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Letters to the Editor

In Reply to Egener

Ripp, Jonathan MD, MPH; Shanafelt, Tait MD

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doi: 10.1097/ACM.0000000000003668
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We agree with Dr. Egener that the well-being of every worker within a health system is important, and there is a need to address burnout across multiple disciplines. We chose the term “clinician,” with the intention to encompass all physicians, nurses, advanced practice providers, pharmacists, and other clinical care personnel. We intentionally focused on clinicians because evidence suggests that these patient-facing health care workers have well-being needs distinct from those of workers in general.1 Indeed, many organizations have created health care chief wellness officer (CWO) roles based on the principle that their function in addressing these needs is distinct from organizational CWOs in other fields, who focus on health behaviors to reduce employee health care expenditures and often fall under more traditional human resources frameworks.

Even among clinicians, the experience of distress differs by occupation. For example, large national studies of physicians show that they have higher levels of burnout and lower work–life integration relative to other fields, even after controlling for work hours and demographic characteristics.1 Similar studies suggest that nurses seem to struggle more with work–life integration than burnout,2 though the opposite is observed among physician assistants.3 Even within a discipline, needs often vary widely by practice setting (e.g., ICU nurses have different stressors than public health nurses). Effective organizational efforts must recognize and address both the shared and unique challenges among and within these many disciplines.4

The ability of an organization to identify challenges and meaningfully address these distinct professional needs depends on the size of the team working to promote well-being and the resources available to them. Organizations must define an appropriate scope and priorities commensurate with these investments for such efforts to be effective. Many organizations are at early phases of a coordinated institutional approach and have focused initial efforts on physicians, trainees, advanced practice providers, and/or nurses given these are the areas of greatest need. Starting small and demonstrating effectiveness can be a critical platform from which to justify increased investment to reach additional team members.

Efforts focused on clinicians require expertise in organizational change to address the system-level drivers contributing to clinician well-being. The health care CWO applies these skills to improve clinician well-being, while partnering with other institutional stakeholders (e.g., human resource teams) to ultimately promote the well-being of clinical and nonclinical staff alike.


1. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94:1681–1694
2. Dyrbye LN, West CP, Johnson PO, et al. Burnout and satisfaction with work-life integration among nurses. J Occup Environ Med. 2019;61:689–698
3. Dyrbye LN, West CP, Halasy M, O’Laughlin DJ, Satele D, Shanafelt T. Burnout and satisfaction with work-life integration among PAs relative to other workers. JAAPA. 2020;33:35–44
4. Shanafelt T, Trockel M, Ripp J, Murphy ML, Sandborg C, Bohman B. Building a program on well-being: Key design considerations to meet the unique needs of each organization. Acad Med. 2019;94:156–161
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