Clinician well-being is essential for safe, high-quality patient care.
However, clinicians of all kinds, across all specialties and care settings, are experiencing alarming rates of burnout. Among the most telling of statistics, more than 50 percent of U.S. physicians report significant symptoms. Burnout is a syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.
Clinician burnout can have serious, wide-ranging consequences, from reduced job performance and high turnover rates to—in the most extreme cases—medical error and clinician suicide. On the other hand, clinician well-being supports improved patient-clinician relationships, a high-functioning care team, and an engaged and effective workforce. In other words, when we invest in clinician well-being, everyone wins.
Supporting clinician well-being requires sustained attention and action at organizational, state, and national levels, as well as investment in research and information-sharing to advance evidence-based solutions.
In the face of the unprecedented challenges created by the COVID-19 pandemic and the accompanying global public health emergency, the Action Collaborative on Clinician Well-Being and Resilience must acknowledge the toll that the current crisis is taking on the well-being of clinicians. We know that the health care and public health community needs our support as they navigate the difficult challenges arising in this unprecedented moment. We have therefore compiled a list of strategies and resources to support the health and well-being of clinicians providing health care during the COVID-19 outbreak.
About the Clinician Well-Being Collaborative
In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience, a network of more than 200 organizations committed to reversing trends in clinician burnout. The Collaborative has three goals:
- Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide
- Improve baseline understanding of challenges to clinician well-being
- Advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.
The Action Collaborative will meet over the course of four years to identify evidence-based strategies to improve clinician well-being at both the individual and systems levels. Products and activities of the Action Collaborative include an online knowledge hub, a series of NAM Perspectives discussion papers, and an all-encompassing conceptual model that reflects the domains affecting clinician well-being.
Questions? Contact us at ClinicianWellBeing@nas.edu.
Clinician Well-Being Collaborative Leadership
Victor Dzau, Chair
Darrell Kirch, Co-Chair
Thomas Nasca, Co-Chair
Anh Tran, Research Associate
Elizabeth (Libbie) Prescott, Director of Programs
Micheline Toure, Senior Program Assistant
Samantha Phillips, Communications Officer
Sharyl Nass, Board Director
Resources from the Clinician Well-Being Collaborative
Clinician Well-Being Knowledge Hub
The Clinician Well-Being Knowledge Hub is a comprehensive resource repository for those seeking to promote clinician well-being at their organizations and in their personal lives. The repository contains peer-reviewed research, personal stories, toolkits, presentations, blog posts and other resources that health system administrators and clinicians can use to build a better system that helps clinicians thrive.
These case studies highlight organizational initiatives that have demonstrated success in supporting well-being and reducing burnout among practicing clinicians, trainees, and/or students. The case studies are intended to inform and inspire organizations facing similar challenges and seeking similar outcomes. Although there is no one-size-fits-all solution for clinician well-being, techniques and resources described in the case studies may provide a useful starting point for other groups.
Validated Instruments to Assess Work-Related Dimensions of Well-Being
A key organizational strategy to improving clinician well-being is to measure it, develop and implement interventions, and then re-measure it. A variety of dimensions of clinician well-being can be measured including burnout, engagement, and professional satisfaction. Click below for a summary of established tools to measure work-related dimensions of well-being. Each tool has advantages and disadvantages and some are more appropriate for specific populations or settings.
Conceptual Model – Factors Affecting Clinician Well-Being and Resilience
This conceptual model depicts the factors associated with clinician well-being and resilience; applies these factors across all health care professions, specialties, settings, and career stages; and emphasizes the link between clinician well-being and outcomes for clinicians, patients, and the health system. The model should be used to understand well-being, rather than as a diagnostic or assessment tool. The model will be revised as the field develops and more information becomes available.
Expressions of Clinician Well-Being
Expressions of Clinician Well-Being is an art exhibit that collects insights directly from clinicians, patients, loved ones, and organizations working to prevent burnout and promote well-being. By allowing people to creatively express their experiences with burnout, this gallery captures critical moments in the journey to well-being.
We hope this art will offer an entry point for conversations that can be difficult to have and shed light on the joys and challenges experienced by so many. We hope that the stories captured through this art will allow you to more fully understand why clinician well-being is so essential to the vitality of our health system.
Recent Publications from the Clinician Well-Being Collaborative
Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence
Dr. Lorna Breen was the head of the Emergency Department at New York-Presbyterian Allen Hospital in New York City. She dedicated her career to helping others and tirelessly treated patients with COVID-19 at the height of the outbreak, eventually contracting COVID-19 herself. Dr. Breen died by suicide after telling her family that she was reluctant to seek help or ask for assistance for overwhelming work-related stress because she feared that she would lose her medical license or be ostracized by her colleagues. Dr. Breen’s sister and brother-in-law reflect on the final weeks of their sister’s life and work and make an impassioned call to break the culture of silence that surrounds mental health support and assistance for clinicians.
Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action
While meant to improve care quality and efficiency, the electronic health record (EHR) has inadvertently burdened clinicians. U.S. health care professionals spend up to two-thirds of their workday on EHR and desk work instead of direct patient care, and current EHR design emphasizes billing and administrative functions over care delivery and clinical decision-making. Fortunately, interventions are available now that can help address clinician burnout associated with EHR use. If implemented carefully and with the input of clinicians, the EHR can be shifted from contributing to clinician burnout to contributing to clinician well-being.
Clinician Well-Being at Virginia Mason Kirkland Medical Center: A Case Study
The following case study provides an overview of initiatives that support well-being and reduce burnout in clinicians who work at the Virginia Mason Kirkland Medical Center (Kirkland Medical Center). The purpose of this case study is to provide readers with tangible information to understand how Kirkland Medical Center has adopted programs and policies that support wellbeing. This case study is not a prescriptive roadmap. Rather, the authors hope that this case study will serve as an idea-generating resource for leaders working to improve the well-being of our nation’s clinicians, trainees, and students. The development of this case study was informed by extensive interviews with Kirkland Medical Center health professionals and their leadership team.
Clinician Well-Being at The Ohio State University: A Case Study
The purpose of this case study is to provide readers with tangible information to understand how The Ohio State University (Ohio State) has adopted programs and policies that support well-being. This case study is not a prescriptive roadmap. Rather, the authors hope that this case study will serve as an idea-generating resource for leaders working to improve the well-being of our nation’s clinicians, trainees, and students. This case study provides an overview of well-being initiatives at Ohio State’s College of Medicine, College of Nursing, Emergency Medicine Residency Program, and the Wexner Medical Center. The development of this case study was informed by extensive interviews with Ohio State leadership, faculty, staff, and students.
Gender-Based Differences in Burnout: Issues Faced by Women Physicians
Individual, institutional, and societal risk factors for the development of burnout can differ for women and men physicians. While some studies on physician burnout report an increased prevalence among women, this finding may be due to actual differences in prevalence, the assessment tools used, or differences between/among the genders in how burnout manifests. In the following discussion paper, we review the prevalence of burnout in women physicians and contributing factors to burnout that are specific for women physicians. Understanding, preventing, and mitigating burnout among all physicians is critical, but such actions are particularly important for the retention of women physicians, given the increasing numbers of women in medicine and in light of the predicted exacerbation of physician shortages.
Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature
While much is known about the prevalence of burnout among physicians and nurses, little is known about burnout in the physician assistant (PA) profession. Approximately 50 percent of physicians and 35 percent of nurses report symptoms of burnout. Burnout is linked to increased health care costs, medical errors, and poor patient outcomes. The PA profession emerged in the 1960s in response to workforce shortages in rural and underserved communities. The profession has evolved from one designed for primary care to one that is adaptable to broad workforce demands. PAs are now employed in almost all medical specialties, including those with physicians reporting high rates of burnout. The authors believe that this is the first paper to explore the literature that relates specifically to PA burnout and career and job satisfaction.
Additional Related Resources
- Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being (New England Journal of Medicine)
- Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being
- National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience podcast (American Society of Health-System Pharmacists)
- Do you know what’s in the landmark report on Clinician Burnout from the National Academy of Medicine? podcast (MissingLogic, LLC)
- Making the Case for the Chief Wellness Officer in America’s Health Systems (Health Affairs)
- To Care is Human: Collectively Confronting the Clinician Burnout Crisis (New England Journal of Medicine)
- Related Perspectives from the National Academies
We currently do not require additional formal sponsors of the collaborative, but we very much want all interested organizations to stay connected as supportive partners. You can join our efforts by becoming a Network Organization of the Clinician Well-Being Collaborative.
Thank you for your commitment to clinician well-being.
If you are suicidal and need emergency help, call 911 immediately or 1-800-273-8255 if in the United States. If you are in another country, find a 24/7 hotline at www.iasp.info/resources/Crises_Centres.