Abstract
IMPORTANCE: Physician burnout and retention problems are threatening workforce stability and patient care. OBJECTIVE: To compare physician well-being in multiple European countries and the US to inform physician well-being interventions and evaluate whether modifiable aspects of hospital care environments are associated with physician job outcomes. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted at 49 hospitals in 6 European countries (Belgium, England, Germany, Ireland, Sweden, and Norway) and 56 US hospitals. European data from physicians and nurses were collected in 2023; US data were collected in 2021. Data were analyzed from February through August 2025. EXPOSURES: Three explanatory variables were measured at the hospital level: nurse staffing adequacy, clinical care environment, and physician and nurse teamwork. MAIN OUTCOMES AND MEASURES: Primary outcomes include individual-level measures of physician well-being and job outcomes (eg, high burnout, job dissatisfaction, intention to leave employer, and willingness to recommend employer). RESULTS: Among a total of 21 396 physicians and nurses, 1149 European physicians (mean [SD] age, 41.3 [10.6] years; 536 female [46.5%] and 609 male [52.9%]) and 5334 US physicians (mean [SD] age, 44.5 [11.8] years; 1861 female [34.9%] and 2373 male [44.5%]) reported on their well-being and 3044 European nurses and 11 869 US nurses reported on hospital care environments. Poor well-being was common among hospital physicians in the US and Europe; for example, 324 of 1083 physicians in Europe with responses to the question (29.9%) and 1178 of 4959 physicians with responses to the question (23.8%) intended to leave their job within a year. Improvements in nurse staffing adequacy, clinical care environments, and clinician teamwork were associated with favorable physician job outcomes in the US and Europe. For example, among US hospitals, a 10% increase in favorable care environments was associated with lower odds of physicians intending to leave (odds ratio [OR], 0.78; 95% CI, 0.68-0.90), not recommending their hospital (OR, 0.75; 95% CI, 0.61-0.92), experiencing high burnout (OR, 0.90; 95% CI, 0.83-0.98), and having job dissatisfaction (OR, 0.81; 95% CI, 0.69-0.95). Among European hospitals, a 10% increase in hospital-level reports of nurse staffing adequacy was associated with lower odds of physicians intending to leave (OR, 0.80; 95% CI, 0.71-0.91), not recommending their hospital (OR, 0.73; 95% CI, 0.61-0.88), reporting high burnout (OR, 0.88; 95% CI, 0.78-0.99), and reporting job dissatisfaction (OR, 0.85; 95% CI, 0.73-0.98). CONCLUSIONS AND RELEVANCE: In this study, improved hospital nurse work environments were associated with more favorable physician outcomes, and modifiable features of the hospital environment, including having adequate numbers of direct care nurses and strong physician and nurse teamwork, were associated with greater physician well-being. These findings may inform the development and implementation of evidence-based interventions to improve physician well-being and retention.
