• Ellis C Dillon, Ming Tai-Seale, Amy Meehan, Veronique Martin, Robert Nordgren, Tim Lee, Teresa Nauenberg, and Dominick L Frosch.
• Center for Health Systems Research, Sutter Health , Palo Alto, CA, USA. dillone@sutterhealth.org.
• J Gen Intern Med. 2020 Jan 1; 35 (1): 261267261-267.

BackgroundNationally over 50% of physicians report symptoms of burnout.ObjectiveTo understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve well-being.DesignWe conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians.ParticipantsThe 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women.ApproachInterviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being.Key ResultsAll 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being.ConclusionInterviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.

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