APM viewsThe well-being of physicians
Introduction
Although there has been tremendous progress in our understanding of disease and in interventions to restore health, many physicians have lost sight of their personal well-being. Physicians now confront the stresses of increasing government regulations, malpractice suits, the business aspects of medicine, increased clinical demands, less time with patients, a rapidly expanding knowledge base, rising student debt, and how to balance their personal and professional lives. Although many physicians acknowledge the existence of these stresses, it is difficult to fully understand their effect on health. After all, “Illness doesn’t belong to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman” (2).
Much has been written about the well-being and quality of life of patients in recent years (3), but although great strides have been made in the assessment of patient quality of life 4, 5, 6, 7, little attention has focused on the well-being of clinicians and how it might affect patients 8, 9, 10. It is important to understand the prevalence, causes, and consequences of physician distress; the factors that contribute to physician well-being; and the steps that academic medical centers, health maintenance organizations, and physician organizations can take to promote physician well-being and those that individual physicians may take to promote their own wellness.
Section snippets
Physician distress
The medical literature began to testify to the problem of physician distress 20 years ago 11, 12, 13. These studies reported “burnout” in a wide range of practicing physicians with 30% to 60% of specialists and general practitioners 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 experiencing burnout when measured with validated instruments 24, 25. Although the problem is common among academic faculty, among whom 37% to 47% experience burnout, it is, alarmingly, even more prevalent in
Causes of burnout
Although the factors that contribute to burnout are unclear, there is evidence that an important role is played by such factors as workload 8, 50, 51, 52, specialty choice 11, 50, 53, practice setting 11, 21, patient characteristics 50, 54, sleep deprivation (33), personality type 22, 55), methods of dealing with death/suffering (22, 56, methods of dealing with medical mistakes 57, 58, malpractice suits 58, 59, 60, lack of control over practice environment 16, 51, and problems with work-life
The well-being of physicians
In his famous address to the Harvard Medical School, Francis Peabody said, “The secret of caring for the medical patient is in caring for the medical patient” (65). Others (66) concur that Candib’s rephrasing, “The secret of the care of the patient is caring for oneself while caring for the patient” (67), may provide even greater insight.
But how do we care for ourselves? What is physician well-being and, more importantly, how do we get there? Although there is a large body of literature about
Practical suggestions for physicians
It is important for physicians to note that recovery from distress and burnout is possible 12, 38. The editors of the Western Journal of Medicine dedicated their January 2001 issue to physician well-being (77). One article by Weiner et al. explored physicians’ own wellness promotion practices by asking “How do you solve dilemmas related to your physical, emotional, and spiritual well-being?” (68). Study participants also completed a survey to measure well-being. The authors identified
Implications for academic medicine, health maintenance organizations, and physician organizations
The implications of the research cited here should be a strong call to action for academic medicine, health maintenance organizations, practice administrators, and physician organizations. Distress has been identified as an issue in nearly every group of physicians that has been studied, from interns in training 8, 9 to department chairs (20). Distress and well-being are intimately associated with factors essential to building an economically healthy 82, 83 and thriving health care
A call for research
Prospective, longitudinal studies that further explore the causes and ramifications of physician distress and new instruments to specifically measure physician well-being are needed. Prospective studies to identify individual and organizational interventions that can promote wellness and evaluate its effect on productivity, patient care, and patient satisfaction will be important. The well-being of female physicians may be dependent on variables distinct from their male counterparts and should
Conclusion
Being a physician carries with it the potential for both great joy and great distress. Sir William Osler distilled this dual potential: “The practice of medicine will be very much as you make it—to one a worry, a care, a perpetual annoyance; to another, a daily job and a life of as much happiness and usefulness as can well fall to the lot of man.” Physicians must identify, nurture, and defend their personal interests and values if they desire personal and professional satisfaction in life.
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Tait D. Shanafelt, Jeff A. Sloan, and Thomas M. Habermann are from the Mayo Clinic, Rochester, Minnesota.