Journal of General Internal Medicine

, Volume 22, Issue 11, pp 1544–1552 | Cite as

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

  • Patrick M. Dunn
  • Bengt B. Arnetz
  • John F. Christensen
  • Louis Homer
Original Article



Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative.


To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being.


From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning.


Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey.


Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study.


A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.


physician satisfaction organizational behavior health care administration 



We thank Jennifer Basada for her dedication to the overall coordination and management of the Legacy Clinic Physician Well-Being Program. We also thank Charlene Tucker for her help in manuscript preparation. Finally, we thank Jonathan Avery for his guidance in developing the program; Malcolm McAninch, John Teller, Gwen Grewe, and Marylee Morris for the implementation; and Keith Marton and Stephen R. Jones for critically reviewing the manuscript and for encouraging a nurturing environment to enhance physician health and well-being.

Potential Financial Conflicts of Interest

QWC is a commercial product marketed and sold by the Sweden-based company Springlife AB, Bengt B. Arnetz is a majority owner of this company.


  1. 1.
    Murray A, Montgomery JE, Chang H, Rogers WH, Inui T, Safran DG. Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:452–9PubMedCrossRefGoogle Scholar
  2. 2.
    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. Health Care Manage Rev. 2001;26:7–19.PubMedGoogle Scholar
  3. 3.
    Crane M. Why burned-out doctors get sued more often. Med Econ. 1998;75:210–2, 215–8.PubMedGoogle Scholar
  4. 4.
    Myers MF. Doctors’ Marriages. A Look at the Problems and their Solutions. Second Edition. New York: Plenum Medical Book Company; 1994.Google Scholar
  5. 5.
    Rollman BL, Mead LA, Wang NY, Klag MJ. Medical specialty and the incidence of divorce. N Engl J Med. 1997;336:800–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. 2000;160:3209–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289:3161–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Baruch-Feldman C, Brondolo E, Ben-Dayan D, Schwartz J. Sources of social support and burnout, job satisfaction, and productivity. J Occup Health Psychol. 2002;7:84–93.PubMedCrossRefGoogle Scholar
  9. 9.
    Canadian Medical Association. CMA policy. Physician health and well-being. CMAJ. 1998;158:1191–200.Google Scholar
  10. 10.
    Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–50.PubMedCrossRefGoogle Scholar
  11. 11.
    O’Connor PG, Spickard A Jr. Physician impairment by substance abuse. Med Clin North Am. 1997;81:1037–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA. 1986;255:1913–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Pincus CR. Have doctors lost their work ethic? Med Econ. 1995;72:24–30.PubMedGoogle Scholar
  14. 14.
    Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Arnetz BB. Psychosocial challenges facing physicians of today. Soc Sci Med 2001;52:203–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Bowman B. Sick docs get cold comfort from colleagues. National Review of Medicine. Available at: Accessed July 26, 2007.
  17. 17.
    Suchman A. The influence of health care organizations on well-being. West J Med. 2001;174:43–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Christensen J, Feldman M. (Guest Editors). Recapturing the spirit of medicine (special issue on physician well-being) West J Med. 2001;174:1–80.Google Scholar
  19. 19.
    Joint Commission on Accreditation of Healthcare Organizations. Medical staff revisions reflect current practices in the field. Jt Comm Perspect. 2000,20:9,13.Google Scholar
  20. 20.
    Scott K. Physician retention plans help reduce costs and optimize revenues. Healthc Financ Manage. 98;52:75–7.Google Scholar
  21. 21.
    Arnetz BB. Techno-stress: a prospective psychophysiological study of the impact of a controlled stress-reduction program in advanced telecommunication systems design work. J Occup Environ Med. 1996;38:53–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Anderzén I, Arnetz BB. The impact of a prospective survey-based workplace intervention program on employee health, biologic stress markers, and organizational productivity. J Occup Environ Med. 2005;47:671–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Berwick D, Kilo C. Idealized design of clinical office practice: an interview with Donald Berwick and Charles Kilo of the Institute for Healthcare Improvement. Manag Care Q. 1999;7:62–9.PubMedGoogle Scholar
  24. 24.
    Frankel VE. Man’s Search for Meaning: An Introduction to Logotherapy. Third Edition. New York: Simon & Schuster; 1984.Google Scholar
  25. 25.
    Maslach C, Jackson SE. Maslach Burnout Inventory Manual. Research Edition. Palo Alto: Consulting Psychologists Press; 1981.Google Scholar
  26. 26.
    Arnetz BB. Staff perception of the impact of health care transformation on quality of care. Int J Qual Health Care. 1999;11:345–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Wallin L, Ewald U, Wikblad K, Scott-Findlay S, Arnetz BB. Understanding work contextual factors: a short-cut to evidence-based practice? Worldviews Evid Based Nurs. 2006;3:153–64.PubMedCrossRefGoogle Scholar
  28. 28.
    Arnetz B, Blomkvist V. Leadership, mental health, and organizational efficacy in health care organizations. Psychosocial predictors of healthy organizational development based on prospective data from four different organizations. Psychother Psychosom. 2007;76:242–8.PubMedGoogle Scholar
  29. 29.
    Arnetz BB. Physicians’ view of their work environment and organisation. Psychother Psychosom. 1997;66:155–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Arnetz BB. Subjective indicators as a gauge for improving organizational well-being. An attempt to apply the cognitive activation theory to organizations. Psychoneuroendocrinology. 2005;30:1022–26.PubMedCrossRefGoogle Scholar
  31. 31.
    Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. Perm J. 1998;2:22–30.Google Scholar
  32. 32.
    Edwards N, Kornacki MJ, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ. 2002;324:835–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Oregon Medical Association. Report of the 2004 Oregon Physician Workforce Survey Report of Results. Available at: Accessed July 27, 2007.
  34. 34.
    Bargellini A, Barbieri A, Rovesti S, Vivoli R, Roncaglia R, Borella P. Relation between immune variables and burnout in a sample of physicians. Occup Environ Med. 2000;57:453–7.PubMedCrossRefGoogle Scholar
  35. 35.
    McCall L, Maher T, Piterman L. Preventive health behavior among general practitioners in Victoria. Aust Fam Physician. 1999;28:854–7.PubMedGoogle Scholar
  36. 36.
    Schwartz JS, Lewis CE, Clancy C, Kinosian MS, Radany MH, Koplan JP. Internists’ practices in health promotion and disease prevention. Ann Intern Med. 1991;114:46–53.PubMedGoogle Scholar
  37. 37.
    Wachtel TJ, Wilcox VL, Moulton AW, Tammaro D, Stein MD. Physicians’ utilization of health care. J Gen Intern Med. 1995;10:261–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Kahn KL, Goldberg RJ, DeCosimo D, Dalen JE. Health maintenance activities of physicians and nonphysicians. Arch Intern Med. 1988;148:2433–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Rosen IM, Christie JD, Bellini LM, Asch DA. Health and health care among housestaff in four U.S. internal medicine residency programs. J Gen Intern Med. 2000;15:116–21.PubMedCrossRefGoogle Scholar
  40. 40.
    Doan-Wiggins L, Zun L, Cooper MA, Meyers DL, Chen EH. Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians. Acad Emerg Med. 1995;2:556–63.PubMedCrossRefGoogle Scholar
  41. 41.
    Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med. 2000;15:441–50.PubMedCrossRefGoogle Scholar
  42. 42.
    Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med 1999;159:1417–26.PubMedCrossRefGoogle Scholar
  43. 43.
    Doherty WJ, Burge SK. Divorce among physicians. Comparisons with other occupational groups. JAMA. 1989;261:2374–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Arnetz BB, Ekman R. Stress in Health and Disease. Weinheim, Germany: Wiley-VCH; 2006:122–40.Google Scholar
  45. 45.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.PubMedGoogle Scholar
  46. 46.
    Forsberg E, Axelsson R, Arnetz B. Effects of performance-based reimbursement on the professional autonomy and power of physicians and the quality of care. Int J Health Plann Manage. 2001;16:297–310.PubMedCrossRefGoogle Scholar
  47. 47.
    Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5:1431–8.PubMedGoogle Scholar
  48. 48.
    Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44:234–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Crouse BJ. Recruitment and retention of family physicians. Minn Med. 1995;78:29–32.PubMedGoogle Scholar
  50. 50.
    Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017–22.PubMedCrossRefGoogle Scholar
  51. 51.
    Suchman A. The influence of health care organizations on well-being. West J Med. 2001;174:43–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990;150:1857–61.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Patrick M. Dunn
    • 1
  • Bengt B. Arnetz
    • 2
    • 3
  • John F. Christensen
    • 1
  • Louis Homer
    • 4
  1. 1.Department of MedicineLegacy Health SystemPortlandPortlandUSAUSA
  2. 2.Division of Occupational and Environmental Health, Department of Family Medicine and Public Health SciencesWayne State UniversityDetroitUSA
  3. 3.Division of Social Medicine, Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  4. 4.Legacy Clinical Research and Technology InstituteLegacy Health SystemPortlandUSA

Personalised recommendations