A high level of work-related physical and mental exhaustion is significantly increasing the likelihood of physicians leaving hospitals worldwide. This global crisis of a physician shortage can potentially compromise patient care and safety, as well as restrict access to hospital and emergency care.
Many studies on physician wellbeing have primarily focused on problems unrelated to work environments within hospitals, such as income concerns. However, designing effective interventions for physician well-being requires an in-depth analysis of internal issues, such as excessive workloads, unresponsive administration, job dissatisfaction, inadequate resources and infrastructure, and a lack of supporting staff.
The current study, led by researchers from the University of Pennsylvania, aimed to address these internal issues and provide evidence to inform interventions for improving physician well-being and reducing turnover.
Surveyed thousands of nurses and doctors
The researchers surveyed 56 United States (US) hospitals in 2021 and 49 hospitals in six European countries in 2023. The survey population consisted of 1149 European physicians, 5334 US physicians, 3044 European nurses, and 11,869 US nurses.
In the survey, nurses reported on hospital environments, including nurse staffing adequacy, quality of the clinical care environment, and interdisciplinary teamwork between nurses and physicians.
Hospitals operating with too few nurses and unfavorable work environments have been found to have higher rates of physician burnout and turnover.
Physicians, on the other hand, reported on their wellbeing and job outcomes, including work-related exhaustion, job dissatisfaction, intention to leave, and willingness to recommend their hospital.
The survey findings revealed poor physician well-being in hospitals across Europe and the US. Among enrolled physicians, approximately 17 to 45 per cent reported high-level exhaustion, 16 to 40 per cent reported job dissatisfaction, and 20 to 44 per cent expressed an intent to leave their hospital within the next year.
Effective physician-nurse teamwork
Notably, the survey indicated that physician job satisfaction in European and US hospitals was higher in hospitals with better nurse staffing, a more favorable clinical care environment, and effective physician-nurse teamwork.
Specifically, the findings revealed that in US hospitals, a 10 per cent improvement in the clinical care environment was associated with a 22 per cent lower risk of physicians intending to leave, a 25 per cent lower risk of not recommending their hospital, and a 10 per cent lower risk of work-related exhaustion.
In European hospitals, a 10 per cent increase in nurse staffing adequacy was similarly associated with a lower risk of exhaustion and job dissatisfaction.
The study identifies several crucial factors that can potentially challenge the retention of enough physicians in European and US hospitals to ensure adequate access to health-care services.
The study also identifies modifiable organisational features of hospitals that can be considered as potential intervention targets for improving physician wellbeing and retention.
Previous studies on physician wellbeing and preventive interventions have primarily focused on individual physicians rather than the institution. Several systematic reviews and meta-analyses have highlighted that interventions such as coaching, mindfulness practices, or discussion groups have a minimal or no meaningful impact on physician outcomes.
. . . physician job satisfaction in European and US hospitals was higher in hospitals with better nurse staffing, a more favorable clinical care environment, and effective physician-nurse teamwork . . .
Hospitals operating with too few nurses and unfavorable work environments have been found to have higher rates of physician burnout and turnover. The present study’s findings are consistent with this literature.
The current study design involved two distinct groups of health-care professionals: nurses, who reported on hospital environments, and physicians, who reported on their well-being and job outcomes. This helped avoid bias where the same health-care professionals provide information on two interconnected variables.
Overall, the study’s evidence highlights the significance of organisational interventions, specifically adequate nurse staffing, supportive care environments, and strong interdisciplinary teamwork, in improving physician wellbeing and addressing the physician shortage.
The study collected data in two phases. The US data was collected during the peak phase of the COVID-19 pandemic in 2021, while the European data was collected in 2023. This variation in data collection timing may have some influence on the findings.
Attracting and retaining skilled nurses
The US hospitals included in the study are Magnet-recognised, meaning that these hospitals provide a supportive work environment that attracts and retains skilled nurses. The European hospitals, on the other hand, had agreed to participate in the study to improve their work environment. These hospitals are not necessarily representative of all hospitals in European countries.
Such country-level differences in health systems may have impacted the findings. However, the study found significant variations in physician wellbeing across hospitals within the same countries. This variation further supports the significance of organizational interventions in improving physician wellbeing regardless of country-level differences in health systems.
Sanchari Sinha Dutta, PhD (physiology) is a science writer. This article was originally published at News Medical and is reproduced with permission.
Reference
- Aiken, L. H., Sermeus, W., & McKee, M. (2025). Informing Hospital Physician Well-Being Interventions in Europe and the US. JAMA Network Open.