Page numbers printed in boldface type refer to tables and figures.
Academic Biomedical Career Customization initiative,256
Accomplishment, personal,5
burnout and,67
Accreditation Council for Graduate Medical Education (ACGME),92, 108–109, 281
“Common Program Requirements,”94
restriction of resident work hours,200
ACEP.
See American College of Emergency Physicians
ACE.
See Adverse Childhood Experiences study
ACGME.
See Accreditation Council for Graduate Medical Education
Achievement, of “typical physician,”90
ACT.
See Assertive community treatment programs
Action Collaborative on Physician Well-Being and Resilience, establishment of,4
Adverse Childhood Experiences (ACE) study,48
Affordable Care Act,32
Aging Physician Task Force, establishment of,13
Alcohol use, among medical students/ residents,194–195, 199
Ambulatory Process Excellence (APEX),139
American Association of Directors of Psychiatry Residence Training,37
American College of Emergency Physicians (ACEP),203
establishment of,13
focus on personal wellness,14
American Medical Association,4
American Psychiatric Association (APA),xvi
challenges to address burnout,19
educational goals of,37
Well-Being Ambassador Tool Kit,284
Work Group on Psychiatrist Wellbeing and Burnout,4, 283–284
American Recovery and Reinvestment Act (ARRA),149
Anger,215
Anhedonia,79
Antipsychotics,110
Anxiety,215
“Anxiety reframe,”54
APA Board of Trustees Ad Hoc Work Group on Psychiatrist Well-being and Burnout,xvi, 17–18, 20, 40
establishment of,4
APEX.
See Ambulatory Process Excellence
Approaches to Work Questionnaire for Physicians,55–56
ARE.
See Authority, responsibility, and expertise
ARRA.
See American Recovery and Reinvestment Act
Artificial intelligence,39–40
Assertive community treatment (ACT) programs,259, 262
Authority, responsibility, and expertise (ARE),271–292.
See also Healthcare system
collaboration in relationships with patients and colleagues,280–281
dynamic factors leading to clinician burnout,275effect on physician identity and professional autonomy,273–274
ethical dimensions of,278–280
vignettes of,279–280
examples of,274–278
of excessive responsibility vignette,277
insufficient authority vignettes,274–276
insufficient expertise vignette,277–278
insufficient responsibility vignette,276
life span developmental considerations of psychiatrists,281–283
overview,271–273
rebalancing,283–286,
285support for,287–289
model of physician professional fulfillment,289vignette,288
Baby boomers,37
Balint, Michael,259
Barbiturates,110
Behavioral health managed care organization (BHMCO),275
Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself,203
Beneficence, definition of,295
Benzodiazepines,110
BHMCO.
See Behavioral health managed care organization
Biobehavioral sensing,260–261
Bioethics, burnout and,7
Biomonitoring,260
BM.
See Burnout Measure
BOURBON national survey of French interns,260
Brain, stress and,48–49
Brooks, Allison Wood,54
Burnout.
See also Emotions
advocacy and awareness of,40
APA challenges to address,19
as barrier to health,xvi
bioethics and,7
clinically significant impact on,89
consequences of,75–76
costs for an organization,77
for patient care,86–87
risk of physical illness,75–76
coping mechanisms for,16
definitions of,6–7, 8–11, 20, 28–29, 66, 70, 283–284
depersonalization and,66–67
depression and,102–103
versus depression,78–79
with depression,9–10
description of,3–4, 233
in dysfunctional clinical teams,303
effects on clinical care,65–83
compassion fatigue and traumatization versus burnout,79–80
depression versus burnout,78–79
illness versus impairment,78
quality of physician’s work,76
EHR and,149–172
in emergency medicine,12–15
emotional exhaustion and,66
etiology of,69–70
history of,3–26
ICD classification of,102
to impairment,85–100
interpersonal signals for,237
affective,237
behavioral,237
cognitive,237
motivational,237
intervention programs for prevention of,11–12, 15
job,56
mediators of,32–33
as a medical disorder,9
model for maintaining well-being and preventing burnout for psychiatrists,211–232
parental,8
personal accomplishment and,67
prevalence rates of,17, 68, 234
professional,xvi
protective factors against,74–75
psychiatrists and,15–19, 233–249
intervention principles and strategies,234–245
burnout and impairment,244
cognitive-behavioral therapy,242–243
computer-based interventions,243–244
for improving work environment,241–242
measuring burnout,237–238
meditation,243
mindfulness training,243
organizational changes,244–245
organization-wide screening for burnout,236–237
prevention strategies against burnout,238–241
primary interventions,235–236
secondary interventions,235, 236–241
for stress management,241
tertiary interventions,235, 241–245
PTSD and,10
as a public health crisis,166
recognition in society,4–8
reduction of,11–12
as response to systemic issues,92
risk factors for,56–59, 70–73
organizational,92–93
alignment of individual and organization values,93
degree of meaning derived from work,93
flexibility/autonomy over schedule and work-life integration,92–93
social support/community at work,93
workload and efficiency,92
role of health system in preventing psychiatrist burnout,251–267
severe forms of,103
social context of,27–42
description of,27–28
spread of,8
stigma and,97
stress and,45–53
substance abuse and,4
symptoms of,68–69
as a syndrome,203
treatment approaches for physician with burnout,97
at various physician career stages,173–192
warning signs of,16
Burnout Measure (BM),237
Careers.
See also Work-life balance
changes and reduction in hours,131–132
physician burnout at various stages of,173–192
stages of physician career development,176Catecholamines,47
CBT.
See Cognitive-behavioral therapy
Center for Epidemiological Studies Depression Scale (CES-D),105
Centers for Medicare and Medicaid Services,151–152
CES-D.
See Center for Epidemiological Studies Depression Scale
“Charter on Physician Well-being,”187
Coaching,187
Codes of conduct,296
Cognitive-behavioral therapy (CBT)for prevention and intervention of at-risk physician suicide,115
for prevention and intervention of psychiatrist burnout,242–243
Collaborative for Healing and Renewal in Medicine,186–187
Communicationdisruptive,296
with peers,222
Community Mental Health Act,16
Compassion, versus empathy,255
Compassion fatiguedescription of,11, 78
with traumatization versus burnout,79–80
Composite Global Well-Being Index,7
Compulsiveness, of “typical physician,”90–91
Computer-based interventions,243–244
Computerized physician order entry (CPOE),155
Control,33
Copenhagen Burnout Inventory,7, 56, 237
Copingdefinition of,69
to reduce risk of burnout,74–75
strategies,69–70
for frenetic subtype,70
for underchallenged subtype,70
for worn-out subtype,70
Cortisol,10, 47
Countertransference,17, 277–278
Covey’s Time Management Matrix technique,240
Cox Transactional Model,253
CPOE.
See Computerized physician order entry
Culturechanging organizational culture,97
generational shift of,37
of medicine,36–37, 72,
299Death, from stress,48.
See also Suicide
Deliberative model,280
Dentists, burnout statistics,7
Depersonalization,5
burnout and,66–67
as consequence of burnout,77
Depressionamong medical students,117
among medical students/residents,198–199
among psychiatrists,110–112
versus burnout,78–79
with burnout,9–10
physician,101–123
burnout and,102–103
variability in prevalence of,105–106
as predisposition to burnout,136
risk and protective factors of,112–113
stress and,49
Diagnostic and Statistical Manual of Mental Disorders (DSM)description of mental disorder,87–89
diagnostic criteria for stress,49–50
neurasthenia diagnosis included in,9
Disappointment,215
Distress,45–46
Doctor-patient-computer relationship,150, 156–157, 169
Do No Harm,116
Dopamine,47
Doubt,90–91
DSM.
See Diagnostic and Statistical Manual of Mental DisorderseWBI.
See eWellBeing Index
EducationAPA goals of,37
learning environments of medical students/residents,196
medical,307
for prevention and intervention of at-risk physician suicide,113–114
for the public,220–221
Effort-Reward Imbalance Model,253
EHR.
See Electronic health record
Electronic health record (EHR),31
adoption rates,151benefits of,150
burnout and,149–172
interventions and approaches,164–168
individual approaches,164, 165
national policy approaches,167
organizational-level approaches,166
practice-level approaches,165–166
vendor/institutional liaison approaches,167–168
measuring burnout,153
Mayo Clinic Model for Key Drivers of Burnout and Engagement,158
minimizing error, maximizing outcome study model,157–158,
159, 159–160
Reciprocity Model,160, 164
Stanford Model for Physician Well-Being,160synthesis of models,159–164,
160–
163models for burnout and sustainability,157–164
outcomes of interventions for,168
prevalence of physician burnout and,152
clerical burden of,155–156
communication and,157
dissatisfaction with,38, 55, 177
doctor-patient-computer relationship,156–157
excessive responsibility of psychiatrist for,276
impact on health care workers,200
practice environment changes and relationship to,153–154
psychiatry-specific views and literature of,156
rise of adoption of,150–152,
151studies and physician responses to,154–155
training for,164–165
as trigger for burnout,71–72
Emergency medicineburnout in,4, 12–15
intervention programs and,15
Emergency Medicine Resident Wellness Consensus Summit,203
Emotionsanger,215
anxiety,215
disappointment,215
emotional exhaustion and burnout,66
exhaustion and,5, 8
fear,215
frustration,215
grief,215
identification of,228
irritation,215
negative,214–215, 223–224
nervousness,215
sadness,215
Empathy, versus compassion,255
Engineering model,280
Epigenetics,47–48
Epinephrine,47
e-Prescribing,152
Erikson, Erik,179
stages of psychosocial development,175,
176Estrogen,47
Ethics, principles in physician well-being,294–297.
See also Well-being
Eustress,45
eWellBeing Index (eWBI),55
Exhaustiondisorder,9
measurement of,237–238
state of vital,9
Expressed emotion,50
Fairness,33
Fear,215
Federation of State Medical Boardson illness,87
on impairment,87
Frankl, Victor,58
Freudenberger, Herbert,4, 233
Frustration,215
Functional impairment,68
General Health Questionnaire–28 (GHQ-28),104
Generation X,37
Generation Y,37
GHQ-28.
See General Health Questionnaire–28
Golden Ticket Project,256
Good for Otto (Rabe),12–13
Harvard Stress Management Special Report,46
Healthcare system.
See also Authority, responsibility, and expertise
role in preventing psychiatrist burnout,251–267
innovations in healthcare and burnout reduction,262–263
innovative systemic approaches to burnout,256–257
institutional interventions to decrease burnout,254–255
reflection of the organization,252–254
systemic approaches for decreasing burnout in large and small healthcare systems,257–258
technological innovation in burnout assessment and intervention,260–261
roots of,273
Health information technologies (HITs),149
Health Information Technology for Economic and Clinical Health (HITECH) Act,149, 167
Health maintenance organizations (HMOs),8, 20, 30
Healthy Work Place study,165
Help-seeking behaviors,91–92
Herzberg, Frederick,33
HITECH.
See Health Information Technology for Economic and Clinical Health Act
HITs.
See Health information technologies
Hope, physician,295–296
ICD-10.
See International Classification of Diseases, 10th Revision
Idealism, loss of,5
Illnessdefinition of,87
versus impairment,78
Impairmentfrom burnout,85–100
burnout and,244
definitions of,78, 87, 244
versus illness,78
of physician,89
protective factors against,96–97
changing organizational culture,97
mindfulness/meditation,97
resilience,96
vignette of resilient psychiatry resident,96
“Imposter syndrome,”53, 277
Informative model,280
Integrated care,262
International Charter for Human Values in Healthcare,255
International Classification of Diseases, 10th Revision (ICD-10), classification of burnout,102
nonpsychotic mental disorders included in,9
problems related to life management difficulty inclusion in,9
recognition of burnout as a lifemanagement problem,66
Interpretive model,280
Interventional mapping,262–263
“iPatient,”150
Irritation,215
Wellness in the Workplace: An Information Paper,14
Jackson, Susan E.,xv
resources for,136
Job Demands-Control Model,4–5
Job Demands-Resources Model,136, 253, 254
Jobsburnout from,56
crafting,240–241
demands from,136
resources for,136
satisfaction with,9, 72
strain from,4–5
Job Strain Model,253
Journaling,222
LegislationAffordable Care Act,32
American Recovery and Reinvestment Act,149
Community Mental Health Act,16
Health Information Technology for Economic and Clinical Health Act,149, 167
Medicare Access and CHIP Reauthorization Act of 2015,167
Levin, Saul,xvi
Life Events and Difficulties Schedule,55
Life Events Checklist,55
The Life of Reason (Santayana),19
Living the Questions (Palmer),27
Lifestyle,75
maintaining habits,294
Likert scale,5
Listen-Act-Develop model,256
Love,18–19
unconditional,225
MACRA.
See Medicare Access and CHIP Reauthorization Act of 2015
Malpractice,178
Marriage, medical,133–134
Maslach, Christina, xv,5
Maslach Burnout Inventory (MBI),5–6, 56, 237–238
limitations of,6
as proprietary survey tool,6
Mayo Clinic Model for Key Drivers of Burnout and Engagement,158,
161–
163, 164
Mayo Clinic’s Serious Leisure Perspective,239
MBI.
See Maslach Burnout Inventory
MBI-Human Services Survey for Medical Personnel,7
MBSR.
See Mindfulness-based stress reduction
McCain, Senator John,57–59
McLellan, M.F.,251
Medical school/residency years,180–184
alcohol use,194–195
ARE and,282
attrition,195–196
burnout,193–208
consequences of,194
factors associated with,194–196
interventions for reduction of,196–197
in residents,200–202
overview,193
prevalence of,194
in residents,197–198
factors associated with,198–200
treatment for,202–203
communication skills,201–202
contributors to satisfaction and burnout,175declining empathy,195
depression,198–199
Erikson stages of psychosocial development and outcomes,176mindfulness,202
restrictions of resident work hours,200
suicidal ideation during,194
vignettesresidency,184
residency choice,181
wellness,201
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),167
Medicinebusiness practice of,35
as a calling,34
consumer movement and,36
corporatization of,31–32
culture of,36–37, 72,
299defensive,38–39
female leadership in,132
for-profit,31
innovation in,38
integrated care,262
medical education,307
medical errors in,39
nonprofit,31
promoting well-being in,306–307
second victim in,39
social transformation of,29–31
stress measurement in,55–56
Triple Aim and,32, 36
Meditation,58
as protective factor against impairment,97
for psychiatrists,243
Medscape Lifestyle Report,14–15
MEMO.
See Minimizing Error, Maximizing Outcome model
Mental disorders, DSM-5 description of,87–89
Mental healthcentrality of,35
of physicians,178
Mental illnessawareness of,35
stigma of psychiatric illness,36
Mentoring,187
Military personnel,57–58
PTSD and,10
Mindfulness-based stress reduction (MBSR),58
among medical students/residents,202
as protective factor against impairment,97
for psychiatrists,223, 243
to reduce medical student burnout,197
Minimizing Error, Maximizing Outcome (MEMO) model,71–72, 157–158,
159Modelscollaborative models of care delivery,263
conceptual models for burnout/satisfaction,169
Cox Transactional Model,254
deliberative,280
Effort-Reward Imbalance Model,253
engineering model,280
informative model,280
interpretive,280
Job Demands-Control model,4–5
Job Demands-Resources Model,136, 253, 254
Job Strain Model,254
Listen-Act-Develop model,256
for maintaining well-being and preventing burnout in psychiatrists,211–232
Clinic Model for Key Drivers of Burnout and Engagement,158,
161–
163, 164
Minimizing Error, Maximizing Outcome model,71–72, 157–158,
159, 159–160
paternal,280
of physician professional fulfillment,289priestly,280
Reciprocity of Wellness Model of Physician Well-Being,158, 160, 164
Spillover-Crossover Model,131
Stanford Model for Physician Well-Being,160Stanford Tripartite Model of Physician Fulfillment,288,
289in the workplace,33
Moral distress, description of,10
Moral stress,297
Mortality, facing,228
Myers, Michael,52, 58
NAM.
See National Academy of Medicine
National Academy of Medicine (NAM),4, 20
Action Collaborative on Clinician Well-Being and Resilience,153
National Comorbidity Survey,107
National Physician Burnout and Depression Report,71
National Violent Death Reporting System,110
Nervousness,215
Neurasthenia,9
Neuroticism,53, 59
Norepinephrine,47
“Numbers Game,”10
Occupational stress,55–56
Office of the National Coordinator for Health Information Technology (ONC),150
OLBI.
See Oldenburg Burnout Inventory
Oldenburg Burnout Inventory (OLBI),17–18, 56, 237–238
ONC.
See Office of the National Coordinator for Health Information Technology
Optimism, physician,295–296
Overworking,71
Paget, Sir James,33
Palmer, Parker J.,27
Parents, burnout of,8
Paternal model,280
Patient care,86–87
burnout as clinically significant impact on,89
patient portals,155
Patient Health Questionnaire–9 (PHQ-9),104
Patientshigh throughput of,297
psychiatrist collaboration in relationships,280–281
well-being of,275
“Peer2Peer” program,114
Peersburnout in dysfunctional clinical teams,303
communication with,22
interprofessional competencies among,286
psychiatrist collaboration in relationships with colleagues,280–281
review and support from,239
social support from,93
support for prevention and intervention of at-risk physician suicide,116
Perceived Stress Scale,55
Perfectionism,53, 59, 72–73, 229
as predisposition to burnout,136
of “typical physician,”90
Performance anxiety, as predisposition to burnout,136
Personal and Professional Well-Being Task Force,13
Personality, Type A,112
PHPs.
See Physician health programs
PHQ-9.
See Patient Health Questionnaire–9
Physician health programs (PHPs),174–176
Physicians.
See also Well-being
academic,132–133
ARE’s effect on identity and professional autonomy,273–274
barriers to accessing care,94–96
belief that treatment does not work,95–96
confidentiality, concern for career, and stigma,95
cost,95
reluctance to seek help,94
time,94
burnout at various career stages,173–192
contributors to satisfaction and burnout,175stages of career development,176burnout statistics,7
caring for physician with burnout and unprofessional behaviors,303–304
community of,33, 39
depression,101–123
dynamic factors leading to burnout of,275economic status of,39
health programs,174–176
hope and optimism of,295–296
impaired,89
lack of recognition of impairment,91–92
leadership,306–307
life stages of,179–188
early-career years,184–185, 188–189, 282
contributors to satisfaction and burnout,175Erikson stages of psychosocial development and outcomes,175vignette of early-career physician,184–185
early formative years,179–180
medical school/residency years,180–184, 282
contributors to satisfaction and burnout,175Erikson stages of psychosocial development and outcomes,176residency choice vignette,181
residency vignette,184
mid-career years,185–186, 282
contributors to satisfaction and burnout,175Erikson stages of psychosocial development and outcomes,176vignette of mid-career physician,186
senior phase,187–188, 283
contributors to satisfaction and burnout,175, 178
Erikson stages of psychosocial development and outcomes,176vignette of senior physician,187–188
mental health issues of,178
patient relationship,252
personality traits of,59
personal satisfaction of,176–178
practicing within the limits of competence,295
prevalence of females,130
professional identities of,27–28
profile of “typical physician,”89–91
high achievement,90
perfectionism,90
triad of compulsiveness,90–91
quality of work,76
reimbursement system for,177
residency training of,37
salaries of,33, 254
satisfaction,175, 176, 178
second victim,39, 51
self-care,239–240
substances use by,178
suicide and,101–123
treatment approaches for burnout,97
Physician Work-Life Study’s Single-Item,7
Positive psychology,18
description of,10
Posttraumatic stress disorder (PTSD)burnout and,10
diagnosis of,51
glucocorticoid levels and,49
in the military,10
recognition of,30
“Presenteeism,”77
Priestly model,280
Principlesof fidelity,296–297
of justice,296
of nonmaleficence,296
of veracity,296
Prisoners of war,57–59
Prisons,5
“Professional depression,”88.
See also Burnout
“Professionalism and Engagement Elevating Physician and Scientist Satisfaction,”257
Professional Quality of Life Scale,55
Psychiatrists.
See also Mindfulness
burnout and,15–19, 233–249, 258–260
risk factors for,70–73
depression and suicide among,110–112
rates of,110–111
life span developmental considerations,281–283
model for maintaining well-being and preventing burnout for psychiatrists,211–232
personality traits of,72–73
psychotherapy for,222
role of health system in preventing psychiatrist burnout,251–267
stressors for,17
symptoms of burnout in,68–69
vignettes,86–87
of burned-out psychiatrist,212–216, 217–219, 220–221, 221–224, 224–227
wellness of,15–16
Psychiatryadvance of knowledge in,34
aspiration of the field,34–35
history of,30–31
Psychotherapy, for psychiatrists,222
PTSD.
See Posttraumatic stress disorder
QIDS-SR.
See Quick Inventory of Depressive Symptomatology—Self-Report
Quadruple Aim,38, 169
definition of,166
proposal for,40
Quality of lifediminished,107
low,134
Quick Inventory of Depressive Symptomatology—Self-Report (QIDS-SR),105
Rabe, David,12–13
Rand Report,14
RANZCP.
See Royal Australian and New Zealand College of Psychiatrists
Reciprocity of Wellness Model of Physician Well-Being,158, 160, 164
Religion,69
Relman, Arnold,31
Research, Data, and Metrics Working Group of NAM,7
Resilience,16
aspects of physician resilience,239
building,239
controversy about,52
definition of,58
description of,239
ethics and physician resilience,305–306
as protective factor against impairment,96
training,51–54
Responsibility,91
as predisposition to burnout,136
Results Only Work Environment (ROWE) initiative,139
Rewards,33
ROWE.
See Results Only Work Environment initiative
Royal Australian and New Zealand College of Psychiatrists (RANZCP),244
Sadness,215
Santayana, George,19
Scholarship,306
Second victim,51
Self-care,239–240, 256, 293–294.
See also Well-being
Serotonin,47
“The Sick Physician,”108
Silent generation,37
Smooth Sailing Life Nautical Metaphor,211–232
definition,213–214
roles in,226–227
Social trends,27–42
culture of medicine,36–37
description of,27–28
versus satisfiers,33–35
dissatisfiers,38–39
mediators of burnout,32–33
satisfiers,33–35
versus dissatisfiers,35–38
social and economic forces of physician experience,29–32
corporatization of medicine,31–32
social transformation of medicine,29–31
Triple Aim,29, 32
social support from peers,93
traditional medical career and,28
Spillover-Crossover Model,131
Spirituality,69
Stanford Model for Physician Well-Being,160Stanford Prison Experiment of 1971,5
Stanford Professional Fulfillment Index,7
Stanford Tripartite Model of Physician Fulfillment,288,
289Starr, Paul,29–30
Stressbiological underpinnings of stress response,47
brain structure and,48–49
burnout and,45–53
coping with,57
death from,48
depression and,49
DSM-5 and,49–50
enduring effects of recurrent stress,47–48
examples of,57
external,46
hormones,47
internal,46
internal and external support systems,235–236
management,241, 245
measurement in the changing practice of medicine,55–56
moral,297
neurochemical response to,47
occupational,55–56
perpetuating factors for,236
pessimism and,53
physical consequences of prolonged, high levels of,48
precipitating factors for,236
predisposition to,236
protective factors and,236
resiliency training and,51–54
response to,59
as symptom for depression and burnout,78–79
tolerance to,54
trauma and,50–51
Stress Management and Resiliency Training Program for Residents,203
Stressors,3
characteristics of,46–47
early career,189
late career,189
mid career,187
for psychiatrists,17
in a social environment,5
Substance abuseburnout and,4
physicians, and,178
vignette of,302–303
Suicide,10.
See also Death
among medical students/residents,194
among psychiatrists,110–112
of patient,73
physician,101–123
history of,107–108
men versus women,109
rates of,107–108
prevention and intervention initiatives,113–116
of psychiatrist,73
Summers, Richard,xvi
Swiggart, William H.,211
Technology,263
biobehavioral sensing,260–261
biomonitoring,260
computer-based interventions for burnout,243–244
computerized physician order entry,155
technological innovation in burnout assessment and intervention,260–261
Terr, Lenore,50
Testosterone,47
Theme interference,277–278
“Threads Among Us” project,257
Time managementfor psychiatrists,138, 240
strategies for,240
Transformational leadership,258
Traumastress and,50–51
vicarious traumatization,79–80
Triple Aim, definition and goals of,14, 32, 166
UCLA Life Stress Interview,55
Values,33
Vanderbilt Medical Student Wellness Program,115
Veterans Affairs programs,30
Vicarious traumatization,79–80
Vietnam War,57–58
Vignettesof burned-out psychiatrist,86–87, 212–216, 217–219, 220–221, 221–224, 224–227
of burnout and substance use,302–303
of ethical dimensions,279–280
of excessive psychiatrist responsibility,277
of insufficient psychiatrist authority,274–276
of insufficient psychiatrist expertise,277–278
of insufficient psychiatrist responsibility,276
of life transition to new parent,304
of mid-career physician,186
of psychiatrist satisfaction and successful career,188–189
of residency,184
of residency choice,181
of resilient psychiatry resident,96
of senior physician,187–188
of support for ARE,288
of well-meaning leader,299–300
of work stressors,301–302
Well-being,137.
See also Physicians; Self-care; Work-life balance
awareness of,40
culture of,299metaphor for,212–229
model for maintaining well-being and preventing burnout for psychiatrists,211–232
phone applications of,230
problems with solutions,217–219, 220–221, 222–224, 225–226
tactics for,229
tips for maintaining,226–227
triage tool for obligations,219vignettes,212–213
physician,xvi, 293–309
adverse clinical events,300
burnout in dysfunctional clinical teams,303
caring for physician with burnout and unprofessional behaviors,303–304
contribution of life and work stressors to burnout and unprofessional behaviors,301–303
vignettes of,301–303
ethical principles in,294–297
ethics and physician resilience,305–306
life and career transitions that challenge well-being,304–305
vignette of new parent,304
values in medicine and impact on,297–300,
299moral stress,297
physician’s fault line,297–300
vignette,299–300
promoting in medicine,306–307
medical education,307
physician leadership,306–307
scholarship,306
Well-Being Index,55–56, 256
Wellness.
See also Work-life balance
ACEP’s focus on,14
among medical students/residents,201
occupation-related, xv programs,11–12
of psychiatrists,15–16
“Wellness booth,”13
“Wellness day,”114–115
WHO.
See World Health Organization
Womenburnout rates for,178
career progress for,132
childbirth and,131
leadership in medicine,132
prevalence of female physicians,130
suicide among female psychiatrists,109
Women Physicians’ Health Study,107
Workaholism,135
Work-life balance,46, 72, 92–93, 127–147, 228, 256.
See also Well-being; Wellness
conflict and burnout,134–136
definition of,128
effects of conflict on the physician,130–134
career choices,131–133
academic physicians,132–133
career changes and reduction in hours,131–132
career progress for women,132
childbirth,131
home life,130–131
medical marriages,133–134
psychological factors,134
work life,130
interference and work-family conflicts,128
managing work-home conflict,137–141
levels of intervention,137–140
addressing home factors,138–139
addressing work factors,137–138
organizational interventions,139–140
psychiatrist’s work-home conflict,140–141
role conflict,129–130
Workload,32–33
Workplacecivility in,257
environmentimportance of,14, 67
improving,241–243
management,18
as model,33
social support in,75
Workplace Climate Questionnaires for Physicians,55–56
Work-work conflict,256
World Health Organization (WHO), on burnout,102
Wu, Albert,51
Zimbardo, Philip,5
