Some physicians not only avoid burnout but also find fulfillment. Here’s how they do it.

Of surveyed and interviewed U.S. physicians who showed significant six-month improvement in follow-up vs. baseline wellness checks, 47% attributed the gain to active personal changes. 

Not far behind were those who credited active work-related changes—40% of the field—while 1 in 4 respondents chalked up their progress to passive work changes.

Only 6.7% cited passive personal changes. 

The project was conducted by burnout expert Tait Shanafelt, MD, of Stanford and colleagues at the American Medical Association and elsewhere.  

JAMA Network Open published the work Sept. 24. 

Shanafelt and co-authors report the two-part survey drew responses to both baseline and follow-up surveys from 359 physicians practicing in the U.S. 

The researchers invited 87 respondents—those with the biggest improvements in burnout and/or professional fulfillment—to participate in qualitative interviews.

Of these, 30 completed the interviews—22 women and eight men. 

Here are details from the interview findings in the researchers’ own words. 
 

1. Active personal changes.  

• Some physicians described shifting from a mindset of self-worth contingent on their professional identify and accomplishments (ie, “My value as a human being is based on the fact that I am a physician”) to a more holistic view (“I have value as a human being; practicing medicine is an important part of who I am, but not the only part”). 
   
• Changes in mindset also involved intentional efforts to look at work in new ways (ie, embracing change) or a shift in focus at work (eg, embracing teamwork, development of others [colleagues, coworkers, trainees]). 
   
• Other active personal changes connected to improvement in occupational well-being included intentional and strategic use of time away from work and greater emphasis on self-care and personal relationships. 
   
• Consistent with the results of controlled trials, in a number of cases, physicians reported that working with a therapist or professional coach had helped effect change.

2. Active work-related changes.

• These shifts often involved a job change (eg, moving to a new organization), taking on or stepping down from a leadership role, or shifting to less than full-time work. 
   
• Notably, many of the active work-related changes involved physician-initiated structural changes to workflow (eg, blocking time on their calendar for documentation or administrative tasks) and outsourcing of nonclinical tasks (eg, office management, billing, personnel management). 
   
• Several physicians reported engaging leadership to advocate for new resources or structural changes and collaborating with these leaders to improve the work environment. 
   
• These latter actions, in which individual physicians took initiative that catalyzed system change, illustrate the intersection between system and individual interventions to improve occupational well-being.

3. Passive work changes.

• Themes in this category included a change in leadership and changes in staffing (eg, filling an open position, adding new physicians or support staff). 
   
• System-initiated improvement to workflows or provision of additional support resources were also frequently noted in this category. 
   
• Consistent with the empirical evidence, ambient AI documentation support was one frequently noted support resource. 
   
• In many ways, the changes described in this category affirm the benefit of system-level interventions to improve occupational well-being, although in some cases, they occurred independent of organizational action (eg, an early-career physician becoming more efficient with experience).

These and other insights from notably well physicians “may be helpful to colleagues who are considering taking action to improve occupational well-being,” Shanafelt et al. write. 

“Ultimately, both individual- and system-level actions may be necessary to reduce occupational distress and promote professional fulfillment among physicians.”

The study is posted in full for free.

Toward making wellness contagious 

In invited commentary on the study, Yale wellness specialist Kristine Olson, MD, MSc, points out that burnout—or the lack thereof—predicts the presence of reliable access to cost-effective, safe, high-quality, patient-centered care by thriving professionals.

Accordingly, she writes, the “presence or absence of physician well-being predicts their engagement (full-time capacity), retention (reduced intent to leave), recruitment (promoting the practice to colleagues), quality (promoting the care delivered, patient experience), daily recharge (work-life balance, self-care), and feeling fulfilled with pride and fidelity to their professional home.”  

To this Olson adds: “Vanguard organizations recognize that physicians’ well-being is synonymous with optimal professional and organizational performance.”

Read the rest.