Thriving among Primary Care Physicians: a Qualitative Study

Abstract

BACKGROUND: Burnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life-a phenomenon we term "thriving." OBJECTIVE: To identify factors contributing to both career and life satisfaction through qualitative interviews. PARTICIPANTS: The subjects were primary care physicians. APPROACH: Qualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach. MAIN MEASURES: Personal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout. RESULTS: Thirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment. CONCLUSIONS: Several factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, s u c h a s h a v i n g v a l u e -o r i e n t e d b e l i e f s a n d inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed.

Relationships among thriving at work, organisational commitment and job satisfaction among Chinese front-line primary public health workers during COVID-19 pandemic: a structural equation model analysis

“…A theoretical model of thriving at work developed by Spreitzer et al 58 suggests that when employees feel energised and full of learning in the workplace, they are energised and willing to invest more time, energy, and effort in their work, resulting in a high level of thriving at work. This will further stimulate their identification with their organisations (ie, affective commitment), which will lead to a higher level of centripetal force towards their careers and the groups they work with (ie, continuance commitment), and a greater willingness to engage in organisational activities and construction out of their own strong sense of responsibility and mission (ie, normative commitment) 59. Additionally, employees' commitment to the organisation inevitably affects employees' attitudes or feelings toward work, which in turn affects their job satisfaction.…”

The Impact of the COVID-19 Pandemic on the Residency Experience: A Qualitative Study

“…A semi-structured interview guide was developed by a prior study on physician satisfaction (Appendix A) [14] . The questions were derived from a review of the literature on physician well-being and focused on aspects of each participants' life and career which have contributed to a sense of thriving, including work environment, learning climate, social networks, institutional supports, and intrinsic personal characteristics.…”

Thriving in Residency: a Qualitative Study

“…A semi-structured interview guide that was developed in a prior study of physician thriving among primary care attendings was used (Appendix). 29 The questions were derived from a review of the literature on physician well-being and focused on aspects of each participants' life and career which have contributed to a sense of thriving, including work environment, social networks, institutional supports, and intrinsic personal characteristics. 27,43…”

“…A qualitative study among primary care attending physicians identified five domains associated with thriving: social connections, love of work, value-oriented practice, agency, and relationships with patients. 29 However, a similar qualitative study among resident physicians has not been conducted. Consequently, it is our aim to develop a conceptual model to better understand resident physician thriving and in so doing address this key gap in the research literature.…”

“…30,31 Indeed, using eudaimonia as a framework to analyze physician well-being was affirmed in the qualitative study among primary care attendings described earlier. 29 Similarly, positive psychology focuses on the study of processes and conditions that contribute to individual, institutional, and societal well-being. 32 Within the field of positive psychology, "flourishing" is viewed as a pinnacle state of well-being.…”