The Thriving Physician: A Qualitative Study
Benjamin Doolittle, MD, Residency Program Director, Yale's Combined Medicine-Pediatrics Residency Program
Burnout is characterized by emotional exhaustion, depersonalization of the other, and lack of accomplishment. The prevalence of physician burnout is 54%, with the prevalence in some specialties as high as 70%. (1) Physicians who experience burnout are more likely to suffer from depression and other mental health issues, endure marital and family stress, have increased job turnover, and commit more medical errors and lapses in professionalism. (2) Much is known about the demographic associations among burned out physicians, who tend to be younger, unmarried, with increased patient demands and work hours. However, very little is known about those physicians who are thriving. What makes a physician happy in their role?
This qualitative study explores thriving and happiness among community-based, mid-career, primary care physicians. Physicians were identified using a self-referential and “snow-ball” strategy. Physicians interviewed included pediatricians, internists, and family practitioners. Average age was 55, with 22 years in practice. The interviews employed a mixed-methods strategy of validated scales and a semi-structured interview. The interviews were then transcribed and reviewed by two independent researchers to extract themes.
Several themes emerged. First, thriving physicians placed a high value on their relationships with their patients. Meaningful therapeutic relationships were at the core of their mission and provided a sense of identity and purpose for themselves. Second, they were intrinsically motivated to provide high-quality care. Several expressed little value on income or social status. Several physicians described upholding core values of quality and compassion, regardless of recompense or recognition. Third, they expressed a value in maintaining autonomy and flexibility in their schedule. Many were independent practitioners who had the freedom to craft their schedule to fit their personal needs. Fourth, many expressed a strong social network of friends and family upon whom they could rely for social support. Fifth, these physicians cited several challenges that threatened their sense of satisfaction. They identified administrative burdens, financial obligations to staff, and the electronic medical record as the three main areas that led to stress.
This is the first known qualitative study on physician thriving. While much is known about the prevalence and demographics of burnout, very little is known about the factors that describe a thriving physician. There are several implications to this project. First, can these behaviors be taught? Can physicians be trained to place a high value on relationships and quality care? Second, are there systemic issues that merit attention? Namely, administrative hassles and the electronic medical record were often cited as a threat while a sense of autonomy and schedule flexibility was often cited as a positive element. Fostering an environment to minimize negative attributes and optimize the positives shows promise towards a replicable model for physician thriving.
This study was approved by the institution’s IRB committee.
1 Archives of internal medicine, 172 Burnout and satisfaction with work-life balance among US physicians relative to the general US population. (18), 1377-1385.
2 Chopra, S. S., Sotile, W. M., & Sotile, M. O. (2004). Physician burnout. Jama, 291(5), 633-633. Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., ... & Oreskovich, M. R. (2012).
This qualitative study explores thriving and happiness among community-based, mid-career, primary care physicians. Physicians were identified using a self-referential and “snow-ball” strategy. Physicians interviewed included pediatricians, internists, and family practitioners. Average age was 55, with 22 years in practice. The interviews employed a mixed-methods strategy of validated scales and a semi-structured interview. The interviews were then transcribed and reviewed by two independent researchers to extract themes.
Several themes emerged. First, thriving physicians placed a high value on their relationships with their patients. Meaningful therapeutic relationships were at the core of their mission and provided a sense of identity and purpose for themselves. Second, they were intrinsically motivated to provide high-quality care. Several expressed little value on income or social status. Several physicians described upholding core values of quality and compassion, regardless of recompense or recognition. Third, they expressed a value in maintaining autonomy and flexibility in their schedule. Many were independent practitioners who had the freedom to craft their schedule to fit their personal needs. Fourth, many expressed a strong social network of friends and family upon whom they could rely for social support. Fifth, these physicians cited several challenges that threatened their sense of satisfaction. They identified administrative burdens, financial obligations to staff, and the electronic medical record as the three main areas that led to stress.
This is the first known qualitative study on physician thriving. While much is known about the prevalence and demographics of burnout, very little is known about the factors that describe a thriving physician. There are several implications to this project. First, can these behaviors be taught? Can physicians be trained to place a high value on relationships and quality care? Second, are there systemic issues that merit attention? Namely, administrative hassles and the electronic medical record were often cited as a threat while a sense of autonomy and schedule flexibility was often cited as a positive element. Fostering an environment to minimize negative attributes and optimize the positives shows promise towards a replicable model for physician thriving.
This study was approved by the institution’s IRB committee.
1 Archives of internal medicine, 172 Burnout and satisfaction with work-life balance among US physicians relative to the general US population. (18), 1377-1385.
2 Chopra, S. S., Sotile, W. M., & Sotile, M. O. (2004). Physician burnout. Jama, 291(5), 633-633. Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., ... & Oreskovich, M. R. (2012).