How to Build a Program to Promote Physician Well-Being
By Christopher Cheney
The best physician well-being programs begin by measuring burnout and well-being, then selecting an appropriate strategy, the chief wellness officer of Allegheny Health Network (AHN) says.
Burnout takes a personal and professional toll on physicians, says Thomas Campbell, MD, MPH, chief wellness officer at AHN.
“On the personal side, there is increased substance abuse,” he says. “Studies have shown that alcohol use and other substance use increases with higher levels of burnout. There is trouble with relationships at home with loved ones. There is also an increase in suicidal ideation and depression.”
“On the professional side, increases in physician burnout cause decreases in quality of care, which we see with increased malpractice claims and increased near misses in patient safety events,” he says. “There is a decrease in productivity—the efficiency of physicians and their ability to see more patients is decreased. Finally, burnout causes physicians to cut back hours or to leave the profession.”
AHN launched a wellness program for physicians, advanced practice providers, nurses, and residents six years ago. The first step was to measure burnout and well-being, Campbell says.
AHN selected a survey tool developed by a company at Penn State Health.
“We looked for a measurement tool that had validity for physicians, advanced practice providers, nurses, and residents,” Campbell says. “They had experience measuring well-being and burnout for all those categories of workers, not just physicians. The company was led by a psychologist named Dan Shapiro, and we have continued to work with him over the past six years.”
“They used Maslow’s Hierarchy of Needs adapted to a healthcare industry well-being model, which includes basics such as good hydration and nutrition, moving up the pyramid to camaraderie, safety, appreciation, and feeling that you are contributing at full capacity,” Campbell says.
The survey data indicates that AHN’s well-being and burnout program is having a positive effect. Physician burnout levels have been running at about 10% lower than the national rate.
Setting a strategy
After selecting a measurement tool, AHN picked an established strategy for its wellness program. The health system picked the Stanford Model of Professional Fulfillment, which features three pillars: culture of wellness, efficiency of practice, and personal resilience.
1. Culture of wellness
The first step involves making sure that providers have multiple ways to reach out for help, Campbell says.
“We created a help line so physicians could reach out to internal behavioral health providers 24/7,” Campbell says. “We now have an EAP program that does not use internal reporting tools if people are uncomfortable with our internal behavioral health resources. We also established external resources, where people could get help through our county medical society.”
AHN also conducted leadership education to create a culture that included psychological safety, so that physicians could feel comfortable sitting down one-on-one with their leaders, according to Campbell.
“The primary focus of the leadership training was how to lead your physicians with wellness in mind,” he says.
The health system also removed questions about mental health history on physician credentialling forms.
“Those questions are a hinderance because they stigmatize doctors and prompt them to not reach out for help,” Campbell says.
2. Efficiency of practice
Efficiency of practice is an essential element of promoting physician well-being, Campbell says.
“When you have a workday where everything is working well, you are less likely to get burned out,” he says. “You are likely to get out of work on time, to be more fulfilled in your day, and to make yourself a better person physically and mentally outside of work.”
AHN’s effort to improve efficiency has focused on their Epic electronic health record.
“We have been trying to limit the amount of time physicians are on a computer to make their work more patient-centered,” Campbell says. “We want physicians to spend less time at night—we call it pajama time—charting because they could not get to it during the workday.”
“We call members of these teams IT officers, and these officers show physicians how to be more efficient in the EHR,” Campbell says.
The health system has also adopted AI-driven ambient listening technology, which automates documentation during physician encounters with patients.
“We are trying to find ways to make the EHR work for the physician to promote a more efficient workday, create better documentation, and create tools that support better care,” Campbell says.
AHN has also been working to build better teams around physicians
“We have been looking at what advanced practice providers, experienced nurses, and medical assistants can do together with physicians to create an optimum team working at the top of their capacity,” Campbell says. “We are trying to establish more synergy and efficiency in the practice of medicine.”
This team building effort has been particularly successful, he says, in the outpatient setting.
“In outpatient clinics, there is a great opportunity to allow advanced practice providers to do more within the scope of their licensure,” Campbell says. “In the outpatient setting, we are also getting more out of nurses and nurse navigators.”
3. Personal resilience
For physicians, teamwork is also tied to personal resilience and a commitment to wellness, Campbell says.
“We have found that resiliency is tied to the team around physicians, but physicians do need to keep an eye on their health and well-being,” he says.
It is important to understand that personal resilience is individualized, Campbell says.
“What one person might need in terms of diet, sleep, hydration, and mental healthcare is often different than what another person might need to keep healthy,” he says.
Campbell has found that his human resources colleagues and AHN’s benefits offerings are crucial to supporting personal resilience.
“I have been looking at what programs that we have and what benefits that we have for those who may need help with issues such as weight management and addiction, including smoking cessation,” he says. “We want to provide multiple ways for people to get the things that they need.”
One such benefit is paternity leave and maternity leave, the latter of which was recently expanded.
An important element of personal resilience is finding ways to balance work and life outside of work, Campbell says.
“It is hard to achieve a perfect balance and a better term is probably integration,” he says. “We have encouraged physicians to look at the integration of their work life and their personal life.”
A national concern
The most recent survey data from the American Medical Association shows physician burnout below 50% for the first time since 2020. In 2023, 48% of physicians reported experiencing at least one symptom of burnout, which was down from 53% in 2022, according to the AMA. Physician burnout reached a record high in 2021, with 62% of physicians reporting at least one symptom of burnout, AMA survey data found.
Despite the improvement, physician burnout remains a troubling problem, according to the AMA.
“The shift marks a milestone in the ongoing battle against physician burnout, but the fight is far from over,” a prepared statement from the AMA says. “Continued efforts are essential to address the root causes of physician burnout and ensure that doctors receive the support they need to thrive.”
Campbell recently led a HealthLeaders strategy call on physician well-being.
Christopher Cheney is the CMO editor at HealthLeaders.