Attention has long been focused on the challenges faced by newly minted physicians as they navigate the intricate maze of medicine. But physician burnout, poor job satisfaction and other professional challenges vary by career stage. And middle career appears to be an especially challenging time for physicians, according to an exclusive survey from the AMA. The results signal a pressing need to tailor efforts to promote physician satisfaction, reduce burnout and improve retention based on where doctors are in their careers.
More than 13,000 responses from physicians and nonphysician providers across 30 states were received from more than 70 health systems that participated in the AMA’s Organizational Biopsy® (PDF). The AMA benchmarking report—which is exclusive data to the AMA that is not published anywhere else—reflects 2022 trends in six key performance indicators: job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization, and total hours spent per week on work-related activities (known as “time spend”).
The purpose of the aggregated data is to provide a national summary of organizational well-being and to serve as a comparison for other health care organizations. The results may be limited by the number of health systems that choose to participate.
Here is what the 2022 AMA data reveals about physician burnout rates and how they vary based on the numbers of year since completing residency or fellowship training:
- 1–5 years: 54%.
- 6–10 years: 61%.
- 11–15 years: 59%.
- 16–20 years at 56%.
- 20 or more years: 46%.
Meanwhile, job satisfaction was highest among physicians who were five or fewer years out of training, as well as among doctors with 20-plus years since residency or fellowship. Part-time respondents also experienced higher job satisfaction. Additionally, 52% of physicians with more than 20 years in practice felt valued by their organization. That compares with 41% of those in the six–10-year post-training category.
Survey to identify needs
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At PeaceHealth Medical Group (PHMG) based in Vancouver, Washington, there were 362 responses to their Organizational Biopsy of which 60.2% were physicians, 18.2% nurse practitioners, 11.6% physician assistants and 9.9% other health professionals. PHMG is part of the nonprofit health system, PeaceHealth, and is comprised of more than 1,100 physicians and other health professionals from dozens of clinics and hospitals across the Pacific Northwest.
The survey uncovered that 59% of physicians who are 6–10 years post-training reported experiencing at least one symptom of burnout. That compares with a 51.3% burnout rate among doctors who are one to five years post-training.
Here is how PHMG is taking steps to reduce physician burnout and improve job satisfaction among all years in practice.
Improve the onboarding process
“Within the first six months of employment, clinicians seemed more satisfied by the measures we had available to us at the time. But between six months and two years of employment, their satisfaction dwindled rapidly and was actually the lowest,” said Patricia Wooden, MD, a family physician and system director for clinician well-being at PHMG. “Then it stabilized and as time went on, their satisfaction seemed to improve within our medical group. … And then we were seeing a very significant turnover at five years.”
“It became really compelling to us when a newer clinician came onto our well-being committee and he described his experience of onboarding,” Dr. Wooden said. “We realized we had worked really hard to recruit this highly trained specialist for a community that had a high level of need and then we were failing him.”
That’s when PHMG started a multiyear project to look at the onboarding process from the day contracts are signed through the end of physicians’ first year.
After talking to different departments and new physicians, “we came up with several large initiatives from that work … and just completed the last phase of that project, which started in November 2022,” she said. The program involves a handoff from the recruitment team to an onboarding specialist who works with the physician managing paperwork, appointments, answering questions and helping with moving details.
Meanwhile, a standardized playbook for managers helps them understand the activities they should be undertaking—and when—to get newly hired physicians “successfully launched,” Dr. Wooden said.
Additionally, PHMG has a mentoring program, and each physician is “assigned a mentor for six sessions over the first year.”
Give doctors tools to fix practice
One PHMG initiative that can be useful to midcareer physicians is the Practice Experience Program. Any PHMG-employed physicians can opt in to the program, which gives doctors “time and space to think about and discover what’s working well in their practice and what’s not,” Dr. Wooden said. “Then we help equip them with time, tools, encouragement, support and education to help improve those areas of their practice that they may be struggling with.”
For example, physicians who “feel like they’re really struggling with documentation, there are six, hourlong sessions during six months where we focus on using the EMR more effectively. If they feel like they’re struggling with burnout, there are six sessions that are on well-being,” Dr. Wooden said. “The thing that works is we don’t tell them what to focus on. They select what they want to work on, set their own goals and we provide the time, support and encouragement.”
So far, 180 physicians and other health professionals have made use of the program, which is “just over 10% of our medical group. And in that particular program, we see significant improvements in Mini Z scores pre- and post,” she said. The Practice Experience Program has helped physicians stay put at PHMG, with some who had expressed an intent to leave then changing their minds and deciding to stay.
Develop clinical leaders
Another initiative “that we’re investing a lot of energy in right now is our clinical leader development,” Dr. Wooden said.
“Helping our leaders understand that keeping themselves well isn’t just cute or fluffy. It’s critical to keeping the other people who work with them well,” she said. “Also, improving the leader’s ability makes a very dramatic improvement on the experience of all the people who work for them.”
One important key to PHMG’s approach is to tackle “one big project at a time,” Dr. Wooden said. Once a well-being initiative is up and running, “we’ll figure out what the next thing is that we have the capacity to take on.”
The AMA Joy in Medicine™ Health System Recognition Program is available to serve as a guide for health systems and organizations interested, committed or already engaged in building well-being and reducing physician burnout.
