CoChat
Sign Up
Cited by 1,776Healthcare professionals’ stress and burnoutStress and Burnout ResearchDiversity and Career in Medicine

Executive Leadership and Physician Well-being

Open access
Shanafelt, Tait D., Noseworthy, John H.·2017·Mayo Clinic Proceedings
DOI 10.1016/j.mayocp.2016.10.004
Open this paper in CoChat — free accountOpen PDF

Abstract

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.mayocp.2016.10.004

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Part of this paper’s reference list could not be split into single entries.

Flagged first, then by citations

Research works printed but not linked: 85

  1. Swensen S, Kabcenell A, Shanafelt T. Physician-organization collaboration reduces physician burnout and promotes engagement: the Mayo Clinic experience. J Healthc Manag. 2016;61(2):105-127.
  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18): 1377-1385.
  3. 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):1600-1613.
  4. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.
  5. Shanafelt TD, Balch CM, Dyrbye LN, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011; 146(1):54-62.
  6. Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal conse- quences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657-667.
  7. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physi- cians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gend Med. 2011;8(4):269-279.
  8. Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24(1):30-38.
  9. Shanafelt TD, Boone SL, Dyrbye LN, et al. The medical marriage: a national survey of the spouses/partners of US physicians. Mayo Clin Proc. 2013;88(3):216-225.
  10. Gabbard GO, Menninger RW. The psychology of postpone- ment in the medical marriage. JAMA. 1989;261(16):2378-2381.
  11. Gabbard GO, Menninger RW, Coyne L. Sources of conflict in the medical marriage. Am J Psychiatry. 1987;144(5):567-572.
  12. Firth-Cozens J, Greenhalgh J. Doctors' perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997; 44(7):1017-1022.
  13. West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9): 1071-1078.
  14. Williams ES, Manwell LB, Konrad TR, Linzer M. The relation- ship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev. 2007;32(3):203-212.
  15. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294-1300.
  16. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010; 251(6):995-1000.
  17. Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the or- ganization of internal medicine group practices. Med Care. 1985;23(10):1171-1178.
  18. Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general inter- nists associated with patient satisfaction? J Gen Intern Med. 2000;15(2):122-128.
  19. Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985; 2(3):128-135.
  20. Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, Wuebker LJ. Stress and medical malpractice: organizational risk assessment and intervention. J Appl Psychol. 1988;73(4):727-735.
  21. DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians' characteristics influence patients' adherence to medical treat- ment: results from the Medical Outcomes Study. Health Psychol. 1993;12(2):93-102.
  22. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714- 1721.
  23. Williams ES, Konrad TR, Linzer M, et al. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study. Health Serv Res. 2002;37(1):121-143.
  24. Williams ES, Konrad TR, Scheckler WE, et al. Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. 2001. Health Care Manage Rev. 2010;35(2):105-115.
  25. Shanafelt T, Sloan J, Satele D, Balch C. Why do surgeons consider leaving practice? J Am Coll Surg. 2011;212(3):421-422.
  26. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? a systematic liter- ature review. BMC Health Serv Res. 2014;14:325.
  27. Shanafelt TD, Raymond M, Kosty M, et al. Satisfaction with work-life balance and the career and retirement plans of US oncologists. J Clin Oncol. 2014;32(11):1127-1135.
  28. Misra-Hebert AD, Kay R, Stoller JK. A review of physician turnover: rates, causes, and consequences. Am J Med Qual. 2004;19(2):56-66.
  29. Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5(11):1431-1438.
  30. Atkinson W, Misra-Hebert A, Stoller JK. The impact on reve- nue of physician turnover: an assessment model and experi- ence in a large healthcare center. J Med Pract Manage. 2006; 21(6):351-355.
  31. Berger JE, Boyle RL Jr. How to avoid the high costs of physi- cian turnover. Med Group Manage J. 1992;39(6):80, 82-84, 86 passim.
  32. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study eval- uating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016;91(4):422-431.
  33. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient- centered care. JAMA. 2009;302(12):1338-1340.
  34. Konrad TR, Williams ES, Linzer M, et al; SGIM Career Satisfac- tion Study Group. Measuring physician job satisfaction in a changing workplace and a challenging environment. Med Care. 1999;37(11):1174-1182.
  35. Scheurer D, McKean S, Miller J, Wetterneck T. U.S. physician satisfaction: a systematic review. J Hosp Med. 2009;4(9): 560-568.
  36. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demandseresources model of burnout. J Appl Psychol. 2001; 86(3):499-512.
  37. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576.
  38. Spinelli WM. The phantom limb of the triple aim. Mayo Clin Proc. 2013;88(12):1356-1357.
  39. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29(1):18-20.
  40. Williams ES, Konrad TR, Linzer M, et al; SGIM Career Satisfac- tion Study Group. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. Med Care. 1999;37(11):1140-1154.
  41. Spreitzer G. Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad Manage J. 1995;38:1142-1465.
  42. Spreitzer GM, McCall MW, Mahoney JD. Early identification of international executive potential. J Appl Psychol. 1997;28(1): 6-29.
  43. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318-1321.
  44. West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med. 2012;27(11):1445-1452.
  45. Demerouti E, Bakker AB, Vardakou I, Kantas A. The conver- gent validity of two burnout instruments: a multitrait- multimethod analysis. Eur J Psychol Assess. 2003;19:12-23.
  46. Schaufeli WB, Bakker AB, Salanova M. The measurement of work engagement with a short questionnaire: a cross- national study. Educ Psychol Measure. 2006;66(4):701-716.
  47. Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assess- ment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85(5):1186-1196.
  48. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The Social Psychology of Health. Newbury Park, CA: Sage; 1988:31-67.
  49. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36), II: psychometric and clin- ical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31(3):247-263.
  50. Singh JA, Satele D, Pattabasavaiah S, Buckner JC, Sloan JA. Normative data and clinically significant effect sizes for single-item numerical linear analogue self-assessment (LASA) scales. Health Qual Life Outcomes. 2014;12:187.
  51. 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):421-427.
  52. Dyrbye LN, Satele D, Shanafelt T. Ability of a 9-item well-being index to identify distress and stratify quality of life in US workers. J Occup Environ Med. 2016;58(8):810-817.
  53. Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individu- alized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82-88.
  54. Linzer M, Poplau S, Babbott S, et al. Worklife and wellness in academic general internal medicine: results from a national survey. J Gen Intern Med. 2016;31(9):1004-1010.
  55. Shanafelt TD, Gorringe G, Menaker R, et al. Impact of organi- zational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432-440.
  56. Stoller JK. Commentary: recommendations and remaining questions for health care leadership training programs. Acad Med. 2013;88(1):12-15.
  57. Arroliga AC, Huber C, Myers JD, Dieckert JP, Wesson D. Leadership in health care for the 21st century: challenges and opportunities. Am J Med. 2014;127(3):246-249.
  58. Stoller JK. Help wanted: developing clinician leaders. Perspect Med Educ. 2014;3(3):233-237.
  59. Lobas JG. Leadership in academic medicine: capabilities and conditions for organizational success. Am J Med. 2006; 119(7):617-621.
  60. Schwartz RW, Pogge C. Physician leadership: essential skills in a changing environment. Am J Surg. 2000;180(3):187-192.
  61. Trastek VF, Hamilton NW, Niles EE. Leadership models in health care: a case for servant leadership. Mayo Clin Proc. 2014;89(3):374-381.
  62. Menaker R. Leadership strategies in healthcare. J Med Pract Manage. 2009;24(6):339-343.
  63. Egener B, McDonald W, Rosof B, Gullen D. Perspective: orga- nizational professionalism: relevant competencies and behav- iors. Acad Med. 2012;87(5):668-674.
  64. Stoller JK, Berkowitz E, Bailin PL. Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years. J Med Pract Manage. 2007;22(4):237-242.
  65. Lee TH. Turning doctors into leaders. Harv Bus Rev. 2010; 88(4):50-58.
  66. Schwartz RW, Pogge CR, Gillis SA, Holsinger JW. Programs for the development of physician leaders: a curricular process in its infancy. Acad Med. 2000;75(2):133-140.
  67. Tangalos EG, Blomberg RA, Hicks SS, Bender CE. Mayo lead- ership programs for physicians. Mayo Clin Proc. 1998;73(3): 279-284.
  68. Horowitz CR, Suchman AL, Branch WT Jr, Frankel RM. What do doctors find meaningful about their work? Ann Intern Med. 2003;138(9):772-775.
  69. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10): 990-995.
  70. Mizumoto R, Cristaudo AT, Hendahewa R. A surgeon-led model to improve operating theatre change-over time and overall efficiency: a randomised controlled trial. Int J Surg. 2016;30:83-89.
  71. Saha P, Pinjani A, Al-Shabibi N, Madari S, Ruston J, Magos A. Why we are wasting time in the operating theatre? Int J Health Plann Manage. 2009;24(3):225-232.
  72. Kamat AS, Parker A. Effect of perioperative inefficiency on neurosurgical theatre efficacy: a 15-year analysis. Br J Neuro- surg. 2015;29(4):565-568.
  73. Shipman SA, Sinsky CA. Expanding primary care capacity by reducing waste and improving the efficiency of care. Health Aff (Millwood). 2013;32(11):1990-1997.
  74. Dyrbye LN, West CP, Burriss TC, Shanafelt TD. Providing primary care in the United States: the work no one sees. Arch Intern Med. 2012;172(18):1420-1421.
  75. Epling JW, Mader EM, Morley CP. Practice characteristics and prior authorization costs: secondary analysis of data collected by SALT-Net in 9 central New York primary care practices. BMC Health Serv Res. 2014;14:109.
  76. Hillman BJ, Pandya BJ. Radiologists' burden of inefficiency using conventional imaging workstations. J Am Coll Radiol. 2013; 10(11):875-877.
  77. Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med. 2013;11(3):272-278.
  78. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007-3014.
  79. Christensen JF, Levinson W, Dunn PM. The heart of darkness: the impact of perceived mistakes on physicians. J Gen Intern Med. 1992;7(4):424-431.
  80. Waterman AD, Garbutt J, Hazel E, et al. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007;33(8): 467-476.
  81. Hu YY, Fix ML, Hevelone ND, et al. Physicians' needs in coping with emotional stressors: the case for peer support. Arch Surg. 2012;147(3):212-217.
  82. Shapiro J, Galowitz P. Peer support for clinicians: a program- matic approach. Acad Med. 2016;91(9):1200-1204.
  83. 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):2565-2577.
  84. Pratt SD, Jachna BR. Care of the clinician after an adverse event. Int J Obstet Anesth. 2015;24(1):54-63.
  85. Khullar D, Kocher R, Conway P, Rajkumar R. How 10 leading health systems pay their doctors. Healthc (Amst). 2015;3(2): 60-62. 108. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014; 32(7):678-686. 109. Rodriguez HP, von Glahn T, Elliott MN, Rogers WH, Safran DG. The effect of performance-based financial incen- tives on improving patient care experiences: a statewide eval- uation. J Gen Intern Med. 2009;24(12):1281-1288. 110. Glickman SW, Peterson ED. Innovative health reform models: pay-for-performance initiatives. Am J Manag Care. 2009; 15(10 suppl):S300-S305. 111. Williams CH, Leatherman S, Christianson JB, Sutherland K. Paying for quality: understanding and assessing physician pay-for-performance initiatives. Synth Proj Res Synth Rep. 2007;(13):pii 24273. 112. Gavagan TF, Du H, Saver BG, et al. Effect of financial incen- tives on improvement in medical quality indicators for primary care. J Am Board Fam Med. 2010;23(5):622-631. 113. Rosenthal MB, Frank RG. What is the empirical basis for paying for quality in health care? Med Care Res Rev. 2006; 63(2):135-157. 114. Berwick DM. The toxicity of pay for performance. Qual Manag Health Care. 1995;4(1):27-33. 115.

Cited by

Sorted by citations

Authors
Shanafelt, T. D., & Noseworthy, J. H.
Affiliations
Mayo Clinic (US)
Corresponding author
Shanafelt, Tait D.
ORCID
Shanafelt, Tait D.
Venue
Mayo Clinic Proceedings
Publisher
Elsevier BV
Published
2017-01
Volume
92
Issue
1
Pages
129-146
ISSN
0025-6196 (ISSN-L)
DOI
10.1016/j.mayocp.2016.10.004
OpenAlex
W2556017715
Cited by
1,776
References
14
Citations by year
2026: 214 · 2025: 230 · 2024: 161 · 2023: 176 · 2022: 207 · 2021: 234 · 2020: 217 · 2019: 179 · 2018: 101 · 2017: 51 · 2016: 1 · 2015: 2
FWCI
21.12
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Mayo Clinic Proceedings (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
Keywords
physician burnout, physician engagement, executive leadership, healthcare executives, organizational strategy, physician well-being, Mayo Clinic, physician turnover, quality of care, patient safety
MeSH terms
Work-Life Balance, Burnout, Professional, Delivery of Health Care, Health Facility Administrators, Health Promotion, Humans, Insurance, Health, Job Satisfaction, Leadership, Occupational Health Services, Organizational Innovation, Physicians, Organizational Culture, Patient Protection and Affordable Care Act

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review