Jan. 2, 2024

‘A privilege and a gift’: Brenda Senger reflects on 20 years at the SMA

Brenda Senger became a staff of one when she was hired in November 2003 as director of the Saskatchewan Medical Association’s (SMA) Physician Support Programs. This area included the Physician Health Program, the Member Advisory Committee, and the Medical Benevolent Society.

“Dr. Briane Scharfstein (then-SMA CEO) brought me on, and I asked him, ‘What do you want to do in these areas?’ He said, ‘I don’t know, go figure it out.’ So that’s what I did.”

Twenty years later, Senger retired in December from a position and department she indeed made into her own, infused with her personality and passionate dedication to the physicians, medical learners, and family members she served.

“What we’ve seen over my tenure is that there is now more permission for help-seeking behavior, which there never was before,” she said about her work in the physician health area. “The first couple of years after I started at the SMA, there were probably five, six files. Last year we had 499 people access the program. Those numbers don’t mean that the profession has become sicker. What it means is that people are becoming more proactive and asking for help.

“Young people are much more likely to reach out,” she continued. “They’re less stigmatized around mental health issues. But what I’ve also seen in the last five years is physicians my age have been reaching out. They would have never done that before. That tells you something about how people see the program and the assistance that they get.”

The Physician Health Program (PHP) started as a joint venture with the College of Physicians and Surgeons of Saskatchewan (CPSS). Called the Saskatchewan Physician At Risk Committee (SPARC), most of the work involved recovering physicians helping other addicted physicians in recovery. SPARC saw a need to expand beyond addictions into mental health and to bring in someone with a clinical background. SPARC changed its name to the Physician Health Program and hired Senger, a psychiatric nurse then with 22 years of experience who sought to change the culture of physician wellness programs and with it, the culture of medicine.

“In her 20 years at the SMA, Brenda has championed physician health and wellness. It is through her efforts and vision that the SMA has one of the best Physician Health Programs and is leading the country with our breadth of physician wellbeing and support programming. It has been a privilege to work with and learn from Brenda. Her unwavering and compassionate commitment to the physicians of this province is inspiring.”

– Bonnie Brossart, SMA CEO

As Dr. Scharfstein told Senger: “Go figure it out.” So she did. Her work with the Member Advisory Committee (MAC) focused on providing advocacy to members struggling with workplace issues and disciplinary processes. Her initial focus in all programs was on developing relationships with the CPSS, the College of Medicine, the precursors to the Saskatchewan Health Authority (SHA), and the Canadian Medical Protective Association.

“That was really important because it is only through those relationships that we made so much progress,” she said. “We often had different mandates but developed ways to address issues – and disagree – without damaging these relationships.”

When a physician contacted the SMA’s PHP, the MAC, or the MBS, Senger was their point of contact. In the PHP, she did initial triage and got a sense of whether the caller needed “more tools in their toolkit” or required the expertise from a physician member of the Physician Health Program Committee. She was aware of everyone who accessed the PHP and acted as their case manager as they navigated through the system. In her MAC role, she offered support and advocacy with a variety of agencies.

“Because I’m not vulnerable like they are, I could be ‘the pit bull with lipstick’ who went into the workplace,” she said. “The finesse was challenging these issues in the workplace, with CPSS, and with the College of Medicine, without damaging the relationship that we had with them. But my job was not to protect physicians from the consequences of their behaviour. It was to support them through the consequences of their behaviour.”

The relationship with CPSS has become a model for the country. “Part of the legacy that we developed is that although the college understands addictions and mental health, what’s different with us is that the college does not do physician health work,” she said. “The college refers that to us, and they trust that we do the things that need to be done to ensure a physician is safe. That’s different than other places across Canada.”

Senger applauds the generosity of Saskatchewan physicians as seen in the yearly donations to the Medical Benevolent Society. The MBS is a joint committee with the CPSS administered by Senger. “Having to ask for financial assistance is very difficult for physicians, so my role was to reassure them that it was OK to ask for help.” Many physicians and medical learners have benefited from the benevolence of this charity.

“Due to the nature of Brenda’s work, her substantial support and accomplishments remain confidential and unknown except to those members, staff, and their families that she touched. Over the past 20 years together at the SMA, there were many times when Brenda and I would collaborate to ensure that physicians and medical learners would have the resources they needed to obtain or continue treatment. The SMA Physician Health Program (that she developed) is so well respected that it is specifically named by Manulife in the SMA Disability Insurance Plan policy as being an accepted therapeutic program. She will be greatly missed.”

– Cindy Anderson, Director, Membership, Benefits & Insurance, SMA

Senger can be blunt, but she embraced her role, and physicians embraced her, often literally, and often behind the scenes at Representative Assemblies. Her talks on physician wellness were among the highlights of RAs. “A lot of what I did was the invisible work at the SMA,” she said. “However, I didn’t feel invisible because I had relationships with people whether in a session or whether I saw them at the RA. People didn’t know why I had the relationships I had with people. That was confidential. But the way that the profession embraced me – I always chuckle because of the role that I was in and my personality, the whole world hugs me, and that’s OK because it fit my style.”

It wasn’t easy convincing physicians they had “permission for help-seeking behavior” due to long-entrenched attitudes and expectations surrounding the practice of medicine. “Physicians think they should be able to handle everything, and the system applauds all the characteristics that end up making people sick,” she said. “Overwork, high volumes, self-sacrifice, competitiveness – the system applauds that. Self-care – the system doesn’t care as much.”

Physician wellness cannot be taught in a one-hour lecture in medical school, she says. If wellness matters, systems must change to reflect that. “You need to be aware of the individual, but you also need to be mindful of the systemic impact – physicians and learners need permission for sustainable practices, appropriate on-call schedules, backup coverage, feeling valued – all those things are important if you want to keep physicians well. It’s not about waiting till they’re burnt out and then sending them to the Physician Health Program.”

“Over the last 20 years, Brenda has created a lasting legacy within the SMA – the Physician Health Program. There are countless physicians, family members, and medical learners who have benefited greatly because of her support. I am sad to see Brenda retiring but am humbled at the work she has done that focuses on physician wellbeing. Thank you, Brenda. Your laugh, sense of humor, and passion will be missed.”

– Dr. Tracy Danylyshen-Laycock, Director, Physician Wellness & Support Programs, SMA

From humble beginnings 20 years ago, the SMA’s Physician Wellness portfolio has expanded to include a Regina office to serve physicians in southern Saskatchewan. Clinical Coordinators, Physician Advocates and Workplace Wellbeing Consultants have been hired, one each in Saskatoon and Regina. Dr. Tracy Danylyshen-Laycock is the Director of a new department called Physician Wellbeing & Support Programs.

Under Senger, the department also incorporated work on equity, diversity, and inclusion (EDI) and hired Physician Lead, Dr. Nnamdi Ndubuka. “It’s not like EDI is a new concept and I never dealt with racism before,” said Senger. “We did a lot of work in that area, but it is now in one place and not distributed. It’s nice to have more personnel and more resources dedicated to this important work.”

Reflecting upon her years at the SMA, Senger thanks her co-workers, her committees who “accepted me and my authenticity,” and the physicians who sought her help.

“I had such great privilege in my work,” she said. “Being invited into people’s lives at their more vulnerable moments, that was a privilege and a gift, and I always honoured that. It was fascinating work because everyone is their own puzzle. Sometimes all people need is a safe place to be treated with respect. It’s not that I have some unbelievably fancy, clinical intervention skills. That’s generally not what people need. They just needed me to create a safe place for them that wasn’t full of judgment, and to understand people’s stories and how they got to where they were and how to make sense of that without shame.

“I always thought of my work as a privilege and a gift that other people gave to me, because it was, and it was rewarding, and it was fulfilling, and it was enjoyable.”

(Photos in order: Brenda Senger at the 2022 Fall RA in Regina; Senger in 2014; Senger in 2008; At the 2017 Spring RA in Saskatoon; Halloween at the SMA office.) 

Seven things Brenda Senger has learned to be truths:

  1. In our work, our friendships, and our intimate relationships, we always get exactly what we settle for. So set the bar high – without apology – and do not settle for mediocrity.
  2. Don’t trade your authenticity for approval. Life is too short to be beige.
  3. If you’re working harder than the patient, you’re doing it wrong.
  4. We are caregivers, not caretakers.
  5. Find every opportunity to laugh!
  6. Celebrate everything.
  7. To all of you – GO BE AMAZING!

I had such great privilege in my work. Being invited into people’s lives at their more vulnerable moments, that was a privilege and a gift, and I always honoured that.

Brenda Senger

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