Building a Framework for Clinician Well-Being and Resilience

As research innovators, medical schools and teaching hospitals are uniquely positioned to develop new approaches for tackling burnout, depression, and suicide among health care providers.
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In July, the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience convened for its first public meeting since it began in early 2017. The NAM Action Collaborative was established out of a growing national awareness that the epidemic of burnout, as well as depression and suicide, has worsened significantly across the health professions in recent years. Its goal is to advance evidence-based solutions to promote clinician well-being and combat burnout, depression, and suicide among U.S. health care workers.
 
I have the privilege of cochairing the NAM Action Collaborative alongside Chair Victor Dzau, MD, NAM president, and Cochair Tom Nasca, MD, MACP, CEO of the Accreditation Council for Graduate Medical Education (ACGME). At our July meeting, the public and invited experts included representatives from professional associations, health care organizations, government, insurers, academia, nonprofits, and other sectors to provide feedback on the collaborative’s overall direction, as well as on the goals of the collaborative’s four working groups: research, data, and metrics; the conceptual model; external factors and workflow; and messaging and communications. The meeting featured a lively discussion about clinician burnout rates as an indicator of health system dysfunction, as there appears to be a positive correlation between increasing burnout rates and clinicians spending more time on regulatory issues and documentation.
 
The facts are alarming: 39% of physicians report experiencing depression.1 Likewise troubling, burnout among physicians is nearly double that of U.S. workers in other fields after controlling for work hours and other factors.2 An NAM perspective piece in July 2017 showed that certain physicians are at even greater risk for burnout. For example:
 
  • Women have significantly increased odds of burnout and are more likely to experience symptoms of depression than male physicians.
  • Younger physicians have a 200% increased risk of burnout over physicians older than age 55.
  • Physicians with children under the age of 21 are also likelier to experience burnout than physicians without young children.
One important priority is the need for more research regarding the prevalence of burnout among clinicians from racial or ethnic minority backgrounds. We do have studies of medical students from minority backgrounds showing that they are more likely to report that racial discrimination, feelings of isolation, and different cultural expectations had adversely affected their medical school experience. The students reporting this were more likely to have burnout and depressive symptoms than students from minority backgrounds who did not experience this.3 The relative lack of data on the experiences of underrepresented minority students, residents, and practitioners is a clear call to action for the AAMC and other organizations to give greater attention to minority colleagues who may find themselves marginalized in this important dimension of well-being.
 
While there is much research left to do, we know that the traditional culture of health care—characterized by hierarchy, autonomy, competition, and individualism—contributes to the isolation, burnout, and lack of work–life balance felt across our community. Further, these stressors exacerbate the challenges that affect women, younger doctors, and minorities most acutely.
 
Near the end of the NAM perspective paper, the authors recommend additional research into improving the work lives of health care professionals as one of three broad research priorities. Our hope is that additional study in this area will highlight effective interventions to reduce burnout among physicians and other members of the clinical team; identify what is needed to create positive work environments that support high-performing teams and individual well-being; and determine how organizations can best evaluate and improve the work environment, help individuals promote their well-being, and support those who experience distress.
 
“While there is much research left to do, we know that the traditional culture of health care—characterized by hierarchy, autonomy, competition, and individualism—contributes to the isolation, burnout, and lack of work–life balance felt across our community.”
Medical schools and teaching hospitals around the country are addressing this crisis in new ways. In June, Stanford Medicine announced the appointment of Tait Shanafelt, MD, as its first chief wellness officer. Dr. Shanafelt, who joined us at the NAM Action Collaborative meeting, has been working with colleagues at the Mayo Clinic to track rates of physician burnout for the better part of a decade and is known for his research into strategies to change systems, the practice environment, organizational culture, and leadership to improve wellness. Since then I have learned of similar positions either in place or being planned in AAMC member institutions around the country. As these programs develop, academic medicine can once again fulfill its role of leading innovation for the health care system as a whole.
 
There is a growing body of evidence about the problem of clinician burnout. Encouragingly, the desire to find solutions also is gaining momentum. I believe that the current movement to improve clinician wellness and resilience is akin to the revolutions in patient safety and quality at the turn of the 21st century. When what was then the Institute of Medicine began seriously studying the issue of quality in health care, our community moved from denying the problem, to accepting the facts, to taking action—action that has dramatically improved care in this country. I believe that the focus on clinician well-being by the NAM can have the same transformative effect on health care professionals and their ability to care for our patients. Through this transformation, we will rediscover our connections to our colleagues, to our patients, and to the meaning in our work.
 
I am hopeful that as we focus on building work and learning environments that promote wellness and social support, we can begin to turn back the rising tide of health professional burnout. While doing so, we can find ways to highlight, preserve, and extend the humanistic reasons we all became health care professionals in the first place. By developing a national-level framework to address the negative factors in our work and learning environments, I believe that we can make a positive difference in the lives of clinicians, in the cultures of our institutions, and ultimately, in the outcomes of our patients.
 
  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015:90(12):1600-1613.
  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med. 2012;172(18):1377-1385.
  3. Dyrbye LN, Thomas MR, Eacker A, et al. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med. 2007; 167(19):2103-2109.