behavior.
That was true when Rutz encountered a patient writhing on a bed. Paramedics brought him to Eskenazi after an aide at a long-term care facility found him on the floor of his room and agitated. He looked to be in his late 50s. He had a patchy white beard and wore only his underwear.
Moore, two nurses, and a paramedic surrounded him, each trying to hold him in place. His words were slurred. A medic said the patient had suffered a stroke two months earlier. Rutz moved to the foot of the bed, placed his hands just above the left knee, and pressed.
The patient muttered at Rutz: "I will f—- you up."
"Just relax, dude," the medic said slowly.
But the man didn't heed the advice, wriggling onto his side. Moore called for a dose of droperidol, a sedative used when a patient is aggressive. Rutz asked the medic about the man's condition when they found him. Details were scant. A nursing aid suspected he'd been down for an hour before she discovered him.
"I'm gonna sue all of you," the patient yelled.
"Seems fair," Rutz quipped.
Good humor embodies Rutz's approach to the stresses of his profession. When overseeing the unit, he keeps the vibe breezy. Any small favor—like a nurse handing him a chart—is met with a pleasant "Grazie." But when he steps into a patient's room, he sounds like a man catching up with a neighbor as they’re knocking out some yard work.
What sustains his affable bearing? "The patients," said Rutz. "A lot of folks are grateful for any care they can receive. Sometimes, it's as simple as giving them meds for high blood pressure or info on how they can get transportation to another clinic."
IN SOME WAYS, Rutz personifies a cultural shift in his field. He finished residency in 2015, coming up in an environment that emphasized the grind: no breaks, no running to the restroom, and, crucially, not vocalizing stress.
Now, those topics are atop the docket when new residents arrive.
Kyra Reed, MD, an assistant professor of clinical emergency medicine and an assistant program director, hosts a retreat at her home where future ER doctors learn about the department's policies and programs. When they open their Outlook calendar, a session with a counselor is already booked. They also complete a psychological needs assessment.
"We want to remove any barrier or stigma," Reed said. "That all conveys just how crucial their mental health and well-being is to us."
Throughout their intern year, lectures return to topics around burnout. The department also uses peer support for residents working ICU shifts—often a young physician's first exposure to caring for very sick patients. During those sessions, a resident leader sits down with the intern to discuss any issues. Older residents, though, have different needs. For those in their second year, their workload ramps up dramatically. Almost half their shifts are in high-acuity areas, leading resuscitations in shock rooms.
"You're making high-level decisions and you’re newly on your own," Reed said. "That's a lot of weight."
Two months into her second year, Moore feels every ounce of it pressing down. "It's very overwhelming," she said. "I pretty much feel all the time like I'm missing something or doing something wrong."
That sensation is normal. Second-year residents might receive a lecture focused on efficient charting, coping with exhaustion, and maintaining work-life balance. By the third year, content shifts to maintaining empathy and workplace safety.
To cope, Moore thinks only of the next step for each patient in her care. She knows the volume she sees at IU—sometimes six patients an hour—surpasses other programs. Stress now means competence later.
Rutz said Moore's experience is unfolding normally. "She's getting her butt kicked," he said. Soon, though, her baseline will reset. Once that acclimation ends, Rutz said his attention would turn to building confidence.
Rutz paused and looked up. Moore had stepped into a room and started chatting with a patient. He grinned. "She's so good," Rutz said. "She just doesn't know it. There's a little bit of imposter syndrome. We need to work through that, but she's got what it takes."
IU School of Medicine trains many of the state’s emergency physicians. To help us offer a stellar training environment, contact Ken Scheer at 317-278-2122 or kescheer@iu.edu.
