Strategies for enriching the resident, fellow, and faculty physician experience: a system-based approach to physician well-being

Background: Physician burnout and psychological distress are recognized as a public health crisis that healthcare institutions have a responsibility to address. We share a process for creating, measuring, and iteratively improving systems-level well-being initiatives for faculty physicians and trainees (residents/fellows) at a large urban healthcare system in New York City. Methods: Our institution implemented a three-pronged approach: creating infrastructure to promote wellbeing, distributing a needs assessment survey, and developing interventions in response to survey results. The needs assessment surveys, one for faculty and another for trainees, included questions ranging from burnout and well-being metrics to proposed well-being intervention components. The infrastructure included Well-Being Champion (WBC) programs for both physician faculty and trainees. We report data from the 2018 faculty survey and 2019 trainee survey that were then used to inform enhancements for well-being programs and infrastructure. Results: In the 2018 faculty survey [response rate 45% (1,870/4,156)], 27.4% of respondents met criteria for burnout and 22% screened positive for depression. From a list of systems-level interventions believed to improve their well-being, faculty respondents most identified opportunity for leadership training, enhanced mentorship and career advancement, documentation assistance, and decreased electronic health record and clerical burden. In the 2019 graduate medical education (GME) trainee survey [response rate 56.5% (1,415/2,504)], 54.8% of respondents met criteria for burnout, 33.1% screened positive for depression, and 49.1% indicated satisfaction with their WBC. GME trainees identified wellness day policy enforcement, workspace redesign, and increased appreciation as top interventions that would most improve their wellbeing. Survey results informed improvements in existing interventions to address unmet needs, including creating departmental well-being plans, spearheading electronic health record and clerical burden reduction efforts, offering faculty leadership development programming, and enforcing trainee wellness day policies. Conclusions: We seek to share our process for using faculty and GME trainee well-being surveys to inform and improve existing interventions. Via the Office of Well-Being and Resilience, we established the foundational structure to support the well-being of our physician faculty and trainees, surveyed these constituents, and developed programs to address the most prominent needs based on the results.