The rate of women physicians at Mayo Clinic in Arizona leaving or reducing their full-time employment (FTE) was higher than their male counterparts. In routine annual surveys of physician staff, it was discovered that women reported higher burnout than men and a follow-up survey geared to understand the factors suggested that burnout and stress was greater in those with caregiving responsibilities.
Developing the Intervention
Dr Stonnington collaborated with Professor Suniya Luthar, PhD, a resilience researcher from Arizona State University, to develop a protocol for a pilot study that would examine methods of creating supportive social environments conducive to flourishing physician mothers. The goal was to test benefits of Authentic Connections, a supportive, group-based intervention created by Dr Luthar for professional working mothers at high risk for distress and burnout, including physicians and advanced practice providers (APP).
Mothers on staff at Mayo Clinic who participated in the 12-week pilot study received one hour per week of protected time away from their regular duties. Participants were then randomly assigned to one of two interventions:
Authentic Connections Groups consisting of 12 weekly, one-hour sessions of a facilitated, structured, relational supportive intervention
One hour per week for 12 weeks to be used as desired
Meetings of the Authentic Connections Groups took place in a small conference room where chairs were arranged in a circle. Boxed lunches were provided for meetings during the noon hour and refreshments were offered during 8 am and 4 pm sessions. The sessions were facilitated by a psychiatrist with group therapy experience and supervised by Dr Luthar to ensure fidelity to manual procedures. Facilitator and supervision fees were included in the budget. Each session focused on a separate topic such as mentoring, setting limits, asking for help, cultivating a support network, “good enough” mothering, and self-care. Topics and session format had been adapted for professionals from Dr Luthar's Relational Psychotherapy Mothers' Group program for high-risk low-income mothers. Most of the sessions were discussion-based but there were opportunities for group exercises. For example, one session included mindfulness meditation. The Support Wallet session involved writing anonymous supportive statements about each of the other women, which were then read aloud during the session. This provided each woman with a “support wallet” with all the statements in it. Many sessions utilized handouts and focused reflection on a particular topic.
Success of the pilot was measured by:
Level of engagement, eg, number of dropouts from the group sessions
Improvement in various measures of distress and well-being
Qualitative data regarding the perceived value of the intervention
If successful, groups would continue as a regular offering, with ongoing success measured by:
Leadership needed to provide time away from the practice for participants to take part in the pilot study. Burnout data and a recent Mayo Clinic initiative to address gender disparities in academic advancement helped secure leadership buy-in. Given the concerns raised regarding physician mothers, Mayo Clinic leadership agreed to fund the time away from the practice and encouraged department/division chairs to allow participation.
The intervention proved to be a great success.1,2 The Authentic Connections Groups became a regular offering for physician and APP mothers at Mayo Clinic in Arizona. The turnover rates for women physicians have since decreased to a relatively low rate (from 4.8% in 2015 to 1.7% in 2017 and 2.1% in 2018).
After the intervention, analyses showed significantly greater improvements for mothers in the Authentic Connections Groups than those in the control group. Three months later, improvements continued in all but one of the measured areas (depersonalization). Mothers participating in the Authentic Connections Group showed improvements in:
Global symptoms
Depression
Self-compassion
Feeling loved
Satisfaction with being held/cared for
Parenting stress
Emotional exhaustion at work
Personal accomplishment at work
Responses gathered from participants regarding what they valued most from the intervention fell into four main themes:
Validation through sense of community, decreased isolation, and uniquely shared experiences
Inspiration and empowerment through shared wisdom, experience, and different perspectives
Modulation of stress and burnout through developing a healthier lifestyle and better work/home balance
The value of self-disclosure in gaining self-awareness and asking for support
The program's success was also evident in the fact that there were no dropouts in the intervention group and participants incorporated attendance into their schedules. This also highlighted an unmet need among this group, many of whom were previously not seeking help for themselves or getting the support they needed. In debriefing interviews, participants expressed gratitude to Mayo Clinic for offering the sessions during work hours (rather than after hours), which made participants feel supported. Furthermore, participants appreciated meeting colleagues from other departments who they may not have otherwise known, describing it as a sort of “secret sisterhood.”
Due to the success of the pilot study, Mayo Clinic leadership supported ongoing mothers' groups during work hours. The pilot study offered the sessions at 8 am for providers in outpatient settings and at 4 pm for inpatient providers. Programs were also offered over the lunch hour. These times worked well and continued after the pilot study ended.
In 2015, before the collaboration with Mayo Clinic, Dr Luthar had established Authentic Connections, a nonprofit organization dedicated to fostering mothers' well-being. Over time, this nonprofit enabled the provision of support groups for women in other medical settings including Mayo Clinic in Rochester (for Nursing Leaders) and Samaritan Medical Group based in Oregon (for clinicians). A number of groups have been offered online for women across the country, providing an alternative to setting up an infrastructure within an organization.3 Given the evidence of success and the potentially wide reach, this intervention was named specifically as promising to foster resilience among mothers (and via them, their children) in a recent report by the National Academies of Science, Engineering, & Medicine.4
Mayo Clinic follow-up to the Authentic Connections Groups pilot study included two initiatives. One was a monthly “Mayo Medical Moms” support network meeting for graduates of the Authentic Connections group sessions. Second, a different, 8-week facilitated support group for women physicians was developed, called “Refreshing Space,” to extend to all women physicians. The sessions encourage networking with colleagues and are intended to provide a safe, supportive environment and time to address topics that disproportionately impact women physicians. Examples of topics include imposter syndrome, professional goals, self-care, time-management, and setting limits.
Mayo Clinic School of Continuous Professional Development now provides CME credit for each hour of the support network and “Refreshing Space” sessions. Participants can utilize days allotted for professional development to participate in 8 sessions.
Testimonials from Authentic Connections Groups' Participants
“It has been validating to hear that my experiences and concerns are normal and experienced by others. Also, inspirational to learn from other women who have gone through these struggles successfully. Hearing other people's experiences aids in trouble shooting and problem solving. It is especially interesting to see how we all handle our journeys differently and it has been great supporting one another. I spend the week reflecting on our discussions, and reflect often on how differently women in the group seem to handle different situations. It gives me perspective on my life and how I can change/improve areas of my life. I'm not sure if it is entirely related, but I've started exercising and eating/drinking better. I find I look forward to the weekly group sessions and learning from the wonderful women in the group. Seeing their example is an inspiration for personal change…I will always cherish our time together and I look forward to this one hour every week, it is the thing I remember not to miss when I come back to work Monday morning.”
“I have found this group helpful largely due to the sense of community. I tend to buckle down and work in isolation when there is so much to be done. Oftentimes this leads to a feeling that one is in it alone. The group has brought to my attention that I am not alone. That my feelings and thoughts are quite common. This alone makes things more manageable. It has forced me out of my shell and allowed me to grow in ways that have been empowering. [The facilitator] has been fantastic. And the women in group dynamic and supportive. I look forward to the weekly groups. I would recommend the group as a way to meet other provider moms and establish a support group. A means to learn about oneself and engage in personal growth. An opportunity to learn to be a better caregiver to patients, family, spouse, and self.”
“It is great to be able to relate to other working moms in healthcare. It is important to feel connected, supported, understood, and listened to. I think for some moms, including myself, it is easier to tell ourselves that living in stress is the ‘new norm' and just keep going without exploring the opportunity to connect with others. I almost wish this group intervention can be made mandatory to all as I was skeptical before signing up for it but having been a participant, I'm so glad I did.”