What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement

Academic Psychiatry

Volumn 42, Issue 1, 2018, Pages 94-108

  Brady, Keri J S ^a   Trockel, Mickey T ^b   Khan, Christina T ^b   Raj, Kristin S ^b   Murphy, Mary Lou ^b   Bohman, Bryan ^b   Frank, Erica ^c   Louie, Alan K ^b   Roberts, Laura Weiss ^b  

^a BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH   (United States)

^b STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

Conceptualization and measurement; Physician burnout; Physician well being; Physician wellness; Review

Indexed keywords

BURNOUT; CONSENSUS; HUMAN; MEDLINE; MOOD; PHYSICIAN; REVIEW; SYSTEMATIC REVIEW; WEB OF SCIENCE; WELLBEING; JOB SATISFACTION; MENTAL HEALTH; PREVENTION AND CONTROL; PSYCHOLOGY;

BURNOUT, PROFESSIONAL; HUMANS; JOB SATISFACTION; MENTAL HEALTH; PHYSICIANS;

EID: 85041636985     PISSN: 10429670     EISSN: 15457230     Source Type: Journal    
DOI: 10.1007/s40596-017-0781-6     Document Type: Review

References (103)

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13.
2. Prins JT, Hoekstra-Weebers JE, Gazendam-Donofrio SM, et al. Burnout and engagement among resident doctors in the Netherlands: a national study. Med Educ. 2010;44(3):236–47.
3. Diez-Pinol M, Dolan SL, Sierra V, Cannings K. Personal and organizational determinants of well-being at work: the case of Swedish physicians. Int J Health Care Qual Assur. 2008;21(6):598–610.
4. Markwell AL, Wainer Z. The health and wellbeing of junior doctors: insights from a national survey. Med J Aust. 2009;191(8):441–4.
5. van der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch Suicide Res. 2008;12(4):344–6.
6. Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manag Rev. 2007;32(3):203–12.
7. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol. 2014;5
8. Frank E, Dresner Y, Shani M, Vinker S. The association between physicians’ and patients’ preventive health practices. Can Med Assoc J. 2013;185(8):cmaj. 121028.
9. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–91.
10. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.
11. Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manag Rev. 2008;33(1):29–39.
12. Scheepers RA, Boerebach BC, Arah OA, Heineman MJ, Lombarts KM. A systematic review of the impact of physicians’ occupational well-being on the quality of patient care. Int J of Behav Med. 2015:1–16.
13. Konrad TR. Measures, methods, and models of doctor satisfaction: future research challenges. Professions and Professionalism. 2015;5(1).
14. West CP. Physician well-being: expanding the triple aim. J Gen Intern Med. 2016;31(5):458–9.
15. World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 1948.
16. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
17. Schrijver I, Brady KJS, Trockel M. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center. Peer J. 2016;4:e1783.
18. Wallace JE, Lemaire J. On physician well being-you’ll get by with a little help from your friends. Soc Sci Med. 2007;64(12):2565–77.
19. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009;302(12):1338–40.
20. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg. 2012;255(4):625–33.
21. Goldberg R, Boss RW, Chan L, et al. Burnout and its correlates in emergency physicians: four years’ experience with a wellness booth. Acad Emerg Med. 1996;3(12):1156–64.
22. Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559–64.
23. Shanafelt TD, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion strategies of medical oncologists in the north central cancer treatment group. Oncology. 2005;68(1):23–32.
24. Uncu Y, Bayram N, Bilgel N. Job related affective well-being among primary health care physicians. Eur J Pub Health. 2007;17(5):514–9.
25. West CP, Shanafelt TD, Cook DA. Lack of association between resident doctors’ well-being and medical knowledge. Med Educ. 2010;44(12):1224–31.
26. Fang CK, Li PY, Lai ML, Lin MH, Bridge DT, Chen HW. Establishing a ‘Physician’s Spiritual Well-being Scale’ and testing its reliability and validity. J Med Ethics. 2011;37(1):6–12.
27. Lebensohn P, Dodds S, Benn R, et al. Resident wellness behaviors: relationship to stress, depression, and burnout. Fam Med. 2013;45(8):541–9.
28. Colon-de Marti LN, Martinez A, Gomez Y, Rivera-Colon I. Perceptions of a group of surgical and non-surgical residents at a Hispanic academic medical center of the impact of the night-float system. P R Health Sci J. 2014;33(2):45–50.
29. Thorndike AN, Mills S, Sonnenberg L, et al. Activity monitor intervention to promote physical activity of physicians-in-training: randomized controlled trial. PLoS One. 2014;9(6):e100251.
30. von Vultee PJ, Axelsson R, Arnetz B. Individual and organizational well-being of female physicians—an assessment of three different management programs. Med Gen Med. 2004;6(1):4.
31. von Vultée PJ, Arnetz B. The impact of management programs on physicians’ work environment and health: a prospective, controlled study comparing different interventions. J Health Organ Manage. 2004;18(1):25–37.
32. Grunfeld E, Zitzelsberger L, Coristine M, Whelan TJ, Aspelund F, Evans WK. Job stress and job satisfaction of cancer care workers. Psychooncology. 2005;14(1):61–9.
33. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544–52.
34. Schaufeli WB, Bakker AB, van der Heijden F, Prins JT. Workaholism, burnout and well-being among junior doctors: the mediating role of role conflict. Work Stress. 2009;23(2):155–72.
35. Grieve S. Measuring morale—does practice area deprivation affect doctors’ well-being? Br J Gen Pract. 1997;47(422):547–52.
36. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165(22):2601–6.
37. von Vultée PJ, Axelsson R, Arnetz B. The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur. 2007;20(6):506–15.
38. Gardiner M, Lovell G, Williamson P. Physician you can heal yourself! Cognitive behavioural training reduces stress in GPs. J Fam Pract. 2004;21(5):545–51.
39. Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health. 2005;13(3):149–55.
40. Gardiner M, Sexton R, Kearns H, Marshall K. Impact of support initiatives on retaining rural general practitioners. Aust J Rural Health. 2006;14(5):196–201.
41. Keim SM, Mays MZ, Williams JM, Serido J, Harris RB. Measuring wellness among resident physicians. Med Teach. 2006;28(4):370–4.
42. Aalto AM, Heponiemi T, Keskimaki I, et al. Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care. Eur J Pub Health. 2014;24(3):445–51.
43. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. Eur J Pub Health. 2011;21(4):520–5.
44. Heponiemi T, Puttonen S, Elovainio M. On-call work and physicians’ well-being: testing the potential mediators. Occup Med. 2014;64(5):352–7.
45. Kuusio H, Heponiemi T, Aalto AM, Sinervo T, Elovainio M. Differences in well-being between GPs, medical specialists, and private physicians: the role of psychosocial factors. Health Serv Res. 2012;47(1 Pt 1):68–85.
46. Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657–67.
47. Shanafelt TD, Raymond M, Horn L, et al. Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into? J Clin Oncol. 2014;32(27):2991–7.
48. Chen DF, Tsai TC, Lei SM. Career satisfaction, commitment, and well-being among Taiwanese pediatricians. Pediatr Neonatol. 2013;54(3):173–8.
49. Lemaire JB, Wallace JE. How physicians identify with predetermined personalities and links to perceived performance and wellness outcomes: a cross-sectional study. BMC Health Serv Res. 2014;14
50. West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174(4):527–33.
51. Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One. 2013;8(4):e61526.
52. Frey R, Decker K, Reinfried L, et al. Effect of rest on physicians’ performance in an emergency department, objectified by electroencephalographic analyses and psychometric tests. Crit Care Med. 2002;30(10):2322–9.
53. Lederer W, Kinzl JF, Trefalt E, Traweger C, Benzer A. Significance of working conditions on burnout in anesthetists. Acta Anaesthesiol Scand. 2006;50(1):58–63.
54. von Vultee PJ, Axelsson R, Arnetz B. The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur. 2007;20(6):506–15.
55. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;02(12):1284–93.
56. Eisenach JH, Sprung J, Clark MM, et al. The psychological and physiological effects of acute occupational stress in new anesthesiology residents: a pilot trial. Anesthesiology. 2014;121(4):878–93.
57. Hoonpongsimanont W, Murphy M, Kim CH, Nasir D, Compton S. Emergency medicine resident well-being: stress and satisfaction. Occup Med. 2014;64(1):45–8.
58. Saadat H, Snow DL, Ottenheimer S, Dai F, Kain ZN. Wellness program for anesthesiology residents: a randomized, controlled trial. Acta anaesthesiologica Scand. 2012;56(9):1130–8.
59. Eley DS, Cloninger CR, Walters L, Laurence C, Synnott R, Wilkinson D. The relationship between resilience and personality traits in doctors: implications for enhancing well being. PeerJ. 2013;1
60. Salles A, Cohen GL, Mueller CM. The relationship between grit and resident well-being. Am J Surg. 2014;207(2):251–4.
61. Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med. 2008;23(7):1090–4.
62. Hill JD, Smith RJ. Monitoring stress levels in postgraduate medical training. Laryngoscope. 2009;119(1):75–8.
63. Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Austr J Rural Health. 2005;13(3):149–55.
64. Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013;28(3):421–7.
65. Walsh J. Gender, the work-life interface and wellbeing: a study of hospital doctors. Gend Work Organ. 2013;20(4):439–53.
66. Beckman TJ, Reed DA, Shanafelt TD, West CP. Impact of resident well-being and empathy on assessments of faculty physicians. J Gen Intern Med. 2010;25(1):52–6.
67. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60.
68. Lovseth LT, Aasland OG, Fridner A, Jonsdottir LS, Marini M, Linaker OM. Confidentiality and physicians’ health. A cross-sectional study of University Hospital Physicians in four European cities (the HOUPE-study). J Occup Health. 2010;52(5):263–71.
69. Beckman HB, Wendland M, Mooney C, et al. The impact of a program in mindful communication on primary care physicians. Acad Med. 2012;87(6):815–9.
70. Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82–8.
71. Aldrees TM, Aleissa S, Zamakhshary M, Badri M, Sadat-Ali M. Physician well-being: prevalence of burnout and associated risk factors in a tertiary hospital, Riyadh. Saudi Arabia Ann Saudi Med. 2013;33(5):451–6.
72. van Vendeloo SN, Brand PL, Verheyen CC. Burnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate. Bone Joint J. 2014;96-b(8):1133–1138.
73. Parshuram CS, Amaral A, Ferguson ND, et al. Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial. CMAJ. 2015;187(5):321–9.
74. Tucker P, Bejerot E, Kecklund G, Aronsson G, Akerstedt T. The impact of work time control on physicians’ sleep and well-being. Appl Ergon. 2015;47:109–16.
75. Beckman TJ, Reed DA, Shanafelt TD, West CP. Resident physician well-being and assessments of their knowledge and clinical performance. J Gen Intern Med. 2012;27(3):325–30.
76. DiLalla LF, Hull SK, Dorsey JK. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004;16(2):165–70.
77. Zare SM, Galanko JA, Behrns KE, et al. Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study. Surgery. 2005;138(2):150–7.
78. Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989;298(6670):366–70.
79. Perry MY, Osborne WE. Health and wellness in residents who matriculate into physician training programs. American J Obstet Gynecol. 2003;189(3):679–83.
80. Stamp T, Termuhlen P, Miller S, et al. Before and after resident work hour limitations: an objective assessment of the well-being of surgical residents. Curr Surg. 2005;62(1):117–21.
81. Virtanen P, Rantalaiho L, Koivisto AM. Employment status passages and psychosocial well-being. J Occup Health Psychol. 2003;8(2):123–30.
82. Heponiemi T, Kouvonen A, Vanska J, et al. Effects of active on-call hours on physicians’ turnover intentions and well-being. Scand J Work Environ Health. 2008;34(5):356–63.
83. Lam TP, Wong JG, Ip MS, Lam KF, Pang SL. Psychological well-being of interns in Hong Kong: what causes them stress and what helps them. Med Teach. 2010;32(3):e120–6.
84. Tucker P, Brown M, Dahlgren A, et al. The impact of junior doctors’ worktime arrangements on their fatigue and well-being. Scand J Work Environ Health. 2010;36(6):458–65.
85. Heijstra TM, Rafnsdottir GL, Jonsdottir LS. Autonomy and well-being among Nordic male and female hospital physicians. Work. 2011;40(4):437–43.
86. Elovainio M, Salo P, Jokela M, et al. Psychosocial factors and well-being among Finnish GPs and specialists: a 10-year follow-up. Occup Environ Med. 2013;70(4):246–51.
87. Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005;5(1):21.
88. Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol. 2011;18(5):1236–42.
89. Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, I: the tension between a culture of productivity and the need for self-care. Ann Surg Oncol. 2011;18(5):1229–35.
90. Fabreau G, Elliott M, Khanna S, et al. Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle. BMC Med Educ. 2013;13:115.
91. Chen I, Vorona R, Chiu R, Ware JC. A survey of subjective sleepiness and consequences in attending physicians. Behav Sleep Med. 2008;6(1):1–15.
92. Lin GA, Beck DC, Stewart AL, Garbutt JM. Resident perceptions of the impact of work hour limitations. J Gen Intern Med. 2007;22(7):969–75.
93. Sangi-Haghpeykar H, Ambani DS, Carson SA. Stress, workload, sexual well-being and quality of life among physician residents in training. Int J Clin Pract. 2009;63(3):462–7.
94. Foster E, Biery N, Dostal J, Larson D. RAFT (Resident Assessment Facilitation Team): supporting resident well-being through an integrated advising and assessment process. Fam Med. 2012;44(10):731–4.
95. Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. CJEM. 2013;15(3):175–7.
96. Waterman AS. Reconsidering happiness: a eudaimonist’s perspective. J Posit Psychol. 2008;3(4):234–52.
97. Huta V, Waterman AS. Eudaimonia and its distinction from hedonia: developing a classification and terminology for understanding conceptual and operational definitions. J Happiness Stud. 2014;15(6):1425–56.
98. Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Wadsworth Cengage Learning; 2002.
99. Ryan RM, Huta V, Deci EL. Living well: a self-determination theory perspective on eudaimonia. J Happiness Stud. 2008;9(1):139–70.
100. Feeney BC, Collins NL. A new look at social support: a theoretical perspective on thriving through relationships. Personal Soc Psychol Rev. 2015;19(2):113–47.
101. Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Arch Intern Med. 1999;159(13):1417–26.
102. Frank E, Bhat SK, Elon L. Exercise counseling and personal exercise habits of US women physicians. J Am Med Women’s Assoc (1972). 2002, 58(3):178–84.
103. Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28–36.