For more than four decades, Christine Sinsky, MD, has been a tireless champion for the people in the white coats. An internist by training and an innovator by nature, Dr. Sinsky has dedicated her career to making medical practice more sustainable and fulfilling—for both physicians and patients. She is set to retire from the AMA May 31.
Well-known for her national leadership as the vice president of professional satisfaction at the AMA, Dr. Sinsky helped shift the conversation around physician burnout from whispered concern to urgent, systemic priority.
Her groundbreaking research, including the seminal “In Search of Joy in Practice” study and co-authorship of the Quadruple Aim framework, has shaped how health systems and organizations nationwide approach team-based care, workflow redesign and physician well-being.
And through initiatives such as AMA STEPS Forward® and the Joy in Medicine® Health System Recognition Program, she helped translate ideas into action—empowering physicians to reclaim time, purpose and joy in their work.
“Dr. Sinsky has been a steadfast voice for efforts to protect the heart of physicians’ work—their direct relationships with patients and their needs. Her commitment to our profession and our primary mission to serve patients has truly transformed how we think about medical practice in the midst of serious countervailing forces, and we owe her tremendous thanks and gratitude,” said Colin West, MD, PhD, an internist in Rochester, Minnesota, and medical director of employee well-being at Mayo Clinic.
Echoing Dr. West’s sentiments, Tait Shanafelt, MD, a hematologist in Palo Alto, California, and chief wellness officer for Stanford Medicine, shared that “for the last decade, Dr. Sinsky has been a potent force for change to improve clinician well-being. She’s been a tireless advocate for physicians and has catalyzed system-level change through her engagement with organizations, regulatory agencies, and government.”
“She has contributed to the clinician well-being movement in countless ways including leading influential research, designing the AMA’s Organizational Biopsy® to help organization assess and develop action plans, and creating the Joy in Medicine Program to provide a road map for organizational action,” Dr. Shanafelt said. “She’s also a trusted expert for organizations and organizational leaders trying to identify pragmatic steps they can take to improve the work environment for physicians.”
“Dr. Sinsky has been a trusted advisor to many organizations and leaders as well as an impactful researcher who has helped generate the data and evidence to inform action,” he said, noting that her key contributions to the field include not only efforts to foster clinician well-being but also ways to optimize team composition, increase flexibility and control for clinicians, and foster relationship-centered care.
For this Q&A, Dr. Sinsky reflected on what drew her to medicine, what drove her to become one of the foremost voices for physician well-being and what she’s most proud of as she looks ahead to a new chapter.
AMA: What is your most meaningful contribution to the body of research on physician burnout and satisfaction?
Dr. Sinsky: One of the first research projects I was part of at the AMA was a study published in 2016 showing that physicians spend two hours on EHR and desk work for every one hour of direct face time with patients. That study has been cited over 1,000 times and has helped raise awareness on the amount of administrative work that physicians were required to perform. That was 10 years ago. With the addition of the new work of the patient portal, this indirect work has continued to be a source of time pressure for physicians.
We have also done a series of studies assessing the financial costs of burnout, which we convert into interactive online calculators. For example, a leader can enter the number of physicians in their organization, their burnout rate and then determine the number of physicians who are likely leaving their organization each year directly because of burnout and the costs of their replacement.
More recently, we have posted interactive calculators to help people understand the costs of three vacation characteristics—taking less than three weeks of vacation, not having full inbasket coverage while on vacation, and doing 30 minutes or more of patient care work on a typical vacation day. We will soon post an interactive calculator showing organizational costs related to physicians experiencing poor control over their clinical environment.
AMA: What high-level lessons have you learned about helping others understand the importance of professional well-being?
Dr. Sinsky: I’ve learned how important language can be. Terms such as “joy in medicine,” “the Quadruple Aim” and “creating a manageable cockpit” help condense big topics into concepts that can be quickly understood and that resonate with physicians.
The other observation I’ve made is that over the past several decades we have evolved to a very transactional conceptualization of health care when, at its core, I believe our work is relational. I believe a health care system intentionally built to support relationships with our patients and within our teams will have better outcomes—better, more efficient, less costly care for patients—and more satisfying work for physicians and other health care workers.
We have a great opportunity to thoughtfully build all the infrastructures of health care—the staffing models, scheduling systems, physical spaces, leadership structures, technologies and institutional policies and practices—in a way that enhances continuity and relationships.
In a paper, “Radical Reorientation of the U.S. Health Care System Around Relationships,” my co-authors and I shared many specific tactics that organizations have used to prioritize relationships throughout the system, at the level of individual teams, the larger health systems and within technology and payment.
Maximizing continuity of relationships, with patients and within teams, hasn’t typically been a driving force in how health care institutions are designed, but I believe patient care will be better, costs will be lower, and physicians and others will find the work more satisfying when relationships are prioritized.
AMA: What was your original vision when you stepped into your role as vice president of professional satisfaction at the AMA?
Dr. Sinsky: Quite early on, our team came together around the mission to “help to create the conditions where joy, purpose and meaning in work are possible for physicians and their teams.” That vision continues to guide us and has provided a shared focus as we've developed research initiatives, done our assessment work, developed the STEPS Forward resources, brought people together for boot camps and conferences, and as we designed the recognition program.
I’m really proud of our team for developing practical, actionable one-stop resources to help physicians, practice managers and other leaders. These free resources delve into the nitty gritty details of how organizations can achieve those outcomes with success stories sharing how others have done it.
Everyone wants to be patient-centered, but how do we do that? People want to have more practice efficiency, but what are the details in terms of how the schedule is constructed, how the workflows are designed, and how the team is constituted? These are all dimensions that impact patient care and physician well-being.
What distinguishes the AMA’s resources are that they are not theoretical, they are written for physicians, by physicians. Dr. Marie Brown, who leads our STEPS Forward work, has scrupulously designed them to be practical and actionable. Likewise, Kyra Ng and Dr. Kevin Hopkins continually improve our Joy in Medicine recognition program. And Nancy Nankivil and Dr. Jane Fogg lead our assessment work.
AMA: Which initiatives at the AMA are you most proud of and why?
Dr. Sinsky: Research has been foundational to everything else that we do. The research that we've been able to do in collaboration with researchers at Stanford and Mayo has really been important to advance our understanding of the prevalence, drivers and consequences of burnout. I also believe this research increases the credibility, reliability and trust that people put into our resources, our assessment work and our recognition program. Lindsey Carlasare has been instrumental in managing and contributing to this research.
At the AMA we’ve also been fortunate to be able to invest, overall, several millions of dollars advancing research in areas that haven’t traditionally been well funded. For example, we funded many early studies using EHR event-log data to both understand and optimize the care environment. I'm really happy with the work that's happened in that domain. Some of these small grants have led to larger funding from outside sources to build on the researchers’ initial work.
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AMA: Where did your idea of the Joy in Medicine program come from and how is it helping set the standard for well-being in medicine?
Dr. Sinsky: I can remember exactly where I was when that idea came to me. In 2016 and 2017, we had a series of Joy in Medicine summits. In the fall of 2016, we had a summit with CEOs and then in the spring we had one with CMOs [chief medical officers] and another with researchers.
The CEOs had said: You've got our attention. We know this is an important issue, we just don't know what to do about it. Can you help us determine what we should be doing as health systems?
That had been in the fall and then in the spring, sitting in the meeting with the CMOs and other leaders, I thought: Well, what if we could provide a road map? What if we could develop a program where we identified what are some key, very practical, actionable steps that you can take as an organization that will put you on a path of improving the well-being of your workforce?
I ran that idea past Dr. Tait Shanafelt, who is one of the most prominent physicians in the world of physician well-being, and he had the brilliant idea to break it down into six domains. We then went back and forth and refined the criteria. Over time we’ve made some minor tweaks, but overall the program, domains and requirements have been largely stable.
One of the things that showed me that the Joy in Medicine recognition program had become an established goal for organizations is when I learned over 150 organizations have been recognized and that’s impacting 400,000 physicians, which is nearly half the physicians in the country. Twelve of the largest 15 health systems in the U.S. are recognized through the program. When we started this initiative, we had no idea where this program would go.
AMA: Since you’ve been at the AMA, the physician burnout rate has fluctuated. Do you think this recent drop in burnout marks real improvement when it comes to well-being?
Dr. Sinsky: Aside from a dip and then a spike around the pandemic, rates of burnout among physicians have been between 45% to 55%. We do this work with the hope that burnout will lessen. But burnout is such a multifactorial thing that I don't think we can expect that it will globally drop within just a few years.
My hope is that it will continue to drop, and my belief is it certainly can, that this is a fixable problem and that there are lots and lots of solutions. At the same time that there are new insights and new solutions, there have also been new stresses.
The next person who takes on the leadership of this work will take it to a whole new level, and I am enthusiastic about that.
AMA: What is one piece of advice you can offer to the next generation of physicians or well-being leaders?
Dr. Sinsky: Recognize that our profession is, at its core, relational, that so much knowledge about patients is housed in the relationship that we have with them and so much efficiency and safety is housed in the relationships of the people doing the work. If we prioritize continuity and relationships, our work will be more rewarding, it will be more efficient and we'll have better outcomes.
AMA: What are your plans for retirement?
Dr. Sinsky: I’ve decided to let retirement come to me and openly experience this new phase, as opposed to feeling the need to immediately fill it up with work-adjacent activities or work substitutes. I trust that this will work out well and am excited to experience a new way of being in the world.
I don’t have plans to do additional work aside from a few previously arranged speaking engagements. I also will be teaching at the Stanford Chief Wellness Officer course again this summer.
But aside from that, I am going to just learn what is right thing for me in the next phase. I have enjoyed the work so thoroughly that I am not leaving something that was noxious or unrewarding; I’m not running from something. I feel like it’s the right time to retire and I am grateful to have been able to do such meaningful work.
AMA: Any final thoughts you’d like to share?
Dr. Sinsky: I just feel so fortunate that the AMA has invested in this work on professional satisfaction, understanding key drivers and developing specific and effective programs which organizations can use to reduce burnout.
And for me personally, it has been rewarding to be able to take the joys and frustrations that I experienced in practice and translate those experiences into something that will be helpful for physicians who follow.
