A Professional Well-Being Continuum: Broadening the Burnout Conversation

Lauren Penwell-Waines, PhD; Mark Greenawald, MD; David Musick, PhD


South Med J. 2018;111(10):634-635. 

In This Article

Abstract and Introduction


Physician burnout is a significant concern that is garnering much-needed attention. Researchers and leaders in health care also have been focusing more on physician wellness. We believe, however, that physician well-being is more nuanced than being either burned out or well (or burned out or not), and the complexities of physician burnout are not fully captured by viewing the problem through this dichotomy.

We propose the use of a professional well-being continuum. We believe this approach offers advantages in both assessment and intervention over the current dichotomies used to discuss physician well-being that consider only burnout or wellness. The proposed model is based on accepted constructs in the well-being literature but has not itself been empirically tested; therefore, the model would benefit from future studies that seek to confirm and/or refine the terms we have used, along with associated outcomes and effective interventions at different points along the continuum.

Interest in physician burnout and well-being has been growing steadily. With increasing attention to these constructs, scholarly work has highlighted some problems with burnout research to date, including an emphasis on emotional exhaustion, the use of unsupported clinical cutoff scores on the Maslach Burnout Inventory, and a narrow focus on burnout without considering positive aspects of well-being.[1] We propose an expansion on the latter criticism—the creation of two artificial categories (burned out and well) that do not represent the range of well-being that physicians may experience.

Although wellness and burnout have been described as "two sides of the same coin,"[2] it seems unlikely that a burned-out physician suddenly would be well. In our experience, improving well-being is an active process that takes time and involves cultivating personal and professional resources to mitigate stressors and enhance wellness. Physicians who are experiencing burnout and struggling to keep up with the demands of their careers and responsibilities outside work may view being well as an unattainable goal. This is supported by literature that indicates that burnout, from a theoretical perspective, is a "complex, continuous, and heterogeneous construct,"[3] and as an experience may be a stable, chronic condition lasting years.[4] Furthermore, attempting to promote skills or states that are more advanced than for what the individual is ready (eg, focusing on wellness when an individual is burned out) may be premature and cause frustration; one must possess basic coping skills to make incremental improvements before moving on to larger-scale changes.[5]

It also is unlikely that a physician would go suddenly from being well to being burned out. Likely there is a gradual decline in well-being related to mounting job stressors and dwindling personal resources or organizational supports to meet these stressors.[4] As such, both burnout and wellness develop over time, being influenced by environmental stressors and personal resources that are available to respond to them.[4,6] Although a well-being dichotomy may have been necessary from a research perspective, this restricted concept limits the generalizability of said well-being research.

In consideration of the complexity of human experience and the deficiencies identified in the burnout literature, we propose that a physician well-being continuum, which reflects a range of subjective experiences, would be a more representative conceptual model than is a dichotomy. Such an approach provides physicians with a more comprehensive, nuanced language with which to discuss their well-being.