Mayo Clinic Proceedings Home

Impact of Organizational Leadership on Physician Burnout and Satisfaction

      Abstract

      Objective

      To evaluate the impact of organizational leadership on the professional satisfaction and burnout of individual physicians working for a large health care organization.

      Participants and Methods

      We surveyed physicians and scientists working for a large health care organization in October 2013. Validated tools were used to assess burnout. Physicians also rated the leadership qualities of their immediate supervisor in 12 specific dimensions on a 5-point Likert scale. All supervisors were themselves physicians/scientists. A composite leadership score was calculated by summing scores for the 12 individual items (range, 12-60; higher scores indicate more effective leadership).

      Results

      Of the 3896 physicians surveyed, 2813 (72.2%) responded. Supervisor scores in each of the 12 leadership dimensions and composite leadership score strongly correlated with the burnout and satisfaction scores of individual physicians (all P<.001). On multivariate analysis adjusting for age, sex, duration of employment at Mayo Clinic, and specialty, each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout ( P<.001) and a 9.0% increase in the likelihood of satisfaction ( P<.001) of the physicians supervised. The mean composite leadership rating of each division/department chair (n=128) also correlated with the prevalence of burnout (correlation=–0.330; r 2=0.11; P<.001) and satisfaction (correlation=0.684; r 2=0.47; P<.001) at the division/department level.

      Conclusion

      The leadership qualities of physician supervisors appear to impact the well-being and satisfaction of individual physicians working in health care organizations. These findings have important implications for the selection and training of physician leaders and provide new insights into organizational factors that affect physician well-being.

      Abbreviations and Acronyms:

      MBI ( Maslach Burnout Inventory), NA ( do not know/not applicable)
      To read this article in full you will need to make a payment

      References

      1. Hawkins M. 2012 Review of physician recruiting incentives. Merritt Hawkins website. http://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/mha2012incentivesurveyPDF.pdf. Accessed May 5, 2014.

        • Stevens G.W.
        Engaging employed physicians: reconceptualizing the role of collective identification.
        Adv Health Care Manag. 2013; 15: 185-209
        • Robinson J.C.
        Consolidation of medical groups into physician practice management organizations.
        JAMA. 1998; 279: 144-149
        • Burchell R.C.
        • White R.E.
        • Smith H.L.
        • Piland N.F.
        Physicians and the organizational evolution of medicine.
        JAMA. 1988; 260: 826-831
        • Lin K.Y.
        Physicians' perceptions of autonomy across practice types: is autonomy in solo practice a myth?.
        Soc Sci Med. 2014; 100: 21-29
        • Relman A.S.
        Medical professionalism in a commercialized health care market.
        JAMA. 2007; 298: 2668-2670
        • Collier D.A.
        • Collier C.E.
        • Kelly T.M.
        Benchmarking physician performance, part 2.
        J Med Pract Manage. 2006; 21: 273-279
        • Madison D.L.
        • Konrad T.R.
        Large medical group-practice organizations and employed physicians: a relationship in transition.
        Milbank Q. 1988; 66: 240-282
        • Schwartz R.W.
        • Pogge C.
        Physician leadership: essential skills in a changing environment.
        Am J Surg. 2000; 180: 187-192
        • Shanafelt T.D.
        • Balch C.M.
        • Bechamps G.
        • et al.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • West C.P.
        • Huschka M.M.
        • Novotny P.J.
        • et al.
        Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
        JAMA. 2006; 296: 1071-1078
        • West C.P.
        • Tan A.D.
        • Habermann T.M.
        • Sloan J.A.
        • Shanafelt T.D.
        Association of resident fatigue and distress with perceived medical errors.
        JAMA. 2009; 302: 1294-1300
        • Wallace J.E.
        • Lemaire J.B.
        • Ghali W.A.
        Physician wellness: a missing quality indicator.
        Lancet. 2009; 374: 1714-1721
        • Haas J.S.
        • Cook E.F.
        • Puopolo A.L.
        • Burstin H.R.
        • Cleary P.D.
        • Brennan T.A.
        Is the professional satisfaction of general internists associated with patient satisfaction?.
        J Gen Intern Med. 2000; 15: 122-128
        • Firth-Cozens J.
        • Greenhalgh J.
        Doctors' perceptions of the links between stress and lowered clinical care.
        Soc Sci Med. 1997; 44: 1017-1022
        • Linn L.S.
        • Brook R.H.
        • Clark V.A.
        • Davies A.R.
        • Fink A.
        • Kosecoff J.
        Physician and patient satisfaction as factors related to the organization of internal medicine group practices.
        Med Care. 1985; 23: 1171-1178
        • Grol R.
        • Mokkink H.
        • Smits A.
        • et al.
        Work satisfaction of general practitioners and the quality of patient care.
        Fam Pract. 1985; 2: 128-135
        • West C.P.
        • Dyrbye L.N.
        • Satele D.V.
        • Sloan J.A.
        • Shanafelt T.D.
        Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment.
        J Gen Intern Med. 2012; 27: 1445-1452
        • Shanafelt T.D.
        • Raymond M.
        • Kosty M.
        • et al.
        Satisfaction with work-life balance and the career and retirement plans of U.S. oncologists.
        J Clin Oncol. 2014; 32: 1127-1135
        • Shanafelt T.
        • Sloan J.
        • Satele D.
        • Balch C.
        Why do surgeons consider leaving practice?.
        J Am Coll Surg. 2011; 212: 421-422
        • Demmy T.L.
        • Kivlahan C.
        • Stone T.T.
        • Teague L.
        • Sapienza P.
        Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.
        Acad Med. 2002; 77: 1235-1240
        • Maslach C.
        • Jackson S.
        • Leiter M.
        Maslach Burnout Inventory Manual.
        3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • Shanafelt T.D.
        • Kaups K.L.
        • Nelson H.
        • et al.
        An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons.
        Ann Surg. 2014; 259: 82-88
        • West C.P.
        • Shanafelt T.D.
        • Kolars J.C.
        Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
        JAMA. 2011; 306: 952-960
        • Dyrbye L.N.
        • West C.P.
        • Satele D.
        • et al.
        Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.
        Acad Med. 2014; 89: 443-451
        • West C.P.
        • Dyrbye L.N.
        • Sloan J.A.
        • Shanafelt T.D.
        Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.
        J Gen Intern Med. 2009; 24: 1318-1321
        • Shanafelt T.D.
        • Sloan J.A.
        • Habermann T.M.
        The well-being of physicians.
        Am J Med. 2003; 114: 513-519
        • Shanafelt T.D.
        Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care.
        JAMA. 2009; 302: 1338-1340
        • Dyrbye L.N.
        • Shanafelt T.D.
        Physician burnout: a potential threat to successful health care reform.
        JAMA. 2011; 305: 2009-2010
        • Dunn P.M.
        • Arnetz B.B.
        • Christensen J.F.
        • Homer L.
        Meeting the imperative to improve physician well-being: assessment of an innovative program.
        J Gen Intern Med. 2007; 22: 1544-1552
        • Egener B.
        • McDonald W.
        • Rosof B.
        • Gullen D.
        Perspective: organizational professionalism: relevant competencies and behaviors.
        Acad Med. 2012; 87: 668-674
        • Buchbinder S.B.
        • Wilson M.
        • Melick C.F.
        • Powe N.R.
        Estimates of costs of primary care physician turnover.
        Am J Manag Care. 1999; 5: 1431-1438
        • Atkinson W.
        • Misra-Hebert A.
        • Stoller J.K.
        The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center.
        J Med Pract Manage. 2006; 21: 351-355
        • Stoller J.K.
        Commentary: recommendations and remaining questions for health care leadership training programs.
        Acad Med. 2013; 88: 12-15
        • Stoller J.K.
        Developing physician-leaders: a call to action.
        J Gen Intern Med. 2009; 24: 876-878
        • Tangalos E.G.
        • Blomberg R.A.
        • Hicks S.S.
        • Bender C.E.
        Mayo leadership programs for physicians.
        Mayo Clinic Proc. 1998; 73: 279-284
        • Lobas J.G.
        Leadership in academic medicine: capabilities and conditions for organizational success.
        Am J Med. 2006; 119: 617-621
        • Arroliga A.C.
        • Huber C.
        • Myers J.D.
        • Dieckert J.P.
        • Wesson D.
        Leadership in health care for the 21st century: challenges and opportunities.
        Am J Med. 2014; 127: 246-249
        • Stoller J.K.
        Help wanted: developing clinician leaders.
        Perspect Med Educ. 2014; 3: 233-237
        • Stoller J.K.
        • Berkowitz E.
        • Bailin P.L.
        Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years.
        J Med Pract Manage. 2007; 22: 237-242
        • Lee T.H.
        Turning doctors into leaders.
        Harv Bus Rev. 2010; 88: 50-58
        • Schwartz R.W.
        • Pogge C.R.
        • Gillis S.A.
        • Holsinger J.W.
        Programs for the development of physician leaders: a curricular process in its infancy.
        Acad Med. 2000; 75: 133-140
        • Trastek V.F.
        • Hamilton N.W.
        • Niles E.E.
        Leadership models in health care: a case for servant leadership.
        Mayo Clin Proc. 2014; 89: 374-381
        • Menaker R.
        Leadership strategies in healthcare.
        J Med Pract Manage. 2009; 24: 339-343
        • Ackerly D.C.
        • Sangvai D.G.
        • Udayakumar K.
        • et al.
        Training the next generation of physician-executives: an innovative residency pathway in management and leadership.
        Acad Med. 2011; 86: 575-579
        • Blumenthal D.M.
        • Bernard K.
        • Bohnen J.
        • Bohmer R.
        Addressing the leadership gap in medicine: residents' need for systematic leadership development training.
        Acad Med. 2012; 87: 513-522
        • Asch D.
        • Jedrziewski M.
        • Christakis N.
        Response rates to mail surveys published in medical journals.
        J Clin Epidemiol. 1997; 50: 1129-1136

      Linked Article

      • Teachable Action for Leaders Committed to Improving Physician Work Life: Continuing Education
        Mayo Clinic ProceedingsVol. 90Issue 10
        • In Brief
          We read with great interest the article by Shanafelt et al1 on the impact of organizational leadership on physician burnout and satisfaction published in the April 2015 issue of Mayo Clinic Proceedings. In their article, the authors identified several specific leadership qualities of physician supervisors as predictors of physician burnout and career satisfaction, including encouraging physicians to develop their talents and skills. We recently conducted a survey of the approximately 1850 clinically active academic physicians at Massachusetts General Hospital focused on physician burnout, career satisfaction, and administrative burden (response rate, 96% [1774]).
        • Full-Text
        • PDF