Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator

Department of Sociology, Faculty of Social Sciences, University of Calgary, Calgary, AB, Canada.
The Lancet (Impact Factor: 45.22). 11/2009; 374(9702):1714-21. DOI: 10.1016/S0140-6736(09)61424-0
Source: PubMed

ABSTRACT When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

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Available from: Jane Lemaire, Jul 16, 2014
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    • "Increasing attention is being paid to provider well-being as an indicator of the quality of health systems and practice organizations. [1] [2] [3] [4] The escalating responsibilities and demands placed on practitioners in the health reform era have contributed to increased professional dissatisfaction, demoralization, and burnout. [5] Prevalence rates for burnout, depression, suicidal ideation, and suicide among physicians exceed those of other adult workers in the United States (U.S.). "
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    ABSTRACT: Background: Provider wellbeing is a barometer of the strength of healthcare systems/organizations. Burnout prevalence among physicians exceeds that among other adult workers in the United States. Rural-based practitioners might be at greater risk. Objective: We investigated predictors of burnout among group-employed providers within an integrated healthcare network. Design: In a prospective observational study of physicians/advanced-practice clinicians serving an 8-county region of central New York, we linked administrative practice-setting data with responses to a questionnaire-survey comprising validated measures of burnout, resilience, work meaningfulness, satisfaction, risk aversion, and uncertainty/ambiguity tolerance. Participants: We included providers on the official payroll, excepting advisory board and/or research team members plus those who retired, resigned or were fired. 308 (65.1%) of 473 eligible clinicians completed the survey. 59.1% of these were physicians/doctoral-level practitioners; 40.9% advanced-practice clinicians. Main Measures: We assessed burnout using a validated 5-level single-item measure formatted as a binary outcome of “burned out/burning out” (levels 3–5) versus not. We derived a parsimonious generalized linear mixed-effects regression of this outcome on provider demographics, work-related needs, risk aversion, satisfaction, and unit characteristics. Key Results: Perceived workload, relatedness needs, practice satisfaction ≥ 50% of the time, dissatisfaction ≥ 75%, resilience, and practicing on a small unit were the significant, independent predictors. Conclusions: Heavy workloads, unmet relational needs, frequent dissatisfaction, low resilience, and serving on a small unit were most significantly associated with being “burned out/burning out”. Feeling satisfied most of the time and high resilience were protective. Profession, specialty, autonomy, and support staffing were not statistically significant. Key Words: Occupational burnout, professional satisfaction, stress resilience, physicians, physician assistants, nurse practitioners, quality of work life.
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    • "In a meta-analysis of studies of physician suicide rates from 1960, Schernhammer & Colditz (2004) found that the incidence of suicide in male doctors was 1.41 times that in the general population, and 2.27 times greater for female doctors. Willcock et al. (2004) suggested that the high incidences of distress and burnout can be attributed inter alia to a doctor's stressful work environment, their long working hours, possible conflict between work and personal life tasks and their individual psychological vulnerability, a view echoed by Wallace et al. (2009) in their literature review. Tartas et al. (2011) in a 10-year longitudinal study in Poland (n ¼ 365) also acknowledged that significant ''psychological qualities'' are related to job and life performance of medical graduates. "
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    ABSTRACT: Abstract Despite the abundant supply of academically outstanding applicants to medical schools in most countries the regularly recurring debate in the academic literature, and indeed sometimes in the popular media, implies that admissions committees are still getting it wrong in a significant number of instances. How can this be so when our procedures are directed unashamedly at selecting the most highly academically and intellectually qualified students in the expectation that they will make the best doctors? Perhaps it is time for a radical change in emphasis. Instead of endeavouring to differentiate among the top ranks of a pool of outstandingly qualified applicants, the selection effort might be better focused on identifying those potentially unsuitable in terms of their non-academic personal qualities to ensure they do not gain entry. The account that follows is an analysis of the problems of medical student selection and offers a potential solution - a solution that was first suggested in the medical literature 70 years ago, but not adopted. It is the present author's contention that the cycle of debate will continue to recur unless such an approach is pursued.
    Medical Teacher 12/2014; 37(3):1-9. DOI:10.3109/0142159X.2014.993600 · 2.05 Impact Factor
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    • "sorders , such as depressed mood or cardiovascular disease . In addition to increasing basic relaxation levels , our sample of physicians obtained significant increases in positive energy ( e . g . " strength - ened " " confident , " " optimism " ) , a dimension of perceived personal competence and well - being at work ( Brown & Gunderman , 2006 ; Wallace et al . , 2009 ) . Finally , the fact that they reported significant improvements of their understanding and communication with patients adds to the external validity of this study ."
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    ABSTRACT: Previous research on mindfulness has focused mainly on stress-related negative symptoms and short-term effects. In contrast, the present article focuses on the impact of a mindfulness-based stress reduction (MBSR) program on improving well-being (i.e. relaxation states and related positive emotions) in a longitudinal study for a period of one year. A randomized controlled trial in a sample of 42 physicians was used. The intervention group participated in an 8-week MBSR program, with an additional 10-month maintenance period and completed measures of mindfulness and relaxation at pre-intervention, post-intervention and after 10 months. Heart rate measures were also obtained. Significant improvements in favor of the experimental group compared with the control group on the levels of mindfulness and relaxation (including positive emotional states, such as at ease/peace, renewal, energy, optimism, happiness, acceptance, and even transcendence) were obtained after eight weeks. Remarkably, change magnitudes (effect size) significantly increased at the end of the maintenance period after a year, especially for mindfulness and positive energy. Additionally, heart rate significantly decreased for the intervention group and maintained a year after the beginning of the treatment. Results are relevant in terms of practical consequences for improving health and well-being in this population and also in terms of cost-efficiency.
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