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Abstract
Background Physician wellness remains a growing concern, not only affecting the physicians’ quality of life but also the quality of care delivered. One of the core tasks of medical regulatory authorities (MRAs) is to supervise the quality and safety of care. This brief report aimed to evaluate the practices of MRAs regarding physician wellness and their views on residents as a high-risk group for decreased physician wellness.
Methods A questionnaire was sent to MRAs worldwide, related to four topics: the identification of physician wellness as a risk factor for quality of care, data collection, interventions and the identification of residents as high risk for poor physician wellness. 26 responses were included.
Results 23 MRAs consider poor physician wellness a risk factor for quality of care, 10 collect data and 13 have instruments to improve physician wellness. Nine MRAs identify residents as a high-risk group for poor physician wellness. Seven MRAs feel no responsibility for physician wellness.
Conclusion Although almost all MRAs see poor physician wellness as a risk factor, actively countering this risk does not yet appear to be common practice. Given their unique position within the healthcare regulatory framework, MRAs could help improve physician wellness.
- health policy
- health system
- regulation
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Introduction
Despite a decade’s worth of efforts battling low physician well-being, physician wellness remains a growing concern, with the COVID-19 pandemic only worsening this issue.1 Especially physicians in residency, a challenging and high-stress environment, appear particularly vulnerable to developing poor physician wellness.2 This not only affects physicians’ own quality of life but also the quality of care they deliver. The detrimental impact of physician wellness on quality of care is beyond dispute, leading to the call to make physician wellness a quality indicator.3 Even prior to the COVID-19 pandemic, physician wellness was recognised as an utmost priority, not simply an optional nicety.4
Medical regulatory authorities (MRAs) supervise the quality of healthcare professionals. The core task of MRAs is to protect the public by assuring quality of care. While MRAs operate in varied contexts across different countries, all could be expected to share a vested interest in upholding physician wellness, as poor physician wellness is detrimental to the quality of care. However, it remains unclear whether this is an issue that MRAs address, as current research on physician wellness focuses solely on issues at the personal or organisational level, leaving MRAs out of the equation.5 6 The purpose of this brief report was to evaluate current practices of MRAs regarding physician wellness and their views on residents as a high-risk group for decreased physician wellness, as a base for future policy decision.
Methods
The ‘Checklist for Reporting the Results of Internet E-Surveys’ was used to ensure the quality of this study.
The International Association of Medical Regulatory Authorities and the European Partnership for Supervisory Organisations in Health Services and Social Care, associations connecting regulator worldwide, were approached to forward our survey by email to MRAs within their network. Participation was voluntary and without incentive. Data were collected from mid-2019 to the beginning of 2020.
A questionnaire on physician wellness policy was designed focusing on four main topics: (1) recognition of physician wellness as a risk factor for quality of care; (2) data collection on physician wellness; (3) instruments to improve physician wellness and (4) identification of residents as a high-risk group. Participants could answer with ‘yes’, ‘no’, ‘I do not know’ or choose from a fixed set of options. Participants were encouraged to provide comments (online supplemental material 1).
Supplemental material
Partially completed questionnaires were accepted for analysis. Data were analysed using descriptive statistics (online supplemental material 2).
Supplemental material
Results
26 MRAs responded to the survey (figure 1). 12 MRAs were based in Europe, 9 in North America, 2 in Asia, 2 in Africa and 1 in Australia. Of the 26 MRAs, 73% (n=19) finished the survey (completion rate).
Survey results on the four main question topics. Each icon represents one responding MRA. Black indicates a ‘yes’ response, while grey indicates ‘no’ or ‘do not know’. The completion rate for the questions regarding the recognition of physician wellness as a risk factor and regarding data collection was 100% (n=26). For the question on instrument to improve physician wellness, the completion rate was 92% (n=24). For the question regarding recognition of residents as a high-risk group, the completion rate was 85% (n=22).
Responsibility
Seven MRAs reported not to be responsible for physician wellness, either through email explaining they would or could not fill out the questionnaire as they are not responsible (n=3) or through the questionnaire (n=4). These MRAs explained that physician wellness falls under a different MRA (n=4), that it is managed by the professional association (n=1), that the MRA has no jurisdiction (n=1) or that the MRA only regulates healthcare organisations, not professionals (n=1).
Recognition as risk-factor
23 MRAs identified poor physician wellness as a risk factor, whereas two MRAs did not and one did not know.
Data collection
10 MRAs collected data on physician wellness. Nine MRAs specified the type and goal of data collection, mostly data on working hours/on-call schedules (n=5) and working/training climate (n=5) (online supplemental material 3). Data were mostly collected with the goal of creating interventions and strategies to improve physician wellness (n=6). One MRA gathered data to investigate the extent of the problem. Two MRAs reported collecting data with different goals, namely for health monitoring purposes (n=1) and to identify risks in healthcare (n=1).
Supplemental material
16 MRAs stated they did not collect data. Four provided an explanation, stating data are gathered by another organisation or MRA (n=3) or that the organisation regulates healthcare services, not professionals (n=1).
Instrument and ideas
Half of MRAs reported to have instruments or ideas on how to improve physician wellness (n=13), mostly aimed at specialists and consultants (n=10), general practitioners (n=9) and residents (n=9) (online supplemental material 4). 12 MRAs specified the type of instrument or idea, mostly reporting guidelines (n=8) and strategies (n=8) (online supplemental material 5).
Supplemental material
Supplemental material
11 MRAs provided more information on what their strategies entail. Seven MRAs reported having instruments aimed at the individual, namely: (1) promoting well-being, self-assessment and treatment-seeking behaviour (n=3), for example, by suggesting licensing questionnaire approaches to stimulate seeking treatment; (2) increased education, on health and well-being in general (n=1) or certain aspects (n=1), specifically substance abuse; (3) providing support (n=2), through support groups or through funding support programmes and (4) identifying physicians whose fitness to practice has been impaired (n=1). Four MRAs reported having instruments aimed at the organisation, namely: (1) collaborating with associations and stakeholders (n=2) (2) a complete strategy consisting of standards to safeguard and improve the well-being of medical students, non-consultant hospital doctors, consultants and general practitioners (n=1) and (3) an action plan including interventions to improve doctors’ well-being and recommendations for a range of organisations (n=1).
11 MRAs reported not to have, or not know if they have, instruments or ideas to improve physician wellness. Six MRAs provided further explanation, stating this falls under a different MRA or organisation (n=3), they only monitor certain aspects of worker well-being (n=1), they solely provide education regarding this topic (n=1) or that the organisation regulates healthcare services, not professionals (n=1).
Residents
Less than half of MRAs identified medical residents as a high-risk group for decreased physician wellness (n=9), whereas 10 explicitly did not. Three MRAs did not know whether their organisation identifies residents as a high-risk group since they do not investigate these groups (n=1) or as it falls under a different organisation (n=1).
Discussion
This brief report shows that while almost all responding MRAs recognise the lack of physician wellness as a risk factor for quality of care, actively monitoring and addressing this problem is not yet common practice. This seems a missed opportunity, as, given their unique position within the healthcare regulatory framework, MRAs could potentially contribute to the improvement of physician wellness and thereby the quality of care.
Multiple MRAs stated not to be responsible for, or to collect data on, physician wellness, as it is outside their remit, stating they, for example, regulate healthcare services, not professionals. Physician wellness relies on multiple factors, in which both personal and workplace aspects play a role.7 We feel, however, that an MRA that does not regulate professionals but providers instead, could still play a role in improving physician wellness, as the regulated healthcare provider creates the working environment influencing physician wellness.
Less than half of responding MRAs reported having instruments or ideas on how to improve physician wellness, most of which are aimed at the individual healthcare professional. Since personal resilience plays a vital role in physician wellness, it makes sense to promote well-being, self-assessment and treatment-seeking behaviour. However, organisational factors and external actors, such as policy-makers, also play important roles.8 Some even suggest the most effective strategy to tackle physician burnout is organisation-directed rather than targeted at individuals.9 Therefore, merely incorporating individual-focused interventions, without addressing system-level changes, seems insufficient.1
To improve physician wellness, it might be worthwhile to address wellness early in the medical career, that is, during residency. Residency is a formative time in physicians’ development in which physicians are particularly vulnerable to developing burn-out.10 Cultural values contribute to this vulnerability: residents often do not want to complain to their colleagues, fearing it may be perceived as an inability to keep up.11 Nevertheless, the majority of responding MRAs do not identify residents as a high-risk group for poor wellness. Improving resident well-being could, however, significantly enhance the quality of care, given that residents perform a substantial portion of hands-on patient care.
Finally, we argue that further research on MRAs that have developed strategies to improve physician wellness would be valuable. Examining how these strategies were developed and their effects could provide learning opportunities for other regulators worldwide. By understanding successful approaches, MRAs can better incorporate both individual-focused and system-level interventions, ultimately leading to more comprehensive and effective wellness strategies for physicians at all stages of their careers.
MRAs hold a unique position within the healthcare system, empowered by their formal regulatory powers established through institutional arrangements. These powers enable MRAs to implement policies that enhance the wellness of healthcare professionals. For example, MRAs can develop and enforce guidelines and standards related to wellness, such as those addressing workplace safety, or establish standards regarding the provision of resources and support. Additionally, MRAs can leverage their influence on providers, other regulators and stakeholders to promote research on healthcare worker wellness, facilitating the development of evidence-based interventions. By effectively using these various levers as, for example, described by the Kings Fund, regulators can play a pivotal role in creating a supportive environment for healthcare providers, ultimately contributing to improved well-being and quality of care.12
However, regulatory involvement may also impede the wellness of healthcare professionals. The implementation of overly burdensome or stringent regulatory policies may inadvertently worsen the well-being of the regulated professional, resulting in the practice of ‘defensive’ medicine and fostering a climate of fear.13 Even if the regulatory policy is not stringent, it can be misinterpreted or misused by other actors. For example, the concept of ‘just culture’ was meant to empower front-line staff but ended up empowering the judicial system’s authority to judge individual staff behaviour.14 Similarly, a regulatory focus on wellness could unintentionally lead to healthcare professionals being held responsible for maintaining their own well-being. In line with the concept of ‘reflexive regulation’, MRAs should, therefore, focus on their own role and influence as well, and not distance themselves from the underlying principles of control.15 Finally, we believe there are opportunities for organisational leaders and MRAs to collaborate as they share a common interest in improving the wellness of the professionals they oversee and, consequently, the quality of care.
The main limitation of this study is the relatively small sample coverage of 26 MRAs worldwide. Nonetheless, this study is the first to provide insights into the role of MRAs in physician well-being. While these results might not be representative of all MRAs, they suggest that physician wellness interventions are not yet common practice among MRAs worldwide.
Ethics statements
Patient consent for publication
Ethics approval
This study did not require ethical oversight, as the study did not obtain data or identifiable private information about specific human subjects, but rather evaluated organizational standpoints in physician wellness.
Acknowledgments
We gratefully acknowledge the MRAs that responded to our questionnaire. This paper has been previously presented during the 2021 IAMRA virtual conference.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors All authors listed contributed considerably to the manuscript and approved this submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.