University of Oklahoma Health Sciences Center

Actions Reported by Physicians With Large Improvements in Burnout and Professional Fulfillment

Author/s:

Tait D. Shanafelt, MD, Maryam S. Makowski, PhD, Brook Hale, et al.

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Importance Occupational distress among physicians is a highly prevalent problem that limits the effectiveness of the health care delivery system. While system change is necessary, individual physicians must also consider personal actions to mitigate occupational distress.

Objective To identify physician actions associated with large-effect-size improvements in burnout and/or professional fulfillment over a 6-month interval.

Design, Setting, and Participants This qualitative study using a mixed-methods approach recruited US physicians from the American Medical Association Physician Data file. The study used 2 quantitative online surveys that were administered 6 months apart (October 2 to November 13, 2024, and April 2 to May 16, 2025) to identify physicians with large-effect-size (≥0.8 SD) improvement in burnout and/or professional fulfillment. These physicians were subsequently recruited to participate in a qualitative study using structured interviews to identify changes they believed contributed to this improvement.

Main Outcomes and Measures Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.

Results A total of 359 practicing physicians responded to both the baseline and follow-up surveys, among whom 87 (24.3%) had an effect size improvement of 0.8 SD or greater in burnout and/or professional fulfillment and were invited to participate in qualitative interviews. Thirty physicians (20 participants [66.7%] aged 30-49 years and 10 [33.3%] aged ≥50 years; 22 [73.3%] female) completed interviews. Thematically, these physicians reported changes in 4 categories: active (ie, intentional) work changes, passive work changes, active personal changes, and passive personal changes. A majority of participants (26 [86.7%]) reported active work and/or personal changes. Active work changes included changes to workload and work schedule, developing new skills or changing the focus of work, changing job or position, taking on or giving up a leadership position, improving efficiency, and advocating for personal needs. Active personal changes included deliberate changes in mindset, contemplative practices, taking time away, working with a therapist or coach, and prioritizing self-care. Passive work changes occurred independent of action by the individual physician and included new leadership, staffing changes, system-initiated workflow changes, and advances in technology. Passive personal changes were infrequently reported.

Conclusions and Relevance Physicians with large improvements in burnout and professional fulfillment reported specific actions at work or in their personal life that they believed led to this improvement. These findings suggest that both individual- and system-level changes may be necessary to optimize occupational well-being among physicians.

Keywords

burnout, professional Occupational Distress Qualitative Study Mixed-Methods Approach U.S. Health Study

Access to Continuity-Strategies for Symbiotic Improvement of Access and Continuity of Care

Author/s:

Kong, Marianna, Lin, Steven, Ramm, Jason D., Weir, Samuel, Newton, Warren P.

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Family medicine and primary care face ongoing pressures for access, with demand for care overwhelming the capacity to deliver it. Common strategies to maximize access often operate to the exclusion or detriment of continuity of care. During the August 2025 Family Medicine Leadership Consortium meeting, rather than presuming a tradeoff between the two as inevitable, the proposition that family medicine is committed to improving access to continuity of care was put forth.

This article summarizes concepts and models for improving access that simultaneously preserve or elevate continuity of care. A full understanding of access requires nuanced data around demand and capacity at the day-to-day level. This data can be used to prioritize both access and continuity by incorporating both into appointment templates, right-sizing panels, and directing capacity to the times of greatest demand. Investing in innovative team models such as those incorporating upskilled medical assistants, or panels shared among small teams of physicians and advanced practice practitioners, allow expanded capacity to deliver access while maintaining continuity. Advanced access scheduling models build on foundations of managing demand and capacity to most efficiently match day-to-day visit capacity to demand and maximize access to the continuity clinician.

Improving access and continuity of care do not have to be a zero-sum game—by valuing and centering continuity among access interventions, healthcare systems can shift the paradigm between access and continuity from “either/or” to a symbiotic relationship, with access meaning access to continuity of care.

Keywords

family medicine access Continuity of Care

Ten tips for advancing a culture of improvement in primary care

Author/s:

Kiran, T., 'Ramji, N.', Derocher, M.B., Girdhari, R., Davie, S., Lam-Antoniades M.

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Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tipsto healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.

Keywords

primary health care Leadership patient care

The 10 Building Blocks of High-Performing Primary Care

Author/s:

Bodenheimer, Thomas, Ghorob, Amireh, Willard-Grace, Rachel, Grumbach, Kevin

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Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements-engaged leadership, data-driven improvement, empanelment, and team-based care-that assist the implementation of the other 6 building blocks-patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement.

Keywords

medical physician’s practice patterns practice management primary health care

leadership

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