Rheumatology Practice Management December 2014 Vol 2 No 6 - NORM Highlights
Rosemary Frei, MSc

Rheumatology managers recently received practical advice on how to cultivate optimal interpersonal working conditions as well as maintain healthy and productive relationships while working in medical group practices. At the National Organization of Rheumatology Managers (NORM) 2014 Annual Conference, Wayne Sotile, PhD, founder of the Sotile Center for Resilience and the Center for Physician Resilience in Davidson, NC, discussed these common concerns as well as ways to address burnout and how to keep medical team members satisfied with their jobs.

According to Dr Sotile, this involves paying close attention to one’s own behavior, and learning to behave in a way that leads others to bring out the best in themselves, creating a safe place for people. He pointed out that workplace conditions that involve high demand as well as low autonomy and team support are strongly associated with career dissatisfaction.

“When you start stripping an individual’s sense of control, people start getting cranky,” Dr Sotile said. “Then we have the greatest risk of all, relative to resilience, and that is when we turn on each other. We start creating those ‘us–them,’ ‘we–they’ ways of thinking that we’re infinitely capable of. The front office, the back office, this subspecialty, and that subspecialty,” observed Dr Sotile.

The remedy is for the practice’s leader to create a safe space for others, drive accountability, and curb inappropriate workplace behaviors, he said.

“Do whatever you can do to boost actual and perceived support and control, for yourself and other people,” said Dr Sotile. “And curb not only aggressive, but passive and passive-aggressive resistance to dynamic collaboration and collegiality. That way you increase the odds that you’re going to lead effectively and you increase the odds you’re going to cope effectively.”

He noted that most physicians are very dedicated to their professions; however, the flip side is overwork and burnout. Three times as many physicians compared with members of other professions work at least 60 hours a week, with 22% of practitioners working more than 80 hours a week. In addition, 46% of physicians are burned out, as well as about half of internists, according to a study he cited.1

Burnout and psychosocial distress are the most pervasive and unchecked risks to work safety, quality, and satisfaction. There is a link between burnout and higher rates of medical errors and medical malpractice suits, and lower patient compliance and patient satisfaction.2

“There’s a universal rule that applies to a lot of high-performing people—we learn well how to practice our profession but we don’t learn how to live our lives as busy people. Mismanaging our work-life challenges and our personal coping style leads to burnout, and physician burnout is the biggest risk factor for disillusionment of the medical professionals’ family members,” stated Dr Sotile.

He uses the Myers-Briggs Type Indicator and 360 Evaluation assessments to help alleviate these difficulties. These systems help people understand themselves better and gain insight into why they might find it challenging to interact with some individuals.

He also emphasized the importance of honestly assessing oneself and one’s strengths and weaknesses with respect to the work environment.

“There is a place for quitting a job, there is a place for leaving a relationship. But the next one you’re in, you’re going to have to face the same journey,” observed Dr Sotile. “I know a physician who is getting his fifth board certification, looking for that perfect organization, that perfect specialty. At some point you’ve got to say, ‘Look, there are no perfect people.’ When the interpersonal conflict heats up, that’s the time to demonstrate your character.”

This points to a need to adjust to different personalities and to manage change. Managing change sustainably requires pitching new ideas or courses of action relative to each person’s sense of autonomy, mastery, and purpose, said Dr Sotile.

“Most often, we try to motivate others by telling them what to do; through verbal persuasion we explain why they should do something. The problem with that is unless the other people can each answer these questions—‘Is it worth it relative to what I value?’ and ‘Am I going to be able to do this?’—the verbal persuasion just sounds like attacking, bullying, nagging, and blaming,” noted Dr Sotile. “The most powerful ways of getting people to change are getting them to try a new way of doing things so they see that they can do it, and to tell them stories that illustrate how the change will be beneficial or going where you’re trying to lead.”

Frequent, immediate, relevant, and positive reinforcement is necessary to sustain change and engagement, and must be contingent on something. This is tied in with making a practice a safe place for someone else, and can be accomplished in less than 20 seconds. Giving a compliment or words of admiration and appreciation can go a long way toward making others feel safe and valued.

He noted it is also important to provide constructive performance feedback and to stop disruptive behavior as quickly as possible. These are key to driving accountability and moving everyone to a high level of both passion for work and organizational identification, observed Dr Sotile.

“Any behavior that detracts from the mission and the performance needs to be addressed,” Dr Sotile said. “What dynamic leaders have to do is find that sweet spot of inner truth-teller but respectfully deliver the truth with no doubt being relentless about the truth as it affects the organization. You don’t get what you want by focusing on what you don’t want.” l


  1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385.
  2. Wallace J, Lemaire J, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.
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Last modified: July 20, 2015
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