Well-being or the lack thereof: how do we support it?

For the last several years, there has been an increasing focus at the national level on physician burnout and its effect on our healthcare system. (1) A recent survey (2) of a community graduate medical education program in Wichita KS adds to the worry.  The authors surveyed all of the residents and core faculty in thirteen programs that are associated with the KUSOM in Wichita. The response rate was about 50 percent (281/439) with higher response from the faculty (55%) than the residents (47%55%) than the residents (47%).  The surveyed used the Abbreviated version of the Maslach Burnout Inventory (MBI-9).  The authors found that 32 percent of the residents and faculty had emotional exhaustion and 31 percent depersonalization.  Overall, 94/281 (43%) were considered burned out, with 51 percent of the residents meeting burnout criteria. There were three themes that emerged as activities that promote wellness among physicians: promotion of healthy and mindfulness activities; enhanced program leadership; and administration, program, and system modification to make the practice of medicine better for physicians.

Another survey of family medicine residents and faculty in Texas explored burnout. (3) Participants included 295 family medicine residents and faculty members across eleven FM programs within the Residency Research Network of Texas. The residents and faculty completed several measures that assessed resilience, burnout, flexibility, and stress. The primary outcome variables were burnout (depersonalization, emotional exhaustion, and personal achievement) and resilience. Depersonalization accounted for 27.1% of the variance (P<.001), with a moderate effect size (f²=.371). Risk factors included younger age, non-Hispanic white ethnicity, and lower resilience predicted. Resilience was the only variable that predicted depersonalization among program faculty while younger age and non-Hispanic white ethnicity along with resilience were significant predictors of depersonalization among residents. Emotional exhaustion accounted for 39% of the variance in the model (F [11,286] = 16.609, P<.001). Resiliency was significantly associated with younger age and greater psychological flexibility. Younger age, identifying as an ethnic minority, and psychological flexibility predicted resiliency among faculty, but there were no statistically significant predictors of resilience among the resident physicians.

And finally, a survey from the Association of Family Medicine Residency Directors (AFMRD) Physician Wellness Task Force (4) was done to help programs create a “culture of wellness.”  Of the 16 elements presented, 14 were rated as essential by at least 80% of the program directors. The five areas that were ranked as the most important after three rounds of questioning included: make wellness part of the residency vocabulary and culture by beginning wellness conversations in orientation and regularly thereafter; create a culture of safe, confidential disclosure for burnout, depression, suicidal ideation, and impairment; provide (directly or referral) accessible, confidential, affordable mental health services;  develop and maintain a regular recurring or longitudinal wellness curriculum (eg, building skills such as mindfulness, resilience, empathy); identify one or more wellness champions (faculty or resident) with explicit leadership support.

I am very excited that Family Medicine has given so much thought to this important issue.  Three studies in the journal that really add to the discourse!  Thanks.

References

(1)   https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources

(2)   Ofei-Dodoo S, Callaway P, Engels K. Prevalence and Etiology of Burnout in a Community-Based Graduate Medical Education System: A Mixed-Methods Study. Fam Med 2019; 51(9): 766-71.

(3)   Buck K, Williamson M, Ogbeide S, Norberg B. Family Physician Burnout and Resilience: A Cross-sectional Analysis. Fam Med 2019; 51(8): 657-663.

(4)   Penwell-Waines L, Runyan C, Kolobova I, et al.  Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts.  Fam Med 2019; 51(8): 670-6.