Actions Reported by Physicians With Large Improvements in Burnout and Professional Fulfillment

Importance Occupational distress among physicians is a highly prevalent problem that limits the effectiveness of the health care delivery system. While system change is necessary, individual physicians must also consider personal actions to mitigate occupational distress.

Objective To identify physician actions associated with large-effect-size improvements in burnout and/or professional fulfillment over a 6-month interval.

Design, Setting, and Participants This qualitative study using a mixed-methods approach recruited US physicians from the American Medical Association Physician Data file. The study used 2 quantitative online surveys that were administered 6 months apart (October 2 to November 13, 2024, and April 2 to May 16, 2025) to identify physicians with large-effect-size (≥0.8 SD) improvement in burnout and/or professional fulfillment. These physicians were subsequently recruited to participate in a qualitative study using structured interviews to identify changes they believed contributed to this improvement.

Main Outcomes and Measures Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.

Results A total of 359 practicing physicians responded to both the baseline and follow-up surveys, among whom 87 (24.3%) had an effect size improvement of 0.8 SD or greater in burnout and/or professional fulfillment and were invited to participate in qualitative interviews. Thirty physicians (20 participants [66.7%] aged 30-49 years and 10 [33.3%] aged ≥50 years; 22 [73.3%] female) completed interviews. Thematically, these physicians reported changes in 4 categories: active (ie, intentional) work changes, passive work changes, active personal changes, and passive personal changes. A majority of participants (26 [86.7%]) reported active work and/or personal changes. Active work changes included changes to workload and work schedule, developing new skills or changing the focus of work, changing job or position, taking on or giving up a leadership position, improving efficiency, and advocating for personal needs. Active personal changes included deliberate changes in mindset, contemplative practices, taking time away, working with a therapist or coach, and prioritizing self-care. Passive work changes occurred independent of action by the individual physician and included new leadership, staffing changes, system-initiated workflow changes, and advances in technology. Passive personal changes were infrequently reported.

Conclusions and Relevance Physicians with large improvements in burnout and professional fulfillment reported specific actions at work or in their personal life that they believed led to this improvement. These findings suggest that both individual- and system-level changes may be necessary to optimize occupational well-being among physicians.

Author/s:

Tait D. Shanafelt, MD, Maryam S. Makowski, PhD, Brook Hale, et al.

Physician burnout in the modern era

Jeffrey Wilson — Mon, 04 Mar 2019 17:37:18 +0000

Date Added:

March 4, 2019

Journal/Publication:

Lancet

Publisher:

Elsevier

Publication Date:

March 2, 2019

Issue:

10174

Volume:

393

Pages:

868-86

URL:

Physician burnout in the modern era

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(19)30399-X

Keywords

burnout

history

MeSH

burnout, professonal

burnout, psychological

This review of the history of medical professional “burnout” is both interesting and informative. I highly recommend it.

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The Library of the Royal College of Surgeons of England is home to a meticulously kept archive of the lives of medical students who attended Sir James Paget's anatomy lectures at St Bartholomew's Hospital in London, UK, between 1839 and 1859. Published in 1869, “What Becomes of Medical Students” is Paget's personal appraisal of his apprentices' achievements, ranging from “distinguished success” to “scandalous misconduct”. Although many went on to differentiate themselves, of the 1226 students under his tutelage, five died by suicide—a rate roughly 25 times higher than the male suicide mortality rate during that period.

Although the knowledge of medicine's heavy toll on its workforce is not new, scant attention has been devoted to this issue historically. But was medicine ignoring an internal crisis? That was the question posed by S Dana Hubbard—the Director of the Bureau of Public Health Education for New York City—in a 1922 letter published in the American Journal of Public Health. Hubbard chronicled the suicide rates of various professions, noting that physicians took their own lives more than twice as often as the next highest field (lawyers). Pointing out that “the occupational strain is greater in medicine than in any of the other professions”, Hubbard insisted that “our scheme of medical practice, as it relates to hours and relief, be revised”. Despite the wide circulation of the letter, few changes materialised.

Author/s:

Marchalik, Daniel