Physician well-being has been studied extensively, considering that being a physician is associated with higher levels of stress which can lead to problems both personally and professionally. Some of this stress can be managed on an individual level; however, there are also organizational interventions that can be helpful.

On an individual level, medical students that had personality characteristics of empathy and self-criticism were more likely to experience adverse effects on future mental health (Firth-Cozens, 1998). In addition to personality types that might predispose to future problems, employing coping strategies of avoidance and denial were found to be especially poor outcomes in mental health. Stress begins early in medical training, and symptoms of burnout have been documented in in medical students with nearly one half of third year student reporting burnout (Shanafelt, Sloan Havmermann 2003), (Dyrbye, Thomas Huscha 2006) and a correlation between burnout and suicidal ideation in medical students (Dyrbye, Thomas, Massie 2008).

On a job level, having high demands or being overloaded is associated with stress. Hours of sleep were significantly related to depression in one study. (Firth-Cozens 2001) Main stressrs were relationships with senior doctors, making mistakes, conflict of career with personal life, and litigation fears (Firth-Cozens, 1995). For those physicians that were general practitioners and not hospital doctors, dealing with patients was also found to be a stressor. A sense of loss of control and/or loss of meaning may well be related to stress and burnout (Dunn, Arnetz 2007). Physicians find "being present" with patients correlates strongly with finding meaning their work (Horowtiz, Suchman, Branch et al, 1995). Programs offering systematic training for primary care physicians in mindfulness have been associated with short term and sustained improvements in well-being and attitudes associated with patient centered care (Krasner, Epstein, Beckmand et al 2009).

In the Firth study which was conducted in the UK, smaller organizations had better mental health outcomes with more cooperation, better communication, more performance monitoring, a stronger emphasis on training and allowing staff more discretion over work. Also, hospitals which were found to have good reputations as places to work had lower staff burnout and better patient outcomes than those without the good reputations (Aiken, Sloane and Sochalski, 1998).

Physician well-being is one of the foundations of professionalism. Joint Commission on Accreditation of Health Care Organization requires all hospital medical staff to have physician wellness committees or to work with already established physician health programs in the state (JCAHO Medical Staff Revisions Reflect Current practices in the Field, Nov/Dec 2000).

Additional Tips on Staying Well:

1. Acknowledge that your time and energy are finite.
2. Acknowledge the need for tradeoffs.
3. Make conscious decisions.
4. Periodically step back, check and re-evaluate your priorities.
5. Get in touch with who you are.
   1. Why did you go into medicine?
   2. What is important to you? What are your values? Do you have a sense of purpose?
6. Be more than a doctor.
   1. What are your other identities?
   2. Friend? Gardener? Parent? Spouse? Sibling?
   3. Don't put all your identities in one basket!
7. Take care of your body.
   1. Sleep, eat, exercise, relaxation, stress reduction exercises
8. Be your own best friend.
   1. Many doctors treat themselves in ways no friend ever would.
9. Foster relationships listen and communicate.
10. Be flexible and open for change.
    (Modified from Jonathan Borus, M.D., "Stresses on Today's Physicians," 2007)

Thanks for reading!
Mina Hah, M.D., on behalf of the AACAP ECP Committee
Kim Dobson, M.D.