Resource Library

Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.

Burnout is a prolonged response to chronic stressors, characterized by emotional exhaustion, feelings of cynicism and depersonalization, and low sense of personal accomplishment. Burnout is well documented among physicians. Additionally, numerous studies have demonstrated a higher prevalence of burnout among women-identifying physicians compared to men-identifying physicians. Recently, multiple randomized controlled trials have shown that professional coaching for physicians significantly decreased burnout and emotional exhaustion and improved resilience, quality of life, work engagement, self-compassion, and psychological capital. To begin addressing the unique drivers of women physicians, specifically physician mothers, we designed and implemented a group coaching program that addressed drivers of burnout for physician mothers. We found that group coaching is an affordable and well-received intervention that can help address burnout drivers of physician mothers and begin to narrow the burnout gender gap. [Psychiatr Ann. 2024;54(1):e14–e18.]

The article titled "Physician ignition: Promoting physician wellness through CME" discusses the importance of physician wellness and the role of continuing medical education (CME) in promoting it. The author shares their personal experience as a family doctor and emphasizes the benefits of setting boundaries and practicing self-care. The article also highlights the 69th Annual St. Paul's Hospital CME Conference for Primary Care Physicians, which focused on physician wellness and included various initiatives to engage and energize participants. The author concludes by expressing their hope for future CME conferences to further address physician burnout and promote physician well-being.

Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.

The Federal Trade Commission hosted a public workshop, Private Capital, Public Impact: An FTC Workshop on Private Equity in Health Care, aimed at examining the role of private equity investment in health care markets.

The FTC is dedicated to fostering competition in health care markets. In recent years, the Commission has become increasingly concerned about the effects of private equity investment in this sector. We are convening a workshop bringing together experts and affected individuals to discuss their insights. The workshop will consist of several panels and feature remarks from government officials, academics, economists, and practitioners, as well as members of the public who have experienced, first-hand, the effects of private equity investment in the health care system.

The workshop recording and transcript are available online.

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This resource is found in our Actionable Strategies for Government AND Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values).

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AIM: This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave. DESIGN: This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021. METHODS: Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms—feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave. RESULTS: Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16–25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience. CONCLUSIONS: This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave. IMPACT: The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay.

Many argue that the concept of “work-life balance” is impossible to achieve for busy physicians. After spending years in medical training and building a career in health care, physicians often find their work encroaching upon other aspects of day-to-day life. Over the past decade, studies have shown that physician burnout, stress, depression, mental health, and general lack of well-being affect productivity, efficiency, and patient care. In this article, we will discuss the concept of “work-life balance” and recommend strategies to strive for a meaningful balance.

BACKGROUND: Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known. PURPOSE: To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R3). METHODS: A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors. RESULTS: Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources. CONCLUSION: Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed.

BACKGROUND: The aim of this study was to examine sex differences in academic rank and productivity among members of the American Society of Transplant Surgeons in the United States. METHODS: Cross-sectional, focusing on current board-certified abdominal transplant surgeons in the United States. Demographic factors such as sex, region, and faculty rank were collected from institutional websites. Academic metrics, including H-index, total publications, and relative citation ratio, were collected from Scopus and iCite. RESULTS: We identified 536 surgeon members of the American Society of Transplant Surgeons with an academic institution. The majority were men (83%). Men were in practice longer than women (17.9 ± 11 vs 11.7 ± 9 years, P < .0001) and had higher academic metrics, including H-index (25.6 ± 20 vs16.4 ± 14, P < .0001) and total publications (110 ± 145 vs 58.8 ± 69, P < .0001). There was a significant difference in faculty appointments by sex (P < .05), with men showing evidence of increased academic advancement. After adjusting for academic rank, PhD status, and location of medical school and residency, women remained associated with a lower H-index on multivariate analysis (P < .01). CONCLUSION: Sex disparities in academic rank and achievement are present among transplant surgical faculty in the United States, and future efforts are needed to promote sex equity in transplant surgery academia.

Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception. To systematically review the experiences of females in ophthalmology (FiO) from training through practice in high-income countries (HICs). A systematic review of English-language studies, published between January 1990 and May 2022, relating to FiO in HICs was performed. PubMed, MEDLINE, and Embase electronic databases were searched, as well as the Journal of Academic Ophthalmology as it was not indexed in the searched databases. Studies were organized by theme at each career stage, starting in medical school when an interest in ophthalmology is expressed, and extending up to retirement. A total of 91 studies, 87 cross-sectional and 4 cohort, were included. In medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Female ophthalmologists had a greater scholarly impact factor than their male counterparts, but this was only after approximately 30 years of publication experience. Pervasive throughout all stages of training and practice was the experience of greater sexual harassment among females from both patients and colleagues. Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates. Ophthalmology is approaching sex parity, however, the increase in the proportion of females in ophthalmology had not translated to an increase in female representation in leadership positions. Sex disparities persisted across many domains including recruitment, training, practice patterns, academic productivity, and income. Interventions may improve sex equity in the field.

National work is urgently needed.

PHENOMENON: Burnout is prevalent amongst long-practicing physicians. For medical educators, it has deleterious effects not only on the educator themselves, but also the students they are teaching. Though significant research has focused on factors associated with burnout, there is limited understanding of its counter: how physicians, particularly medical educators, derive joy from their work. APPROACH: This qualitative study included 15 highly-rated clinician educators in Internal Medicine who took part in individual semi-structured interviews. Participants were invited to discuss their sources of professional joy. After transcription, we used thematic content analysis: 50 themes were identified. Themes were then coded using the domains of the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model of positive psychology, assigning each theme a best fit domain. Forty-five themes were mapped into the PERMA model. FINDINGS: When describing professional joy, highly-rated clinician educators displayed high levels of overlap with all domains of the PERMA model. Interaction with the learner was a prominent source of professional joy, particularly within Positive Emotion, Engagement, and Relationship domains. INSIGHTS: Our findings indicate that the PERMA model appropriately defines the sources of professional joy for these educators. Future research could employ this model to identify targets for interventions aimed at amplifying joy at work for this group.

As spine surgeons continue to strive for high-quality patient care in an ever-changing health care environment, their individual health can often be put on the back burner. Under the stress of caring for and operating on the spine patient, surgeons must juggle additional hardships in the form of occupational exposures such as intraoperative radiation, degenerative conditions secondary to ergonomics and the inherent physical tax of spine surgery, and an increasing incidence of mental health disorders. In this review, we discuss the current body of literature as it relates to physical, mental, and occupational tolls placed on surgeons.

The 2024 State of U.S. Nursing Report provides insights into the current landscape of nursing in the United States, highlighting both positive developments and significant challenges.

[This is an excerpt.] Student incivility in nursing programs is a growing and urgent problem. Nursing faculty increasingly struggle to manage its impact on effective teaching and learning in classroom and clinical settings. The extent of this incivility, which includes derogatory language and physical confrontations with peers and faculty, reflects the divergence in worldviews and complex stressors observed in our daily news cycle and acted out on social media platforms, contributing to the perception that it is permissible in our educational and professional spheres. These behaviors, likely multi-factorial in their origins, could reflect student burnout, feeling overwhelmed by academic and personal demands, and the inability to effectively negotiate personal stressors and relationships. Student burn-out is associated with lower self-concept, self-confidence, self-esteem, and engagement, negatively affecting learning and motivation (Wei et al., 2021). The student with burnout usually conveys anxiety, depression, aggression, frustration, reluctance to do schoolwork, despair, and inefficiency (Wei, 2021). The 2023 Stress in America Survey supports the overwhelming stress reported by adults age 18 to 34 years. Seventy-one percent of respondents do not discuss stress to avoid burdening others, 67% indicate stress makes it hard to focus, and 55% report it is difficult to do anything when stressed (American Psychological Association, 2023). Fifty percent report having a mental health diagnosis, and 51% report a chronic illness. [To read more, click View Resource.]

[This is an excerpt.] For transgender and nonbinary individuals, early and continued access to gender-affirming care is critical to improving confidence and allowing people to use their focus for transitioning socially while navigating the complex and sometimes unwelcoming healthcare system. Gender-affirming care can include social affirmation, puberty blockers, hormone therapy, and gender-affirming surgeries. This care can be life-saving, as it improves the mental health and overall well-being of gender-diverse children, adolescents, and adults.

Gender non-conforming students can find access to gender-affirming treatment at many colleges in the United States and abroad, and healthcare providers working in these schools receive training on gender-affirming, patient-centered care. For younger students, school nurses play an important role in supporting gender non-conforming students by directing them to resources and assuring them that their identities and feelings are valid and meaningful. For adults, healthcare provider education is crucial since many gender diverse individuals report discrimination within the healthcare system.

These resources are made available to anyone in the healthcare field, preparing as a student to work with diverse populations, including gender non-conforming youth, allies, educators, the transgender community, and more. You'll find research articles, helpful websites, links to organizations, and even legal and healthcare resources here. We hope you find these resources informative and helpful, no matter what part of your journey. [To read more, click View Resource.]

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In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians. A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system’s pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher’s exact tests were used, and effect size between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression. A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians.Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.

BACKGROUND: Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians. METHODS: A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies. Through ongoing collaborations, a recruitment advertisement was provided to EMS leadership at respective agencies for distribution among their female staff. Sessions were recorded and transcribed for thematic analysis. A six-phase inductive analytical approach was utilized to evaluate focus group data. Qualitative findings were utilized to inform a cross-sectional, self-report survey consisting of occupational specific experiences, such as harassment and pregnancy, and validated measures of mental wellbeing. Descriptive statistics were used to describe the study sample and female EMS clinician occupational and personal experiences. RESULTS: A total of 22 female EMS clinicians participated across the three focus group sessions. Four major themes were identified: 1) the female EMS experience; 2) impact on personal wellbeing; 3) impact on occupational wellbeing; and 4) coping mechanisms. Each theme had multiple subthemes. There were 161 participants that attempted the 72-item survey, 13 partial and 148 competed surveys. Median age was 32 years (IQR: 25-42), and the majority were EMT-Bs (55.1%). Approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout. Almost 73.0% reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Over 61.0% reported reconsideration of their career in EMS. Overall, survey data indicated interactions with peers and leadership, and social support were positive. CONCLUSIONS: Findings highlight the need to improve the occupational experiences of female EMS clinicians to preserve and encourage the continuation of their participation in this workforce. Specifically tailored interventions aimed at protecting and improving their overall wellbeing are critical, particularly considering the increased occupational burden resulting from the pandemic. Future research should aim to understand specific predictors of adverse mental health outcomes among this population.

PURPOSE: The Fortify Resilience Initiative focuses on building and sustaining a culture of wellbeing for Residents and Fellows (R/Fs) at The University of Texas Rio Grande Valley (UTRGV) School of Medicine’s (SOM) Graduate Medical Education (GME) residency and fellowship programs. In order to address the multitude of threats to physician wellness and to mitigate the silent, but pernicious effects of burnout on these physician learners serving in the RGV, this Initiative from the Office of GME will strengthen existing wellbeing pathways while expanding additional solutions that will work to sustain wellbeing. Utilizing a combination of prevention, promotion, and intervention strategies targeted at the individual, program, and system levels, this initiative increases resilience by addressing existing gaps that only further propagate the spread of risk and vulnerability to the community. DESCRIPTION: The Fortify Resilience Initiative maintains three key drivers (Access Strategy, Empowerment Initiatives, and System Redesign) that all work to address and enhance components central to wellbeing management. Within the Access Strategy is continuous access to direct online clinical and coaching services, annual opt-out wellness check-ins, monthly live online learning sessions with embedded didactics as well as skill development practical labs. Launch of a Wellbeing Mobile Application (WMA), allowing users to periodically self-assess and receive suggestions to improve self-management as well as the establishment of Program Specific Wellness Committees (PSWC), constitute the Empowerment Initiatives. Consultations with each partnered program’s leadership, along with the introduction of a faculty development pathway to train faculty to full competency over current wellbeing methodologies, aim at establishing a presence of institutional expertise and represent the System Redesign driver. Partners: The Fortify Resilience Initiative at UTRGV is illuminated through a vital partnership with Tend Health (TH). TH is an innovative company specialized in the care and well-being of health professionals, with a history of successful partnerships with GME programs offering mental health and well-being focused services. TH is an essential partner in two of the key drivers – Access Strategy and System Redesign. LOOKING AHEAD: By year 2024, the Fortify Resilience Initiative seeks to impact 249+ UTRGV R/Fs and clinical faculty, as demonstrated by: Graduating all R/Fs with self-management of well-being competencies, Embedding access strategy services as routine part of UTRGV GME programs, Integrating technology solutions – WMA – as a core strategy for resilience for GME programs, Enrolling 100% of new R/Fs as users on the WMA via GME on-boarding each program year, Sustaining PSWC’s across 11+ GME programs with routine use of the WMA, Establishing a scalable culture of wellbeing strategy for the UTRGV SOM, Building resilience supporting policies within programs and institution, Developing a UTRGV Faculty Affairs sustained Master Trainer Faculty Development (MTFD) track to continue delivery of resilience trainings by MTFD scholars

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.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.