SPECIAL ARTICLE

Healing the Professional Culture of Medicine

Tait D. Shanafelt, MD; Edgar Schein, PhD; Lloyd B. Minor, MD;
Mickey Trockel, MD, PhD; Peter Schein, MBA; and Darrell Kirch, MD

Abstract

The past decade has been a time of great change for US physicians. Many physicians feel that the care
delivery system has become a barrier to providing high-quality care rather than facilitating it.
Although physician distress and some of the contributing factors are now widely recognized, much of
the distress physicians are experiencing is related to insidious issues affecting the cultures of our
profession, our health care organizations, and the health care delivery system. Culture refers to the
shared and fundamental beliefs of a group that are so widely accepted that they are implicit and often
no longer recognized. When challenges with culture arise, they almost always relate to a problem with
a subcomponent of the culture even as the larger culture does many things well. In this perspective, we
consider the role of culture in many of the problems facing our health care delivery system and
contributing to the high prevalence of professional burnout plaguing US physicians. A framework,
drawn from the field of organizational science, to address these issues and heal our professional
culture is considered.
ª 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/) n Mayo Clin Proc. 2019;94(8):1556-1566

T
he past decade has been a time of this clerical work is performed on personal
great change for US physicians. The time, with studies suggesting that the
For editorial demand for medical care and the average physician spends 28 hours on clin-
comment, see complexity of the care delivered have ical documentation on nights and weekends
page 1401 increased. Narrowing insurance networks each month.7
have decreased access and eroded continuity Although each of these changes had an
From the Department of of care. Increased physician productivity ex- underlying rationale and, in many cases,
Medicine (T.D.S.), Depart-
ment of Otolaryngology
pectations have led to shorter clinic visits were intended to improve patient care or
(L.B.M.), Department of Psy- and decreased time with patients. New regu- manage costs, they place new burdens on
chiatry and Behavioral Sci- latory requirements (meaningful use, e-pre- physicians. As a result, many physicians
ences (M.T.), Stanford
University School of Medi- scribing, and medication reconciliation) feel the care delivery system has become a
cine, Stanford, CA; Organiza- and more widespread penetration of elec- barrier to providing high-quality care rather
tional Culture and Leadership
Institute, Menlo Park, CA (E.S.,
tronic health records (EHRs) have increased than a supportive infrastructure facilitating
P.S.); and Association of clerical burden.1,2 Simultaneously, an array it.3,8 National studies indicate that the prev-
American Medical Colleges, of metrics (eg, patient satisfaction, how alence of burnout in physicians is dramati-
Washington, DC (D.K.).
rapidly physicians process inbox messages cally higher than that in the general US
and close charts, quality measures, and rela- working population.4,9,10 Extensive evidence
tive value unit generation) have been intro- indicates professional burnout, and erosion
duced to assess physician performance.3 of meaning in work have both personal
These measures are imperfect, often fail to and professional implications.11,12 Recog-
capture the nature of physicians’ work, and nizing the importance of this problem, a
leave many physicians feeling micromanaged number of vanguard organizations and pro-
and demoralized.2-4 Time and motion fessional societies have prioritized address-
studies as well as analyses using EHR time ing this issue.13 To date, these efforts have
stamps indicate that 50% of the physician typically focused on a collection of opera-
workday is now spent on administrative tional approaches to improve efficiency,
work and “desktop medicine.”5,6 Much of redesign workflows, and enhance teamwork

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www.mayoclinicproceedings.org n ª 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
HEALING THE CULTURE OF MEDICINE

as well as individual efforts to help physi- that drive our daily behavior. In this context,
cians strengthen personal resilience it should be emphasized that the term arti-
skills.14-20 Although these efforts may be facts refers to tangible characteristics of the
part of the solution, they do not address culture or institution not “something
many of the fundamental cultural issues un- belonging to an earlier period” or “a specious
derlying this problem. effect.”
In the culture of medicine broadly, how
UNDERSTANDING CULTURE we design clinics as well as how we treat pa-
Although physician distress and some of the tients and colleagues are examples of arti-
contributing factors are now widely recog- facts; the Hippocratic Oath and the Charter
nized, we believe that many of these prob- on Professionalism22 are examples of
lems are symptoms of more insidious espoused values. The belief that physicians
issues affecting the culture of our profession should always be motivated by the best inter-
as well as the culture of our health care orga- est of the patient is an example of a tacit
nizations and the health care delivery sys- assumption.
tem. Culture refers to the shared and In addition to the overarching culture of
fundamental beliefs, normative values, and the profession, physicians practice within or-
related social practices of a group that are ganizations that have their own cultures.
so widely accepted that they are implicit Each health care organization has its own ar-
and no longer scrutinized. In the life of indi- tifacts (eg, their policies about access for the
viduals, organizations, and societies, culture underserved or their compensation system),
is a pervasive, powerful, and often unseen espoused values (the mission statement),
force. Although visible manifestations of cul- and tacit assumptions (we exist to provide
ture, such as workplace regulations, policies, medical care to all residents in our commu-
benefits, tolerance of mistreatment or harass- nity regardless of the ability to pay [or
ment, professional behavior, and the incen- not]). A review of the mission statements
tive system, are often mistaken for culture, of nearly all US health care organizations in-
such characteristics are better thought of as dicates that they claim to be committed to
climate and can be altered through the ac- providing the highest quality of care to indi-
tions and influence of an individual leader vidual patients in need. They simultaneously
or group of leaders. espouse different degrees of emphasis on
Culture is more expansive, multifaceted, compassion, learning, discovery, healing hu-
and deeply rooted in the history of the pro- manity, and strengthening communities, all
fession or organization. Culture provides of which are noble ambitions. They differ
identity, order, meaning, and stability. Cul- at the tacit assumption level in the degree
ture is preserved over time (passed from to which they emphasize other values such
older members to younger members) as quality, community or employee health,
because it served an adaptive purpose that or economics as deep drivers of their
allowed a group to endure through historical practices.
challenges.21 There are at least 3 levels to
culture.21 Artifacts (or symbols) are the DIAGNOSING PROBLEMS IN THE CULTURE
visible manifestations of culturedour ac- OF MEDICINE AND HEALTH CARE
tions, behaviors, heroes, and rituals. When challenges with culture arise, they
Espoused values are what we claim our values almost always relate to a problem with a sub-
and priorities to be, as manifested in mission component of the culture even as the larger
statements, the communications shared culture is well adapted to operating realities.
across the organization or profession, pub- A simple way to diagnose problems with a
licly stated values, and even advertising given dimension of culture is to look at in-
and promotional messaging. Tacit assump- congruity between artifacts and espoused
tions are the underlying things we truly values. This is often best accomplished
believe and value, that is, the unwritten rules through group interviews and discussion
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TABLE 1. Incongruence Between Artifacts and Espoused Values in Medicine

Domain Espoused value (what we say) Artifact (our behavior) What it reveals
Culture of our organizations Physicians are professionals (we Preauthorization and excessive We do not trust you
and health care system trust them) documentation required to
justify billing and prevent
malpractice suits
Physicians are our most highly Excessive clerical burden and Your time is not valuable
trained and expensive workers ineffective use of time
(we should maximize their
efforts)
High-quality care is our top priority A delivery system that drives Economic priorities are more
fatigue and burnout which important than quality
erode quality of care
Focus on relative value units/ Commoditization of physicians and
volume/net operating income patients
We value patient autonomy, Visit lengths and limited staff Economic priorities are more
shared decision making, and support preclude shared important than patient agency
tailoring care to individual needs decision making and tailoring
care to individual patient needs
We believe in social justice and fair Organizational tactics that tailor Economic priorities are more
distribution of resources for our access to optimize payer mix important than social justice
patients and communities and care for highly reimbursed assumptions
medical conditions rather than
patient need
Professional culture Self-care is important Excessive hours, work always first, Self-care is not important; short-
and often do not take care of term productivity is more
ourselves (diet, exercise, sleep, important than sustainability
and preventive health care)
Prevention is better than treatment We do not attend to our own Physician health is not important
health needs
To err is human A professional culture of Physicians expected to be
perfectionism, lack of superhuman
vulnerability, and low self-
compassion
Belief that mistakes are the fault of We have not yet internalized many
the individual and are of the lessons of the quality
unacceptable movement that errors are
inevitable in complex systems
Fatigue impairs performance Excessive work hours; We do not believe this adage
work even when ill applies to physicians or we are
too arrogant to admit it does

among members of the organization or pro- When we see behavior that does not
fession along with external experts (often reflect espoused values, it invites reflection
consultants) who are not part of the culture. to identify the tacit assumption that may
The inclusion of experts from outside the actually be driving behavior.21 In this frame-
culture is important because insiders often work, we would propose that challenges
become blind to some inconsistencies and with the EHR, excessive clerical work, over-
might opt for an approach that violates emphasis on productivity (generating rela-
some fundamental mission assumptions tive value units), loss of flexibility/
without realizing it. autonomy, and too little time with patients

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HEALING THE CULTURE OF MEDICINE

represent artifacts that are incongruent with requirements that are costly and inefficient
espoused values (Table 1). This incongru- and show a lack of trust.1,35 We claim that
ence reveals the deeper more fundamental physicians are our most valuable resource
tacit assumptions of our organizations, but saddle them with excessive, low-value,
health care delivery systems, and our profes- clerical work.2 We decry conflicts of interest
sion that require reflection. with the pharmaceutical industry yet simul-
We must acknowledge that at the profes- taneously promulgate compensation systems
sional level, we have some blind spots and in our health care organizations that are
unhealthy norms that can lead to potentially designed to maximize productivity over
destructive behavior. As physicians, we tend quality, reward overuse of resources, and
to overwork, imply that normal human lim- treat physicians like a unit of production
itations do not apply to us, and often assume rather than a professional.36-38 We claim to
the role of a hero.23-26 We inculcate future value shared decision making and personal-
physicians with a mindset of perfectionism, ized care for patients yet demand 20-
lack of vulnerability, and low self-compas- minute office visits that do not provide
sion.27 We teach them that they should al- adequate time to pursue these goals.39 Our
ways defer self-care and personal mission statements espouse social justice
relationships as long as needed to meet pro- and fair distribution of resources for our pa-
fessional demands. Mistakes are the fault of tients and communities,32,33,40 yet we use
the individual and are unacceptable.25,28 To organizational tactics that limit access on
err is human, but we are superhuman. We the basis of ability to pay.
espouse the importance of prevention, self- These incongruities between stated
care, and personal behaviors to promote values and organizational behavior are clear
health for our patients, but often do not to physicians and create cognitive disso-
engage in these behaviors ourselves.29-31 nance that breeds cynicism and a sense of
We prioritize professional life above all, misalignment between the organization’s
even if it means we are working in a manner goals and the altruistic aims of the profes-
that is not sustainable or that renders our sion. What can we do to change some of
medical decision making suboptimal.25 the tacit assumptions that are driving this
One view is that these approaches served system or ameliorate their negative effects?
a purpose in historical settings in which
there were too few physiciansda world in THE IMPERATIVE FOR CULTURE CHANGE
which all physicians needed to care for as Cultures change when there is a stimulus
many patients as possible and, in such situa- that upsets the equilibrium. Leaders and
tions, an exhausted physician was better members of a culture must believe some-
than no physician at all. Similarly, 50 years thing bad will happen if they do not change.
ago, individual perfectionism by an authori- This precipitates “survival anxiety.”21 There
tarian physician was our profession’s is now overwhelming evidence that this is
approach to quality. In most settings today, the situation that our profession, our organi-
these assumptions no longer serve the best zations, and the US health care delivery sys-
interest of patients, physicians, or our care tem find themselves in. Symptoms of
delivery system. burnout and professional distress are
In the cultures of our organizations and dramatically more common in physicians
the health care system, there is also incon- than in workers in other fields.4,9,10 Burnout
gruence between behaviors and espoused has been associated with social problems
values.32-34 We claim to believe that physi- ranging from broken relationships to aban-
cians are competent and trustworthy profes- doning the profession.41 Equally concerning,
sionals who set, maintain, and enforce there are clear associations between burnout
professional standards but payers and regu- and mental disorders, including substance
lators have created a tedious process of pre- abuse, anxiety, depression, and suicidal-
authorization and onerous documentation ity.42-45 At the professional level, our lack
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Survival anxiety Learning anxiety

Factors driving survival anxiety Concerns contributing to
• Physician suicide learning anxiety
• Decreased quality/medical • Can we change?
errors due to distress • I do not know what to do
• Turnover Status quo Positive change • What will I give up/lose?
• Productivity issues • It will be too hard (will it work?)
• Decrease patient satisfaction • Fear loss of power or prestige
• Fear we may not achieve our • Fear temporary incompetence
organizational goals
A
Steps to create psychologic safety
Survival anxiety Learning anxiety and reduce learning anxiety
• Involvement in the implementation
of change
• Education and formal training
• Positive role models
• Advisors and coaches
Status quo Positive change • Opportunities to practice
• Bidirectional communication
between leaders and those affected
• Supportive structures, processes,
B rewards, and controls

FIGURE. Balance of forces. A, Survival anxiety driving change in medicine offset by learning anxiety. B, Reducing learning anxiety to tip
the balance in favor of change.

of self-care, dysfunctional perfectionism, too disruptive. The resulting resistance to

excessive work hours, fatigue/exhaustion, change often manifests as minimizing the
lack of vulnerability, and “physician as problem, ignoring evidence, or total denial.21
hero” mentality are not serving us well. It also takes the form of defending tradition
Survival anxiety should also be high for (“This is how we’ve always done it.”), using
all stakeholders in our health care organiza- anecdotes (“It worked for me.”), blaming the
tions and delivery system. Physician burnout individual (“You chose this profession.”),
is associated with reduced quality of care, suggesting change will be too costly (“We
increased medical errors, and lower patient don’t have the resources.”), trying to justify
satisfaction.11,12,46,47 Multiple studies now ignoring one problem by articulating a larger
report that burnout is associated with unrelated or tangentially related problem
reduced productivity, turnover, and physi- (“There are children starving in Africa.” or
cians leaving the profession,41,48-50 all of “Many of our patients cannot even afford
which threaten access to care precisely at a to buy food.”), or the belief that virtues
time we are already facing substantial short- and vice cannot be separated (eg, “If we
ages of physicians.51 The threat and the acknowledge human limitations, we cannot
imperative for change are not hypothetical. uphold high standards.”).
There are already negative effects on patient
care, the profession, and the system in which INITIATING CULTURE CHANGE
they interact. Survival anxiety and learning anxiety are
Once survival anxiety occurs, an competing forces. The key to initiating
opposing forced“learning anxiety”dis also change is tipping the balance of these forces
created and manifests as resistance to (Figure).21 Although the temptation is to do
change.52 The essence of learning anxiety is so by further increasing survival anxiety, this
the realization that we may not be able to approach often just increases resistance to
make the changes needed to solve the prob- change and the tension in the system.
lem. They will be too difficult, too costly, or Once the need for change is recognized, it
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TABLE 2. Present State and Ideal Future State

Present state Ideal future state
Neglect and self-sacrifice to a fault Self-care (rest and mental health)dviewed as
necessary to preserve the effectiveness of physicians
Isolation Activated support network (personal and colleagues)
Fatigue Healthy rest and sleep habits
Rarely self-calibrate Regular self-calibration
Multiple barriers (including state licensure questions) No stigma for seeking help for mental health issues
and stigma associated with seeking help
Asking for help is a sign of weakness Accept vulnerability (ok to ask for help)
Staffing models without redundancy and without Systems that acknowledge human limitations and
margin for physician illness. Staff to average demand; provide staffing for optimal care at peak demand,
times of peak demand handled by the existing staff not at average demand
taking on the overload to the point of exhaustion
and unsafe practices
No limits on work or workload. No attention to Systems that acknowledge humanity and human
fatigue or sleep-related impairment after complete limitations
training. Failure to acknowledge the personal impact
of traumatic events, patient death, and unfavorable
patient outcomes on the physician
Perfectionism Self-compassion
Excessive low-value clerical and bureaucratic work that Limited low-value clerical work
does not improve quality of care
Culture of fear Culture of safety
Work always first; no limitations on intrusion of work Work-life integration; group norms favoring personal
into personal life health and healthy relationships
Burnout common Burnout rare
Professional environment that often leads to erosion Environment that cultivates and strengthens meaning,
of meaning, purpose, and altruism purpose, and altruism
New regulations and requirements implemented Time and cognitive burden associated with new
without accounting for the time or cognitive burden regulations and requirements accounted for and
associated with those requirements or adequate greater input from physicians in design before
input from physicians implemented

is best catalyzed by decreasing learning anxi- the ideal future state, we can then evaluate
ety. To do so, we must find specific areas in how it differs from the present state and
which change is feasible and in which the in- identify gaps and barriers that need to be
dividuals who will have to change are addressed to make progress (Table 2). This
engaged and supported rather than forced comparison helps us define the old beliefs
to change. and habits we need to unlearn as well as
We begin by articulating a compelling the new things we need to learn, thereby
positive vision of what the ideal future state allowing us to plan and manage the change.
would look like. The recently published In planning culture changes, it is critical
Charter on Physician Well-being is an excel- to recognize that many of the elements that
lent framework from which to build.53 constitute our professional culture are a
Mature cultures, such as the culture of med- source of strength. These positive aspects
icine and the culture of most health care or- of our culture will help us change the dimen-
ganizations, typically must unlearn some old sions that need changing.21 The robust cul-
habits and ways of thinking before new ones ture of medicine includes countless
can be incorporated. Once we have defined praiseworthy elements such as altruism,

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service, dedication, compassion, and a understood and appreciated. Although this

commitment to excellence and professional inclusive approach is slower, such involve-
competence. We are motivated by the needs ment is critical to implementing and inter-
of our patients and what is best for them. We nalizing the new norms and values and
are deeply committed to supporting our col- incorporating them into the existing culture.
leagues. We believe in the biomedical basis When it comes to improving physician well-
of disease, including mental disorders, and being, all of these steps have already begun
are fervently against stigmatizing health con- (Table 3).
ditions. Although we believe in being heroic It is important to recognize that once a
healers, we also have a foundational belief in culture is mature, it can only be purposefully
humility. We know some of our current ap- changed through “managed evolution.”21
proaches are wrong and we are dedicated to This means that some beliefs and values
objectively testing interventions and using have to be deliberately dropped, some new
evidence to refine them. The distress and ones adopted, and some transformed. The
burnout created by select professional norms hardest part of this process is to come to
and certain aspects of the practice environ- terms with the present culture, which is
ment run counter to these deeply held taken for granted. Therefore, in diagnosing
values, and it is these values that will help the present culture and identifying the po-
us reform those aspects of our professional tential areas of change, it is important to
and organizational cultures that require create a temporary parallel learning structure
changing. to both design the future and assess the pre-
Once we have identified the future state sent. A parallel learning structure involves a
to which we aspire in specific behavioral group within the culture developing and
terms, we must decrease learning anxiety testing a new approach. Some member(s)
by creating psychological safety for the peo- (individuals, work units, divisions/depart-
ple and organizations who will have to learn ments, or organizations) within the culture
new things.21 We will have to identify new must separate and be exposed to new ways
collaborative strategies and tactics for physi- of thinking, allowing an objective assess-
cians and leaders to gain experience with ment of the strengths and weakness of the
new modes of working, group dynamics, current approach, as well as learning new
and different organizational norms.21,52 We ways of behaving and thinking.21 This may
must provide formal training opportunities involve scanning the environment for solu-
and the time and resources to participate tions that can be adopted or “trial and error
for leaders, groups, and teams. We will learning.” New solutions in the parallel sys-
need positive role models (individuals, tem can then illustrate for the rest of the or-
leaders, and organizations) who help show ganization (or to other organizations) how
what the new way looks like. We will need the new way can work and help define
practice fields that allow units to try new ap- what it looks like. This decreases learning
proaches to work, along with advisors and anxiety for the rest of the group and encour-
coaches to help them be successful. We ages those who continue to resist change to
will need new systems, structures, controls, adapt or leave. Pilot studies, phased initia-
rewards, and processes consistent with tives, or empowering one department or
desired changes.21 Although the learners do group to develop and test as an alternative
not always get to choose the goal, they method before scaling it more broadly are
must have some control of the process of also useful structures to facilitate learning
learning and how they will achieve the new approaches.
goal.52,54 Bidirectional communication be-
tween leaders and learners throughout this MANAGING THE TRANSITION
process is critical to ensure that the vision For a dimension of culture to change, it is
of the future state is clear and that the con- also necessary for leaders to be convinced
cerns or reservations of the learners are that a change is necessary. To manage the
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TABLE 3. Steps to Facilitate Culture Change Related to Physician Well-being

Key step Existing examples
Defining ideal future state d Charter on Physician Well-being53
d Charter on Professionalism for Health Care Organizations32,33
d National Academy of Medicine Action Collaborative on Clinician
Well-being and Resilience13
Formal training for individuals and d Stanford Medicine Chief Wellness Officer (CWO) Training Course
organizations d American Medical Association STEPS Forward modules
d Publications delineating a road map for progress11,16,55,56
Involvement of those who will be affected Recognition of the need for a menu of choicesdthere is not a single
by the changedgoal defined but not the solution (eg, scribes are not the only approach to improve the
process; not everyone (organization or efficiency of practice and mindfulness is not the only approach to
individual) will get to the goal in the personal resilience)
same way
Training of groups and teams COlleagues Meeting to Promote And Sustain Satisfaction
(COMPASS) groups,57,58 Schwartz Center Rounds,59 and Balint
groups60
Practice fields, coaches, and feedback Time, resources, and support to learn the new way
Positive role models Vanguard organizations that have appointed a CWO and established a
program on physician well-being55,61
Efforts by leading professional societies: American Medical Association,
Association of American Medical Colleges, Accreditation Council of
Graduate Medical Education, American College of Physicians,
American Academy of Family Physicians, and others13
Support groups for learning organizations American Conference on Physician Health/International Conference
on Physician Health
Stanford CWO Training Course
Physician Wellness Academic Consortium
Collaborative for Healing and Renewal in Medicine
Systems, rewards, controls, and structures Training and coaching for leaders in new behaviors that cultivate
consistent with the desired changes engagement; assess and reward the new behaviors desired in
leaders62,63
Reward behavior and achievement of teams, not individuals

transition, a team consisting of top execu- cover for the various initiatives that will arise
tives and representatives of the major units within the different parts and levels of the
of the organization plus representative stake- organization.
holders outside the organization should be The steering committee must understand
constituted as a “change steering task force.” the dynamics of the change process and recog-
This team must identify the problem and set nize that all forms of the assessment of the pre-
in motion the design, planning, and imple- sent culture as well as change proposals are
mentation of the next steps. The group interventions in their own right and will have
should become part of the basic “parallel” known and unknown consequences. If major
structure and continue to exist throughout behavioral changes or changes in beliefs and
the change program and be accountable for values are envisioned, it becomes essential
the various interventions that are made. for this planning group to involve the individ-
Top level leaders (eg, dean, chief executive uals who will become targets of the change,
officer, and chief medical officer) must because the best way to overcome learning
spearhead and remain deeply involved in anxiety and make the learners feel psycholog-
this work to sponsor, support, or supply ically safe is for them to become involved in the

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change process. The first step would typically Potential Competing Interests: Dr Shanafelt is a coin-
be to “share the problem” by bringing together ventor of the Physician Well-Being Index, Medical Student
Well-Being Index, Nurse Well-Being Index, and Well-
leaders of the relevant groups that would be Being Index. Mayo Clinic holds the copyright for these in-
affected by the changes to begin dialogues struments and has licensed them for use outside Mayo
around their perception of the problem and Clinic. Dr Shanafelt receives a portion of any royalties paid
cocreate what adaptive moves might have to to Mayo Clinic. As an expert on the topic of the well-
being of health care providers, Dr Shanafelt often presents
be made, how the culture might aid or hinder ground rounds/keynote lecture presentations as well as ad-
the change, what parts of the culture would vises health care organizations. He receives honoraria for
have to be evolved, and especially what the sys- some of these activities. Dr E. Schein and Mr P. Schein
temic effects would be of proposed changes. are cofounders of the Organizational Culture and Leader-
ship Institute and have received honorarium for teaching
Building relationships at this level early is in the Clinical Effectiveness Leadership Training course
also a necessary investment in successful work at Stanford Health Care. Dr Minor reports receiving
implementation at the later intervention compensation during the past 12 months as an advisor to
stages. General Atlantic and unvested stock options for serving
on advisory boards of Ancestry.com, Mammoth Biosciences,
and Mission Bio. He has received payment for lectures from
CONCLUSION Shanghai Sansi Institute Business Management Consulting,
If we are going to make substantive progress Weill Cornell Medicine, and Vanderbilt University Medic.
He is on the scientific advisory board of Sensyne Health.
in many of the problems facing our health He was a senior advisor to Havencrest Healthcare Partners.
care delivery system and the high prevalence He spoke at the Imagine Solutions Conference held in
of professional burnout plaguing US physi- Naples, FL, and received support for travel and hotel ac-
cians, we must recognize the cultural dimen- commodation. Dr Trockel receives occasional honorarium
payments for talks given on the topic of physician wellness.
sions to these challenges. This will require Dr Kirch reports no competing interests.
an honest appraisal and new dialogue at
the level of our profession, our health care Correspondence: Address to Tait D. Shanafelt, MD, Stan-
ford University School of Medicine, 300 Pasteur Dr,
organizations, and the health care delivery
Room 3215, Stanford, CA 94305 (Tshana@stanford.edu).
system. Some may say such efforts are weak-
ening the profession. They incorrectly will
suggest that we are overstating the depth REFERENCES
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