Physician wellbeing – what do physicians want?

The often quoted epitaph of an unnamed ancient Athenian physician, “These are the duties of a physician: First. to heal his mind and to give help to himself before giving it to anyone else,” is too often ignored in medical education, medical training, and clinical practice. Despite duty hour restrictions and wellness programs, as well as a plethora of opinions regarding physician wellbeing, we continue to read that “burnout,” depression, and suicide remain areas of grave concern within our profession. We cannot afford to ignore these problems, and research is critical to developing a clearer understanding of what constitutes burnout, how it differs from depression, what the protective factors might be, and which management strategies are most effective. Professional dissatisfaction is not restricted to physicians whoare relics of another age,unable orunwilling to adapt to the electronic health record and the touted efficiencies and improvements that accompany our modern health care system. Even medical students and residents are struggling with these issues [1–4]. In their recent article, “Predictors of emotional wellbeing in osteopathicmedical students in a COVID-19world,” [1] Jacobs, Lanspa, Kane, and Caballero discussed a vexing concept that remains poorly understood and researched – physician wellbeing. The authors addressed factors that appeared to promote emotional wellbeing in a cohort of osteopathicmedical students during the earlymonths of the coronavirus 2019 (COVID-19) pandemic [1]. Their cross sectional study included a convenience sample of 1,310 medical students from onemedical school whowere invited to complete a 56 item questionnaire that the authors developed containing validatedmeasures [1]. Of themedical students invited to participate, 202 (15.4%) fully completed the questionnaire, and the authors found that utilizing a variety of coping strategies, having personal resilience, and taking care of one’s health (specifically not sleeping more or exercising less than they did prior to COVID-19) contributed to maintaining emotional wellbeing among the respondents. Osteopathic physicians–with our focus on the dynamic interaction between body,mind, and spirit – are in an excellent position to study these thorny questions around what contributes to and helps sustain medical student and physician wellbeing, and conversely, what contributes to physicians’ dissatisfaction and unhappiness with their work. Most medical students are aware well before they beginmedical school that theywill be tested and pushed to their cognitive and emotional limits, but clearly that has not been a deterrent. In 2021, applications to American Association of Colleges of Osteopathic Medicine (AACOM) schools are up 19% from 2020 and applications to Association of American Medical Colleges (AAMC) schools have increased 18% [5]. However, it also appears from a recent study of 268 medical students [3] that despite entering medical school with eagerness, optimism, and a spirit of idealism, by their final year, some are more depressed, anxious, and “worn out. ” Duty hour restrictions were initially instituted in 2003 to address concerns about medical errors and deaths secondary to resident fatigue, spurred on by a high profile death in which the role of resident fatigue remains debated [6]. Additional duty hour restrictions were introduced for ACGMEaccredited residencies in 2011, retaining the limit of 80 hours set forth in the 2003 duty hour reforms, ostensibly to decrease medical errors; however, there is a lack of empirical support for either decreases in medical errors or mortality, or improvements in medical knowledge as assessed by board certifying examination scores [7, 8]. So, what’s going on here? Why are medical students and residents experiencing high levels of depression and anxiety, even with duty hour restrictions and wellness programs? The reality is that we really don’t know. Continued research to better define and understand the factors that influence physician wellbeing across our full career lifecycle are critical – and that journey starts in medical school, with our students. The study from Jacobs et al. [1] is important for several reasons. It is the first to explore emotional wellbeing among the newest members of our osteopathic family during the COVID-19 pandemic. Further, despite an abundance of articles related to physician burnout, there *Corresponding author: Eileen P. Ryan, DO, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 UphamDrive, Suite 130, Columbus, OH43210-1250, USA, E-mail: Eileen.ryan@osumc.edu J Osteopath Med 2021; 121(7): 607–609