In this article, a 2-dimensional work stressor framework is used to explain inconsistencies in past research with respect to stressor relationships with retention-related criteria. Results of meta-analyses of 183 independent samples indicated that whereas hindrance stressors had dysfunctional relationships with these criteria (negative relationships with job satisfaction and organizational commitment and positive relationships with turnover intentions, turnover, and withdrawal behavior), relationships with challenge stressors were generally the opposite (positive relationships with job satisfaction and organizational commitment and negative relationships with turnover intentions and turnover). Results also suggested that the differential relationships between challenge stressors and hindrance stressors and the more distal criteria (withdrawal behavior and turnover) were due, in part, to the mediating effects of job attitudes.

http://psycnet.apa.org/journals/apl/92/2/438.pdf

Differential challenge stressor-hindrance stressor relationships with job attitudes, turnover intentions, turnover, and withdrawal behavior: A meta-analysis

Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce. Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Design, Setting, and Participants Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Main Outcome Measures Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Results Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ = −6.8; 95% CI, −4.8 to −8.8; depersonalization, 8.4 to 5.9; Δ = −2.5; 95% CI, −1.4 to −3.6; and personal accomplishment, 40.2 to 42.6; Δ = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ = −4.1; 95% CI, −1.8 to −6.4); total mood disturbance (33.2 to 16.1; Δ = −17.1; 95% CI, −11 to −23.2), and personality (conscientiousness, 6.5 to 6.8; Δ = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = −0.39, P  Conclusions Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

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Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout

The Social Transformation of American Medicine is one of the most comprehensive studies on the rise of the medical profession and the development of the health care industry published to date, Starr is able to span the fields of medicine so that he discusses intelligently the economic, political, and historical developments in medical care. His wri ting is clear and succinct, his arguments are copiously footnoted, and the inferences he draws are sound. In Book I, he covers \"the rise of medical authority and the shaping of the medical system\"; in Book II, \"doctors, the State, and the coming of the corporation.\" Reviews by Daniel Bell of Harvard and George Silver of Yale call Starr's work brilliant-I would agree. I would recommend this book to anyone who wants to understand the current health care system. Starr describes the movement of the medical profession from one that was initially viewed skeptically to one that was later embraced; and now, coming full circle, to one that is viewed critically. Starr maintains that the current status of American medicine is the result of our history of accommodating professional interests while failing to exercise control over health programs, and then needing to adopt piecemeal regulations and cut-backs on programs that become too inflationary, One of the primary messages I take from this book is the importance of a com bination of forces: a profession's authority, the political climate, and the current philosophy about health care. Starr illustrates how these forces coalesce to defeat or achieve medical improvements. As occupational therapists, we are dependent on the development of the health care industry. It is wise for us to understand the forces that have an impact on medical care and what they could mean for our profession, Kay Barbara Schwartz, M.S., OTR

The social transformation of american medicine.

https://www.amjmed.com/article/S0002-9343(03)00117-7/pdf

The well-being of physicians

Health care organizations may incur high costs due to a stressed, dissatisfied physician workforce. This study proposes and tests a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health.

Mark Schwartz

Papers

Understanding physicians: Intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health