CRAJ Spring 2023

Spring 2023 (Volume 33, Number 1)

Is Professional Fulfillment the Wellness and Sustainability Solution?
Exploring the Relationship Between Professional Fulfillment, Burnout, and Sustainability Among Canadian Physicians

By Taylor McFadden, PhD; Caroline Gérin-Lajoie, MD; and Christopher Simon, PhD (Canadian Medical Association, Physician Wellness and Medical Culture Team)

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Taylor McFadden, PhD	Caroline Gérin-Lajoie, MD	Christopher Simon, PhD

Disclosure: The opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association.

What keeps physicians going, through the pandemic and beyond, despite the long hours and challenging work environments? Does professional fulfillment (PF) — which encompasses happiness, meaningfulness, contribution, self-worth, satisfaction, and joy in medicine — provide the necessary drive? Can PF mitigate against burnout or the temptation to reduce clinical hours or leave the profession altogether? The Stanford Model of Professional Fulfillment, one of the most well-known in the area of physician wellness, recognizes the importance of PF by placing it in the model’s centre and surrounding it with three key pillars: personal resilience, a culture of wellness, and efficiency of practice. However, during the COVID-19 pandemic in Canada, what were the links between PF, burnout, and intention to leave the profession? The Canadian Medical Association (CMA) conducted the 2021 National Physician Health Survey (NPHS) to provide some insight into these questions.

Why Is Professional Fulfillment So Important in Medicine?
Professional fulfillment is the intrinsic positive reward we derive from our work. While research on PF in medicine is somewhat limited, the concept of intrinsic motivation has been widely studied and has been positively linked to wellness, optimal functioning, productivity, and behaviour change/maintenance. When we experience inherent satisfaction and enjoyment from doing something, we feel good and are motivated to continue doing it. Considering this, we hypothesized that PF could mitigate burnout and positively influence sustainability in medicine.

The CMA NPHS, which is administered on a three-to-four-year cycle, measures and tracks physician wellness indicators over time, as well as wellness-related behavioural and occupational factors. The 2021 iteration of the NPHS includes the first national professional fulfillment data among Canadian physicians. For full details on the methodology, participant characteristics, prevalence data, and the questionnaire, see the "2021 National Physician Health Survey – Foundational Report" available at cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf.

Results from the 2021 NPHS revealed that 79% of physicians and medical residents score low on PF, with only 21% scoring high
(N = 3864). In line with our hypothesis, further analyses indicated that low PF is a leading driver of burnout and increases the likelihood that a physician will reduce their work hours (p < 0.05). Indeed, the 2021 NPHS binomial logistic regression analyses identified PF as one of the strongest drivers of burnout, which aligns with previous research. That is, those who score low on PF are 2.5 times more likely to experience burnout. Moreover, physicians who score low on PF are 1.5 times more likely to say they intend to reduce their work hours in the next 24 months. This has also been found previously and is quite concerning given Canada’s healthcare crisis and challenges with physician shortages and access to care, which are increasingly reported in the media. See "From data to action: Understanding the drivers of physician wellness" (available at cma.ca/sites/default/files/2022-11/NPHS-Regression-Analysis-EN.pdf) for full details on the regression analyses.

How Do We Enhance Professional Fulfillment to Promote a Sustainable Workforce?
The 2021 NPHS results also offer some insight into ways that PF can be enhanced, including increasing opportunities to accomplish worthwhile tasks, ensuring physicians feel that they are positively influencing other people’s lives, optimizing time spent working closely with patients (and reducing time devoted to administrative tasks), making sure professional values are aligned with those of the department, increasing control over workload, promoting a collegial workplace, increasing job satisfaction and reducing fatigue, stress and burnout levels. Targeting organizational factors (e.g., reducing administrative load) and workplace culture (e.g., enhancing collegiality) to promote professional fulfillment and reduce burnout are consistent with recommendations made by others.

Where Do We Go From Here?
While the fundamental system-level changes that need to occur to improve physician wellness, professional fulfillment and healthcare sustainability may take time, many of the suggestions above can be readily implemented at the local levels. The findings from the 2021 NPHS, that low PF is a driver of burnout and increases the likelihood that a physician will reduce their work hours, is simply a starting point and future research in this area is recommended. Additional questions that warrant further investigation include:

What factors promote and hinder PF in medicine (e.g., administrative load, quality of leadership, meaningful recognition, equitable remuneration, etc.)? Among them, which is the strongest?
Does increasing PF decrease burnout and increase retention?
What is the link between low PF and other outcomes such as quality care, patient experience, physician productivity, recruitment, and retention?

To conclude, professional fulfillment is a factor that researchers, healthcare organizations, and stakeholders should focus on moving forward, as a potential solution to wellness challenges experienced by Canadian physicians and to the health workforce crisis we are facing today.

Taylor McFadden, PhD
Senior Research Advisor,
Physician Wellness & Medical Culture,
Canadian Medical Association
Ottawa, Ontario

Caroline Gérin-Lajoie, MD
Executive Vice-President,
Physician Wellness and Medical Culture,
Canadian Medical Association
Ottawa, Ontario

Christopher Simon, PhD
Director,
Physician Wellness and Medical Culture,
Canadian Medical Association
Ottawa, Ontario

References:

Angus Reid Institute. (2022). Doc Deficits: Half of Canadians either can’t find a doctor or can’t get a timely appointment with the one they have. Available at https://angusreid.org/canada-health-care-family-doctors-shortage/. Accessed February 27, 2023.

Burns KE, Pattani R, Lorens E, et al. (2021). The impact of organizational culture on professional fulfillment and burnout in an academic department of medicine. Plos one.16(6). Available at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252778. Accessed February 27, 2023.

Canadian Medical Association. (2022). CMA 2021 National Physician Health Survey. Available at https://www.cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf. Accessed February 27, 2023.

Canadian Medical Association. (2022). From data to action: Understanding the drivers of physician wellness. Available at https://www.cma.ca/sites/default/files/2022-11/NPHS-Regression-Analysis-EN.pdf. Accessed February 27, 2023.

Olson K, Marchalik D, Farley H, et al. (2019). Organizational strategies to reduce physician burnout and improve professional fulfillment. Current problems in pediatric and adolescent health care, 49(12). Available at https://www.sciencedirect.com/science/article/abs/pii/S1538544219301051. Accessed February 27, 2023.

Ryan RM & Deci EL (2017). Self-Determination Theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.

Stanford Medicine. (2023). Self-Assessment: Evaluating your well-being. Available at https://wellmd.stanford.edu/self-assessment.html. Accessed February 27, 2023.

Stanford Medicine. (2016). The Stanford Model of Professional Fulfillment. Available at https://wellmd.stanford.edu/about/model-external.html. Accessed February 27, 2023.