Skip to main content
SpringerLink
Log in

Physician and Clinician Well-Being

  • Chapter
  • First Online:
Quality Improvement and Patient Safety in Orthopaedic Surgery

  • 456 Accesses

Abstract

Physician and clinician well-being is an increasingly recognized problem. There is mounting evidence that more caregivers are experiencing the signs and symptoms of burnout, and many individuals are finding the profession of caring for people less rewarding. Multiple factors are conspiring to exacerbate the loss of meaning and purpose. Career dissatisfaction significantly impacts the larger healthcare system in the form of increased physician turnover, increased medical error rate, and decreased patient satisfaction. Early retirement, substance abuse, depression, and in the worst cases, suicide are all real problems in healthcare today. Optimal care cannot be provided by healers who have exhausted their reservoirs of resilience. The global coronavirus pandemic has further frayed the bonds of community that have served to tie doctors, nurses, and other healthcare team members together. Individual and organizational strategies have been described to restore a sense of personal and professional satisfaction. Thoughtful and inclusive institutional leadership has been shown to be valuable and effective in establishing a culture that is compassionate to all participants. Intentional application of these strategies and investment of resources at multiple levels is the challenge before the medical community.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–85. https://doi.org/10.1001/archinternmed.2012.3199.

    Article  PubMed  Google Scholar 

  2. Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681–94. https://doi.org/10.1016/j.mayocp.2018.10.023.

    Article  PubMed  Google Scholar 

  3. Halbesleben JR, 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. https://doi.org/10.1097/01.HMR.0000304493.87898.72.

    Article  Google Scholar 

  4. Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170(11):784–90. https://doi.org/10.7326/M18-1422.

    Article  PubMed  Google Scholar 

  5. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. https://doi.org/10.1146/annurev.psych.52.1.397.

    Article  CAS  PubMed  Google Scholar 

  6. Jha AK, Iliff AR, Chaoui AA, Defossez S, Bombaugh MC, Miller YR. A crisis in healthcare: a call to action on physician burnout; 2019.

    Google Scholar 

  7. Lacy BE, Chan JL. Physician burnout: the hidden health care crisis. Clin Gastroenterol Hepatol. 2018;16(3):311–7. https://doi.org/10.1016/j.cgh.2017.06.043.

    Article  PubMed  Google Scholar 

  8. Noseworthy JH, Cosgrove J, Edgeworth M, Ellison E, Krevans S, Rothman P, et al. Physician burnout is a public health crisis: a message to our fellow healthcare CEO’s. Health Affairs Blog; 2017.

    Google Scholar 

  9. Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400–2.

    PubMed  PubMed Central  Google Scholar 

  10. Marmon LM, Heiss K. Improving surgeon wellness: the second victim syndrome and quality of care. Semin Pediatr Surg. 2015;24(6):315–8. https://doi.org/10.1053/j.sempedsurg.2015.08.011.

    Article  PubMed  Google Scholar 

  11. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237):726–7. https://doi.org/10.1136/bmj.320.7237.726.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Balch CM, Oreskovich MR, Dyrbye LN, Colaiano JM, Satele DV, Sloan JA, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657–67. https://doi.org/10.1016/j.jamcollsurg.2011.08.005.

    Article  PubMed  Google Scholar 

  13. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559–65. https://doi.org/10.1016/j.bbi.2020.04.049.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–7. https://doi.org/10.1016/j.bbi.2020.05.026.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kannampallil TG, Goss CW, Evanoff BA, Strickland JR, McAlister RP, Duncan J. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS One. 2020;15(8):e0237301. https://doi.org/10.1371/journal.pone.0237301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020;323(15):1439–40. https://doi.org/10.1001/jama.2020.3972.

    Article  CAS  PubMed  Google Scholar 

  18. Sasangohar F, Jones SL, Masud FN, Vahidy FS, Kash BA. Provider burnout and fatigue during the COVID-19 pandemic: lessons learned from a high-volume intensive care unit. Anesth Analg. 2020;131(1):106–11. https://doi.org/10.1213/ane.0000000000004866.

    Article  CAS  PubMed  Google Scholar 

  19. Raudenská J, Steinerová V, Javůrková A, Urits I, Kaye AD, Viswanath O, et al. Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Pract Res Clin Anaesthesiol. 2020;34(3):553–60. https://doi.org/10.1016/j.bpa.2020.07.008.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Coleman JR, Abdelsattar JM, Glocker RJ. COVID-19 pandemic and the lived experience of surgical residents, fellows, and early-career surgeons in the American College of Surgeons. J Am Coll Surg. 2021;232(2):119–35. https://doi.org/10.1016/j.jamcollsurg.2020.09.026.

    Article  PubMed  Google Scholar 

  21. Evanoff BA, Strickland JR, Dale AM, Hayibor L, Page E, Duncan JG, et al. Work-related and personal factors associated with mental well-being during the COVID-19 response: survey of health care and other workers. J Med Internet Res. 2020;22(8):e21366. https://doi.org/10.2196/21366.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1–8. https://doi.org/10.1016/j.genhosppsych.2020.06.007.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Adibe B, Perticone K, Hebert C. Creating wellness in a pandemic: a practical framework for health systems responding to Covid-19. NEJM Catal Innov Care Deliv. 2020; https://doi.org/10.1056/cat.20.0218.

  24. Watson P. Caring for yourself & others during the COVID-19 pandemic: managing healthcare workers’ stress. Compassion in Action Webinar the Schwartz Center for Compassionate Healthcare; 2020.

    Google Scholar 

  25. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, 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. https://doi.org/10.1016/j.mayocp.2015.08.023.

    Article  PubMed  Google Scholar 

  26. National Academies of Sciences E, and Medicine. Taking action against clinician burnout: a systems approach to professional Well-being. Washington,DC; 2019.

    Google Scholar 

  27. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. Arch Surg. 2011;146(2):211–7. https://doi.org/10.1001/archsurg.2010.310.

    Article  PubMed  Google Scholar 

  28. Pulcrano M, Evans SR, Sosin M. Quality of life and burnout rates across surgical specialties: a systematic review. JAMA Surg. 2016;151(10):970–8. https://doi.org/10.1001/jamasurg.2016.1647.

    Article  PubMed  Google Scholar 

  29. Sudol NT, Guadarrama N, Honsberger P, Weiss J, Li Q, Whitcomb EL. Microaggressions: a macro problem in the surgical workplace; 2020.

    Google Scholar 

  30. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–71. https://doi.org/10.1097/SLA.0b013e3181ac4dfd.

    Article  PubMed  Google Scholar 

  31. Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62. https://doi.org/10.1001/archsurg.2010.292.

    Article  PubMed  Google Scholar 

  32. Wible P. 33 orthopedic surgeon suicides. How to prevent #34. Annual Chicago Orthopedic Symposium, Chicago, IL; 2018.

    Google Scholar 

  33. Hui RWH, Leung KC, Ge S, Hwang AC, Lai GGW, Leung AN, et al. Burnout in orthopaedic surgeons: a systematic review. J Clin Orthop Trauma. 2019;10(Suppl 1):S47–s52. https://doi.org/10.1016/j.jcot.2019.01.028.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty. J Bone Joint Surg Am. 2009;91(10):2395–405. https://doi.org/10.2106/JBJS.H.00665.

    Article  PubMed  Google Scholar 

  35. Carter CW, Talwalkar V, Weiss JM, Schwend RM, Goldberg MJ. Pediatric orthopaedists are not immune: characterizing self-reported burnout rates among POSNA members. J Pediatr Orthop. 2019; https://doi.org/10.1097/BPO.0000000000001440.

  36. Saleh KJ, Quick JC, Sime WE, Novicoff WM, Einhorn TA. Recognizing and preventing burnout among orthopaedic leaders. Clin Orthop Relat Res. 2009;467(2):558–65. https://doi.org/10.1007/s11999-008-0622-8.

    Article  PubMed  Google Scholar 

  37. Lichstein PM, He JK, Estok D, Prather JC, Dyer GS, Ponce BA, et al. What is the prevalence of burnout, depression, and substance use among orthopaedic surgery residents and what are the risk factors? A collaborative orthopaedic educational research group survey study. Clin Orthop Relat Res. 2020;478(8):1709–18. https://doi.org/10.1097/corr.0000000000001310.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Strauss EJ, Markus DH, Kingery MT, Zuckerman J, Egol KA. Orthopaedic resident burnout is associated with poor in-training examination performance. J Bone Joint Surg Am. 2019;101(19):e102. https://doi.org/10.2106/jbjs.18.00979.

    Article  PubMed  Google Scholar 

  39. Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Quality of life during orthopaedic training and academic practice: part 2: spouses and significant others. J Bone Joint Surg Am. 2012;94(19):e145(1–6) https://doi.org/10.2106/jbjs.K.00991.

  40. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000. https://doi.org/10.1097/SLA.0b013e3181bfdab3.

    Article  PubMed  Google Scholar 

  41. Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018;93(11):1571–80. https://doi.org/10.1016/j.mayocp.2018.05.014.

    Article  PubMed  Google Scholar 

  42. West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071–8. https://doi.org/10.1001/jama.296.9.1071.

    Article  CAS  PubMed  Google Scholar 

  43. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294–300. https://doi.org/10.1001/jama.2009.1389.

    Article  CAS  PubMed  Google Scholar 

  44. To err is human - building a safer health system. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  45. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol. 2014;5:1573. https://doi.org/10.3389/fpsyg.2014.01573.

    Article  PubMed  Google Scholar 

  46. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–67. https://doi.org/10.7326/0003-4819-136-5-200203050-00008.

    Article  PubMed  Google Scholar 

  47. 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. https://doi.org/10.1097/01.Hmr.0000281626.28363.59.

    Article  Google Scholar 

  48. Zheng H, Shao H, Zhou Y. Burnout among Chinese adult reconstructive surgeons: incidence, risk factors, and relationship with intraoperative irritability. J Arthroplast. 2018;33(4):1253–7. https://doi.org/10.1016/j.arth.2017.10.049.

    Article  Google Scholar 

  49. Rosenstein AH, O’Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006;203(1):96–105. https://doi.org/10.1016/j.jamcollsurg.2006.03.027.

    Article  PubMed  Google Scholar 

  50. Goldberg MJ. Compassionate care: making it a priority and the science behind it. J Pediatr Orthop. 2020;40(Suppl 1):S4–7. https://doi.org/10.1097/BPO.0000000000001502.

    Article  PubMed  Google Scholar 

  51. Sotile WM, Fallon R, Orlando J. Curbing burnout hysteria with self-compassion: a key to physician resilience. J Pediatr Orthop. 2020;40(Suppl 1):S8–S12. https://doi.org/10.1097/BPO.0000000000001503.

    Article  PubMed  Google Scholar 

  52. Weiss JM. When did “patient” become a dirty word? Psychology today; 2019.

    Google Scholar 

  53. Weiss JM. Nope, “provider” still doesn’t work. KevinMDcom. 2018;

    Google Scholar 

  54. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–69. https://doi.org/10.1377/hlthaff.27.3.759.

    Article  Google Scholar 

  55. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6. https://doi.org/10.1370/afm.1713.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Hamidi MS, Bohman B, Sandborg C, Smith-Coggins R, de Vries P, Albert MS, et al. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. BMC Health Serv Res. 2018;18(1):851. https://doi.org/10.1186/s12913-018-3663-z.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826–32. https://doi.org/10.1001/jamainternmed.2017.4340.

    Article  PubMed  Google Scholar 

  58. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–81. https://doi.org/10.1016/s0140-6736(16)31279-x.

    Article  PubMed  Google Scholar 

  59. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–46. https://doi.org/10.1016/j.mayocp.2016.10.004.

    Article  PubMed  Google Scholar 

  60. Daniels AH, DePasse JM, Kamal RN. Orthopaedic surgeon burnout: diagnosis, treatment, and prevention. J Am Acad Orthop Surg. 2016;24(4):213–9. https://doi.org/10.5435/jaaos-d-15-00148.

    Article  PubMed  Google Scholar 

  61. Talwalkar VR, Weiss J. Wellness and drivers of burnout. J Pediatr Orthop. 2020;40(Suppl 1):S1–3. https://doi.org/10.1097/BPO.0000000000001536.

    Article  PubMed  Google Scholar 

  62. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21. https://doi.org/10.1016/s0140-6736(09)61424-0.

    Article  PubMed  Google Scholar 

  63. Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, Menaker R, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990–5. https://doi.org/10.1001/archinternmed.2009.70.

    Article  PubMed  Google Scholar 

  64. Bohman B, Dyrbye L, Sinsky C, Linzer M, Olson K, Babbott S, et al. Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst. 2017;

    Google Scholar 

  65. Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, et al. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care. 2019;49(12):100664. https://doi.org/10.1016/j.cppeds.2019.100664.

    Article  PubMed  Google Scholar 

  66. Casey VF, Schenk JL. Building a culture of wellness in an orthopaedic group: experiences at OrthoCarolina. J Pediatr Orthop. 2020;40(Suppl 1):S38–41. https://doi.org/10.1097/BPO.0000000000001539.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Aimee Choi, MS, Medical Animator & Illustrator at Boston Children’s Hospital, for her adaptations and design of chapter figures and images.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Melissa A. Christino

  2. Department of Orthopedic Surgery and Pediatrics, Shriners Hospital for Children Medical Center, University of Kentucky, Lexington, KY, USA

    Vishwas R. Talwalkar

  3. The Schwartz Center for Compassionate Healthcare, Boston, MA, USA

    Michael J. Goldberg

  4. Department of Orthopedic Surgery, Kaiser Permanente, Los Angeles, CA, USA

    Jennifer M. Weiss

Authors
  1. Melissa A. Christino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vishwas R. Talwalkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer M. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa A. Christino .

Editor information

Editors and Affiliations

  1. Department of Orthopedics, Nationwide Children’s Hospital, Columbus, OH, USA

    Julie Balch Samora

  2. Department of Orthopedics, Stanford University, Stanford, CA, USA

    Kevin G. Shea

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Christino, M.A., Talwalkar, V.R., Goldberg, M.J., Weiss, J.M. (2022). Physician and Clinician Well-Being. In: Samora, J.B., Shea, K.G. (eds) Quality Improvement and Patient Safety in Orthopaedic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-07105-8_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-07105-8_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-07104-1

  • Online ISBN: 978-3-031-07105-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation