Impact of organizational leadership on physician burnout and satisfaction

Comparison of Burnout and Fulfillment Rates between Physicians in Direct Primary Care and Other Practice Models

OBJECTIVES

Primary care internal medicine and family medicine physicians experience the second and sixth highest rates of burnout among all medical specialties. Direct primary care (DPC) is an understudied model of practice in which physicians are believed to have lower rates of burnout. In this study, we surveyed primary care physicians to assess burnout and fulfillment rates as well as quantify several burnout risk factors in DPC and non-DPC practicing physicians.

METHODS

The Stanford Professional Fulfillment Index was used to measure physician fulfillment and burnout in a select population of currently practicing primary care physicians in the southeastern United States. Physicians were classified by current practice model as DPC or non-DPC (self-identified). Data were analyzed to assess whether any differences existed in physician fulfillment, burnout, and other practice characteristics by medical practice/payment model.

RESULTS

DPC physicians had significantly lower burnout (P = 0.002) and higher fulfillment scores (P = 0.013) compared with non-DPC physicians despite working a similar number of hours per week (P = 0.923). DPC physicians had a higher rate of practice ownership (P < 0.001) and saw a lower number of patients per day (P < 0.001).

CONCLUSIONS

Results show that compared with non-DPC physicians, physicians practicing the DPC model of care experience greater professional fulfillment and lower burnout. Given these significant results and the small sample size of this study, more research is warranted. A larger sample size and additional data collection would increase statistical power to better evaluate clinic and physician characteristics, allow for further exploration of the findings from this study, and increase the generalizability of results.

The Practice: A Leadership-Endorsed Workplace Intervention to Improve Well-being in Healthcare Professionals

BACKGROUND

Highly prevalent and worsened by the COVID-19 pandemic, burnout is associated with more frequent self-reported medical errors, suboptimal patient care, staff attrition, and lower professional fulfillment. There is a growing call for "wellness-centered leaders" who model, integrate, and prioritize well-being within the practice environment.  OBJECTIVE: Having piloted a novel intervention called "The Practice" in one work unit with promising outcomes, we set out to implement and prospectively study the intervention more broadly at our institution.

DESIGN

Departmental leaders were offered an opportunity for their team to participate. Within each interested departmental group, participants were trained in the core components of "The Practice": five daily well-being exercises taking less than 15 min. Biweekly facilitated group meetings to share challenges and successes of doing "The Practice" were integrated into departmental meetings for 3 months. Outcome measures included the WHO-5 Well-being Index, the Wong & Law Emotional Intelligence Scale (WLEIS), and the Professional Fulfillment Index (PFI), completed at baseline and months 3, 6, 9, and 12 after enrollment. Changes over time were analyzed using mixed models. Supplemental experience data were collected from a convenience sample and analyzed using the Framework approach.

PARTICIPANTS

From May 2021 through January 2022, 191 physicians and allied health staff from 14 clinical departments were enrolled. Participants were majority female (84%, n = 161) and White (83.2%, n = 159).

KEY RESULTS

We observed significant improvements in scores from baseline compared to month 3 that were sustained at later time points for WHO-5, WLEIS, and three of four PFI scales (p < 0.05). Experience data reflected feelings of gratitude that the institution was invested in their well-being, "humanization" of leaders, and increased awareness of coworker's feelings.

CONCLUSION

"The Practice" may be an effective, integrated, departmental wellness program by which healthcare organizations can support the well-being of their staff.

Burnout syndrome and healthy lifestyle among Egyptian physicians: A cross-sectional study

INTRODUCTION

The phenomenon of burnout and the lifestyle of physicians significantly influence the delivery of healthcare. Over time, burnout intensifies, negatively impacting professional performance, which in turn leads to decreased quality of treatment, patient satisfaction, and productivity. Additionally, it increases the occurrence of medical mistakes and turnover among physicians. In addition to the direct influence of lifestyle on those components.

AIM OF THE STUDY

The purpose of this study is to assess burnout syndrome among Egyptian physicians, as well as to investigate factors that contribute to burnout, especially demographic characteristics, lifestyle patterns, and health habits.

METHODS

A cross-sectional study examined burnout prevalence and determinants among 502 Egyptian physicians in different governorates. An electronic questionnaire was used to collect data for the study. Questionnaire covered socio-demographics, The abbreviated Maslach Burnout Inventory (aMBI), and The Health Lifestyle and Personal Control Questionnaire (HLPCQ).

RESULTS

Younger physicians under 30 showed higher burnout on emotional exhaustion and depersonalization scales, with significant findings (P = 0.047), (P <  0.01) respectively. Male physicians showed stronger depersonalization than females (P <  0.01). Burnout was higher among residents and fellowship trainees, with significant differences in depersonalization (P = 0.021). PhDs showed decreased burnout with significant outcomes (P = 0.002). Longer-working doctors had increased burnout in depersonalization (P = 0.005). Single doctors were more depersonalized than married ones (P = 0.025). Depersonalization was higher in childless people (P = 0.002). However, non-chronic illness physicians were more emotionally exhausted (P = 0.042).

CONCLUSION

These findings highlight the intricate relationship between burnout and lifestyle among physicians. A healthy lifestyle, including diet, routines, social support, and physical activity was linked to reduced burnout, while dietary harm avoidance was negatively correlated. This suggests opportunities to enhance the well-being of medical professionals through lifestyle interventions.

First Year in a New Leadership Role: Lessons Learned

When discussing leadership, multiple questions arise: what does it mean to be an effective leader?; what are the characteristics of a person that make them so?; and are leaders born, or are they made? Organizations need effective leaders at all levels, especially in the constant and rapidly changing landscape that is healthcare provision. Those in senior leadership roles should encourage junior team members to engage in leadership activities appropriate to their level of comfort and expertise. Integrity and principle are also essential leadership characteristics, particularly when faced with making decisions that are difficult, or considered to be "unpopular." Organizations that wish to develop and maintain effective leadership programs must ensure that they balance the needs of the organization with those of the leaders. Adequate space must be made to facilitate leadership activities as well as personal, academic, and clinical duties. Ultimately, leadership takes practice and persistence on the part of the leader themselves, but also on the part of the organization in which they work.

Causes of Moral Distress in Academic Radiologists: Variation Among Institutions

PURPOSE

To assess whether causes of moral distress vary by academic institution. Moral distress is experienced when health care providers are unable to provide the right care to patients because of institutional or resource constraints.

MATERIALS AND METHODS

A survey was performed based on Moral Distress Scale-Revised for Health Care Professionals for 16 clinical scenarios assessing frequency and severity of moral distress among academic radiologists. The survey was sent to members of the RSNA Quality Improvement Committee for distribution to their department. Measure of Moral Distress for Health Care Professionals (MMD-HP) was calculated for individuals and moral distress index for clinical scenarios. MMD-HP were compared by sex, ethnicity, age, years of practice, weekly work hours, practice setting or type, and consideration of leaving the workplace. Statistical analysis was performed using Kruskal-Wallis test and Kendall ordinal correlation.

RESULTS

In all, 126 respondents from five institutions from five different states were included in the analysis. MMD-HP ranged from 24 to 66 (maximum 266). Median MMD-HP was higher in radiologists working >60 hours per week (59 versus 32.5, P = .048). Radiologists across institutions consistently reported four main sources of moral distress: pressure to perform unsafe numbers of studies (108 of 126, 85%), high workloads impeding resident teaching (102 of 126, 81%), lack of administrative support for patient care issues (102 of 126, 81%), and pressure to conduct unnecessary imaging (111 of 126, 88%). Higher MMD-HPs correlated significantly with job turnover intentions or past job changes (P < .001). The average percentage of radiologists with an intention to leave or having left as position was 44% with a range of 26% to 84%.

CONCLUSION

Moral distress is pervasive in radiology, with four primary causes consistently identified across academic institutions. Strong association between higher moral distress levels and job turnover intentions highlights its impact on workforce retention.

Physician burn-out, transformational and servant leadership

BACKGROUND

Physician burn-out was associated negatively with physicians' health, patient outcomes and healthcare system performance. Reducing physician burn-out may potentially benefit physicians and patients, improve healthcare performance and reduce societal healthcare costs.

AIM

The purpose of this study was to clarify the relationship between transformational and servant leadership behaviours and physician burn-out.

METHODS

A cross-sectional, non-experimental quantitative correlation study was conducted using scores on the Maslach Burnout Inventory, Global Transformational Leadership Scale and Servant Leadership Behaviour Scale-6-item Short Form. The data were obtained by an online survey of physicians working at a metropolitan hospital in Australia.

RESULTS

82 physicians participated in the study. The result showed significant correlations between transformational and servant leadership and lower physician burn-out, particularly in supporting fellow physicians' personal accomplishments, a burn-out construct (Pearson r=0.42 and 0.32, respectively). Among the constructs of transformational leadership, leaders who are clear about their values and demonstrate them in their actions correlate strongly with the constructs of burn-out. In servant leadership behaviours, helping subordinates generate meaning out of everyday work was the most influential factor in fellow physicians' burn-out. The finding may be related to the effects of observing the positive values and actions of their supervisor and the physicians' own understanding of the value of their work.

CONCLUSIONS

A positive role model and the meaning of everyday work could be protective against physician burn-out. Positive role modelling and mentorship may be relevant in physician supervisor training. Encouraging physicians to discover meaning from their everyday work may help to promote physician well-being.

Intent to Leave Associated More Strongly with Workplace Belonging Than Leadership Behaviors of Supervisor in Women Health Care Professionals

Background: The attrition of health care professionals from institutions has historically been high, with reports of higher rates in women than men. High attrition jeopardizes the institution's financial stability, quality of patient care, and scholarly contributions to advancing health care. The disproportionate loss of women reduces the diversity of perspectives and skills needed to meet patient needs. Attrition risk has been demonstrated to relate to both the leadership behaviors of supervisors and the sense of belonging in the workplace. Toward informing health care institutions about strategies for curtailing high attrition, we sought to assess the relative strength of the association of attrition risk with leadership behaviors of supervisors versus workplace belonging. Methods: Attendees of a continuing education course on women's leadership skills in health care were surveyed about the intent to leave (ITL) their institution within 2 years, perceived leadership behaviors of their supervisor, and experiences of workplace belonging. Dimensions of workplace belonging were identified by factor analysis. The strength of association of ITL with supervisor's leadership behaviors and each workplace belonging dimension was analyzed in a multivariable ordinal logistic regression model. Results: Women comprised 94% of survey participants. In the regression analysis, lower ITL was associated strongly with more frequent experiences of institutional culture supporting workplace belonging, modestly with more favorable perceptions of supervisor's leadership behaviors, and not with frequency of experiences of interpersonal relationships supporting workplace belonging. Conclusions: An institutional culture that supports workplace belonging is particularly important for reducing attrition risk in health care professionals. For health care institutions seeking to improve retention of its professionals and women in particular, our findings point to investing in a culture of workplace belonging that involves a diverse workforce, an environment in which its professionals feel heard, supported, and empowered and are provided strong career advancement opportunities.

Voices of Frontline Leaders: Challenges and Opportunities from Frontline Primary Care Clinic Leaders in a Safety-Net Health Care System

BACKGROUND

Burnout, disengagement, and turnover among clinicians is a major challenge for the US health care industry. Research has shown that higher direct supervisor leadership scores correlate with decreased provider burnout and increased professional fulfillment. Safety-net health systems such as Federally Qualified Health Centers (FQHCs) face increased challenges due to limited financial resources, more complex social determinants of health among patients, and often fewer physician leaders who can serve as mentors compared to large, integrated health systems.

METHODS

The authors interviewed frontline physician leaders of primary care clinics in a large, urban FQHC network regarding their approach to leadership, prior training and support, opinions related to provider burnout, and ideas for improvement. Qualitative data analysis was completed using the Immersion-Crystallization method, reaching theme saturation.

RESULTS

Key themes were structure of leaders' roles, challenges in daily leadership that outstripped time set aside for leadership activities, and the nature of and response to team members' burnout. Leaders found their roles meaningful and viewed themselves as a bridge between institutional decisions and frontline providers. Longer duration in leadership roles, formal and informal mentoring, and networks of support were related to increased confidence. Variation existed in the amount and perceived value of leadership training, development, and support. Physician leaders emphasized the importance of a high-functioning clinic leadership team and expressed frustration with a lack of connection to institutional decision-making. Leaders were empathetic to the drivers of burnout among their teams and strove to assist individual providers while facing challenges from structural causes of burnout.

CONCLUSION

Frontline leaders in safety-net clinics play a powerful role in the well-being and resilience of their provider care teams and typically are highly engaged despite facing significant barriers to success. Investing in development and formal support for frontline physician leaders in primary care safety-net settings is important to ensure their longevity and a resilient provider workforce.

Internalized Shame Experiences and Burnout in General Surgery Residents

OBJECTIVE

General surgery residents have high rates of professional burnout, characterized by depersonalization, emotional exhaustion, and reduced sense of personal accomplishment. While shame experiences in surgical residency have been sparsely studied, there are no studies evaluating internalized shame states in surgical residents. This study quantifies internalized shame in surgical residents and its association with burnout. We hypothesized that higher levels of internalized shame would be associated with higher odds of burnout.

DESIGN

This cross-sectional study was conducted via an anonymous survey consisting of demographic information, the Maslach Burnout Inventory (MBI), and the Experience of Shame Scale (ESS), both validated measures. Multivariable logistic regression was used to determine the association between ESS and MBI scores, controlling for age, sex, relationship and parental status, and resident seniority level.

SETTING

The survey was distributed among United States general surgery residency programs via email through the Association of Program Directors in Surgery.

PARTICIPANTS

Categorical general surgery residents were invited to participate.

RESULTS

122 general surgery residents responded to the survey. Respondents were 61.48% female (n = 75), with a median age of 31 (IQR 29-32) and distributed across postgraduate years. On multivariable logistic regression, increased ESS scores were significantly associated with higher odds of burnout (OR 1.11, 95% CI 1.06-1.16, p < 0.001).

CONCLUSIONS

General surgery residents experience high rates of internalized shame (median ESS score 54.5, IQR 43-69), and shame states are significantly associated with increased odds of experiencing burnout. Interventions to minimize internalized shame experiences may help mitigate the high rates of burnout found in general surgery residents.

What's in a leader? Association of perceived leadership effectiveness and psychological safety among clinical physician faculty

OBJECTIVE

To identify leadership qualities associated with psychological safety among physician faculty in a large medical centre in New York City.

PATIENTS AND METHODS

An anonymous, institution-wide cross-sectional survey was sent to all physician faculty with clinical responsibilities between July and September 2022. Demographic and occupational characteristics were assessed. Perceived leadership effectiveness was measured with the nine-item Mayo Leadership Index and psychological safety was measured using the seven-item Fearless Organisation Questionnaire. Multivariable logistic regression analyses were conducted to determine associations between leadership, psychological safety, and demographic and occupational correlates of psychological safety.

RESULTS

Of 3086 eligible clinical faculty members, 867 (28.1%) physicians with clinical responsibilities participated. On average, 57.6% of physicians reported that their workplace was psychologically safe and the majority agreed with items on the Mayo Leadership Index (60.0%-84.5%), the most prevalent being 'treats me with respect and dignity,' 'employs me to do my job' and 'encourages employees to suggest ideas for improvement.' In a multivariable model, higher overall leadership index scores were positively associated with psychological safety scores.

CONCLUSIONS

Greater perceived leadership effectiveness was positively associated with psychological safety among clinical physician faculty at a large, urban hospital. These results suggest that organisational investment in promoting leadership effectiveness may have positive downstream effects on healthcare delivery, burn-out and attrition rates.

Leadership development as a novel strategy to mitigate burnout among female physicians

BACKGROUND

Female physicians are more likely to experience burnout and less likely to hold leadership positions. Effective interventions are needed to support women physicians in the workforce.

OBJECTIVE

To determine if a shared learning, social-based leadership development program will impact burnout and career trajectory for female physicians.

DESIGN

Cohort study.

SETTING

Multispecialty healthcare system and state medical society members.

PARTICIPANTS

Burnout and Engagement surveys were emailed to 5000 physicians within the Baylor Scott & White Health System (BSWH). The external control group consisted of 516 female physicians within the Texas Medical Association (TMA) and not associated with BSWH. Internal controls included both male (670) and female physicians (240) who did not participate in the program.

INTERVENTION

The Women Leaders in Medicine (WLiM) program included twice-annual in person summits and support programs throughout the 2-year study period.

MEASUREMENTS

The Maslach Burnout Index (MBI) was utilized to evaluate burnout. Surveys were conducted at three separate points and included interest in leadership, intent to retain current employment, and open comments.

RESULTS

Participants in WLiM had decreased frequency of high emotional exhaustion (mean 2.9 decreased to 2.5), decreased occurrence of high depersonalization (mean 1.6 decreased to 1.3), and improved levels of personal accomplishment (mean 4.7 improved to 5.1) and leadership aspiration (mean 7.4 to 7.8). Intention to stay went from 4.0 to 4.1.

CONCLUSIONS

Burnout can be improved, and leadership aspirations fostered with a group leadership development in a cohort of female physicians.

Association of gender-based discrimination and burnout among faculty in an urban academic medical center

BackgroundBurnout in physician and scientist faculty threatens professional satisfaction, mental health, and work quality while impacting women more than men. Women experience gender mistreatment more often than men, which may impact burnout.ObjectiveTo determine the differences in burnout, discrimination and harassment by gender, and whether these variables were associated with burnout in physician and scientist faculty.MethodsAn anonymous cross-sectional survey from November 2018 through February 2019 was conducted in physician and scientist faculty at a large urban hospital. Survey instruments included MaslachBurnout Inventory-2, gender-based discrimination and harassment questions, and demographic and professional characteristics.ResultsOf 4156 faculty, 1497 (36%) provided gender identification and were included in analyses. Women experienced burnout at higher rates than men (30.9% vs. 23.3%, p = 0.002). Women also experienced gender discrimination and gender harassment at 11 (25.0% vs 2.3%, p < 0.001) and 5.7 (13.0% vs 2.3%, p < 0.001) times the rate of men, respectively. In a multivariable analysis, gender-based discrimination and harassment was associated with burnout among women (OR 1.65, p = 0.035) and overall (OR 1.65, p = 0.017), but not among men. In men, those aged 40-60 experienced increased burnout compared to those aged >60 (OR 2.67, p = 0.017). For all participants, burnout was associated with depression symptoms, poor work life integration, and lower leadership scores.ConclusionBurnout is prevalent in both men and women physicians and scientists, but correlates vary by gender. Findings suggest that interventions to reduce burnout should account for gender differences, target leadership behaviors and address gender bias and mistreatment.

Resilience Differences Among Health Professionals: Examining the Impact of Body Image Appreciation

INTRODUCTION

Body image (BI) is a determinant of mental health and has a strong association with self-esteem and self-worth, core elements of resilience. The relationship between BI appreciation and resilience in health professionals (HPs) remains largely unexplored.

AIM

The aim of the study was to compare HPs' resilience and determine the relationship of resilience with BI appreciation.

METHODS

A cross-sectional comparative study was conducted using an online questionnaire that was completed by 484 HPs that included a) demographic and occupational characteristics, b) the Body Appreciation Scale-2 (BAS-2), and c) the Connor-Davidson Resilience Scale (CD-RISC-10). Data was collected between January and March 2024.

RESULTS

Nurses reported significantly higher BI (3.96 ± 0.60 vs. 3.45 ± 0.73, p < 0.001) and resilience (3.25 ± 0.64 vs. 2.98 ± 0.55, p < 0.001) compared to physicians. Multiple regression analysis identified BI as a strong positive predictor of resilience for both nurses and physicians (p < 0.001). Nurses' resilience was also positively associated with increased working experience (p = 0.001) and negatively with the managerial position (p < 0.001) and higher level of education (p = 0.003). Physicians' resilience was also positively linked to cohabitation (p = 0.001) and the existence of children (p = 0.006) while negatively associated with working in internal departments (p = 0.001).

CONCLUSIONS

BI appreciation appears to play a significant role in HPs' resilience, while professional and personal factors influence each group differently. Interventions targeting in enhancing BI appreciation among HPs are suggested.

Physician Burnout: The Making of a Crisis

This essay places contemporary efforts to understand and respond to the crisis of physician burnout in historical perspective, proposing that the origins of such efforts lie in nineteenth century concerns over "nervous exhaustion," well before the term "physician burnout" was coined by social scientists in the early 1970s. Only very recently, however, have physician-scholars started to bring more sophisticated tools to bear in conceptualizing the problem, moving from a "systems approach" to the most recent efforts to frame the issue as a problem of corporate culture. The essay proposes that these different approaches to physician burnout illustrate the changing self-images of the medical profession over the last century and a half. Because such self-images are embedded in normative assumptions, contextualizing physician burnout in these terms reveals the crisis to be as much social and political as professional.

Needs, rationale, and outcomes of leadership education in neurosurgery

BACKGROUND

Surgeons are expected to lead teams/organizations to achieve optimal patient outcomes; however, few receive formal education in leadership. The goals of the study were to: 1) assess the unmet needs and gaps in leadership education for neurosurgeons and residents/fellows; 2) identify factors associated with availability of leadership education, access to leadership positions and the similarities/differences across geographic regions and institutional type; 3) describe the associations between gender and leadership; 4) determine the impact of leadership education.

METHODS

International survey of 657 neurosurgeons, residents/fellows. A series of univariate analysis and multivariate were conducted to assess the association between specific variables and leadership outcomes.

RESULTS

Almost half (48%) indicated that leadership education did not exist in their organization. This lack was more notable in non-academic centers (p < 0.001), among neurosurgeons with less than 5 years of work experience (p = 0.03), and respondents from South America (p = 0.02). Nearly two-thirds (61.1%) reported never having leadership training. Significantly fewer respondents in the age range 35-44 years old (p = 0.02), those working in the Middle East (p = 0.02), neurosurgeons with work experience less than 5 years (p = 0.004), working in non-academic center (p = 0.02) attended leadership training. In contrast to the differences seen across geographic regions and types of institutions, overall, the proportions of males and females having access to leadership training and being offered leadership positions were similar. Among participants, 87.1% of those with leadership training were offered leadership roles, compared to 65.5% of those without leadership training (p <  0.001). Additionally, participants with leadership training experienced a burnout rate of 29.2%, whereas those without leadership training had a higher rate of burnout of 40.5% (p =  0.02).

CONCLUSIONS

There is a pressing need to develop educational opportunities for leadership in neurosurgery, especially for younger neurosurgeons, neurosurgeons working in non-academic centers, in countries and non-academic institutions where leadership education is less accessible. Leadership education is associated with increased numbers of neurosurgical leaders at all levels as well as reduced levels of burnout.

Physician Leadership and Its Effect on Physician Burnout and Satisfaction During the COVID-19 Pandemic

Purpose

Physician burnout is a global issue associated with low job satisfaction, decreased quality of patient care, reduced productivity, and early retirement from clinical practice. We sought to evaluate the impact of the leadership qualities of direct physician supervisors on the burnout and professional satisfaction of the physicians they supervise.

Methods

An online survey was distributed by Email to all staff physicians practicing at a large Canadian academic tertiary care hospital. The primary outcome was the prevalence of burnout and professional satisfaction, assessed using the 2-item Maslach Burnout Inventory and a single item 5-point Likert scale rating, respectively. The secondary outcome was the relationship between composite leadership score and burnout/satisfaction, with leadership assessed by the 12-item Mayo Clinic Participatory Management Leadership Index.

Results

Out of the 1176 physicians surveyed, 383 (32.6%) responded (51.2% male; 41.5% female). Overall, 41.7% of physicians reported at least one symptom of burnout (40.0% reported high emotional exhaustion; 15.3% reported high depersonalization). 40.1% of physicians reported being satisfied with the organization, 26.3% were neutral, and 33.6% were dissatisfied. On multivariate analysis adjusting for age, sex, duration of employment at the institution, and specialty, each one-point increase in composite leadership score was associated with a 3.1% decrease in the likelihood of burnout (p = 0.0017), and a 6.6% increase in the likelihood of satisfaction (p < 0.0001).

Conclusion

Physician burnout is prevalent and positive leadership qualities of direct supervisors decreases the likelihood of burnout in physicians and increases the likelihood of their satisfaction with the organization.

Trial Registration

ClinicalTrials.gov; Identifier: NCT04896307.

Not all call is created equally: The impact of culture and sex on burnout related to in-house call

BACKGROUND

In-house call (IHC) has previously been shown to result in increased burnout in acute care surgeons (ACSs). There is wide variation, however, in the implementation and culture of work surrounding IHC across trauma centers and within the demographics of practicing ACSs. We hypothesized that local work practices and culture surrounding IHC as well as sex of ACSs would impact burnout.

METHODS

Continuous physiologic data were collected over 6 months from 224 ACSs who wore a fitness wearable. Acute care surgeons were sent daily surveys to record work, personal activities, and feelings of burnout. The Maslach Burnout Inventory was completed by ACSs at the beginning and end of the study period.

RESULTS

Forty-eight (21.5%) of ACS reported being expected to complete the usual workday after IHC, 94 (42.2%) were expected to finish work from IHC, and 81 (36.3%) were expected to leave immediately after IHC was over. Acute care surgeons expected to complete a usual workday postcall were more likely to be burned out, and IHC resulted in a greater increase in their daily feelings of burnout than among ACSs who reported working in other work cultures. Females showed higher levels of daily burnout than males but no difference in the degree to which IHC led to burnout.

CONCLUSION

In-house call results in increased burnout in all ACSs; however, IHC had a larger impact on daily feelings of burnout in ACSs expected to work without adjustments to their work schedule postcall. Although female ACSs reported higher levels of daily burnout than male ACSs, IHC increased daily feelings of burnout equally between the two sexes. Taken together, these findings necessitate caution about work expectations surrounding IHC and suggest a need for the deliberate creation of a postcall culture for ACS.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.

Exploring the Relationship Between Clinical Supervision and Well-Being in the Otolaryngology Residency Board in Saudi Arabia

Background/ Objectives: Surgical residency is widely recognized as a highly stressful phase due to long working hours and the challenges of managing complex cases. Additionally, family responsibilities, such as being a spouse or parent, can have a positive or negative impact on residents' well-being. This study aimed to explore the relationship between clinical supervision and mental well-being among otolaryngology residents in Saudi Arabia, focusing on how supervision conditions influence well-being at different stages of training.

METHODS

This was an analytical cross-sectional correlational study conducted among Saudi otolaryngology head and neck surgery residents. An online survey was used to collect data from 64 residents, utilizing the Dutch Residents Educational Climate Test (D-RECT) to assess clinical supervision and the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) to measure well-being. The data were analyzed to determine the association between supervision conditions and well-being across different residency levels.

RESULTS

The results showed that the majority of residents reported higher mean scores for items such as "I've been feeling useful" (3.53 ± 1.23), "I've been feeling interested in new things" (3.28 ± 1.13), and "I've been dealing with problems well" (3.27 ± 1.10). No statistically significant difference in overall WEMWBS scores was found between junior and senior residents. However, mental well-being was significantly associated with all four D-RECT domains (supervision, feedback, coaching assessment, and consultant attitude), with a positive correlation observed between clinical supervision and well-being.

CONCLUSIONS

This study highlights the critical role of clinical supervision in supporting the mental well-being of otolaryngology residents. Enhanced supervision practices, particularly those emphasizing constructive feedback and supportive consultant attitudes, could mitigate burnout and improve resident outcomes. These findings underscore the need for targeted interventions in residency programs to promote well-being and optimize the learning environment.

Challenges and opportunities in pediatric surgery training in Germany: a view from the trenches

INTRODUCTION

Pediatric surgery training in Germany faces significant challenges related to structural issues and resource limitations, including variability in training sites and a lack of standardized oversight. This study aims to assess the current state of pediatric surgery training including its structure, quality, and resident satisfaction and identify areas for improvement.

MATERIALS AND METHODS

We conducted an online survey between May 2022 and November 2023 using single-choice, multiple-choice and open-ended questions. Additionally, information was gathered via analysis of available statistics and through direct contact with the State Chambers of Physicians.

RESULTS

75 pediatric surgery residents and 15 young specialists participated in the survey. 12 of 17 state medical chambers responded to our inquiry, but only 4 maintain detailed statistics. Training often extends beyond the planned six years, mainly (75%) due to insufficient surgical exposure. Residents reported a predominant role of attendings in surgical training and other residents in clinical training. They desired more involvement from chiefs in their education. A significant proportion (58.9%) noted a lack of dedicated scientific education. Nearly half (44.4%) of the respondents had changed training sites, primarily due to clinical rotations (26,7%) and dissatisfaction with training conditions (30,0%).

CONCLUSION

Pediatric surgery residents in Germany face inconsistent training quality and extended training periods, mainly due to insufficient surgical exposure. They report that some chiefs do not meet their obligations as trainers adequately. To address these issues, there is a need for enhanced oversight, standardized curricula, more surgical exposure and improved collaboration among training institutions.

Association of Psychological Safety with Burnout and Intent to Leave Among Physician Faculty in New York City

BACKGROUND

Data on the potential protective effect of psychological safety (PS) on well-being and satisfaction among physicians are lacking.

OBJECTIVE

We sought to examine (1) prevalence of PS; (2) relationship between PS, burnout, and intent to leave one's job (ILJ); and (3) demographic and occupational factors associated with PS within our physician faculty.

DESIGN

Participants: An institution-wide survey was sent to all faculty within our eight-hospital health system, between July and September 2022.

MAIN MEASURES

PS was assessed using the seven-item Fearless Organization Questionnaire and burnout with the Maslach Burnout Inventory-2. Demographics and a measure of ILJ were assessed. Multivariable logistic regression analyses were conducted to determine associations between PS, burnout, ILJ, and demographic and occupational correlates of PS.

KEY RESULTS

A total of 867 out of 3086 total estimated clinical faculty members (28.1%) participated in the survey. The majority were 40 and older (67.4%), female (51.9%), white (60.0%), and married/partnered (80.4%); worked in ambulatory care departments (53.7%); and ranked assistant or associate professors (75.8%). On average, 57.6% of physicians evaluated their workplace as psychologically safe (range across items = 40.9-69.9%), with 35.2% screening positive for burnout and 13.4% reporting ILJ. After adjusting for demographic and occupational characteristics, each standard deviation unit increase in PS scores was associated with 27% lower odds of screening positive for burnout (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.63-0.84) and 38% lower odds of ILJ (OR = 0.62, 95% CI = 0.52-0.74). Female gender was associated with lower scores of PS.

CONCLUSIONS

A majority of faculty physicians reported working in a psychologically safe environment. Greater PS was associated with lower odds of burnout and ILJ. Investment in gender and diversity equity training may be one concrete step in advancing PS in the workplace.

Curriculum mapping to audit and grow longitudinal graduate medical education leadership training

BACKGROUND

Residents need and want practical leadership training, yet leadership curricula are lacking in graduate medical education (GME). We describe our process of curriculum mapping, a method for auditing a curriculum, and its role in iterative leadership curriculum development.

AIMS

To show how to create a curriculum map for auditing a curriculum using examples from our leadership curriculum and to demonstrate its value through case examples of leadership education integration into existing resident experiences.

METHODS

We selected our recent systematic review on current leadership curricula to prioritise leadership content given it was the basis for our initial curriculum. We identified existing resident experiences where training can occur. We use the selected content and training environments, layered with a modified Miller's pyramid, to construct a curriculum map.

RESULTS

Our curriculum map provides an example of curriculum auditing that reveals opportunities for leadership training that could be integrated into current residency experiences. We provide case examples of application.

DISCUSSION

Effective leadership training should address critical topics and capitalise on experiential learning opportunities that exist within residency training programmes. The training must be seamlessly integrated into the demanding obligations of GME trainees, a process that can be achieved using curriculum mapping. Curriculum mapping can provide insight into a residency programme's leadership curriculum and create a direction for future leadership curriculum development.

Putting Traits Associated with Effective Medical Leadership into Action: Support for a Faculty Development Strategy

Leadership development is essential to the well-being of medical organizations, but leadership concepts do not easily translate into skills or actions. The Mayo Leadership Behavior Index© (Leader Index), a validated instrument describing eight leadership traits associated with constituent well-being, can serve as a guide. The authors analyzed narratives from a qualitative study of senior medical leaders describing successful leadership behaviors to see how the tenets of the Leader Index can be applied. Current/emeritus chairs of major academic departments/divisions from a single institution were asked to describe anecdotes of actions used by leaders in actual settings. Narratives from interviews were analyzed for behaviors that map to the eight traits in the Leader Index. Eleven senior leaders volunteered multiple scenarios of effective and ineffective leadership with illustrative examples. The behaviors they identified mapped to all eight traits of the Leader Index, specifically career conversations, empowerment to do the job, encouragement of ideas, treatment with respect and dignity, provision of job performance feedback and coaching, recognition of well-done work, information about organizational changes, and development of talents and skills. These findings provide faculty development experts and psychologists tangible behaviors and actions they can teach to enhance leadership skills.

Leaders' Perspectives on Approaches and Challenges in Enacting Faculty Vitality in the Contemporary Landscape of Academic Medicine: A Deductive Thematic Analysis

Continual changes in organizational structures within medical schools have contributed to the expanded scope and the centralization of faculty affairs offices, which support faculty administration and supportive functions. Using qualitative interviews, we investigated the perspectives of academic medicine faculty affairs leaders regarding their offices' priorities in sustaining faculty vitality in the face of current and anticipated challenges. A semi-structured interview protocol based on the researchers' practical knowledge, informed by the study's research inquiries, and pertinent academic literature guided the interviews. Deductive thematic analysis approach was used to identify the patterns and themes across the interviews. Our analysis revealed a central theme: the pivotal nature of the leader's role in strengthening faculty identity. Additionally, three sub-themes emerged concerning the leader's role in nurturing faculty well-being within today's academic medicine context: redefining faculty role, acknowledging and appreciating faculty contributions, and maintaining faculty engagement through a whole-person approach. Faculty affairs leaders describe widening roles with an emerging focus on a whole-person approach valuing the diverse contributions of faculty across the academic mission, supporting professional development, reflecting the individual motivations of faculty, and championing institutional processes that holistically evaluate and recognize faculty contributions.

Coaching Program to Address Burnout, Well-being, and Professional Development in Pediatric Surgery Trainees: A Randomized Controlled Trial

OBJECTIVE

To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being.

BACKGROUND

Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being.

METHODS

With IRB approval, a coaching program was implemented during the COVID-19 pandemic (September 2020 to July 2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed prestudy and poststudy surveys containing validated measures, including positive emotion, engagement, relationships, meaning, accomplishment, professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, or χ 2 test.

RESULTS

Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), and 65% were first-year fellows. Coached trainees showed an improved change in positive emotion, engagement, relationships, meaning, accomplishment ( P =0.034), burnout ( P =0.024), and gratitude ( P =0.03) scores from precoaching to postcoaching compared with noncoached trainees. Coping skills also improved. More coaching sessions were associated with higher self-valuation scores ( P =0.042), and more opportunities to reflect were associated with improved burnout and self-valuation.

CONCLUSIONS

Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefits in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support the acquisition of coping skills that help trainees cope with the stressors they will face during their careers.

Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment

BACKGROUND

The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.

OBJECTIVES

(1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.

METHODS

We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors' knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.

RESULTS

The key moments where participants felt they needed the most support were "treatment", "report of findings", "informed consent", "physical examination", and "before the appointment". All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.

CONCLUSION

Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.

The Impact of Leadership Training on Burnout and Fulfillment Among Direct Reports

GOAL

Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports' perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports.

METHODS

We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment.

PRINCIPAL FINDINGS

Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports).

PRACTICAL APPLICATIONS

The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

Psychosocial work environment in Swedish primary healthcare: a cross-sectional survey of physicians' job satisfaction, turnover intention, social support, leadership climate and change fatigue

BACKGROUND

Primary healthcare, the first line of care in many countries, treats patients with diverse health problems. High workload, time pressure, poor job control and negative interpersonal experiences with supervisors have been documented in primary healthcare. The work environment in primary healthcare is also affected by several types of changes.

AIM

We aimed to explore the levels of job satisfaction, turnover intention, social support, leadership climate and change fatigue according to physicians in Swedish primary healthcare. We also aimed to identify and characterize physicians exhibiting both high turnover intention and low job satisfaction, i.e., "discontent with current job".

METHODS

A cross-sectional survey based on a random sample of physicians working in Swedish primary healthcare.

RESULTS

Approximately one-quarter of the respondents were discontented with their current job. Discontent was negatively associated with poor general health and change fatigue among the respondents; social support from colleagues and a favorable leadership climate showed positive associations in terms of reducing the levels of discontent with current job.

CONCLUSIONS

The findings of this study highlight the association between low levels of job satisfaction and high levels of turnover intention (i.e., discontent with current job) among physicians in primary healthcare. Moreover, these variables exhibited a strong association with physicians' general health; poor health significantly increased the likelihood of discontent with current job. Our findings also show that experiencing change fatigue is associated with discontent with current job among physicians in primary healthcare. This knowledge can help identify and improve shortcomings within the psychosocial work environment in Swedish primary healthcare.

Suicidal ideation among non-physician hospital system staff: Prevalence and workplace correlates

BACKGROUND

Research suggests that healthcare workers are at greater risk for suicide than other occupations, but most published studies focus on physicians. This study examines the prevalence of suicidal ideation (SI) and associated occupational factors among a broad group of non-physician healthcare staff.

METHODS

An anonymous online survey was sent to a random sample of 30 % of non-physician healthcare staff at a large urban healthcare system between September and November 2022. Weighted multivariable binary logistic regressions were conducted to determine the workplace and mental health factors associated with SI.

RESULTS

The 1084 respondents included nurses, administrative staff, research staff, medical assistants, nurse practitioners, physician assistants, and other roles. Of the sample, 8.8 % endorsed having SI over the prior two weeks. Results of the regression indicated that, after adjusting for demographic factors, greater odds of SI were associated with physical violence experienced from a patient or visitor (odds ratio [OR] = 2.15, 95 % confidence interval [CI] = 1.06-4.37), lower perceived leadership support (OR = 0.95, 95 % CI = 0.92-0.98), and positive screening for depression (OR = 4.66, 95 % CI = 2.45-8.86). Exploratory analysis suggests that depression may be a mediating factor between workplace stressors and SI.

LIMITATIONS

Limitations include the response rate, the use of a single item to assess SI, and the cross-sectional design.

CONCLUSION

Findings suggest that workplace violence and leadership support are important occupational factors associated with SI among healthcare workers. Reducing and mitigating workplace violence, enhancing leadership support, and improving access to mental health care should be considered targets for interventions to decrease suicide risk in this population.

"For the first time…I am seriously fighting burnout": clinician experiences with a challenging electronic health record transition

Objectives

The Department of Veterans Affairs (VA) is transitioning from its legacy electronic health record (EHR) to a new commercial EHR in a nationwide, rolling-wave transition. We evaluated clinician and staff experiences to identify strategies to improve future EHR rollouts.

Materials and Methods

We completed a convergent mixed-methods formative evaluation collecting survey and interview data to measure and describe clinician and staff experiences. Survey responses were analyzed using descriptive statistics; interview transcripts were coded using a combination of a priori and emergent codes followed by qualitative content analysis. Qualitative and quantitative findings were compared to provide a more comprehensive understanding of participant experience. Employees of specialty and primary care teams at the first nationwide EHR transition site agreed to participate in our study. We distributed surveys at 1-month pre-transition, 2 months post-transition, and 10 months post-transition to each of the 68 identified team members and completed longitudinal interviews with 30 of these individuals totaling 122 semi-structured interviews.

Results

Interview participants reported profoundly disruptive experiences during the EHR transition that persisted at 1-year post implementation. Survey responses indicated training difficulties throughout the transition, and sharp declines (P ≤ .05) between pre- and post-go-live measures of EHR usability and increase in EHR burden that were perceived to be due in part to system inefficiencies, discordant positive messaging that initially ignored user challenges, and inadequate support for and attention to ongoing EHR issues. Participants described persistent high levels of stress associated with these disruptions.

Discussion

Our findings highlight strategies to improve employee experiences during EHR transitions: (1) working with Oracle Cerner to resolve known issues and improve usability; (2) role-based training with opportunities for self-directed learning; (3) peer-led support systems and timely feedback on issues; (4) messaging that responds to challenges and successes; and (5) continuous efforts to support staff with issues and address clinician and staff stress and burnout.

Conclusion

Our findings provide relevant strategies to navigate future EHR transitions while supporting clinical teams.

Eight Domains of Pediatrician Wellness: A Stakeholder Informed Model

BACKGROUND

Physician wellness is important to health care systems and quality patient care. There has been limited research clarifying the physician wellness construct. We aimed to develop a stakeholder-informed model of pediatrician wellness.

METHODS

We performed a group concept mapping (GCM) study to create a model of pediatrician wellness. We followed the four main steps of GCM and recruited pediatricians at multiple sites and on social media. During brainstorming, pediatricians individually responded to a prompt to generate ideas describing the concept of pediatrician wellness. Second, pediatricians sorted the list of brainstormed ideas into conceptually similar groups and rated them on importance. Sorted data were analyzed to create maps showing each idea as a point, with lines around groups of points to create clusters of wellness. Mean importance scores for each cluster were calculated and compared using pattern match.

RESULTS

Pediatricians in this study identified eight clusters of wellness: 1) Experiencing belonging and support at work, 2) Alignment in my purpose, my work, and my legacy, 3) Feelings of confidence and fulfillment at work, 4) Skills and mindset for emotional well-being, 5) Harmony in personal, professional, and community life, 6) Time and resources to support holistic sense of self, 7) Work boundaries and flexibility, and 8) Organizational culture of inclusion and trust. There were no significant differences in mean cluster rating score; the highest rated cluster was Harmony in personal, professional and community life (3.62).

CONCLUSION

Pediatricians identified eight domains of wellness, spanning professional and personal life, work, and individual factors.

Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout

OBJECTIVES

Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths.

METHODS

In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead".

RESULTS

Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians.

CONCLUSION

A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.

Associations Between Organizational Support, Burnout, and Professional Fulfillment Among US Physicians During the First Year of the COVID-19 Pandemic

GOAL

This research aimed to evaluate variations in perceived organizational support among physicians during the first year of the COVID-19 pandemic and the associations between perceived organizational support, physician burnout, and professional fulfillment.

METHODS

Between November 20, 2020, and March 23, 2021, 1,162 of 3,671 physicians (31.7%) responded to the study survey by mail, and 6,348 of 90,000 (7.1%) responded to an online version. Burnout was assessed using the Maslach Burnout Inventory, and perceived organizational support was assessed by questions developed and previously tested by the Stanford Medicine WellMD Center. Professional fulfillment was measured using the Stanford Professional Fulfillment Index.

PRINCIPAL FINDINGS

Responses to organizational support questions were received from 5,933 physicians. The mean organizational support score (OSS) for male physicians was higher than the mean OSS for female physicians (5.99 vs. 5.41, respectively, on a 0-10 scale, higher score favorable; p < .001). On multivariable analysis controlling for demographic and professional factors, female physicians (odds ratio [OR] 0.66; 95% CI: 0.55-0.78) and physicians with children under 18 years of age (OR 0.72; 95% CI: 0.56-0.91) had lower odds of an OSS in the top quartile (i.e., a high OSS score). Specialty was also associated with perceived OSS in mean-variance analysis, with some specialties (e.g., pathology and dermatology) more likely to perceive significant organizational support relative to the reference specialty (i.e., internal medicine subspecialty) and others (e.g., anesthesiology and emergency medicine) less likely to perceive support. Physicians who worked more hours per week (OR for each additional hour/week 0.99; 95% CI: 0.99-1.00) were less likely to have an OSS in the top quartile. On multivariable analysis, adjusting for personal and professional factors, each one-point increase in OSS was associated with 21% lower odds of burnout (OR 0.79; 95% CI: 0.77-0.81) and 32% higher odds of professional fulfillment (OR 1.32; 95% CI: 1.28-1.36).

PRACTICAL APPLICATIONS

Perceived organizational support of physicians during the COVID-19 pandemic was associated with a lower risk of burnout and a higher likelihood of professional fulfillment. Women physicians, physicians with children under 18 years of age, physicians in certain specialties, and physicians working more hours reported lower perceived organizational support. These gaps must be addressed in conjunction with broad efforts to improve organizational support.

Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures

OBJECTIVE

To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions.

METHODS

In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC).

RESULTS

Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity.

CONCLUSION

In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.

[Relationship between non-medical reading and burnout as well as professional satisfaction among urologists with migrant background: results of the EUTAKD survey study conducted at German hospitals]

BACKGROUND

There are no study results on the private and professional satisfaction and the burnout risk of urologists with a migrant background at German hospitals to date. Non-medical reading has been described to have an influence on lower burnout rates among physicians of different specialties.

MATERIAL AND METHODS

A SurveyMonkey questionnaire with 101 items on criteria characterising the study participant, questions on private and professional satisfaction and the complete Maslach Burnout Inventory was opened to urologists with a migrant background at German clinics between August and October 2020. The impact of non-medical reading on professional satisfaction and burnout was comparatively assessed (group A: ≤1 book/12 months versus group B: ≥2 books/12 months).

RESULTS

Eighty-one study participants were included. They were almost equally distributed into groups A (49.4%) and B (50.6%). In several items on personal and professional satisfaction, there was a significantly higher satisfaction in group B. In the burnout dimensions of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA), a high risk of burnout was present in 27.9%, 35.3% and 73.5% of the study participants. A group comparison revealed significant advantages for Group B in the PA dimension in both the sum score (p=0.001) and the categorical comparison (p=0.002). Study participants in Group B also had a significantly lower DP dimension sum score compared with Group A (p=0.047). The group variable was independently associated with a combined score of EE and DP on the one hand (OR 0.316; p=0.031) and the PA dimension on the other (OR 0.170; p=0.024).

CONCLUSIONS

Reading non-medical books was associated with higher professional satisfaction and a lower burnout risk among urologists with a migrant background at German hospitals.

What has the appraisal for hospitals brought to job satisfaction of healthcare professionals? A cross-sectional survey in China

OBJECTIVE

The purpose of this study is to evaluate the effectiveness of hospital appraisals, specifically the Performance Appraisal for Tertiary Public Hospitals (PATPH), and to examine its impact on the job satisfaction of healthcare professionals in tertiary public hospitals in China.

DESIGN

A cross-sectional study using a multistage sampling method. Improvements induced by PATPH in the working environment, job satisfaction and other covariates were measured. A series of weighted linear regressions with weights from the inverse probability-of-treatment weighting method were used to examine the effect of PATPH on job satisfaction.

SETTING

Nine tertiary public hospitals across three economic and geographic regions in China.

PARTICIPANTS

In August 2020, a total of 13 211 hospital employees were surveyed, and 8417 doctors and nurses fully completed questionnaires forming the primary dataset for analysis. Of these respondents, males comprised 18.64% and doctors constituted 28.15%.

RESULTS

This study revealed that PATPH had a positive impact on the job satisfaction of healthcare professionals. A 'more effective' PATPH working environment resulted in an improvement of 9.57 points (95% CI 8.99 to 10.16) in job satisfaction scores, controlling for all other variables. The finding persisted consistently through a series of sensitivity analyses.

CONCLUSION

The findings offered insights and inspiration for improving the job satisfaction of healthcare professionals, especially in the development of macrolevel policies targeted towards organisational enhancement.

Approaches for the Use of AI in Workplace Health Promotion and Prevention: Systematic Scoping Review

BACKGROUND

Artificial intelligence (AI) is an umbrella term for various algorithms and rapidly emerging technologies with huge potential for workplace health promotion and prevention (WHPP). WHPP interventions aim to improve people's health and well-being through behavioral and organizational measures or by minimizing the burden of workplace-related diseases and associated risk factors. While AI has been the focus of research in other health-related fields, such as public health or biomedicine, the transition of AI into WHPP research has yet to be systematically investigated.

OBJECTIVE

The systematic scoping review aims to comprehensively assess an overview of the current use of AI in WHPP. The results will be then used to point to future research directions. The following research questions were derived: (1) What are the study characteristics of studies on AI algorithms and technologies in the context of WHPP? (2) What specific WHPP fields (prevention, behavioral, and organizational approaches) were addressed by the AI algorithms and technologies? (3) What kind of interventions lead to which outcomes?

METHODS

A systematic scoping literature review (PRISMA-ScR [Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews]) was conducted in the 3 academic databases PubMed, Institute of Electrical and Electronics Engineers, and Association for Computing Machinery in July 2023, searching for papers published between January 2000 and December 2023. Studies needed to be (1) peer-reviewed, (2) written in English, and (3) focused on any AI-based algorithm or technology that (4) were conducted in the context of WHPP or (5) an associated field. Information on study design, AI algorithms and technologies, WHPP fields, and the patient or population, intervention, comparison, and outcomes framework were extracted blindly with Rayyan and summarized.

RESULTS

A total of 10 studies were included. Risk prevention and modeling were the most identified WHPP fields (n=6), followed by behavioral health promotion (n=4) and organizational health promotion (n=1). Further, 4 studies focused on mental health. Most AI algorithms were machine learning-based, and 3 studies used combined deep learning algorithms. AI algorithms and technologies were primarily implemented in smartphone apps (eg, in the form of a chatbot) or used the smartphone as a data source (eg, Global Positioning System). Behavioral approaches ranged from 8 to 12 weeks and were compared to control groups. Additionally, 3 studies evaluated the robustness and accuracy of an AI model or framework.

CONCLUSIONS

Although AI has caught increasing attention in health-related research, the review reveals that AI in WHPP is marginally investigated. Our results indicate that AI is promising for individualization and risk prediction in WHPP, but current research does not cover the scope of WHPP. Beyond that, future research will profit from an extended range of research in all fields of WHPP, longitudinal data, and reporting guidelines.

TRIAL REGISTRATION

OSF Registries osf.io/bfswp; https://osf.io/bfswp.

Adaptive Leadership and Burnout in Military Healthcare Workers During a Global Health Pandemic

INTRODUCTION

Occupational burnout among healthcare workers has continued to climb, impacting workforce well-being, patient safety, and retention of qualified personnel. Burnout in military healthcare workers, who have had the added stress of increased deployments, remains unknown. Although certain leadership styles have been associated with lower rates of burnout, the association between adaptive leadership and burnout in military healthcare has not previously been described. The aim of this study is to examine the role of adaptive leadership in burnout among military healthcare workers following the Coronavirus Disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS

A convenience sampling of military healthcare workers employed at a military medical treatment facility between March 2020 and March 2023 was anonymously surveyed using an online link, which included demographics, the Maslach-Burnout Inventory Health Services Survey (MBI-HSS), the Adaptive Leadership with Authority Scale, and the Pandemic Experiences and Perceptions Survey. Data were analyzed for associations. Structural equation modeling (SEM) was performed using MPlus 8.0, which included demographics, all three subscales that contribute to burnout (emotional exhaustion, depersonalization, and personal accomplishment [PA]), adaptive leadership (indicated by a subscale mean), and COVID impact and COVID risk perception.

RESULTS

Of the 365 participants analyzed, 88.5% had high emotional exhaustion, and 80.4% had high depersonalization. Burnout was significantly associated with adaptive leadership (r = -0.302, P < .001), COVID impact (r = 0.208, P < .001), and COVID risk perception (r = 0.174, P < .001). A total of 93.0% scored high in at least one subscale of the MBI-HSS (i.e., emotional exhaustion ≥27, depersonalization ≥10, or PA ≤33), although 78 (21.8%) met the complete definition of burnout, because of the overwhelmingly high levels of PA (77.8% reported high PA). In the SEM model, burnout was significantly and negatively predicted by adaptive leadership (b = -0.28, SE = 0.05, Standardized b = -0.31, P < .001). Burnout was also significantly and positively predicted by COVID impact (b = 0.25, SE = 0.09, Standardized b = 0.17, P = .028) and health professions' perception of risk (b = 0.15, SE = 0.07, Standardized b = 0.14, P = .008). Together, this model explained 17% of the total variance in health professions' reported burnout.

CONCLUSIONS

The findings of burnout in this military healthcare worker population were higher than have previously been described in healthcare workers or other military personnel, and the significant associations between adaptive leadership and burnout suggest the protective role of adaptive leadership in healthcare systems to address burnout. Implementing adaptive leadership training or selecting leaders with more adaptive leadership skills may be beneficial in a health care system where employee burnout is prevalent, especially during periods stressed by adaptive problems. This may be especially important in military healthcare when active duty service obligations preclude attrition in the presence of additional stressors such as deployments and Federal Emergency Management Agency responses. Further research is needed to determine whether this intervention is successful at reducing healthcare burnout.

The Mayo Leadership Impact Index Adapted for Matrix Leadership Structures: Initial Validity Evidence

Importance

Physician burnout has reached crisis levels. Supportive leadership is one of the strongest drivers of physician well-being, and monitoring supervisor support is key to developing well-being focused leadership skills. Existing measures of leader support were designed within "direct report" supervision structures limiting their applicability to matrixed leadership reporting structures where direct reports are not the predominant norm. Antecedently, no measure of leadership support is validated specifically for implementation in matrixed leadership structures.

Objective

Adapt and validate the Mayo Leadership Impact Index (MLII) for settings with matrixed leadership structures.

Design

A psychometric validation study utilizing classical test theory and item response theory.

Setting

A tripartite hospital system in the southwestern US.

Participants

Physician-respondents to a 2023 cross-sectional survey.

Main Outcomes and Measures

After pilot testing, the adapted MLII was examined using a unidimensional graded response model and confirmatory factor analyses. Convergent validity was investigated via correlations with professional fulfillment, perceived autonomy support, self-valuation, and peer connectedness/respect. Divergent validity was tested via correlations with burnout.

Results

Of the three candidate revisions of the MLII, the 9-item adaptation was selected for its superior validity/reliability indices. Standardized Cronbach's and Ordinal alpha coefficients were 0.958 and 0.973, respectively. CFA loadings exceeded 0.70 (p < 0.001), and coefficients of variation (R2) exceeded 0.60 for all items. GRM slope parameters indicated "high" to "very high" item discrimination. Items 2, 5, and 8 were the most informative. Positive correlations of the adapted MLII with professional fulfillment, perceived autonomy support, and peer connectedness/respect were observed, supporting convergent validity. Negative correlation with overall burnout supports divergent validity.

Conclusions and Relevance

The findings provide evidence of the adapted MLII's validity, reliability, and appropriateness for implementation within matrixed leadership settings. Prior to this study, no leadership support measure had been validated for use among the growing number of healthcare systems with matrixed leadership reporting structures.

Characteristics and Habits of Psychiatrists and Neurologists With High Occupational Well-Being: A Mixed Methods Study

Objective

To identify the characteristics that distinguish occupationally well outliers (OWO), a subset of academic psychiatrists and neurologists with consistently high professional fulfillment and low burnout, from their counterparts with lower levels of occupational well-being.

Participants and Methods

Participants included faculty physicians practicing psychiatry and neurology in academic medical centers affiliated with the Professional Well-being Academic Consortium. In this prospective, longitudinal study, a mixed qualitative and quantitative approach was used. Quantitative measures were administered to physicians in a longitudinal occupational well-being survey sponsored by the academic organizations where they work. Four organizations participated in the qualitative study. Psychiatrists and neurologists at these organizations who competed survey measures at 2 consecutive time points between 2019 and 2021 were invited to participate in an interview.

Results

Of 410 (213 psychiatrists and 197 neurologists) who completed professional fulfillment and burnout measures at 2 time points, 84 (20.5%) met OWO criteria. Occupationally well outliers psychiatrists and neurologists had more favorable scores on hypothesized determinants of well-being (values alignment, perceived gratitude, supportive leadership, peer support, and control of schedule). Ultimately, 31 psychiatrists (25% of 124 invited) and 33 neurologists (18.5% of 178 invited) agreed to participate in an interview. Qualitatively, OWO physicians differed from all others in 3 thematic domains: development of life grounded in priorities, ability to shape day-to-day work context, and professional relationships that provide joy and support.

Conclusion

A multilevel approach is necessary to promote optimal occupational well-being, targeting individual-level factors, organizational-level factors, and broader system-level factors.

Career transition plans of veterinarians in clinical practice

Objective

Gain an understanding of the career transition plans of veterinarians in clinical practice.

Sample

Veterinary members of the Veterinary Information Network (VIN) working as small animal clinicians.

Procedures

An electronic survey distributed via the VIN data collection portal.

Results

A total of 1,256 responses from veterinarians in clinical practice were analyzed, with 61% indicating they plan to decrease their clinical work, and 31% to stop entirely within the next 5 years. The most common reasons for these choices were to have more free time for oneself and/or family/friends (76%), to maintain good health (59%), and feeling burned out (50%). Factors that might entice them to retain their current number of clinical hours included reduced workload or shorter hours (42%), financial incentivization (38%), and improved working conditions (26%). Concerns related to retirement were common with 47% of participants in our study reported feeling concerned about the loss of professional identity, 34% reported concern about reduced social connections, and 28% reported concern as to how they would fill their time.

Conclusions and clinical relevance

The reported desire to reduce/stop one's clinical work within the next 5 years by 42% of veterinarians ≤44 years of age, with burnout a primary predictor, offers insights into the necessity of change at the organizational, systemic (versus individual) level. The fact that many participants reported concerns related to retirement and 32% reported that they did not have adequate retirement information suggests a need for supportive services to help ensure a successful transition.

Compassion Fatigue in Emergency Medicine: Current Perspectives

Compassion fatigue (CF), or loss of ability to empathize or feel compassion for others for whom one cares, is a growing concern for emergency physicians (EP). EPs, by the nature of their jobs, work under unpredictable conditions at odd hours with high levels of exposure to traumatic events. They are placed under substantial psychological, physical, and cognitive pressure, with little opportunity to recover or reflect. CF occurs when this workplace stress leads to feelings of being overwhelmed, helpless, unsupported, and unable to cope. Additionally, primary traumatic stress from threats of workplace violence and secondary traumatic stress (STS) from witnessing the suffering of others increase the likelihood of developing CF. Unchecked, this progression to CF causes reduction in quality of care to patients, reduction in patient satisfaction, increased levels of EP depression and anxiety, increased levels of EP substance use, and increased attrition from the specialty. To truly improve CF, individuals and organizations should be aware of the contributors to CF: namely, emotional exhaustion, depersonalization, primary and STS, and personal achievement. EPs should maximize their resilience to CF by using cognitive behavioral techniques and mindfulness, taking care of their physical health, seeking meaning and development within their work, developing hobbies outside of work, and creating boundaries between work and home. Organizations should actively address the known drivers of physician burnout: workload and job demands, efficiency and resources, meaning in work, culture and values, control and flexibility, work community, and work-life integration. Organizations should also provide adequate safety within facilities to reduce the threat of primary trauma and should supply adequate support and destigmatization for post-traumatic symptoms for EPs suffering from STS.

The four Cs of physician leadership: A key to academic physician success

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the "Four Cs of Physician Leadership": character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Embracing Failure: Nurturing Learning and Well-Being in Anesthesiology and Perioperative Medicine

Failure, ubiquitous in life and medical practice, offers myriad opportunities for learning and growth alongside challenges to overall well-being. In this article, we explore the nature of failure, it's sources and impacts in perioperative medicine, and the specific challenges it brings to trainee well-being. With a deeper understanding of the societal, psychological and cognitive determinants and effects of failure, we propose solutions in order to harness the opportunities inherent in failures to create brave and supportive learning environments conducive to both education and well-being.

Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction

BACKGROUND

Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.

OBJECTIVE

Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction.

DESIGN

We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout.

PARTICIPANTS

Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174).

MAIN MEASURES

Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. 31 and Walling et al. 32 RESULTS: Thirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05).

CONCLUSIONS

Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.

A Pragmatic Approach to Assessing Supervisor Leadership Capability to Support Healthcare Worker Well-Being

GOAL

We sought to build upon previous studies that have demonstrated how healthcare workers' ratings of their immediate supervisor's leadership capabilities relate to their well-being and job satisfaction.

METHODS

In 2022, we analyzed cross-sectional data from 1,780 physicians and 39,896 allied health professionals (collected in 2017) and 729 residents (collected in 2019), as well as longitudinal data from 1,632 physicians (collected from 2015 to 2017), to identify a psychometrically strong, broadly applicable, actionable, and low-burden approach to assessing supervisor leadership capability to support healthcare worker well-being.

PRINCIPAL FINDINGS

The magnitude of association between our 1-, 2-, 3-, and 9-item leadership indexes and burnout, and between our 1-, 2-, 3-, and 9-item leadership indexes and satisfaction with the organization were similar to each other in the cross-sectional and longitudinal cohorts and across diverse groups of healthcare workers, including physicians, residents, and allied health professionals. The likelihood ratio for a high leadership score increased with an increasing score for each leadership measure. The area under the receiver operating characteristic curve for the 1-, 2-, and 3-item measures for a high leadership score was 0.9349, 0.9672, and 0.9819, respectively.

PRACTICAL APPLICATIONS

A single item assessing perceptions of leadership capability efficiently provides useful information about leadership qualities of healthcare workers' immediate supervisors. The inclusion of this item in healthcare worker surveys may be useful for evaluating interventions and galvanizing organizational action to support healthcare worker well-being.

Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning

Purpose

Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format.

Participants and Methods

Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation.

Results

Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences.

Conclusion

Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.

Pathologist workload, burnout, and wellness: connecting the dots

No standard tool to measure pathologist workload currently exists. An accurate measure of workload is needed for determining the number of pathologists to be hired, distributing the workload fairly among pathologists, and assessing the overall cost of pathology consults. Initially, simple tools such as counting cases or slides were used to give an estimate of the workload. More recently, multiple workload models, including relative value units (RVUs), the Royal College of Pathologists (RCP) point system, Level 4 Equivalent (L4E), Work2Quality (W2Q), and the University of Washington, Seattle (UW) slide count method, have been developed. There is no "ideal" model that is universally accepted. The main differences among the models come from the weights assigned to different specimen types, differential calculations for organs, and the capture of additional tasks needed for safe and timely patient care. Academic centers tend to see more complex cases that require extensive sampling and additional testing, while community-based and private laboratories deal more with biopsies. Additionally, some systems do not account for teaching, participation in multidisciplinary rounds, quality assurance activities, and medical oversight. A successful workload model needs to be continually updated to reflect the current state of practice.Awareness about physician burnout has gained attention in recent years and has been added to the World Health Organization's International Classification of Diseases (World Health Organization, WHO) as an occupational phenomenon. However, the extent to which this affects pathologists is not well understood. According to the WHO, burnout syndrome is diagnosed by the presence of three components: emotional exhaustion, depersonalization from one's work (cynicism related to one's job), and a low sense of personal achievement or accomplishment. Three drivers of burnout are the demand for productivity, lack of recognition, and electronic health records. Prominent consequences of physician burnout are economic and personal costs to the public and to the providers.Wellness is physical and mental well-being that allows individuals to manage stress effectively and to thrive in both their professional and personal lives. To achieve wellness, it is necessary to understand the root causes of burnout, including over-work and working under stressful conditions. Wellness is more than the absence of stress or burnout, and the responsibility of wellness should be shared by pathologists themselves, their healthcare organization, and governing bodies. Each pathologist needs to take their own path to achieve wellness.