From Mayo Clinic: Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism: A Randomized Clinical Trial

JAMA Intern Med. 2014 Feb 10. doi: 10.1001/jamainternmed.2013.14387. [Epub ahead of print]

Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism: A Randomized Clinical Trial.

West CP1, Dyrbye LN2, Rabatin JT3, Call TG4, Davidson JH5, Multari A6, Romanski SA5, Hellyer JM7, Sloan JA8, Shanafelt TD4.

Author information

• 1Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota2Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
• 2Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
• 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
• 4Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
• 5Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
• 6Division of Preventive, Occupational, and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
• 7Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota.
• 8Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

Abstract

IMPORTANCE Despite the documented prevalence and clinical ramifications of physician distress, few rigorous studies have tested interventions to address the problem. 

OBJECTIVE To test the hypothesis that an intervention involving a facilitated physician small-group curriculum would result in improvement in well-being. 

DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 74 practicing physicians in the Department of Medicine at the Mayo Clinic in Rochester, Minnesota, conducted between September 2010 and June 2012. Additional data were collected on 350 nontrial participants responding to annual surveys timed to coincide with the trial surveys. 

INTERVENTIONS The intervention involved 19 biweekly facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning for 9 months. Protected time (1 hour of paid time every other week) for participants was provided by the institution. 

MAIN OUTCOMES AND MEASURES Meaning in work, empowerment and engagement in work, burnout, symptoms of depression, quality of life, and job satisfaction assessed using validated metrics. 

RESULTS Empowerment and engagement at work increased by 5.3 points in the intervention arm vs a 0.5-point decline in the control arm by 3 months after the study (P = .04), an improvement sustained at 12 months (+5.5 vs +1.3 points; P = .03). Rates of high depersonalization at 3 months had decreased by 15.5% in the intervention arm vs a 0.8% increase in the control arm (P = .004). This difference was also sustained at 12 months (9.6% vs 1.5% decrease; P = .02). No statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction were seen. In additional comparisons including the nontrial physician cohort, the proportion of participants strongly agreeing that their work was meaningful increased 6.3% in the study intervention arm but decreased 6.3% in the study control arm and 13.4% in the nonstudy cohort (P = .04). Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the trial intervention arm, decreased slightly in the trial control arm, and increased in the nontrial cohort (P = .03, .007, and .002 for each outcome, respectively). 

CONCLUSIONS AND RELEVANCE An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months after the study.