Physician Wellness - What is the Level of Expertise in Your Organization

Posted by Dike Drummond MD

physician-wellness-levels-of-expertise-stop-physician-burnout-the-happy-md.jpgPhysician Wellness - What is the Level of Expertise in Your Organization?

In this post let me show you two important new developments in the prevention of physician burnout.

1) The definition of Five Levels of Expertise in Physician Well-being as proposed by Tait Shanafelt et al in an important new study.

2) A new way for your organization to leap frog to LEVEL FIVE in a single step.

Take a look at the table below and LEAVE A COMMENT telling us the level of your organization's expertise in preventing physician burnout.

(Download the Quick Take and Action Plan Here)

Blog Post Naturally Lousy LeadersAn important new article about the prevention of physician burnout was just published in JAMA Internal Medicine. It comes with the provocative title of The Business Case for Investing in Physician Well-being.

The article is a must read for any physician leader who understands the importance of the Quadruple Aim. I have included a link to the full article at the end of this post.

For now, let's focus on a table with in the article that outlines Five Levels of Organizational Expertise in Physician Well Being

Here are the levels. 
Where does your organization fall in this hierarchy??

Note that well over 50% of healthcare organizations nationwide in the USA are struggling to hit Level One. If that is true for you and your employer, don't lose hope. There are proven methods to leap from Level Zero to Level Five in a short period of time if your senior leadership is willing to support the Quadruple Aim


Figure 1: 
“Typical Steps in an Organization’s Journey Toward Expertise in Physician Well-being”

From: Tait Shanafelt, MD. et al  JAMA Intern Med. 2017;177(12): 1826-1832

physician-wellness-levels-of-expertise-stop-physician-burnout-dike-drummond_opt-300W.jpg1) NOVICE

  • Aware of the issue
  • Wellness committee
  • Individual focused interventions such as
    • Mindfulness training
    • Resources for exercise/nutrition


  • Understand driver dimensions
  • Peer support program
  • Cross-sectional survey assessing physician well-being
  • Identifies struggling units
  • Physician wellbeing considered when organizational decisions implemented


  • Understands business case to promote physician well-being
  • Practice redesign based on driver dimensions
  • Coaching resources to support career, work-life integration, self-care
  • Regularly measures burnout/well-being to monitor trends [1]
  • Physicians given greater voice in decisions
  • Designs work unit-level interventions but does not objectively assess efficacy
  • Creates opportunity for community building among physicians


  • Understands impact of physician well-being on key organization objectives
    • Finances
    • Turnover
    • Safety/Quality
    • Patient Satisfaction
  • Physician wellbeing considered in all operational decisions
  • Funded program on physician wellbeing with internal focus
  • Measures and reduces clerical burden
  • Training for leaders in participatory management
  • System-level interventions with robust assessment of effectiveness
  • Improves workflow efficiency by engaging and supporting local transformation


5) EXPERT [2]

  • Physician well-being influences key operational decisions
    • Strategy
    • Priorities
    • Resource allocation
    • New Initiatives
  • Shared accountability for well-being among organizational leaders
  • Chief wellbeing officer on executive leadership team [3]
  • Endowed program in physician well-being creates new knowledge that guides other organizations [4] (Only appropriate for Academic Programs)
  • Strategic investment to promote physician well-being
  • Culture of wellness


[1] This is a very controversial point that deserves additional discussion.

[2] Many of these points are aspirational.

[3] I am only aware of one CWO. The lead author of the study from which this table is adapted, Tait Shanafelt MD, was hired into that position by Stanford in 2017.

[4] The only endowed chair of Physician Wellness I am aware of was created in 2017 at the University of Alabama Birmingham.



The Business Case for Investing in Physician Well-being.
Tait Shanafelt, MD. et al  JAMA Intern Med. 2017;177(12): 1826-1832 



Where is your organization in the table?
What is the level of support for investing in physician wellbeing in your senior leadership team?

Tags: physician wellness, stop physician burnout, quadruple aim