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Strategies to improve General Practitioner wellbeing: A focus group study



Background Primary care physicians are particularly prone to high levels of burnout and poor wellbeing. Despite this, no qualitative studies have specifically investigated the best ways to improve wellbeing and prevent burnout in primary care physicians. Previous interventions within primary care have been person-oriented and mainly focused on mindfulness, but there has been no prior research on whether general practitioners (GPs) deem this to be the best approach. Objectives To explore strategies that could improve GP wellbeing and reduce or prevent burnout, based on GP perceptions of the workplace factors that affect their levels of wellbeing and burnout. Methods Five focus groups were conducted, with 25 GPs (locums, salaried, trainees, and partners) in the UK, between September 2015 and February 2016. Focus groups took place in GP practices and private meeting rooms. Discussions were centered on the workplace factors that they perceived to influence their wellbeing, along with strategies that they use either personally, or as a practice, to try and prevent burnout. Furthermore, strategies that could feasibly be implemented by individuals and practices to improve wellbeing, as well as changes that are needed by groups or organizations that are external to their practice (e.g. the government) to improve the working conditions, were explored. Thematic analysis was conducted on the transcripts. Results Based on the contributors to burnout and workplace wellbeing that the participants identified, the following feasible strategies were suggested: compulsory daily coffee breaks, increasing self and organizational awareness of the risks of burnout, and mentoring/buddy systems. System-level organizational changes were voiced as vital, however, to improve the wellbeing of all primary care physicians. Increasing resources seemed to be the ideal solution, to allow for more administrative staff and GPs. Conclusion These strategies merit further consideration by researchers, physicians, healthcare organizations, and policy makers both in the UK and beyond. Failure to do so may result in healthcare staff becoming even more burnt-out, potentially leading to a loss of doctors from the workforce.
Article published in Family Practice (accepted 2017)
Strategies to improve General Practitioner wellbeing: A focus group study
Running Head: General Practitioners’ burnout coping strategies
Louise H. Hall1,2, Judith Johnson1,2, Jane Heyhoe2, Ian Watt3, Kevin Anderson4,5,
Daryl B. O’Connor1
1. School of Psychology, University of Leeds; Leeds, England
2. Yorkshire Quality and Safety Research Group, Bradford Institute for Health
Research, Bradford Royal Infirmary; Bradford, England
3. Department of Health Sciences, University of York; York, England
4. Haxby Group Surgeries; Hull, England
5. Hull York Medical School; York, England
Corresponding author: Miss L. H. Hall; School of Psychology, University of Leeds;
Lifton Place, Leeds, LS2 9JT, England;
Word Count: 3,261
References: 31
Key Messages
Organisational changes are needed to improve GP wellbeing and burnout levels
Organisational and individual awareness and training around burnout could help
Increases in resources (staff) could reduce workload and improve wellbeing
Practice and individual-level strategies could reduce burnout in the interim
Introducing daily coffee/lunch breaks could greatly benefit staff wellbeing
More support from various sources (colleagues, public, government) is needed
Primary care physicians are particularly prone to high levels of burnout and poor wellbeing. Despite
this, no qualitative studies have specifically investigated the best ways to improve wellbeing and
prevent burnout in primary care physicians. Previous interventions within primary care have been
person-oriented and mainly focused on mindfulness, but there has been no prior research on whether
general practitioners (GPs) deem this to be the best approach.
To explore strategies that could improve GP wellbeing and reduce or prevent burnout, based on GP
perceptions of the workplace factors that affect their levels of wellbeing and burnout.
Five focus groups were conducted, with 25 GPs (locums, salaried, trainees, and partners) in the UK,
between September 2015 and February 2016. Focus groups took place in GP practices and private
meeting rooms. Discussions were centered on the workplace factors that they perceived to influence
their wellbeing, along with strategies that they use either personally, or as a practice, to try and prevent
burnout. Furthermore, strategies that could feasibly be implemented by individuals and practices to
improve wellbeing, as well as changes that are needed by groups or organizations that are external to
their practice (e.g. the government) to improve the working conditions, were explored. Thematic
analysis was conducted on the transcripts.
Based on the contributors to burnout and workplace wellbeing that the participants identified, the
following feasible strategies were suggested: compulsory daily coffee breaks, increasing self and
organizational awareness of the risks of burnout, and mentoring/buddy systems. System-level
organizational changes were voiced as vital, however, to improve the wellbeing of all primary care
physicians. Increasing resources seemed to be the ideal solution, to allow for more administrative staff
and GPs.
These strategies merit further consideration by researchers, physicians, healthcare organizations, and
policy makers both in the UK and beyond. Failure to do so may result in healthcare staff becoming
even more burnt-out, potentially leading to a loss of doctors from the workforce.
Burnout and poor mental wellbeing in healthcare professionals are rising internationally1-3. Burnout, “a
state of vital exhaustion”4 can be characterized by feelings of emotional exhaustion, depersonalization,
and reduced personal accomplishment5. Wellbeing is a broader concept, with clinicians often viewing it
as a spectrum from low to high6. Low wellbeing includes symptoms or diagnoses of depression and/or
anxiety, and high wellbeing as feelings of happiness and flourishing7. Primary care physicians are at
high risk of these ailments8,9. Rates of burnout in UK General Practitioners (GPs) are particularly high
compared with other European countries and similar to rates within the US and Canada 10-12, leading to
concerns that UK general practice is currently ‘in crisis’ 13. Negative implications of burnout and poor
wellbeing for the individual include an unfavourable work-life balance, poorer quality of life, substance
abuse, and suicidality12,14. Implications of staff burnout and poor wellbeing on healthcare organisations
include high staff turnover, increased sickness absence, poorer quality of care (e.g. negative attitudes
towards patients and reduced patient satisfaction), and poorer patient safety outcomes (e.g. increased
likelihood of making a wrong diagnosis or medication error) 15-17. All of these outcomes also cost
healthcare organizations billions of pounds/dollars annually18,19.
Several studies have investigated the factors contributing to stress, burnout, and depression
within primary care physicians. They have suggested that causes include high workload, difficult
patients, lack of support, and lack of control8,10,20. The majority of research however, has been survey
based, lacking the depth and explanatory power that qualitative methods provide. In some instances
little justification was provided for why particular organizational variables were measured. Whilst one
study by Fisher et al., 21 has taken a qualitative approach, they focused solely on workload stressors and
strategies to deal specifically with workload. Our study aims to build upon these findings and extend
them by focusing on general workplace stressors (including but not limited to workload), along with
potential strategies to deal with these stressors and their effects on the individuals.
Despite similar demands amongst healthcare staff, not all practitioners experience such
problems. Strategies used by resilient physicians and practices to cope with workplace demands
include; limiting one’s practice/reducing work hours, improving communication and team functioning,
having job control and seeking peer and personal support21-23. Although these strategies have been
found useful, they mostly rely on the physician themselves to ensure implementation. This requires
individuals to have the relevant resources (time, support, flexibility) to make changes to their routines.
Those who are already struggling and therefore have limited resources are less able to make these
amendments, keeping them trapped in a negative feedback loop.
Regarding formal interventions to reduce physician burnout, both organizational and
individual approaches have been successful, however no organizational interventions have been trialed
in primary care 24. Organizational interventions are warranted so that a) the responsibility for burnout
reduction is shared between the practitioner and the organization and b) working conditions improve
for all staff. Furthermore, many interventions simply aim to treat outcomes, without addressing the
cause of the problem. As such, our aim was to explore potential strategies that GPs think could improve
their wellbeing and reduce/prevent burnout, based on their perceptions of the workplace factors that
affect their levels of wellbeing and burnout. To accomplish this we took a two-part approach, to meet
the following objectives:
1) To understand which workplace factors GPs’ perceive to influence their levels of wellbeing
and burnout.
2) To explore strategies and changes that GPs think could improve their wellbeing/prevent
Five focus groups were conducted with a total of 25 practicing General Practitioners who worked in the
North of England. Each group consisted of three to six GPs. Three focus groups consisted of GPs
working within the same practices, the other two consisted of locum GPs. Participant and focus group
characteristics are displayed in Table 1.
GP surgery/
Number of
Patient list
Number of
Sex Job roles Part/Full-time
Mean age (range) Mean no. years as
registered GP
1 GP surgery 2 45,000 6 2M, 4F 2 Trainees
2 Partners 1
1 Unknown
3 FT, 1 PT,
2 Unknown
35 (29 – 40)* 3.5 (0 – 11)*
2 Locums - - 4 2M, 2F 4 Locums 4 PT 47 (36 – 57) 17.5 (4 – 28)
3 Locums - - 5 2M, 3F 5 Locums 4 PT, 1FT 42.2 (34 – 56) 10.4 (0 – 28)
4 GP surgery 7 15,000 6 4M, 2F 6 Partners 6 FT 46 (35 – 55) 17.2 (8 – 28)
5 GP surgery 5 11,000 4 1M, 3F 3 Salaried
1 Partner
3 PT, 1FT 38.75 (33 – 44) 9.5 (4 – 17)
Table 1
Focus Group Characteristics
M = Male, F = Female, *Missing two participants’ data
We recruited GPs via an existing network and then by a snowballing method between August 2015 and
February 2016. Participants who took part in the first focus group put the researchers in contact with
the practice managers in their associated practices. They also gave the researchers contact details of
their personal contacts within local locum groups. Potential participants were fully informed of the
topics to be discussed during the recruitment stage. LH conducted the semi-structured focus groups
either in practice premises, or at a mutually convenient alternative location. Once written informed
consent had been given by each participant, the questions listed in Box 1 were asked, with some room
for emerging discussions. The transcripts were audio-recorded and then transcribed verbatim. Focus
groups lasted 45minutes to 1.5 hours.
Box 1. Discussion topic guide
Thematic analysis (TA) was conducted based on Braun and Clarke’s (2006) six phase guidelines25. The
transcripts were coded by hand, based on inductive, semantic principles, from the first author’s realist
Questions (prompts)
How would you define wellbeing?
How would you define burnout?
What would you consider to be the main contributors to wellbeing at work?
(Positive and negative contributors)
Do you have a way to try and minimize the impact these issues have on your
wellbeing? (Personally, as a practice)
Would you say that burnout is a worry generally among doctors?
Do you do anything to try and prevent burnout occurring?
Are you aware of any services or coping mechanisms that could help prevent
Do you think that burnout and/or poor wellbeing is increasing amongst doctors?
(Why? What’s changed?)
Are you encouraged to talk about your own wellbeing? (To your colleagues,
professionals, family. Is it a taboo?)
What, in your opinion, would be the best way to improve the wellbeing of GPs,
and prevent burnout? (Feasible ideas, if the sky was the limit)
epistemological approach. All transcripts were coded by LH, with 20% double coded by JH to provide
outside insight, allow discussions about the emerging themes, and guard against investigator bias. After
initial coding of all the transcripts, codes were grouped into themes and sub-themes. Any
disagreements regarding themes were discussed with one or more additional author until a consensus
was agreed. Once a thematic map had been generated, the authors revisited the entire data set to check
that the themes accurately reflected the majority of the data.
The focus groups were heterogeneous with regards to job position (partner, locum, etc.), but all
discussed very similar themes.
Objective 1: Contributors to wellbeing and burnout
When discussing which workplace factors contribute to their sense of wellbeing and levels of burnout,
two distinct themes emerged: Those that were internal to their practice and/or the individual, and those
that were external to their practice that they had no control over.
Internal influencers of wellbeing comprised of Team support, Variety (within their roles,
practices, or patients), Control (over their work environment and/or timetable), and an Intense and
unmanageable workload. The importance of working within a supportive, interactive team was
mentioned by all focus groups as particularly vital for good wellbeing. Those who felt like they did not
receive peer support or have the time to interact with their team described how it could have very
negative effects on their wellbeing.
External influencers of wellbeing were discussed in negative terms. These consisted of;
Increases in pressures and workload, Increases in patients’ expectations and complaints, the Negative
portrayal of general practice (in the media, by patients, and the government), and a Lack of support
(from the public, patients, the government, and the media). An increase in the amount of
administrative work that GPs have to do for external regulating organizations was described as adding
to their workload, adding stress, and taking away their time which would be better spent on direct
patient care.
Objective 2: Strategies to improve wellbeing
Participants discussed possible strategies to improve wellbeing and prevent burnout in two similar
themes to the first objective: Strategies that could be implemented at an individual or practice level,
and changes needed at a higher, organizational or policy level.
Individual and practice level strategies
GPs discussed strategies that fell under the following categories; Breaks, Support, Physical needs,
Psychological strategies, and Control. There was some overlap between these sub-themes, particularly
between Breaks and Psychological strategies and Physical needs.
Breaks. Scheduling a coffee and/or lunch break into the working day was viewed as a feasible strategy
that would be very beneficial to their wellbeing. Having the opportunity and being encouraged to leave
their individual and often isolated offices, interact with their colleagues, and have a short respite from
work was seen as something that positively impacted on GPs’ wellbeing in practices where this was
already implemented, and something that those who did not get the chance to, wished they did.
“M1: (…) the coffee break in the middle of morning surgery. We try and get here and meet for
a bit of rest and recuperation (…) … I’ve definitely recognized that it is a positive factor for
our wellbeing and therefore it’s something that we need to maintain and cherish ….” [FG4]
Breaks served as fulfilling psychological needs by having that mental break from ‘being the doctor’
[M2, FG1], physical needs by having the chance to have a drink, some food, perhaps some fresh air,
and a toilet break, and social needs through interacting with colleagues. Lunch breaks were not viewed
as a realistic option that could be implemented, however one short coffee break a day was deemed
feasible. Participants voiced that even if GPs only briefly left their office to make a cup of tea and take
it back to their office, this very short respite and chance of interaction could be enough to make a big
change to their wellbeing.
Support (social, supervisory, workload, and from patients). Having social support within the practice,
peer-to-peer, and from both medics and non-medics outside of their practice was found to be useful for
preventing burnout. To improve support at the practice level, buddying and mentoring systems were
suggested, along with regular meetings to ‘check in’ with how team members are doing.
“F1: But I think also, looking after each other… I think we're quite good at looking over our
shoulder at the other person (… ) if you see somebody's got a really full load, getting them a
cup of tea, or going and seeing one of their extras, (…) is quite a positive thing about our
team that we tend to do.” [FG1]
A suggestion for improving support from patients was to communicate the state of the surgery with
them and ask for their patience and support.
Physical needs. In addition to the physical needs within the breaks theme (food and drink), participants
discussed the need to make time for exercise to support physical and psychological wellbeing. Exercise
additionally served their social needs through team sports, and as a psychological strategy through
being a form of ‘escapism’.
Psychological strategies. Strategies that participants used to deal with the emotional toll of patient
contacts included being emotionally guarded/setting boundaries, and isolating themselves. The latter
approach, however, was acknowledged to be unhealthy and did indeed worsen one participant’s ability
to cope. Maintaining awareness of the risk of burnout was voiced as a useful strategy that some
participants used. Additionally, it was mentioned that this could be implemented in practices through
discussions and meetings, and externally at the training stage. It was evident that awareness was needed
at the individual, practice, and external levels.
“F1: I agree. Self-awareness is often the key thing. I certainly wasn’t taught that in a training
stage. I think if trainees are taught or encouraged to be more self-aware so they know what
their personal stresses are, how to manage them, how to identify them…(…) I suppose that’s
actually resilience isn’t it, it probably makes people feel more resilient because they’re more
aware of their limits.” [FG 2]
Control. Control over how much, where, and when they worked was seen as a positive strategy that
some GPs (mostly locums) used to prevent burnout. Many had chosen this manner of work specifically
to prevent them from burning out. Or it was chosen as a way forward to protect their wellbeing after
previously working full-time and suffering from burnout or depression.
External changes
Despite the positive changes that could be implemented within practices at a team or individual level, it
was evident that system-level changes are needed to have a larger impact on GPs’ work environment
and their wellbeing. The need for more Support, a Reduction in pressures, and an Increase in
resources, was discussed.
Support. Participants voiced the need for support from the government, their patients, the healthcare
organization as a whole, and the wider public and press through a reduction in negative media
portrayal. Additionally, a need for support from other services was discussed, for example from social
services, to reduce the workload falling to primary care related to care-related and social problems.
However this may be an issue with (a lack of) funding and access also within those organizations.
“F1: But wider support about if it’s an over the counter medication that you can buy from the
chemist please don’t request it from your doctor.” [FG3]
Reduction in pressure. Participants stated the need for a reduction in the tasks that decrease their time
that should be spent on direct patient care, such as; administrative work, quality assessment exercises,
additional work pushed onto them from secondary care.
“F1: they [secondary care] treat us like um -
F3: - yeah like can you recheck this and do that and -
F1: - they give us lots of menial, not menial tasks but things that they should be doing
themselves they’re pushing onto us all, so if they stopped doing that…” [FG5]
Increase in resources. Increasing resources for primary care was seen as an ideal solution that would
help to improve all the previous factors mentioned, such as reducing pressures and enabling time for
breaks. Ideally, having more GPs and funding to pay for more administrative staff would improve the
wellbeing of the GPs and also the quality of care by enabling GPs to offer longer appointments.
Increasing funding in other sectors (such as social care and mental healthcare) would also reduce the
added pressure currently within primary care.
“F1: So your options are you could increase funding in general practice back to the 11% it
should be at, which would be a 3 or 4% rise, and that additional resource would pay for
either more doctors or more staff within practices to do the things actually you don’t need a
doctor to do, and free up the doctors to then treat patients (...) it’s better for the doctors but
it’s better for the patients as well” [FG3]
Additional quotes for each theme and sub-theme can be found in the supplementary files (tables 2-5)
Five focus groups of GPs discussed issues that they perceived contributed to their wellbeing and levels
of burnout. They also considered possible strategies to improve wellbeing and prevent burnout. Their
responses fell under two main themes; those that were internal to the individual and practice, and those
that were external to themselves and their practice and therefore perceived to be outside of their direct
control. Internal influencers of wellbeing mainly consisted of having good team support, variation
within the job, job control, and unmanageable workloads. Individual and practice strategies to improve
wellbeing and prevent burnout tied in with these. In particular, participants noted strategies to look
after their physical needs (e.g. exercising), to have control (e.g. through choosing to locum), having
breaks, offering support, and psychological strategies such as increasing their self-awareness. External
influencers of wellbeing were framed in negative terms and comprised perceived increases in pressure
and workload, increasing patient expectations and complaints, lack of support from multiple sources,
and a perceived negative portrayal of general practice. External changes to improve wellbeing also
drew a parallel with these. Increases in support from the public, patients, media, and the government,
reduction in pressures, and increases in resources (e.g. funding) were stated as the three main external
changes that would be needed to improve wellbeing. It is important to note that control was seen as an
important contributor to wellbeing and yet the changes most likely to have a big impact in improving
all GPs’ wellbeing were mainly things outside of their control, suggesting a state of helplessness and
vulnerability to burnout with primary care physicians.
There were no obvious differences between or within groups based on job role, gender, or
number of years working as a GP. The only difference was in the language used: focus groups with
locum workers were more willing to discuss personal experiences of poor wellbeing or burnout,
whereas groups run with colleagues in the same practices spoke about more general workplace
contributors to stress, with fewer participants sharing their personal experiences of burnout or
depression. This is unsurprising given the potential stigma attached to discussing personal mental
health issues in front of colleagues. However this could also be explained by their current roles, as
many of the locum workers had chosen that line of work in a concerted effort to prevent burnout, or as
a way to improve their wellbeing after experiencing burnout/poor wellbeing when previously working
Previous literature
Similar contributors to wellbeing have previously been reported across various countries, including
America, Canada, and the UK 10,20,26,27. Some of these factors have also been cited as reasons why UK
GPs have left general practice in recent years28. Our study complements their findings, giving further
evidence for the lack of support within primary care in the UK, showing that these issues are
widespread and geographically generalizable. Furthermore, our study extends these findings by shifting
the focus away from strategies to deal specifically with workload, and instead offering practical
recommendations for individuals and practices to implement in the workplace to prevent burnout and
improve wellbeing generally. Additionally, our findings put forward system-level changes that are
needed to improve working conditions.
Improving self-awareness of personal stressors and signs of stress was a strategy suggested by our
participants. This has been successfully trialed within healthcare staff, through mindfulness training
courses, as an effective way to reduce burnout 29,30. The GPs also discussed the need for more self-
awareness and stress management coaching from their education providers during early stages of
professional training. This could encourage practitioner awareness of burnout whilst simultaneously
encouraging a wider, organizational understanding. Additionally, participants suggested various
strategies to foster peer-support. Balint groups (a group of clinicians/doctors who regularly meet to
discuss their difficult patient cases in a safe and supportive environment), could be one way of
increasing both peer-support whilst also increasing competence, and are used by some physicians as a
means to prevent burnout31. The primary novel strategy suggested by the participants of this study, was
the need for regular coffee/lunch breaks. These were believed to help to improve both physical and
psychological wellbeing, whilst also fostering a better team culture.
There are some practical strategies that individuals and practices can implement to reduce burnout,
such as introducing compulsory coffee breaks, and mentoring/buddying systems. However, it is evident
that system level changes may also be valuable. These could include training future GPs and
organizations to be aware of the signs of burnout and evaluating the impact this has on workforce
wellbeing. The changes that are likely to have the biggest impact on wellbeing however, such as
increases in funding, resources, and staff, are those that are the most challenging to implement.
Strengths and limitations
All participants were working within UK general practice, which challenges the representativeness and
generalizability of the sample and results. However many of the themes discussed were of international
relevance, particularly regarding the need for increases in support, resources, and breaks. The primary
strength of this study is the practical and feasible strategies that could be implemented within practices
immediately to improve workplace wellbeing in the interim before organizational change can be
GPs identified both practice-level and organizational-level factors that influenced their wellbeing. They
suggested that the best, feasible way to reduce the negative impact of these factors on their wellbeing is
through daily breaks. However, external changes were deemed vital to provide increases in resources to
allow for more administrative staff, GPs, and time for patient contact, as well as an increase in support
from various sources. These factors all merit further consideration by researchers, physicians,
healthcare organizations, and policy makers worldwide. Failure to do so may result in the primary care
workforce becoming even more burnt-out, depressed, and a subsequent increase in sick leave and early
Ethical Approval
This study received ethical approval from the School of Psychology, University of Leeds Ethics
Committee (ref #15-0075 accepted on 06/03/15) and Health Research Authority R&D approval (IRAS
ref #178501).
This project forms part of a PhD that is part-funded by an NIHR grant. This paper presents independent
research by the National Institute for Health Research Collaboration for Leadership in Applied Health
Research and Care Yorkshire and Humber (NIHR CLAHRC YH). The views
and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the
Department of Health.
We gratefully thank all the GPs who gave up their time to participate in this study.
Conflict of Interest
The authors declare that they have no conflict of interest.
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of Family Medicine. 2008;6(2):138-145.
... Other qualitative studies used focus groups and individual interviews with doctors, and thematically analysed discussions about various break-related topics with a wellbeing or performance component. [51][52][53][54] One (UK) focus group study investigated themes regarding breaks as a potential strategy to improve general practitioner (GP) well-being. 51 GPs described breaks as a valuable, desirable opportunity to remove oneself from the workplace that is a feasible well-being improvement strategy, though shorter coffee breaks were deemed more feasible than lunch breaks. ...
... [51][52][53][54] One (UK) focus group study investigated themes regarding breaks as a potential strategy to improve general practitioner (GP) well-being. 51 GPs described breaks as a valuable, desirable opportunity to remove oneself from the workplace that is a feasible well-being improvement strategy, though shorter coffee breaks were deemed more feasible than lunch breaks. ...
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Objectives To summarise evidence on intrawork breaks and their associated effect on doctors’ well-being and/or performance at work. Design Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines Data sources Embase, PubMed, Web of Science (Core Collection) and PsychINFO were systematically searched on 6 June 2021. Eligibility criteria No restrictions were placed on language, study design or date of publication. Data extraction and analysis Methodological quality was appraised using Cochrane’s Risk of Bias (ROB-2), Cochrane’s Risk of Bias in Non-randomised Studies (ROBINS-I), and the Johanna Briggs Institute (JBI) checklists for cross-sectional, cohort and qualitative studies. Quantitative synthesis was not undertaken due to substantial heterogeneity of design and outcomes. Results are presented narratively. Results Database searches returned 10 557 results and searches of other sources returned two additional records. Thirty-two papers were included in the systematic review, comprised of 29 unique studies, participants and topics and 3 follow-up studies. A variety of well-being and performance outcome measures were used. Overall, findings indicate that intrawork breaks improved some measures of well-being and/or work performance. However, methodological quality was judged to be low with a high risk of bias in most included studies. Discussion Using existing evidence, it is not possible to conclude with confidence whether intrawork breaks improve well-being and/or work performance in doctors. There is much inconsistency regarding how breaks are defined, measured and the outcomes used to assess effectiveness. Future research should seek to: (a) define and standardise the measurement of breaks, (b) use valid, reliable outcome measures to evaluate their impact on well-being and performance and (c) minimise the risk of bias in studies where possible. PROSPERO registration number CRD42020156924; .
... 38 39 Another group qualitatively explored 'well-being' in GPs as distinct from 'burnout'. 40 We aimed to add to this burgeoning approach, and explore GP's well-being in the Australian context. ...
... Similar to our results, they identified the importance of team support, taking breaks, variety of and control over their work, on an internal level; and wider governmental and public support, resources and funding on an external level. 40 British GP trainee focus groups (n=16) discussed the benefits of supportive professional relationships (ie, supportive trainers), control over workload and barriers to well-being of 'not being valued', and work-life imbalance. 55 The European General Practice Research Network interviewed 183 GPs across eight countries, and described factors that promote job satisfaction: freedom to organise and choose their practice environment; professional education; and establishing strong patient-doctor relationships. ...
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Objectives: The well-being of doctors is recognised as a major priority in healthcare, yet there is little research on how general practitioners (GPs) keep well. We aimed to address this gap by applying a positive psychology lens, and exploring what determines GPs' well-being, as opposed to burnout and mental ill health, in Australia. Design: Semi-structured qualitative interviews. From March to September 2021, we interviewed GPs working in numerous settings, using snowball and purposive sampling to expand recruitment across Australia. 20 GPs participated individually via Zoom. A semi-structured interview-guide provided a framework to explore well-being from a personal, organisational and systemic perspective. Recordings were transcribed verbatim, and inductive thematic analysis was performed. Results: Eleven female and nine male GPs with diverse experience, from urban and rural settings were interviewed (mean 32 min). Determinants of well-being were underpinned by GPs' sense of identity. This was strongly influenced by GPs seeing themselves as a distinct but often undervalued profession working in small organisations within a broader health system. Both personal finances, and funding structures emerged as important moderators of the interconnections between these themes. Enablers of well-being were mainly identified at a personal and practice level, whereas systemic determinants were consistently seen as barriers to well-being. A complex balancing act between all determinants of well-being was evidenced. Conclusions: GPs were able to identify targets for individual and practice level interventions to improve well-being, many of which have not been evaluated. However, few systemic aspects were suggested as being able to promote well-being, but rather seen as barriers, limiting how to develop systemic interventions to enhance well-being. Finances need to be a major consideration to prioritise, promote and support GP well-being, and a sustainable primary care workforce.
... Taking regular coffee or lunch breaks with colleagues to share problems and receive advice should not be underestimated as an important intervention to prevent burn-out. 13 A quarter of the survey respondents were not aware of staff well-being resources available to them which has not improved much since the previous BSG surveys in 2020. 2 3 There are several online resources available to medical professionals and BSG members. [23][24][25] Those surveyed want the BSG to focus efforts on advocating for increased national training numbers (NTNs), nursing and allied health professional recruitment. ...
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Objective The aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology. Design/method A cross-sectional survey of British Society of Gastroenterology physician and trainee members was conducted between August and October 2021. Multivariable binary logistic regression and qualitative analyses were performed. Results The response rate was 28.8% (180/624 of opened email invites). 38.2% (n=21/55) of those who contracted COVID-19 felt pressured to return to work before they felt ready. 43.8% (71/162) had a regular increase in out-of-hours working. This disproportionately affected newly appointed consultants (OR 5.8), those working full-time (OR 11.6), those who developed COVID-19 (OR 4.1) and those planning early retirement (OR 4.0). 92% (150/164) believe the workforce is inadequate to manage the service backlog with new consultants expressing the highest levels of anxiety over this. 49.1% (80/163) felt isolated due to remote working and 65.9% (108/164) felt reduced face-to-face patient contact made their job less fulfilling. 34.0% (55/162) planned to work more flexibly and 54.3% (75/138) of consultants planned to retire early in the aftermath of the pandemic. Early retirement was independently associated with male gender (OR 2.5), feeling isolated from the department (OR 2.3) and increased anxiety over service backlog (OR 1.02). Conclusion The pandemic has placed an additional burden on work-life balance, well-being and workforce retention within gastroenterology and hepatology. Increased aspirations for early retirement and flexible working need to be explicitly addressed in future workforce planning.
... Our studies suggest that improving general practitioner working conditions is especially important in areas of high deprivation. 25 Recruitment and retention of GPs in areas of deprivation is challenging. 26 Support for medical student applicants from diverse socioeconomic backgrounds may help; research from the USA has shown that students from minority ethnic backgrounds are more likely to work with minority ethnic populations 27,28 and are perceived as more patient centred. ...
Background and aims: The 'inverse care law', first described in 1971, results from a mismatch of healthcare need and healthcare supply in deprived areas. GPs in such areas struggle to cope with the high levels of demand resulting in shorter consultations and poorer patient outcomes. We compare recent national GP and patient satisfaction data to investigate the ongoing existence of this disparity in Scotland. Methods and results: Secondary analysis of cross-sectional national surveys (2017/2018) on upper and lower deprivation quintiles. GP measures; job satisfaction, job stressors, positive and negative job attributes. Patient measures; percentage positive responses per practice on survey questions on access and consultation quality. GPs in high deprivation areas reported lower job satisfaction and positive job attributes, and higher job stressors and negative job attributes compared with GPs in low deprivation areas. Patients living in high deprivation areas reported lower satisfaction with access and consultation quality than patients in low deprivation areas. These differences in GP and patient satisfaction persisted after adjusting for confounding variables. Conclusions: Lower GP work satisfaction in deprived areas was mirrored by lower patient satisfaction. These findings add to the evidence that the inverse care law persists in Scotland, over 50 years after it was first described.
... 15 In addition, the buddy system was introduced to HCWs as a method to work on patient safety initiatives 16 or to improve the overall wellbeing of HCWs during non-crisis times. 17 Peer mentor and buddy systems have also been reported to be effective in patient care and in enhancing patient compliance with treatments. 18 In all of these instances, peer support has been shown to be beneficial, particularly to residents and students by helping them achieve their intended goals, whether those are training or introduction to a new or changing work environment. ...
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Objective: The coronavirus disease 2019 pandemic stressed healthcare organizations. Initial efforts focused on supplies with a minimal empha- sis on frontline healthcare workers' wellbeing. Anaesthesiology residents represent vulnerable frontline healthcare workers because airway pro- cedures increase nosocomial infection risks. Peer support can promote healthcare workers' wellbeing during crises; its application to graduate medical trainees is underrepresented in the literature. We implemented a quality improvement project to improve wellbeing among anaesthesiol- ogy residents via a peer support system called BUilding Dynamic Duos for Your Support. Methods: BUilding Dynamic Duos for Your Support consists of pairing 2 anaesthesiology residents with instructions to support each other in anticipation of a coronavirus disease 2019 case surge. A lecture presentation introduced this system to the residents and described frequent check-ins with another resident. We evaluated the initiative with a survey 2-4 weeks postimplementation. Results: BUilding Dynamic Duos for Your Support began in April 2020 and involved 88 residents. Survey respondents (n = 58) indicated that BUilding Dynamic Duos for Your Support had a positive impact on their wellbeing. BUilding Dynamic Duos for Your Support implementation had no additional costs, requiring minimal resource dedication. Conclusions: BUilding Dynamic Duos for Your Support promoted wellbeing among anaesthesiology trainees. This quality improvement project highlights the positive impact of a peer support system on anaesthesiology residents' wellbeing with a potential broader application to graduate medical education.
... Second, qualitative research can highlight unexpected results, enabling the identification of novel solutions not previously considered. For example, a qualitative study in general practitioners (GPs) highlighted some unexpected strategies to improve general practitioner wellbeing, such as the scheduling of compulsory team coffee breaks [14]. However, no similar studies have been conducted in surgeons. ...
Background Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. Purpose This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work. Setting Surgical departments in the United Kingdom's National Health Service (NHS). Materials Telephone interview and face to face interview. Methods This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout. Results A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of rising to the challenge of surgical work, interpersonal conflict at work, greater demands than resources, the challenge of work-life balance, and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely cognitive restructuring, seeking social support, stepping aside or down from the job, and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping. Conclusion Healthcare organisations, surgeons and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.
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Objectives In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies. Design We conducted a cross-sectional online self-report survey. Setting The survey was conducted in Chongqing, China from July to August 2022. Participants Data were collected from 2145 GPs, with an effective response rate of 91.0%. Primary and secondary outcome measures The main evaluation indicators were stress (Cohen’s Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being. Results Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work–life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05). Conclusion This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.
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Burnout is a major social and economic problem, specifically among general practitioners (GPs). The amount of literature on generic determinants of burnout is impressive. However, the size of the library on occupation-specific determinants of burnout among GPs are minimal. With the present study, we aim to gain insight into the existing academic literature on generic and occupation-specific determinants of burnout among GPs. Moreover, we aim to contribute to the ecological validity of this study by emphasizing occupation-specific determinants. We conducted a systematic quantitative literature review in which we followed the PRISMA statement and performed quality assessments according to the AXIS, CASP, MMAT, and 3-MIN procedures. Furthermore, we assessed frequency effect sizes (FES) and intensity effect sizes (IES). By performing Fisher’s exact tests, we investigated whether the quality of the studies influenced the outcomes. An extensive literature search revealed 60 eligible studies among which 28 strong studies, 29 moderate studies, and 3 weak studies were identified. Analyzing those studies delivered 75 determinants of burnout, of which 33 were occupation-specific for GPs. According to the average FES, occupation-specific determinants play a significant role in acquiring burnout compared to the generic determinants. The results of the Fisher exact tests provided evidence that the quality of the 60 studies did not affect the outcomes. We conclude that it is surprising that a profession with such an important social position and such a high risk of burnout has been so little researched.
School psychologists are key school‐based personnel when responding to suicidal thoughts and behaviors. The present paper explored the experiences and attitudes of school psychologists, with a special focus on collaborating during suicide intervention activities. Using a descriptive phenomenological approach, a purposive sample procedure identified 10 school psychologists. Data were collected via in‐person, semi‐structured interviews. Most participants were female (n = 9) and all were practicing within the school setting and had delivered suicide intervention activities. Experiences described through interviews suggested collaboration while responding to suicide was a common activity that enhances the quality of services, external collaboration—though beneficial for students—can be a barrier to the provision of services, school psychologists cope through collaboration, and suicide intervention services would benefit from increased collaboration. Implications for practice include working to develop stable partnerships with external stakeholders and increasing collaboration during suicide assessment and response. School psychologists frequently collaborate when completing suicide intervention activities. Collaboration with other agencies is beneficial, but difficulty communicating across systems presents a barrier to suicide intervention services. School psychologists frequently cope with suicide intervention activities through collaboration with other school‐based mental health providers. School psychologists frequently collaborate when completing suicide intervention activities. Collaboration with other agencies is beneficial, but difficulty communicating across systems presents a barrier to suicide intervention services. School psychologists frequently cope with suicide intervention activities through collaboration with other school‐based mental health providers.
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Objectives: The aims of the study were (1) to explore whether primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact on the quality and safety of patient care and (2) to determine potential mechanisms behind these associations. Method: Five focus groups with 25 practicing GPs were conducted in England, either in the participants' practice or in a private meeting room outside of their workplace.An interview schedule with prompts was followed with questions asking how participants perceive GP burnout and poor well-being could impact on patient care delivery. Audio recordings were transcribed verbatim and analyzed using thematic analysis. Results: General practitioners believed that poor well-being and burnout affect the quality of care patients receive through reducing doctors' abilities to empathize, to display positive attitudes and listening skills, and by increasing the number of inappropriate referrals made. Participants also voiced that burnout and poor well-being can have negative consequences for patient safety, through a variety of mechanisms including reduced cognitive functioning and decision-making abilities, a lack of headspace, and fatigue. Furthermore, it was suggested that the relationship between well-being/burnout and mistakes is likely to be circular. Conclusions: Further research is needed to ascertain the validity of these perceptions. If found, physicians, healthcare organizations, and policy makers should examine how they can improve physician well-being and prevent burnout, because this may be a route to ensure high-quality and safe patient care.
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Objective: To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety. Design: Systematic research review. Data sources: PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility criteria for selecting studies: Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results: Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions: Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications: This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic review registration: PROSPERO registration number: CRD42015023340.
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We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life's vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.
Background: 'Neoliberal' work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs. Aim: To explore GPs' experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change. Design and setting: Study design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews. Method: Focus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis. Results: There were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for 'good' doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work-life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced. Conclusion: GPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues.
Objective To report on any adverse effects on health and wellbeing of working as a doctor, as described by senior doctors. Design Questionnaires sent in 2014 to all medical graduates of 1974 and 1977. Participants 3695 UK medical graduates. Setting United Kingdom. Main outcome measures Statements about adverse effects upon health, wellbeing and career. Results The aggregated response rate from contactable doctors was 84.6% (3695/4369). In response to the question ‘Do you feel that working as a doctor has had any adverse effects on your own health or wellbeing?’, 44% of doctors answered ‘yes’. More GPs (47%) than hospital doctors (42%) specified that this was the case. Three-quarters of doctors who answered ‘yes’ cited ‘stress/work–life balance/workload’ as an adverse effect, and 45% mentioned illness. In response to the statement ‘The NHS of today is a good employer when doctors become ill themselves’, 28% of doctors agreed, 29% neither agreed nor disagreed and 43% disagreed. More women doctors (49%) than men doctors (40%) disagreed with this statement. More general practitioners (49%) disagreed than hospital doctors (37%). Conclusions Chronic stress and illness, which these doctors attributed to their work, were widely reported. Although recent changes may have alleviated some of these issues, there are lessons for the present and future if the NHS is to ensure that its medical workforce receives the support which enables current doctors to enjoy a full and satisfying career and to contribute fully to health service provision in the UK. Older doctors, in particular, need support to be able to continue successfully in their careers.
Background: The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative. Aim: To explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each. Design and setting: Semi-structured, qualitative interviews with GPs working within NHS England. Method: All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically. Results: Responses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful. Conclusion: This in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.
Background: Healthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of this relationship. This meta-analysis examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and the quality (perceived quality, patient satisfaction) and safety of healthcare. Methods: Publications were identified through targeted literature searches in Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, and ProQuest Dissertations & Theses through March of 2015. Two coders extracted data to calculate effect sizes and potential moderators. We calculated Pearson's r for all independent relationships between burnout and quality measures, using a random effects model. Data were assessed for potential impact of study rigor, outliers, and publication bias. Results: Eighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = -0.26, 95 % CI [-0.29, -0.23]) and safety (r = -0.23, 95 % CI [-0.28, -0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients. Moderators for the quality relationship included dimension of burnout, unit of analysis, and quality data source. Moderators for the relationship between burnout and safety were safety indicator type, population, and country. Rigor of the study was not a significant moderator. Discussion: This is the first study to systematically, quantitatively analyze the links between healthcare provider burnout and healthcare quality and safety across disciplines. Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators, and perceptions of safety. Though the effects are small to medium, the findings highlight the importance of effective burnout interventions for healthcare providers. Moderator analyses suggest contextual factors to consider for future study.
Background: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians' own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Education Resources Information Center from inception to Jan 15, 2016, for studies of interventions to prevent and reduce physician burnout, including single-arm pre-post comparison studies. We required studies to provide physician-specific burnout data using burnout measures with validity support from commonly accepted sources of evidence. We excluded studies of medical students and non-physician health-care providers. We considered potential eligibility of the abstracts and extracted data from eligible studies using a standardised form. Outcomes were changes in overall burnout, emotional exhaustion score (and high emotional exhaustion), and depersonalisation score (and high depersonalisation). We used random-effects models to calculate pooled mean difference estimates for changes in each outcome. Findings: We identified 2617 articles, of which 15 randomised trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Overall burnout decreased from 54% to 44% (difference 10% [95% CI 5-14]; p<0·0001; I(2)=15%; 14 studies), emotional exhaustion score decreased from 23·82 points to 21·17 points (2·65 points [1·67-3·64]; p<0·0001; I(2)=82%; 40 studies), and depersonalisation score decreased from 9·05 to 8·41 (0·64 points [0·15-1·14]; p=0·01; I(2)=58%; 36 studies). High emotional exhaustion decreased from 38% to 24% (14% [11-18]; p<0·0001; I(2)=0%; 21 studies) and high depersonalisation decreased from 38% to 34% (4% [0-8]; p=0·04; I(2)=0%; 16 studies). Interpretation: The literature indicates that both individual-focused and structural or organisational strategies can result in clinically meaningful reductions in burnout among physicians. Further research is needed to establish which interventions are most effective in specific populations, as well as how individual and organisational solutions might be combined to deliver even greater improvements in physician wellbeing than those achieved with individual solutions. Funding: Arnold P Gold Foundation Research Institute.
In this review we argue in favour of further integration between the disciplines of positive and clinical psychology. We argue that most of the constructs studied by both positive and clinical psychology exist on continua ranging from positive to negative (e.g., gratitude to ingratitude, anxiety to calmness) and so it is meaningless to speak of one or other field studying the “positive” or the “negative”. However, we highlight historical and cultural factors which have led positive and clinical psychologies to focus on different constructs; thus the difference between the fields is more due to the constructs of study rather than their being inherently “positive” or “negative”. We argue that there is much benefit to clinical psychology of considering positive psychology constructs because; (a) constructs studied by positive psychology researchers can independently predict wellbeing when accounting for traditional clinical factors, both cross-sectionally and prospectively, (2) the constructs studied by positive psychologists can interact with risk factors to predict outcomes, thereby conferring resilience, (3) interventions that aim to increase movement towards the positive pole of well-being can be used encourage movement away from the negative pole, either in isolation or alongside traditional clinical interventions, and (4) research from positive psychology can support clinical psychology as it seeks to adapt therapies developed in Western nations to other cultures.
Background: Adverse primary care work conditions could lead to a reduction in the primary care workforce and lower-quality patient care. Objective: To assess the relationship among adverse primary care work conditions, adverse physician reactions (stress, burnout, and intent to leave), and patient care. Design: Cross-sectional analysis. Setting: 119 ambulatory clinics in New York, New York, and in the upper Midwest. Participants: 422 family practitioners and general internists and 1795 of their adult patients with diabetes, hypertension, or heart failure. Measurements: Physician perception of clinic workflow (time pressure and pace), work control, and organizational culture (assessed survey); physician satisfaction, stress, burnout, and intent to leave practice (assessed by survey); and health care quality and errors (assessed by chart audits). Results: More than one half of the physicians (53.1 %) reported time pressure during office visits, 48.1 % said their work pace was chaotic, 78.4% noted low control over their work, and 26.5% reported burnout. Adverse workflow (time pressure and chaotic environments), low work control, and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave. Some work conditions were associated with lower quality and more errors, but findings were inconsistent across work conditions and diagnoses. No association was found between adverse physician reactions, such as stress and burnout, and care quality or errors. Limitation: The analyses were cross-sectional, the measures were self-reported, and the sample contained an average of 4 patients per physician. Conclusion: Adverse work conditions are associated with adverse physician reactions, but no consistent associations were found between adverse work conditions and the quality of patient care, and no associations were seen between adverse physician reactions and the quality of patient care. Primary Funding Source: Agency for Healthcare Research and Quality.