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FIGURE. Balance of forces. A, Survival anxiety driving change in medicine offset by learning anxiety. B, Reducing learning anxiety to tip the balance in favor of change.
Source publication
The past decade has been a time of great change for US physicians. Many physicians feel that the care delivery system has become a barrier to providing high-quality care rather than facilitating it. Although physician distress and some of the contributing factors are now widely recognized, much of the distress physicians are experiencing is related...
Citations
... Yes 249 (31.5) [6]. Further understanding of this phenomenon is critical in creating a culture of medicine that supports selfcare, boundary setting, and a sustainable, healthy work environment [38]. In addition, the identified communication domain may have implications for understanding psychological safety, an emerging important construct in understanding and addressing group dynamics in healthcare [15,39]. ...
Background
Measurement is one of the critical ingredients to addressing the well-being of health care professionals. However, administering an organization-wide well-being survey can be challenging due to constraints like survey fatigue, financial limitations, and other system priorities. One way to address these issues is to embed well-being items into already existing assessment tools that are administered on a regular basis, such as an employee engagement survey. The objective of this study was to assess the utility of a brief engagement survey, that included a small subset of well-being items, among health care providers working in an academic medical center.
Methods
In this cross-sectional study, health care providers, including physicians and advanced clinical practitioners, employed at an academic medical center completed a brief, digital engagement survey consisting of 11 quantitative items and 1 qualitative item administered by Dialogue™. The emphasis of this study was on the quantitative responses. Item responses were compared by sex and degree, domains were identified via exploratory factor analysis (EFA), and internal consistency of item responses was assessed via McDonald’s omega. Sample burnout was compared against national burnout.
Results
Of the 791 respondents, 158 (20.0%) were Advanced Practice Clinicians (APCs), and 633 (80.0%) were Medical Doctors (MDs). The engagement survey, with 11 items, had a high internal consistency with an omega ranging from 0.80–0.93 and was shown, via EFA, to have three domains including communication, well-being, and engagement. Significant differences for some of the 11 items, by sex and degree, in the odds of their agreement responses were found. In this study, 31.5% reported experiencing burnout, which was significantly lower than the national average of 38.2%.
Conclusion
Our findings indicate initial reliability, validity, and utility of a brief, digital engagement survey among health care professionals. This may be particularly useful for medical groups or health care organizations who are unable to administer their own discrete well-being survey to employees.
... The culture of medicine often rewards physician attitudes and behaviors that detract from wellness. 31 Physicians internalize the culture of medicine that promotes perfectionism and downplays personal vulnerability. 32 Physicians are reluctant to protect and preserve their wellness, believing selfsacrifice makes them good doctors. ...
Physician burnout is increasing, but navigating its prevention involves a complex intersection of physical, psychological, social, and organizational strategies.
... The hidden curriculum [43] describes certain informal, often unspoken norms that make it difficult for the doctor to expose emotions, weakness, and illness or to admit mistakes in a professional medical setting. The conclusion of a paper by Tait Shanafelt and Schein that discussed several of these elements is that change is necessary to "heal the professional culture of medicine" [44]. ...
... Some researchers argue that psychological safety of employees, such as valued feed-back and openly admitting to mistakes, is not part of the organizational tradition in the field of health care [44,60]. To create psychological safety, Schein suggests several activities that can be implemented including a focused dialogue with the goal of helping participants to relax sufficiently to examine their own assumptions and to be able to consider other assumptions as equally valid or true. ...
... Several topics emphasized in peer support conversations are known drivers of burnout among doctors: lack of support, fear of voicing concerns at work, excessive workloads, work-home conflicts, negative leadership culture and a lack of comfort with their amount of responsibility at work [3,4,8,44,[61][62][63][64][65][66]. In the interviews, explicit statements were made indicating that speaking up at work entails taking a personal risk and that some of the interviewees did not know where else to turn for help with their workrelated problems. ...
Background
Doctors’ health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs.
Materials and methods
Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein.
Results
The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised.
Conclusions
Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors’ needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.
... Supporting network: As the health care system becomes more complex, physicians are increasingly employed by large health care organizations. 76 Physicians within these complex health care systems have a decreased sense of autonomy and control over their work. 77 Many physicians feel they are just "cogs in the wheel" at their institutions. ...
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the “second victim,” results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
... It has been hard to miss an immodesty in public health leaders who are clinicians, which tracks with long-standing concerns that physicians have "some blind spots and unhealthy norms," including "assum[ing] the role of a hero" and implying that "to err is human, but … [they] are superhuman." 30 People speak grandly of "following the science" when what they actually follow is a narrow epidemiological slice of available knowledge about human health behavior. Growing recognition of the essential value of humility in patient care 31 should extend to those working in public health leadership as well. ...
Under-resourced and fragmented public health infrastructure has contributed to a poor pandemic response in the United States. There have been calls to redesign the Centers for Disease Control and Prevention and to increase its budget. Lawmakers also have introduced bills aiming to change public health emergency powers at the local, state, and federal levels. Public health is ripe for reform, but reorganization and enhanced funding will not address an equally pressing problem: chronic failures of judgment in the definition and implementation of legal interventions. Without a more informed and nuanced appreciation for the value and limits of law as an instrument of health promotion, the public will remain at unnecessary risk.
... More broadly, achieving a work culture in which health care systems are sensitive to burnout, designing systems to prevent it, implementing the processes to screen for it, and offering interventions early on could salvage both professional fulfillment and professionalism. A step further is to incorporate attention to well-being as a principle of professionalism, as advocated by Shanafelt et al. 5 What would have happened if the fictional resident who only wanted to "see high-functioning, stable patients" had a safe space to speak openly about demoralization engendered from interactions with patients' ...
... One caveat: The systems in which physicians work must be willing to listen, reinforcing the call for organizational accountability in establishing a culture of accepting human limitations. 5 Trainees and early-career physicians are fortunate to enter the workforce at a time when organizational leaders in medicine have achieved extraordinary gains at a national level to relieve burnout, both raising awareness and validating empirically supported interventions. [4][5][6] Moreover, the surgeon general and the National Academy of Medicine have spoken on behalf of physicians as one voice-a voice that has conveyed an understanding of what it means to care for complex patient populations in the setting of a resourcebased relative value scale payment model unforgiving of such complexity. ...
... 5 Trainees and early-career physicians are fortunate to enter the workforce at a time when organizational leaders in medicine have achieved extraordinary gains at a national level to relieve burnout, both raising awareness and validating empirically supported interventions. [4][5][6] Moreover, the surgeon general and the National Academy of Medicine have spoken on behalf of physicians as one voice-a voice that has conveyed an understanding of what it means to care for complex patient populations in the setting of a resourcebased relative value scale payment model unforgiving of such complexity. But the perils remain of practicing academic medicine in a health care system expected to meet so many simultaneously com-peting demands. ...
This Viewpoint highlights the increasing levels of burnout among physicians, discusses how burnout can erode professionalism, and suggests possible steps physicians and health care organizations might take to lessen burnout and maintain professionalism in the setting of burnout.
... Moreover, they are ingrained in a system that tends to value perfectionism and lack of vulnerability over self-care and personal health. [1,4,5]. Not unexpectedly, physicians report increasing distress and symptoms of burnout [6,7], such as mental and physical exhaustion and professional inefficacy [8]. ...
Background:
Physicians increasingly show symptoms of burnout due to the high job demands they face, posing a risk for the quality and safety of care. Job and personal resources as well as support interventions may function as protective factors when demands are high, specifically in times of crisis such as the COVID-19 pandemic. Based on the Job Demands-Resources theory, this longitudinal study investigated how monthly fluctuations in job demands and job and personal resources relate to exhaustion and work engagement and how support interventions are associated with these outcomes over time.
Methods:
A longitudinal survey consisting of eight monthly measures in the period 2020-2021, completed by medical specialists and residents in the Netherlands. We used validated questionnaires to assess job demands (i.e., workload), job resources (e.g., job control), personal resources (e.g., psychological capital), emotional exhaustion, and work engagement. Additionally, we measured the use of specific support interventions (e.g., professional support). Multilevel modeling and longitudinal growth curve modeling were used to analyze the data.
Results:
378 medical specialists and residents were included in the analysis (response rate: 79.08%). Workload was associated with exhaustion (γ = .383, p < .001). All job resources, as well as the personal resources psychological capital and self-judgement were associated with work engagement (γs ranging from -.093 to .345, all ps < .05). Job control and psychological capital attenuated the workload-exhaustion relationship while positive feedback and peer support strengthened it (all ps < .05). The use of professional support interventions (from a mental health expert or coach) was related to higher work engagement (estimate = .168, p = .032) over time. Participation in organized supportive group meetings was associated with higher exhaustion over time (estimate = .274, p = .006).
Conclusions:
Job and personal resources can safeguard work engagement and mitigate the risk of emotional exhaustion. Professional support programs are associated with higher work engagement over time, whereas organized group support meetings are associated with higher exhaustion. Our results stress the importance of professional individual-level interventions to counteract a loss of work engagement in times of crisis.
... Clearly, changing the work culture is extremely challenging, requiring leadership, role models, and commitment from all staff. 46,47 This may explain why most organizations choose to first address inhibiting work structures and inefficient practices, 47 although these too are not always easily changed. ...
... Clearly, changing the work culture is extremely challenging, requiring leadership, role models, and commitment from all staff. 46,47 This may explain why most organizations choose to first address inhibiting work structures and inefficient practices, 47 although these too are not always easily changed. ...
Aims
This is the first study to provide a holistic examination of cardiologists’ well-being, investigating positive and negative dimensions, and its determinants.
Methods
We conducted a national, multicenter, self-administered web-based questionnaire. We used frequencies to depict scores on three well-being indicators (professional fulfillment, work exhaustion and interpersonal disengagement) and performed three multiple regression analyses to elucidate their determinants.
Results
Cardiologists’ mean scores (scale 1 to 5) were 3.85 (SD = 0.62) for professional fulfillment, 2.25 (SD = 0.97) for work exhaustion and 2.04 (SD = 0.80) for interpersonal disengagement. Workload, work-home interference and team atmosphere predicted the negative dimensions of well-being. Autonomy predicted cardiologists’ professional fulfillment. Physician-patient interactions, person-job fit and individual resilience affected both dimensions.
Conclusion
Dutch cardiologists score relatively high on professional fulfillment and average on work exhaustion and interpersonal disengagement. In order to foster cardiologists’ well-being it is critical to increase energy providing work- and individual aspects.
... While medical culture's shared values and rituals provide comfort, solidarity and purpose, they may also be challenging to revise when circumstances evolve over time. The result can be the persistence of behaviors such as elaborate chart notes, which undermine clinician well-being and do little to improve patient care [5]. ...
... 2,5,6 Although occupational burnout among physicians is a system issue primarily attributable to problems in the practice environment, 2,7-9 professional norms and aspects of the culture of medicine often contribute to the distress experienced by individual physicians. 10 These dimensions have been well characterized and include suggestions that physicians should be impervious to normal human limitations (ie, superhuman), work should always come first, and seeking help is a sign of weakness. [11][12][13][14] In aggregate, these mindsets lead many physicians to engage in unhealthy levels of self-sacrifice manifested by excessive work hours, anxiety about missing something that would benefit their patients, and prioritizing work over personal health. ...
... 11,12,53 Mindsets of perfectionism and "unforgiving excellence" can also become ingrained in the culture of organizations. 10,63 Deliberate and sustained efforts to evolve an organizational culture of perfectionism to an organizational culture of excellence and growth mindset may be required in such situations. 63 Our study is subject to several limitations. ...
Objective
To determine the prevalence of imposter phenomenon (IP) experiences among physicians and evaluate their relationship to personal and professional characteristics, professional fulfillment, burnout, and suicidal ideation.
Participants and Methods
Between November 20, 2020, and February 16, 2021, we surveyed US physicians and a probability-based sample of the US working population. Imposter phenomenon was measured using a 4-item version of the Clance Imposter Phenomenon Scale. Burnout and professional fulfillment were measured using standardized instruments.
Results
Among the 3237 physician responders invited to complete the subsurvey including the IP scale, 3116 completed the IP questions. Between 4% (133) and 10% (308) of the 3116 physicians endorsed each of the 4 IP items as a “very true” characterization of their experience. Relative to those with a low IP score, the odds ratio for burnout among those with moderate, frequent, and intense IP was 1.28 (95% CI, 1.04 to 1.58), 1.79 (95% CI, 1.38 to 2.32), and 2.13 (95% CI, 1.43 to 3.19), respectively. A similar association between IP and suicidal ideation was observed. On multivariable analysis, physicians endorsed greater intensity of IP than workers in other fields in response to the item, “I am disappointed at times in my present accomplishments and think I should have accomplished more.”
Conclusion
Imposter phenomenon experiences are common among US physicians, and physicians have more frequent experiences of disappointment in accomplishments than workers in other fields. Imposter phenomenon experiences are associated with increased burnout and suicidal ideation and lower professional fulfillment. Systematic efforts to address the professional norms and perfectionistic attitudes that contribute to this phenomenon are necessary.
