American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level

Health professional wellness hierarchy.

Burnout has been implicated in higher physician turnover, reduced patient satisfaction, and worsened safety, but understanding the degree of burnout in a given physician or team does not direct leaders to solutions. The model proposed integrates a long list of variables that may ameliorate burnout into a prioritized, easy-to-understand hierarchy. Modified from Maslow’s hierarchy, the model directs leaders to address physicians’ basic physical and mental health needs first; patient and physician physical safety second; and then address higher-order needs, including respect from colleagues, patients, processes, and the electronic health record; appreciation and connection; and finally, time and resources to heal patients and contribute to the greater good. Assessments based on this model will help leaders prioritize interventions and improve physician wellness.

Administrators hoping to address physician burnout face a dilemma. In 2017 the National Academy of Science created an Action Collaborative focused on Clinician Well Being and Resilience, bringing together more than 60 key constituents including representatives from professional societies, the Agency for Health Care Research and Quality, leading clinician researchers, electronic health record (EHR) developers, and many others. Working together, the academy listed 80 factors that contribute to burnout.1 In a similar effort, prominent pioneering research groups have provided a categorized list offering specific strategies by scale so that individuals, units, and organizations can conceptualize opportunities for intervention at whatever level they wish.2

While these lists are impressively thorough, institutions and executive teams hoping to address burnout may have difficulty choosing which factors to prioritize, as these lists are overwhelming, even for well-resourced organizations. The lack of structure may result in institutions addressing a random list of factors and they may miss key drivers. Or worse, institutions may avoid addressing the structural issues that cause burnout, choosing instead to cosmetically initiate wellness classes, programs, and trainings that may do little to impact the underlying drivers or consequences of burnout.

With these concerns in mind we have adapted Maslow’s Hierarchy into a Physician Burnout and Wellness Hierarchy (Figure). While hardly innovative, this model is practical, necessary, and offers easy-to-understand guidance to leaders hoping to improve burnout. Maslow asserted that humans are motivated by unsatisfied needs. As needs at a given level are sufficiently satisfied, we strive toward needs at the next level. In his classic 1943 paper, Maslow3 proposed a hierarchical model starting with physiological needs and moving up the pyramid to safety needs, the need for love and belonging, esteem and culminating for those fortunate few striving toward, and at least briefly realizing, a state in which they actualize or realize their true potential.

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-Daniel E. Shapiro, PhD, Cathy Duquette, RN, PhDb, Lisa M. Abbott, MBAb, Timothy Babineau, MDb,c, Amanda Pearl, PhDd, Paul Haidet, MDd

This article originally appeared in the May 2019 issue of The American Journal of Medicine.

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