David W. Musick, PhD
Senior Dean, Faculty Affairs
Professor, Internal Medicine
Virginia Tech Carilion School of Medicine
Faculty vitality and well-being is an important and prominent issue being widely discussed within academic medicine. Effective communication about this issue should address three distinct areas:
Communication with various groups about this issue is challenging, in that various terms are used to describe it: “faculty vitality,” “professional fulfillment,” “well-being,” “wellness,” “burnout,” “clinician distress,” “work-life balance,” and many others. The words chosen to talk about this issue may mean different things to different individuals and/or groups. For example, the term “burnout” may be viewed by many as a label that conveys a sense of “blaming” an individual for experiencing workplace challenges. Related to this use of “burnout,” the word “wellness” may be interpreted in very individualistic terms and used to describe activities such as enhancing one’s resilience, exercising more often, engaging in mindfulness training, or similar efforts. It is now recognized that the issue of burnout is very complex and involves multiple challenges at both the personal and system level. Examples of issues at the system level that contribute to burnout are excessive workload, higher patient acuity, inefficient work environments, and loss of a sense of professional autonomy. Therefore, if efforts to address well-being or burnout only concentrate on the individual faculty member becoming more resilient, it is not likely that those efforts will achieve solutions with the desired impact.1
When communicating with faculty, “well-being” is the best descriptive term to use. The term “well-being” is defined as a state of experiencing the absence of distress, finding positive meaning, and achieving success in various aspects of personal and professional life.2 Properly understood, well-being is viewed as a continuum and not a steady state; one can move between various stages of well-being, ranging from feeling burned out to feeling a sense of thriving.3 While many faculty may be experiencing significant challenges to their well-being, many are not and may indeed be thriving. Our conversations with faculty should reflect recognition of this continuum of well-being. Regardless of the terminology used, it is important to recognize that the absence of burnout does not necessarily equate to well-being. Equally important, a comprehensive approach to programming related to well-being must include interventions at both the individual and organizational levels.
Scope of Work
A 2018 article in JAMA stated that “when physicians are well, they are best able to meaningfully connect with and care for patients.”4 Issues of well-being and burnout are especially prominent in the literature related to physician education and development, but these issues are also applicable to all faculty, both clinical and nonclinical. This topic is prevalent in the literature related to other health professions, as well as other helping professions in general (e.g., social work). Basic science faculty also report feeling challenged in terms of their sense of well-being, albeit with different types of stressors.5 Additionally, learners in various health professions education programs report facing similar challenges. Therefore, any efforts made to address well-being would ideally be comprehensive so that such efforts address issues facing all of these groups. Establish an oversight committee to oversee work to address issues pertaining to well-being in a manner that focuses on all different groups affected by the issue. Ongoing collaboration with representatives from all sectors of the academic health center will facilitate a comprehensive approach to addressing well-being and likely have more widespread impact. Committees should include representatives from various disciplines and administrative units (e.g., offices of student affairs, graduate medical education, and departmental leadership). The endorsement of the work by medical school and health system leadership is critically important. Increasingly, academic health centers are naming a “chief well-being officer” (or similar title) with overall responsibility for overseeing these efforts. Regardless of the structure chosen, it is necessary to devote the appropriate human and other resources to these efforts.
Accreditation can play a significant role in making the case for programs focused on enhancing the well-being of faculty and learners within the academic health center.6 Health professions education programs are accredited by a variety of entities, including the Liaison Committee on Medical Education for allopathic medical schools, the Commission on Osteopathic College Accreditation for osteopathic medical schools, and the Accreditation Council for Graduate Medical Education for residency training programs. Hospitals are most often accredited by the Joint Commission. Each of these accrediting bodies have requirements concerning the well-being and/or work-life balance of learners and professional staff. Such requirements are most often stated in relation to the learning environment and/or the workplace culture of a given program and organization. These accrediting bodies expect schools and hospitals to address issues of well-being in a proactive, systematic manner. Educating various constituent groups about the expectations and requirements of accrediting bodies is an essential early step in establishing a formal program to address well-being issues. Leveraging these requirements may serve to gain additional support for such programs.
- Panagioti M, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205.
- Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114:513-19.
- Penwell-Waines L, Greenawald M, Musick DW. A professional well-being continuum: broadening the burnout conversation. South Med J. 2018;111(10):634-35.
- Thomas LR, Ripp JA, West CP. Charter on physician well-being. JAMA. 2018;319(15):1541-42.
- Messias E, Gathright MM, Freeman ES, et al. Differences in burnout prevalence between clinical professionals and biomedical scientists in an academic medical centre: a cross-sectional survey. BMJ Open. 2019;9:e023506.
- Chappell K, Holmboe E, Wall JR. The role of health care accreditors in promoting health and well-being across the learning continuum [discussion paper]. NAM Perspectives. Nov.5, 2018. https://nam.edu/the-role-of-health-care-profession-accreditors-in-promoting-health-and-well-being-across-the-learning-continuum. Accessed Feb. 21, 2020.