By Dike Drummond MD, CEO TheHappyMD.com
The National Academy of Medicine just published the first discussion paper from their Action Collaborative on Clinician Wellbeing and Resilience
It is a wide-ranging summary of the issue of Physician Burnout and its negative effects on all aspects of healthcare.
It ends in classic academic fashion with a prolonged and detailed plea for more research.
Perhaps the most fascinating part of the whole paper is a comprehensive list of physician burnout study references – by far the largest I have ever seen. I share them with you here if you ever find yourself in need of a study to “prove” burnout’s negative effects and convince leadership to take a stand for the Quadruple Aim.
Here is the full NAM Action Collaborative Discussion Paper:
Here’s the Physician Burnout Bibliography and Comprehensive Reference Library
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;172:1377-85.
Shanafelt TD, Hasan O, Dyrbye L, 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;90:1600-13.
Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA 2015;314:2373-83.
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. JAMA 2016;316:2214-36.
Dyrbye LN, Massie FS, Jr., Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA 2010;304:1173-80.
Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med 2008;149:334.
Dyrbye LN, West CP, Satele D, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med 2014;89:443-51.
West CP, Shanafelt TD, Kolars J. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA 2011;306:952-60.
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288:1987-93.
McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff 2011;30:202-10.
Letvak SA, Ruhm CJ, Gupta SN. Nurses’ presenteeism and its effects on self-reported quality of care and costs. Am J Nurs 2012;112:30-8; quiz 48, 39.
Benson MA, Peterson T, Salazar L, et al. Burnout in rural physician assistants: An initial study. J Physician Assist Educ 2016;27:81-3.
Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg 2010;251:995-1000.
Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg 2011;213:657-67.
West CP, Huschka M, Novotny P, et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006;296:1071-8.
West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA 2009;302:1294-300.
Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, Wuebker LJ. Sress and medical malpractice: Organizational risk assessment and intervention. J Appl Psychol 1988;73:727-35.
Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection.[Erratum appears in Am J Infect Control. 2012 Sep;40(7):680]. Am J Infect Control 2012;40:486
Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol 2015;5:1-13.
Welp A, Meier LL, Manser T. The interplay between teamwork, clinicians’ emotional exhaustion, and clinician-rated patient safety: A longitudinal study. Crit Care (London, England) 2016;20:110.
Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008;33:29-39.
Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associate with patient satisfaction? J Gen Intern Med 2000;15:122-8.
DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study.[see comment]. Health Psychol 1993;12:93-102.
Leiter MP, Harvie P, Frizzell C. The correspondence of patient satisfaction and nurse burnout. Soc Sci Med 1998;47:1611-7.
Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care 2004;42:II57-66.
Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:463-71.
Shanafelt TD, Sloan JA, Satele D, Balch C. Why do surgeons consider leaving practice? J Am Coll Surg 2011;212:421-2.
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;32:1127-35.
Leiter MP, Maslach C. Nurse turnover: The mediating role of burnout. J Nurs Manag 2009;17:331-9.
Spence Laschinger HK, Leiter M, Day A, Gilin D. Workplace empowerment, incivility, and burnout: Impact on staff nurse recruitment and retention outcomes. J Nurs Manag 2009;17:302-11.
Hayes LJ, O’Brien-Pallas L, Duffield C, et al. Nurse turnover: A literature review—an update. Int J Nurs Stud 2012;49:887-905.
Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 2016;91:422-31.
Shanafelt TD, Dyrbye LN, West CP, Sinsky C. Potential impact of burnout on the US physician workforce. Mayo Clin Proc 2016;91:1667-8.
Dyrbye LN, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc 2013;88:1358-637.
Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care 1985;23:1171-8.
Association of American Medical Colleges, Center for Workforce Studies. The complexities of physician supply and demand: Projections through 2025. 2008.
Jones CB. The costs of nurse turnover, part 2: Application of the Nursing Turnover Cost Calculation Methodology. J Nurs Adm 2005;35:41-9.
Jones CB. Revisiting nurse turnover costs: Adjusting for inflation. J Nurs Adm 2008;38:11-8.
Fibuch E, Ahmed A. Physician turnover: A costly problem. Physician Leadersh J 2015;2:22-5.
Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care 1999;5:1431-8.
Kushnir T, Greenberg D, Madjar N, Hadari I, Yermiahu Y, Bachner YG. Is burnout associated with referral rates among primary care physicians in community clinics? Fam Pract 2014;31:44-50.
Bachman KH, Freeborn DK. HMO physicians’ use of referrals. Soc Sci Med 1999;48:547-57.
Parker PA, Kulik JA. Burnout, self- and supervisor-rated job performance, and absenteeism among nurses. J Behav Med 1995;18:581-99.
Stone PW, Du Y, Gershon RRM. Organizational climate and occupational health outcomes in hospital nurses. J Occup Environ Med 2007;49:50-8.
Toppinen-Tanner S, Ojajarvi A, Vaananen A, Kalimo R, Jappinen P. Burnout as a predictor of medically certified sick-leave absences and their diagnosed causes. Behav Med 2005;31:18-27.
Hilton MF, Scuffham PA, Sheridan J, Cleary CM, Vecchio N, Whiteford HA. The association between mental disorders and productivity in treated and untreated employees. J Occup Environ Med 2009;51:996-1003.
Oreskovich M, Kaups K, Balch C, et al. The prevalence of alcohol use disorders among American surgeons. Arch Surg 2011;147:168-74.
Shanafelt TD, Balch CM, Dyrbye LN, et al. Suicidal ideation among American surgeons. Arch Surg 2011;146:54-62.
Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: A consensus statement. JAMA 2003;289:3161-6.
Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, CA: Consult Psychol Press; 1996.
Williams ES, Konrad TR, M. L, 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;37:119-41.
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;32:203-12.
Balch CM, Shanafelt TD, Dyrbye LN, et al. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg 2010;211:609-19.
Dyrbye LN, Shanafelt TD, Balch C, Satele D, J. F. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg 2011;146:211-7.
Dyrbye LN, West CP, Satele D, Sloan JA, TD S. Work-home conflict and burnout among academic internal medicine physicians. Arch Intern Med 2011;171:1207-9.
Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med 2009;169:990-5.
Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016;91:836-48.
Campbell DA, Jr., Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surg 2001;130:696-702; discussion -5.
Bertges Yost W, Eshelman A, Raoufi M, Abouljoud MS. A national study of burnout among American transplant surgeons. Transplant Proc 2005;37:1399-401.
Leiter MP, Spence Laschinger HK. Relationships of work and practice environment to professional burnout: Testing a causal model. Nurs Res 2006;55:137-46.
Spence Laschinger HK, Leiter MP. The impact of nursing work environments on patient safety outcomes: The mediating role of burnout/engagement. J Nurs Adm 2006;36:259-67.
Laschinger HKS, Wong CA, Greco P. The impact of staff nurse empowerment on person-job fit and work engagement/burnout. Nurs Adm Q 2006;30:358-67.
Woodhead EL, Northrop L, Edelstein B. Stress, social support, and burnout among long-term care nursing staff. J of Appl Gerontol 2016;35:84-105.
Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care 2015;24:412-20.
Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Crit Care Med 2007;35:422-9.
Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: The personal health habits and wellness practices of US surgeons. Ann Surg 2012;255:625-33.
Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Ann Intern Med 2016;Epub ahead of print 6 September 2016.
Dyrbye LN, West CP, Burriss TC, Shanafelt TD. Providing primary care in the United States: The work no one sees. Arch Intern Med 2012;172:1420-1.
Shanafelt TD, Gorringe G, Menaker R, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc 2015;90:432-40.
Dyrbye LN, Shanafelt TD, Balch C, Satele D, Freischlag J. Physicians married/partnered to physicians: A comparative study in the American College of Surgeons. J Am Coll Surg 2010;211:663-71.
Dyrbye LN, Thomas MR, Eacker A, et al. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med 2007;167:2103-9.
Maslach C. Burnout. The cost of caring. Cambridge, MA: Malor Books; 2003.
McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Med 2004;2:29.
Tyssen R, Hem E, Vaglum P, Gronvold NT, Ekeberg O. The process of suicidal planning among medical doctors: Predictors in a longitudinal Norwegian sample. J Affect Disord 2004;80:191-8.
Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ 2001;35:110-20.
Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student well-being: A multicenter study. Acad Med 2006;81:374-84.
Brazeau CM, Shanafelt TD, Satele D, Sloan JA, Dyrbye LN. Distress among matriculating medical students relative to the general population. Acad Med 2014;89:1520-5.
Shanafelt TD, Bradley K, Wipf J, Back A. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.
Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114:513-9.
West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet 2016.
Dyrbye LN, Shanafelt TD. Physician burnout. A potential threat to successful health care reform. JAMA 2011;305:2009-10.
West CP, Shanafelt TD. The influence of personal and environment factors on professionalism in medical education. BMC Med Educ 2007;7.
West CP, Shanafelt TD. Physician well-being and professionalism. Minn Med 2007;90:44-6.
Dunn LB, Iglewicz A, Moutier C. A conceptual model of medcial student well-being: Promoting resilience and preventing burnout. Acad Psych 2008;32:44-53.
Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80:1615-22.
Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2016;92:129-46.
Dyrbye LN, Satele D, Shanafelt TD. Ability of a 9-item well-being index to identify distress and stratify quality of life in US workers. J Occup Environ Med 2016;58:810-7.
Dyrbye LN, Satele D, Sloan JA, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med 2013;28:421-7.
Dyrbye LN, Schwartz A, Downing SM, Szydlo DW, Sloan JA, Shanafelt TD. Efficacy of a brief screening tool to identify medical students in distress. Acad Med 2011;86:907-14.
Dyrbye LN, Satele D, Sloan JA, Shanafelt TD. Ability of the Physician Well-Being Index to identify residents in distress. J Grad Med Educ 2014;6:78-84.
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 Published online May 2, 2016.
Shanafelt TD, Kaups KA, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg 2014;259:82-8.
Dewa CS, Jacobs P, Thanh NX, Loong D. An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Serv Res 2014;14:254.
Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med 2016.
Dike Drummond is a family physician, executive coach and author of “Stop Physician Burnout”. He provides coaching, training and consulting on burnout prevention and physician leadership as CEO of The Happy MD.