Enigma Program Beats Burnout and Boosts Physician Morale

Virginia Newman, M.D.

About six years ago, to combat what she saw as a dip in physician morale among her colleagues at Franciscan Alliance Michigan City, Virginia Newman, M.D., started the Enigma Series, a continuing medical education program in which physicians discuss medical cases with their peers. The program’s successes have been far-reaching—not only helping physicians beat burnout, but even strengthening communication between physicians and hospital administration and improving decision-making around physician preference items.

What sparked the desire to start the Enigma Series?

While making rounds and spending time in the doctor’s lounge of my hospital, I kept noticing that most physicians were walking around with their heads bowed and there wasn’t much talking or interaction. You could feel a lot of tension among physicians in different specialties, and even among different groups within the same specialties. I decided we needed to find a way to remind one another of why we got into medicine, reaffirm the talent of our colleagues and help break down barriers between physicians.

What’s a typical Enigma session like?

With the Enigma Series, we’ve gone from a receptive type of learning—the lectures we’re all so familiar with—to an interactive type of learning, making the education process much more gratifying. Each session has between 25 and 35 physicians and a moderator who gives a short review of the case and explains current treatments. The cases are presented in a way that helps the group arrive at a diagnosis together. All cases are from the local medical community and are not disclosed before the event so as to discourage selective participation based on cases or specialties being presented.

We designed the format to facilitate as much interaction between audience members as possible. Instead of having tables in which people sit to watch a presentation, tables are configured into a large U-shape that requires people to intersperse and not separate into cliques. In this scenario, a podiatrist sits next to a heart surgeon who sits next to an infectious diseases specialist who sits next to an orthopedist.

As moderator for the first few sessions, I had to initiate the conversation and call on people. At first everyone was a little reluctant to ask a question or venture an answer and potentially look foolish, so I started by picking a specialist with some familiarity with the topic being presented. That person would start talking, then another person would chime in and someone else would say something funny. That helped everyone loosen up and naturally sparked a friendly, sometimes challenging, and often humorous conversation. Once everyone started talking, they decided they weren’t all so bad and that they even liked each other!

These interactions have certainly fostered collegiality among physicians. They’ve also broken down preconceived biases and re-energized interest in the respective specialties. Now when we start a presentation, we can hardly go through two sentences before someone wants to contribute. That’s a sign to me that it’s working.

What were your goals with the program and how have those been reached?

What we wanted out of the program, we achieved—a change in physician morale and a dissolution of barriers and biases between specialties. Since a majority of physicians and medical staff return every session, we’ve gotten much closer as colleagues and as people. The interpersonal relationships have progressed as the program goes on.

When we see each other outside the program, the dynamic is different now. When an issue needs to be discussed, our familiarity with one another means we tend to be frank and honest and get right to the point. Reaching a solution together, or finding consensus, has become much simpler.

The most important thing that came out of Enigma is a reaffirmation of the physicians’ love of medicine, which counterbalanced much of their frustrations with administrative duties, lack of autonomy and shrinking reimbursement. Physician morale has definitely improved. The resurgence of interest in medical education has lead us to initiate a quarterly publication called the Specialty Corner, which is dedicated to the most recent and relevant advances in a particular specialty, substantiated with a bibliography, and written by physicians in a featured specialty, even if they are from competing groups.

How else has this interaction benefited your hospitals and physicians?

It has helped us administratively. Many of the physicians who attend Enigma are also part of the hospital’s committee structure and are either engaged in peer review, credentialing, directorships or clinical operations groups. Let’s take a cath lab subcommittee as an example of how it has helped us make decisions. Say I need to make some inventory decisions because I realize I have three balloon catheters that do the same thing. Discussing the possibility of streamlining the balloon inventory with the interventional cardiologist and interventional radiologist is a much more comfortable, non-confrontational experience as a result of the relationships built around the Enigma Series and the resulting camaraderie. Thus we can reach consensus around a common objective, which is to have what we need to provide good care while supporting the financial viability of our hospital. They aren’t threatened by my opinion because we have more trust and a better personal relationship. And from that, we can work more productively on committees and better serve the interest of the medical staff as a whole.

What are some of the common tension points between administrators and physicians, and what are ways to overcome them?

What I see, having been in private practice and now as an employed physician, is the hospital’s interest and physicians’ interests are perceived as being separate. I think that’s a misperception on the part of both parties. Physicians can’t have a successful practice if they don’t have a strong support system, and a hospital can’t have market share or proper reimbursement models if they don’t have a productive cadre of physicians doing good quality work. Their interests are actually very aligned.

So, those of us in leadership roles need to help both sides see how valuable each is to the other. We need to keep building trust and show how the interest of the hospital is intertwined with that of the physician. A happy, satisfied doctor will be more empathetic, more productive, more inclined to incorporate new initiatives into their practices, and more willing to work with administrators about quality measures.


Virginia Newman, M.D., is a vascular surgeon at Vascular Center of the Great Lakes and Franciscan St. Anthony Health, in Michigan City, Indiana. She’s the director of the Limb Preservation Center at Franciscan St. Anthony Health. Her treatment for pelvic congestion syndrome was once featured in an international blog, and she has an emerging reputation as a specialist in renal autotransplantation. Dr. Newman received her bachelor’s degree from Harvard University, and medical degree from Cornell University Medical College.

Share Email
, , ,