Physician Well-Being and the Pursuit of Human Flourishing

Physician well-being is a crucial cornerstone of an effective healthcare system. However, it has often been dominated by the relentless demands of the medical profession, where long hours, emotional stress, and administrative burdens are the norm. In recent years, growing concerns about physician burnout have sparked a movement to shift the conversation beyond mere survival to one focused on human flourishing — a comprehensive state of well-being characterized by engagement, purpose, resilience, and meaningful connections.

Understanding Physician Burnout

Burnout among physicians is not a new phenomenon. The factors have been well described and, perhaps to some extent, normalized. The World Health Organization defines burnout as an “occupational phenomenon” caused by chronic stress in the workplace that has not been managed.(1)

According to a July 2024 AMA article, exclusive survey data show doctor burnout has fallen to 45% for the first time since 2020.(2) If this trend is to continue, executive leaders must remain committed to physician and organizational well-being. While systemic factors such as increased workload, staff shortages, and inefficient healthcare processes contribute to burnout, an equally important aspect is the lack of attention to cultivating and sustaining well-being and the pursuit of human flourishing.

The Science of Human Flourishing

Flourishing is a state in which individuals experience positive emotions, have meaningful relationships with people and their communities, have a sense of purpose, and recognize and appreciate each other’s accomplishments, even when challenges are present. Understanding the conditions necessary to flourish encompasses more than just the absence of mental distress; it involves thriving in various aspects of life.

Tyler VanderWeele, director of Harvard University’s Human Flourishing Program, proposed measuring and conceptualizing flourishing to promote human flourishing.(3) Human flourishing also draws from positive psychology, a field pioneered by Martin Seligman. Positive psychology shifts the focus from pathology to flourishing, emphasizing values, virtues, strengths, and well-being.

For physicians, positive psychology offers tools to navigate the stressors of their profession while reconnecting with the intrinsic rewards of caregiving. Key concepts in positive psychology relevant to physician well-being include:

1. Resilience: The ability to bounce back from adversity. When resilience is combined with a flourishing mindset, physicians are better equipped to bounce back from setbacks and are best supported by cognitive reframing and stress management techniques.

2. Meaning and Purpose: Aligning or realigning to a sense of purpose and meaning (a calling) can lead to higher satisfaction levels and lower burnout rates. The National Academy of Medicine reinforces this view: “Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of healthcare.”(4)

3. Gratitude: Gratitude improves emotional well-being, fosters positive relationships, and enhances life satisfaction. Integrating gratitude practices into medical teams creates a sense of feeling valued and supported.

4. Flow: This is the point where strengths and challenges converge. Physicians who experience flow in their clinical work often lose track of time and report greater job satisfaction and lower stress levels.

A study across eight U.S. medical schools examined physicians’ motivations and the barriers impeding their humanistic practice and teaching.(5) Key factors that contribute to their human flourishing include:

• Identifying with humanistic values;

• Providing care that they or their family would want;

• Connecting to patients;

• Passing on values through role modeling; and

• Being in the moment.

Accordingly, the Human Flourishing Program at Harvard University identifies five domains necessary to flourish:

1. Happiness and life satisfaction;

2. Mental and physical health;

3. Meaning and purpose;

4. Character and virtue; and

5. Close social relationships.

These elements align closely with the factors that support physician well-being, suggesting that flourishing research can provide valuable insights for transforming the medical profession.

Ethos: Why Physician Flourishing Matters

The moral imperative to prioritize physician well-being is grounded in ethical and professional responsibilities. Physicians are entrusted with the care of patients and play a pivotal role in shaping the healthcare experience. When physicians are well, they are better equipped to provide compassionate, competent care, make sound clinical decisions, and foster trusting relationships with patients.

Fostering these factors, such as compassion and trusting relationships, aligns with the concept of the good doctor. Patients expect physicians to be proficient in knowledge and technical skills and consistently prioritize the quality of interpersonal relationships between the patient and physician that reflect an inherent value for human beings and the validity of shared human needs.(6)

Moreover, healthcare institutions have an ethical obligation to create environments that support the well-being of their staff. Physicians dedicate countless hours to ensuring the health of their patients, often at a significant personal cost. Addressing their well-being is a professional necessity and recognizes their intrinsic value as individuals.

Research linking well-being to improved healthcare outcomes reinforces the ethos of prioritizing physician flourishing. Studies show that physicians with high levels of well-being are less likely to make medical errors, more engaged in their work, and more likely to remain in the profession.(7) By embracing a flourishing-focused approach, healthcare leaders can create an environment where physicians and patients thrive.

Pathways to Physician Flourishing

Consider these pathways to flourishing:

Cultivate Purpose and Meaning. Create an environment for physicians to further cultivate purpose and meaning. Purpose is a central pillar of flourishing. Physicians often enter the profession driven by a desire to heal and make a difference in patients’ lives. In a national study of more than 2,200 U.S. physicians, those experiencing burnout were significantly less likely to identify medicine as a calling.(8)

Build Resilience and Beyond. Go beyond mindfulness and meditation practices, albeit resourceful to many physicians. Support further resiliency through cognitive reframing and stress management techniques.

Additionally, antifragility is going beyond resilience. Antifragility is the capacity not just to survive, but also to benefit and evolve from stress and volatility. At a personal level, embracing antifragility helps harness adversity through the lens of growth and development. Taking a holistic approach to well-being supports antifragility.

Enhance Social Connections. Our connections with each other are critical to human flourishing. Yet medical practice is isolating, hindering work-life balance and time for meaningful connections. Include physicians’ ideas to foster a culture of teamwork and connection.

Promote a Holistic Approach. Physician well-being requires resources to support where your physicians may desire improvement. Making physicians’ well-being a priority in an organization’s strategic plan heightens the attention and level of importance.

Create an Environment for Engagement and Flow. Align physicians’ roles with their strengths and passions. Provide opportunities for individual physicians or a team to engage in self-reflection, a sense of purpose, meaning, values, strengths, and the commitment to personal growth.

Healthcare executives have a crucial role in fostering an environment that supports physician flourishing. Leadership practices that prioritize well-being can create a ripple effect throughout the organization.

Consider these key actions:

• Incorporate well-being metrics into organizational performance evaluations.

• Lead by example by prioritizing self-care and work-life balance.

• Establish clear communication channels to address physician concerns.

• Provide resources and support for well-being initiatives.

Don’t Forget to Measure Physician Flourishing

To effectively promote and sustain physician flourishing, it is essential to measure well-being outcomes. Traditional metrics such as burnout rates are necessary but insufficient. New assessment tools, such as the Flourishing Index and several well-being assessments, offer a more comprehensive understanding of physicians’ experiences.

Conclusion: A Call to Action

The pursuit of human flourishing in medicine is not a luxury — it is a necessity. By moving beyond the reactive focus on burnout and embracing a proactive approach to well-being, healthcare organizations can create an environment where physicians thrive. This fosters better patient care, improved organizational outcomes, and a more sustainable healthcare system.

Physicians dedicate their lives to the healing and well-being of others. It is time to prioritize their flourishing, acknowledging that their well-being is integral to the health of our communities and the future of healthcare.

References

1. World Health Organization. Burn-out an “Occupational Phenomenon”: International Classification of Diseases. WHO Departmental Update. May 28, 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases .

2. Berg S. Physician Burnout Rate Drops Below 50% for First Time in 4 Years. AMA Newswire. July 2, 2024. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years .

3. VanderWeele TJ. On the Promotion of Human Flourishing. Proc Natl Acad Sci U S A. 2017;114(31):8148–8156. https://doi.org/10.1073/pnas.1702996114 .

4. National Academy of Medicine. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press;2024. https://doi.org/10.17226/26744

5. Branch WT, Weil AB, Gilligan MC, Litzelman DK, et al. How Physicians Draw Satisfaction and Overcome Carriers in Their Practice: “It Sustains Me.” Patient Education and Counseling. 2017;11(12):2320–2330. https://doi.org/10.1016/j.pec.2017.06.004

6. Borracci RA, Álvarez Gallesio JM, Ciambrone G, Matayoshi C, Rossi F, Cabrera S. What Patients Consider To Be a “Good” Doctor, and What Doctors Consider To Be a “Good” Patient. Rev Med Chil. 2020;148(7): 930–938. https://doi.org/10.4067/S0034-98872020000700930

7. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc. 2018;93(11):1571–1580. https://doi.org/10.1016/j.mayocp.2018.05.014

8. Jager AJ, Tutty MA, Audiey C, Kao AC. Association Between Physician Burnout and Identification with Medicine as a Calling. Mayo Clin Proc. 2017;92(3): 415–422. https://doi.org/10.1016/j.mayocp.2016.11.012 .