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From the American College of Nuclear Medicine

Quality and Safety in Healthcare, Part LIX

More on Promoting Wellness

Harolds, Jay A. MD

Author Information
doi: 10.1097/RLU.0000000000002827



The reasons for physician burnout usually will be any combination of the following: relationships at work and with the administration, rewards, “workload, efficiency, control and flexibility, work-life integration, meaning in work, fairness and equity, collegiality, or values assignment between individuals and the organization or unit.”1

To address some of the workload issues, it may be useful to analyze whether there is a more efficient way to handle them or whether help could be made available from other healthcare professionals or whether some things could be delegated.2 This is so important that it will be discussed in detail in the next section.

Regarding improving the relationships between those in the workplace community, the individual could try to positively impact the relationships between workers by listening more, thanking others more for their help, and helping others more. Regarding rewards, the individual could talk to the decision makers that he/she would like time for research or teaching or going to a particularly valuable course. Other rewards could include positive feedback, public recognition, or some sought-after position in an organization. Regarding a perception of unfairness, it may be helpful to respectfully point out to the decision makers what are felt to be areas of inequitable treatment. Regarding values, it is important to have a reasonable match between the values of the individual and the organization. How resources are allocated is part of that. Regarding lack of control, a conversation with colleagues or superiors may result in some improvements in scheduling or some delegation of authority to the individual.2

In the past, many doctors were self-employed, but now about three-quarters of physicians are employees of very big organizations such as healthcare systems and big private groups. This has lessened the control the physician has over how and what he/she does on the job, including scheduling and how much work is done per day. Restoring some autonomy to the doctor helps to reduce burnout, and this means giving some choices to the physician.3,4 If any of these causes of burnout cannot be changed, it may be necessary to change jobs.2

Many interventions have been suggested to deal with burnout. The interventions aimed at the doctors to decrease burnout include ways to reduce stress with mindfulness techniques, exercise, and education to improve self-confidence and communication. Interventions aimed at the healthcare organizations include diminishing the work performed per shift by each doctor, more teamwork, better leadership, changes in the scheduling of physicians, alterations in how work is evaluated, increased resources made available, and increased doctor control. A meta-analysis with attention for articles with controlled intervention showed very small but statistically significant diminutions in the symptoms of burnout with interventions aimed at the physicians. Greater effects, but still small, were obtained for the interventions that were aimed at the organization rather than the individual physician, but such initiatives were rarely undertaken.5 However, recently, a number of articles have emphasized the importance of organizational interventions and how to improve their impact.1,6–8


An inefficient workplace is an important cause not only of job dissatisfaction, but also of burnout. The types of inefficiency are different not only in different healthcare systems and specialties, but also in different components of an institution, including different patient floors serving the same type of patients. Therefore, it is important that not only the top leadership of an institution does what it can from its perspective to make the practice more efficient, but also delegates some of the responsibilities to midlevel and lower management, who are more aware of the local problems.6

Redesigning the workflow is one way to increase efficiency and/or decrease stress. Nurses, nurse practitioners, and physician assistants can help make physicians more efficient. Physician extenders may perform many important duties including doing certain types of examinations, counseling patients regarding certain disorders such as obesity, and performing screening for certain problems including depression.9

The electronic medical record entries waste a huge amount of time for most physicians, and some of this can often be done by scribes.9 The majority of physicians spend 30% of their day doing progress notes, 190 minutes a day on a computer, and only 27% of their day meeting with their patients.10

Having appropriate laboratory results before the patient arrives for an office or clinic visit can increase productivity. Clerks, rather than more extensively trained medical professionals, can perform certain other duties, such as answering the phone, finding people, faxing materials, keeping track of a multitude of items, and so on. On the other hand, sometimes the amount of time allocated for an outpatient visit or other healthcare services is currently inadequate and results in more stress for the physician and worse care for the patient.9

The doctors must have the opportunity to do excellent work for patient care, quality improvement, and efficiency individually and in teams. The doctors should help design processes that decrease the duties that a physician currently performs that do not require a physician's expertise.4 Designing better protocols, such as for discharging patients, and having new or better management processes for diabetes prevention or hypertension or adherence to prescribed drugs are examples of such initiatives that should both increase quality and make the physician more efficient. Innovative scheduling for the physicians and others can result in the ability to attract more qualified people to the organization and decrease stress for the caregivers and better patient care.9 Such activities not only give the physician more control, but it also gives the physician more of a sense of meaning and being part of an effort for excellence and being connected to the organization and the people in it.4

Another way to make things more efficient is to increase communication between all members of the organization. Such initiatives could include putting certain team members in the same location rather than being separated, having huddles on the floors to talk about how to best help the sickest patients or those most in need of services from multiple care givers, or having meetings of the physicians and others regarding work-life balance, problems with dealing with certain clinical situations, and other difficulties related to work.9 Newsletters, informative websites, and meetings with top leaders are also desirable.

The use of clinical decision support can be helpful to eliminate needless studies and elevate value to the patient. The physical working conditions should also be optimized, including an attention to appropriate soundproofing, ergonomics, and cleanliness. Many members of the department should be involved in the recruitment process for new physicians. Opportunities to reduce stress should be sought, but necessary service obligations, such as radiology report turnaround pressures, do cause additional stress for radiologists, which can be ameliorated with adequate staffing and teleradiology.11

Technological advances can cause increased workload. One example is the digital tomosynthesis units, which generate a vast number of images, instead of the typical 4-view mammogram. There was about a 64% increase in digital breast tomosynthesis machines in the 18-month period starting from mid-2016. However, technology such as deep learning and also artificial intelligence has the potential to help radiologists read these and other images more quickly.12


In addition to having teams specifically designed to prevent burnout and have more happiness at work, it has been found that other teams in the hospital can be quite helpful. High-performing clinical healthcare teams can improve the quality and safety of patient care, increase efficiency, help create a culture of mutual support, improve job satisfaction, and increase the happiness of the workers. It has been found that members of successful clinical teams had less burnout.13

In a recent study, it was found that when primary care physicians had social workers and/or pharmacists on their clinic team, the social needs of their patients were better met, the doctors perceived this, and the doctors had less burnout.14

“Meaningful work, strong relationships with patients, positive team structures, and social connection at work are important factors for physician well-being.”15


Meetings often do not produce optimal results or actively engage the participants, and yet consume much time. This combination of factors can contribute to burnout or reduce the effectiveness of efforts to combat burnout. Involving the attendees of a meeting can involve having the individuals vote on the importance of various issues or solutions, making sure all the individuals can safely voice their ideas, and asking unexpected questions such as how the group can best fail at coming up with a workable solution.16


The importance of having good leadership and good communication at all levels of the organization cannot be overemphasized in the effort to decrease burnout and promote happiness and wellness. This includes leadership development opportunities with formal education and leadership opportunities in the workplace. Leaders should also be evaluated periodically, and if poor leaders cannot improve with appropriate direction and training, they should be replaced.4,6–8,17–19


Having greater efficiency is important to decrease the workload, decrease burnout, and increase happiness in the workplace. The use of teams, skilled enlightened leadership, and distributed leadership (where all work together cooperatively to achieve important goals and everyone's input is respected) increase everyone's control over the workplace. This in turn also increases everyone's sense of ownership and togetherness, which also leads to less burnout and more job satisfaction.


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19. Harolds JA. Quality and safety in healthcare, part LV: leadership to prevent burnout and increase joy. Clin Nucl Med. 2019; [Epub ahead of print].

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burnout; burnout prevention; happiness at work; joy at work; physician job satisfaction; physician well-being; physician wellness

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