Physician Mental Health: Where to Intervene? A Framework and a Pilot Survey of Psychiatrists
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LETTER TO THE EDITOR
Physician Mental Health: Where to Intervene? A Framework and a Pilot Survey of Psychiatrists Christopher T. Lim 1
&
Steven M. Kleiner 2 & John M. Santopietro 3 & Hyong Un 4 & J. Wesley Boyd 1
Received: 28 March 2020 / Accepted: 17 June 2020 # Academic Psychiatry 2020
To the Editor: Suboptimal physician mental health in the USA and around the world is well recognized, whether as elevated rates of physician burnout, depression, or other forms of distress [1]. These problems must be addressed, but it is not clear how best to solve them. Given that low professional satisfaction is considered a core dimension of burnout and to the extent that it contributes to mental illness [1], what must change in the workplace for physician mental health to meaningfully improve? A survey of internists at a large academic center found that professional satisfaction was significantly associated with three factors: feeling valued by leadership, feeling respected by the department, and working in a social and supportive environment [2]. We see these as aspects of the interpersonal culture of the workplace, representing relationships with peers and workplace leadership. A qualitative synthesis of interviews and a survey across 30 US medical practices [3] identified the importance of interpersonal culture factors as well, including practice leadership and collegiality, fairness, and respect. This study also identified factors related to work mechanics: autonomy and work control, work quantity and pace, regulatory and professional liability concerns, and electronic health records. Separately, the study highlighted a connection between perceived quality of care and professional satisfaction; we believe that quality of care is an embodiment of the mission and purpose of medicine. Finally, while few * Christopher T. Lim [email protected] 1
Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
2
Private Practice, New York, NY, USA
3
Hartford HealthCare/University of Connecticut School of Medicine, Hartford, CT, USA
4
Aetna Inc., Hartford, CT, USA
respondents reported dissatisfaction with their income, income stability was important to satisfaction. Income is one of several material benefits that employers provide; other studies have suggested that physicians are offered suboptimal employee benefits, such as parental leave policies [4]. Thus, benefits and compensation must be considered among the collection of factors impacting professional satisfaction. We propose that these four categories of workplace factors—interpersonal culture, work mechanics, mission and purpose, and benefits and compensation—are what underlie professional satisfaction. To address the factors that undermine physician mental health, we must identify which factors are most critical. We present the findings of a pilot study in which we sought to prioritize these factors. In particular, we sought to determine the importance of physician autonomy, as represented by workplace control and workflow predictability. We hosted a
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