Predictors of Wellness Behaviors in U.S. Army Physicians
Abstract
Introduction: In 2013, the U.S. Army Surgeon General implemented the Performance Triad (P3), an educational initiative to improve health-related behaviors of soldiers throughout the U.S. Army. The components of P3 are Sleep, Activity, and Nutrition with tenet behaviors for each component. This study reports the results of the 2015 U.S. Army Medical Corps survey regarding physician knowledge and adherence to the tenet behaviors of P3. Methods: In 2015, an anonymous survey was sent to all active duty U.S. Army physicians to assess demographic information, work hours, and knowledge of and adherence to P3. The survey assessed the tenets of P3 with questions about the following topics: obtaining 8 h of sleep per day; performing at least 2 d of resistance training and 1 day of agility training per week; re-fueling 30-60 min after exercise; incorporating at least 150 min of moderate and 75 min of vigorous aerobic exercise per week; going caffeine free 6 h before bedtime; eating at least 8 servings of fruits and vegetables per day; and getting 15,000 steps per day. For each question, there were four response options which ranged from "Always" to "Never." A positive response to the questionnaire was defined as answering frequently or always. The responses were analyzed by comparison of several physician categories utilizing descriptive statistics and multivariable analysis. Results: Surveys were completed by 1,003 of approximately 4,500 U.S. Army physicians. 79.1% of the respondents were male. Staff physicians made up 834 (83.6%) of the respondents compared with 164 (16.4%) physicians in training. Overall 25% of respondents were adherent to the sleep tenet, 45% to the exercise tenet, and 38% to the nutrition tenet. Reported work hours were significantly higher in physicians in training compared with staff physicians (p < 0.001). About 28.4% of staff reported a positive response to obtaining at least 8 h of sleep per night, compared with 12.7% of residents/fellows. In multivariable analyses, better sleep was associated with being a staff physician [odds ratio 2.4 (95% confidence interval 1.40-4.13)], working fewer hours per week [1.75 (1.37-2.25)], and belief in supervisor adherence to P3 [2.04 (1.59-2.56)]. Increased exercise was associated with male gender [2.09 (1.45-3.02)], being a staff physician [1.63 (1.09-2.43)], and belief in supervisor adherence to P3 [1.43 (1.18-1.75)]. Positive response to the nutrition tenet was associated with belief in supervisor adherence to P3 [1.23 (1.01-1.49)]. Conclusion: Overall, U.S. Army physicians are most adherent to the exercise tenet and least adherent to the sleep tenet of P3; this is consistent with the military culture. Work hours seem to affect wellness behaviors. Specifically, physicians who work fewer hours are more likely to report obtaining 8 h of sleep per day and exercise on a regular basis. Importantly, belief in supervisor adherence to P3 was associated with better adherence to P3, suggesting that physician leadership has a positive effect on wellness behaviors. This suggests a role for similar wellness programs in civilian healthcare institutions. Future research should also include changes in health system policies to motivate physician wellness behaviors.
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Among 1,003 US Army physicians, 25% adhered to the recommended 8 h sleep per day.
“Hsu et al. (72) observed that among 1,003 US Army physicians just 25% of respondents were adherent to the recommended 8 h sleep per day.”
Research on sleep disturbances among military MDs is scarce and consistent data are lacking.
“Regarding sleep disturbances among military MDs, research is scarce, and consistent data are lacking.”
Better sleep among US Army physicians is associated with being a staff physician and working fewer hours per week.
“Better sleep was associated with being a staff physician (compared to being a physician in training), and working fewer hours/week.”
Cites
National Sleep Foundation's sleep time duration recommendations: methodology and results summary.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., et al. (2015) · Sleep Health · doi:10.1016/j.sleh.2014.12.010 · Cited by 4,404 · see citing works
Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.3199 · Cited by 3,439 · see citing works
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.08.023 · Cited by 2,885 · see citing works
Executive Leadership and Physician Well-being
Shanafelt, T. D., & Noseworthy, J. H. (2017) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.10.004 · Cited by 1,776 · see citing works
How does burnout affect physician productivity? A systematic literature review
Dewa, C. S., Loong, D., Bonato, S., Thành, N. X., & Jacobs, P. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-325 · Cited by 625 · see citing works
Sleep Loss and Fatigue in Residency Training: A Reappraisal
Veasey, S., Rosen, R., Barzansky, B., Rosen, I., & Owens, J. (2002) · JAMA · doi:10.1001/jama.288.9.1116 · Cited by 405 · see citing works
Personal Exercise Habits and Counseling Practices of Primary Care Physicians: A National Survey
Abramson, S., Stein, J. M., Schaufele, M. K., Frates, E. P., & Rogan, S. (2000) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200001000-00008 · Cited by 371 · see citing works
Mansukhani, M. P., Kolla, B. P., Surani, S., Varon, J., & Ramar, K. (2012) · Postgraduate Medicine · doi:10.3810/pgm.2012.07.2583 · Cited by 227 · see citing works
Drolet, B. C., & Rodgers, S. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181c46963 · Cited by 216 · see citing works
Weight, C., Sellon, J. L., Lessard-Anderson, C. R., Shanafelt, T. D., Olsen, K. D., & Laskowski, E. R. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2013.09.010 · Cited by 213 · see citing works
Eckleberry-Hunt, J., Dyke, A. V., Lick, D., & Tucciarone, J. (2009) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-09-00026.1 · Cited by 206 · see citing works
McClafferty, H. H., Brown, O. W., MEDICINE, S. O. I., Vohra, S., Bailey, M. L., Becker, D. K., CULBERT, T. P., Sibinga, E. M., Zimmer, M., Simon, G. R., et al. (2014) · PEDIATRICS · doi:10.1542/peds.2014-2278 · Cited by 145 · see citing works
Patient-Related Diet and Exercise Counseling: Do Providers’ Own Lifestyle Habits Matter?
Howe, M., Leidel, A., Krishnan, S. M., Weber, A., Rubenfire, M., & Jackson, E. A. (2010) · Preventive Cardiology · doi:10.1111/j.1751-7141.2010.00079.x · Cited by 139 · see citing works
Sleep Deprivation, Physician Performance, and Patient Safety
Olson, E. J., Drage, L. A., & Auger, R. R. (2009) · CHEST Journal · doi:10.1378/chest.08-1952 · Cited by 116 · see citing works
Running on empty: a review of nutrition and physicians' well-being
Hamidi, M. S., Boggild, M. K., & Cheung, A. M. (2016) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2016-134131 · Cited by 103 · see citing works
Preventive, Lifestyle, and Personal Health Behaviors Among Physicians
Bazargan, M., Makar, M., Bazargan-Hejazi, S., Ani, C., & Wolf, K. E. (2009) · Academic Psychiatry · doi:10.1176/appi.ap.33.4.289 · Cited by 102 · see citing works
Lefebvre, D. C. (2012) · Academic Medicine · doi:10.1097/acm.0b013e31824d47ff · Cited by 81 · see citing works
Sleep as a component of the performance triad: the importance of sleep in a military population.
Lentino, C. V., Purvis, D. L., Murphy, K. J., & Deuster, P. A. (2013) · PubMed · Cited by 80 · see citing works
Physician nutrition and cognition during work hours: effect of a nutrition based intervention
Lemaire, J. B., Wallace, J. E., Dinsmore, K., Lewin, A. M., Ghali, W. A., & Roberts, D. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-241 · Cited by 70 · see citing works
Taub, S., Morin, K., Goldrich, M. S., Ray, P., & Benjamin, R. M. (2006) · Occupational Medicine · doi:10.1093/occmed/kqj025 · Cited by 70 · see citing works
Disturbing Trends in Physician Burnout and Satisfaction With Work-Life Balance
Ariely, D., & Lanier, W. L. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.10.004 · Cited by 70 · see citing works
Creating a Culture of Wellness: Conversations, Curriculum, Concrete Resources, and Control
Place, S., & Talen, M. R. (2013) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.45.4.d · Cited by 62 · see citing works
Food for thought: an exploratory study of how physicians experience poor workplace nutrition
Lemaire, J. B., Wallace, J. E., Dinsmore, K., & Roberts, D. (2011) · Nutrition Journal · doi:10.1186/1475-2891-10-18 · Cited by 55 · see citing works
Lifestyle Behavior Counseling for Women Patients among a Sample of California Physicians
Livaudais, J. C., Kaplan, C. P., Haas, J. S., Pérez‐Stable, E. J., STEWART, S. L., & Jarlais, G. D. (2005) · Journal of Women s Health · doi:10.1089/jwh.2005.14.485 · Cited by 46 · see citing works
Physician Well-Being: Expanding the Triple Aim
West, C. P. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3641-2 · Cited by 46 · see citing works
The Impact of Housestaff Fatigue on Occupational and Patient Safety
Mountain, S., Quon, B. S., Dodek, P., Sharpe, R., & Ayas, N. (2007) · Lung · doi:10.1007/s00408-007-9010-5 · Cited by 41 · see citing works
The Impact of Fatigue on Patient Safety
Parshuram, C. S. (2006) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2006.09.009 · Cited by 27 · see citing works
Understanding the exercise habits of residents and attending physicians: a mixed methodology study.
Williams, A. S., Williams, C. D., Cronk, N. J., Kruse, R. L., Ringdahl, E. N., & Koopman, R. J. (2015) · PubMed · Cited by 27 · see citing works
Changing Eating Habits for the Medical Profession
Lesser, L. I., Cohen, D. A., & Brook, R. H. (2012) · JAMA · doi:10.1001/2012.jama.10427 · Cited by 25 · see citing works
Can Arts and Communication Programs Improve Physician Wellness and Mitigate Physician Suicide?
Genovese, J. M., & Berek, J. S. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.65.1778 · Cited by 23 · see citing works
Overweight Physicians During Residency: A Cross-Sectional and Longitudinal Study
Leventer‐Roberts, M., Zonfrillo, M. R., Yu, S., Dziura, J. D., & Spiro, D. M. (2013) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-12-00289.1 · Cited by 22 · see citing works
Improving Soldier Health and Performance by Moving Army Medicine Toward a System for Health
Caravalho, J. (2015) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000001107 · Cited by 20 · see citing works
Daneshvar, F., Weinreich, M., Daneshvar, D., Sperling, M., Salmane, C., Yacoub, H., Gabriels, J. K., McGinn, T. G., & Smith, M. C. (2016) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-15-00720.1 · Cited by 15 · see citing works
The Effect of Physician Sleep Deprivation on Patient Safety in Perinatal-Neonatal Medicine
Majekodunmi, A., & Landrigan, C. P. (2011) · American Journal of Perinatology · doi:10.1055/s-0031-1286184 · Cited by 13 · see citing works
Duty hours as viewed through a professionalism lens
Ginsburg, S. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-s1-s15 · Cited by 11 · see citing works
Rafferty (1986) · doi:10.1002/1097-4679(198605)42:3
Flagged first, then by citations
Cited by
Sorted by citations
Organizational strategies to reduce physician burnout and improve professional fulfillment
Olson, K. D., Marchalik, D., Farley, H. L., Dean, S. M., Lawrence, E., Hamidi, M. S., Rowe, S. G., McCool, J. M., O’Donovan, C. A., Micek, M. A., et al. (2019) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2019.100664 · Cited by 144 · see citing works
Shanafelt, T. D., Makowski, M. S., Wang, H., Bohman, B. D., Leonard, M. B., Harrington, R. A., Minor, L. B., & Trockel, M. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.7961 · Cited by 107 · see citing works
The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call
Aggarwal, M., Ospina, N. S., Kazory, A., Joseph, I., Zaidi, Z., Ataya, A., Agito, M. D., Bubb, M., Hahn, P. C., & Sattari, M. (2019) · American Journal of Lifestyle Medicine · doi:10.1177/1559827619883603 · Cited by 39 · see citing works
Sadeghi-Bahmani, D., Rigotti, V., Stanga, Z., Lang, U. E., Blais, R. K., Kelley, M. L., & Brand, S. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1390636 · Cited by 6 · see citing works
“Hsu et al. (72) observed that among 1,003 US Army physicians just 25% of respondents were adherent to the recommended 8 h sleep per day.”
BackgroundHydration and meal habits of physicians and medical learners: a literature review
Lai, J. C.-Y., & Manis, D. (2022) · European Journal of Nutrition · doi:10.1007/s00394-022-02914-y · Cited by 4 · see citing works
Hill, C. G., Beymer, M. R., Jarvis, B. P., Smith, J. D., Nichols, J., Mysliwiec, V., Pecko, J. A., & Watkins, E. Y. (2019) · Military Medicine · doi:10.1093/milmed/usz423 · Cited by 4 · see citing works
Self-citationSoldier Self-Regulation: Applying Self-Regulatory Concepts to the U.S. Army Context
Moon, N. A., Milosevic, M., Lor, K., Clubb, A. R., Converse, P. D., Griffith, R., Pitts, K. P., Graves, R., Gomes, K., Kirshenbaum, J. M., et al. (2023) · Journal of Military Social Work and Behavioral Health Services · doi:10.1080/21635781.2023.2246897 · Cited by 3 · see citing works
Nutritional Wellness for the Busy Health Care Provider
Bielsky, A. R., & Foley, C. B. (2022) · Anesthesiology Clinics · doi:10.1016/j.anclin.2022.01.008 · Cited by 1 · see citing works
Changing Patterns of Insomnia Incidence Among U.S. Air Force Physicians, 2014 and 2024
Aycock, C. A., Stone, E. A., Copeland, C. M., Kang, S., & You, W. (2026) · Military Medicine · doi:10.1093/milmed/usag156
- Authors
- Hsu, D. P., Hansen, S. L., Roberts, T. A., Murray, C. K., & Mysliwiec, V.
- Affiliations
- Brooke Army Medical Center (US)
- 1st Area Medical Laboratory, 44th Medical Bde, 5116 Bel Air St, Aberdeen Proving Grounds, MD
- Wilford Hall Ambulatory Surgical Center (US)
- Venue
- Military Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-04-18
- Volume
- 183
- Issue
- 11-12
- Pages
- e641-e648
- ISSN
- 0026-4075 (ISSN-L)
- 1930-613X
- OpenAlex
- W2800122891
- Cited by
- 9
- References
- 36
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 1 · 2019: 3
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Military Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- wellness behaviors, military physicians, sleep, physical activity, nutrition, physician work hours, health behavior adherence, U.S. Army Medical Corps, fruit and vegetable intake, step count, resistance training, aerobic exercise
- MeSH terms
- Adult, Feeding Behavior, Female, Health Promotion, Humans, Male, Middle Aged, Military Personnel, Physicians, Surveys and Questionnaires, Sleep, Texas, United States, Health Behavior, Exercise
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