Association of Burnout, Professional Fulfillment, and Self-care Practices of Physician Leaders With Their Independently Rated Leadership Effectiveness
Authors: Tait D. Shanafelt, Maryam S. Makowski, Hanhan Wang, Bryan Bohman, Mary Leonard, Robert A. Harrington, Lloyd Minor, Mickey Trockel
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Although leadership behavior of physician supervisors is associated with the occupational well-being of the physicians they supervise, the factors associated with leadership behaviors are poorly understood. <h3>Objective</h3> To evaluate the associations between burnout, professional fulfillment, and self-care practices of physician leaders and their independently assessed leadership behavior scores. <h3>Design, Setting, and Participants</h3> This survey study of physicians and physician leaders at Stanford University School of Medicine as conducted from April 1 to May 13, 2019. The survey included assessments of professional fulfillment, self-valuation, sleep-related impairment, and burnout. Physicians also rated the leadership behaviors of their immediate physician supervisors using a standardized assessment. Leaders’ personal well-being metrics were paired with their leadership behavior scores as rated by the physicians they supervised. All assessment scores were converted to a standardized scale (range, 0-10). Data were analyzed from October 20, 2019, to March 10, 2020. <h3>Main Outcomes and Measures</h3> Association between leaders’ own well-being scores and their independently assessed leadership behavior. <h3>Results</h3> Of 2656 clinical faculty and affiliated physicians invited to participate, 1487 (60.0%) returned surveys, including 1285 of the 1924 faculty physicians (66.8%). Among faculty respondents, 651 (50.7%) were women and 729 (56.7%) were 40 years or older. Among the 117 leaders, 57 (48.7%) both had their leadership behaviors evaluated by at least 5 physicians (median, 11 [interquartile range, 9-15]) they supervised and completed their own wellness survey. Overall, 9.8% of the variation in leaders’ aggregate leadership behavior scores was associated with their own degree of burnout. In models adjusted for age and sex, each 1-point increase in burnout score of the leaders was associated with a 0.19-point decrement in leadership behavior score (β = −0.19; 95% CI, −0.35 to −0.03;<i>P</i> = .02), whereas each 1-point increase in their professional fulfillment and self-valuation scores was associated with a 0.13-point (β = 0.13; 95% CI, 0.01-0.26;<i>P</i> = .03) and 0.15-point (β = 0.15; 95% CI, 0.02-0.29;<i>P</i> = .03) increase in leadership behavior score, respectively. Each 1-point increase in leaders’ sleep-related impairment was associated with a 0.15-point increment in sleep-related impairment among those they supervised (β = 0.15; 95% CI, 0.02-0.29;<i>P</i> = .03). The associations between leaders’ well-being scores in other dimensions and the corresponding well-being measures of those they supervised were not significant. <h3>Conclusions and Relevance</h3> In this survey study, burnout, professional fulfillment, and self-care practices of physician leaders were associated with their independently assessed leadership effectiveness. Training, skill building, and support to improve leader well-being should be considered a dimension of leadership development rather than simply a dimension of self-care.