Faculty perceptions of wellness at an academic medical center

Abstract

Background

Despite national recommendations and decades of literature highlighting the importance of faculty wellness, gaps at academic medical centers remain. Multilevel wellness initiatives are necessary to create change and optimally support academic faculty.

Objective

The purpose of this study is to examine faculty perceptions of factors contributing to lack of wellness and proposed solutions in the context of current resources at our academic medical center in the Mid-Atlantic region of the United States.

Methods

The Georgetown University Medical Center Faculty Development Committee created a Wellness Task Force in response to a charge by leadership. The 11-member Task Force included faculty members from different disciplines: psychiatry, neurology, family medicine, pediatrics, nursing and oncology. Data collection occurred September 2021 to January 2022. Interviews and focus groups elicited faculty input on 1) factors that contribute to and detract from wellness and 2) strategies to enhance wellness within our academic medical center.

Results

Faculty described individual and organizational factors contributing to lack of wellness: challenges with balance; lack of connection, autonomy, resources and feeling valued; communication; culture; attention to diversity, equity, and inclusion; leadership; and workload. Proposed solutions included a comprehensive, centralized and consistent plan; culture change; incentives; increased autonomy, feelings of value, and resources.

Conclusions

Wellness as a budgetary priority and strategic initiative remains a critical goal for academic medical centers. Faculty perceptions of factors contributing to lack of wellness and proposed solutions underscore and add to national recommendations.

Keywords

wellness faculty academic medical center qualitative research focus groups

Faculty in academic medicine pursue activities that aim to further wellness in their students, patients and communities through teaching, clinical care, research, and advocacy.

Unfortunately, demands including complex reimbursement structures, electronic medical records, competitive grant funding rates, administrative burden and teaching loads can contribute to lack of wellness, including burnout, among faculty.¹ In keeping with the World Health Organization's model of health, wellness is not simply the absence of burnout.² Brady et al.'s conceptual model of wellness “is defined by quality of life, which includes the absence of ill-being and the presence of positive physical, mental, social, and integrated well-being experienced in connection with activities and environments that allow [faculty] to develop their full potentials across personal and work-life domains.”³

Failure to address faculty wellness has high costs. 50% of physicians suffer from burnout as characterized in Maslach and Jackson's definition of burnout with emotional exhaustion, depersonalization, and reduced personal achievement.⁴ Similarly, faculty in biomedical sciences⁵ and nursing⁶ experience high rates of burnout. Women physicians experience more emotional exhaustion and higher rates of burnout.⁷ Recent research has documented increasing rates of burnout among research faculty, particularly research faculty underrepresented in academic medicine.⁸ Burnout results in decreased patient satisfaction,^9,10 decreased productivity,¹¹ decreased career engagement,¹² decreased care and safety for self,^13,14 increased medical errors,^6,15 increased absenteeism,¹⁶ and increased health care costs.¹⁷ Physicians and nurses who experience burnout are more likely to reduce their hours¹⁸ or exit the profession.¹⁹ Faculty burnout is associated with decreased workplace fulfillment and decreased likelihood of staying at the institution.^6,20 Additionally, the COVID-19 pandemic led to increased workload, pathogen exposure, limited resources, and personal anxiety – which have contributed to increased burnout prevalence.²¹ In a recent study, 63% of physicians had at least one characteristic of burnout in 2021 compared to 38% in 2020; satisfaction with work-life integration went from 46% in 2020 to 30% in 2021.²²

The significant attention toward wellness among academic faculty has been supported by national recommendations and decades of literature.^23–26 For the past two decades, efforts were underway to examine the risk factors for burnout and lack of wellness among faculty in academic medicine,⁴ with recent attention on the development of wellness programs.⁵ Despite increased attention towards wellness, gaps remain. A 2019 National Academy of Medicine report called for “research to identify organizational and health care system factors that increase risk of distress for health care professionals.”²⁵ Identifying and incorporating wellness initiatives at individual and organizational levels is necessary to create and sustain change and optimally support the workforce at academic medical centers.²⁷ In this study, we examined faculty experiences to identify factors contributing to lack of wellness in the context of current resources at our academic medical center in the Mid-Atlantic region of the United States.

Methods

Ethical consideration

This focus group and interview data was acquired as a quality improvement initiative for our academic medical center, and was thus deemed exempt from further review and monitoring by the Institutional Review Board (#00004877).

Overview

The Georgetown University Medical Center (GUMC) is an academic medical center consisting of a School of Medicine and, at the time of data collection, the School of Nursing and Health Studies (currently School of Nursing and School of Health). The Faculty Development Committee (FDC) is a GUMC committee that provides programming and professional development resources for all faculty. The GUMC Executive Vice President charged the FDC to identify wellness needs, examine factors contributing to lack of wellness, and provide recommendations on increasing utilization of current resources and filling gaps of unmet needs. In response, the FDC created a Wellness Task Force that included 11 self-nominated FDC faculty members from the School of Medicine and the School of Nursing and Health Studies at ranks including Assistant Professor, Associate Professor or Professor and from different disciplines: psychiatry, neurology, family medicine, pediatrics, nursing and oncology. The Task Force developed a year-long plan for data collection, benchmarking and development of recommendations. Data collection occurred between September 2021 and January 2022 and consisted of two phases: interviews and focus groups. Data was used to formulate draft recommendations which were iteratively revised by Task Force members. Recommendations were presented to the Executive Vice President in Spring 2022.

Participants

We recruited participants in two ways. For interviews, we purposively sampled key stakeholders from relevant groups (e.g., faculty governance, staff leadership council, benefits, academic affairs), the School of Medicine, the School of Nursing and Health Studies, and our clinical hospital partner, MedStar Health.

For focus groups, we used a convenience sampling approach. All faculty members were invited to attend via weekly electronic GUMC newsletters. To be eligible, individuals had to have a formal faculty appointment and be employed by the GUMC or MedStar Health.

Between September 2021 and January 2022, 41 faculty members participated across both phases of research.

Procedures

Individual qualitative interviews and focus groups elicited faculty input on 1) factors that contribute to and detract from wellness and 2) strategies to enhance wellness within our academic medical center.

Two members of the wellness task force with prior training and experience in qualitative interviewing conducted the individual interviews. The Chair and two members of the task force led the focus groups. In terms of positionality, the interviews and focus groups leaders were all members of the wellness task force, and thus had a vested interest in understanding the wellness experiences of the study participants. The interviewers’/focus group leaders’ roles in the task force may have affected their line of questioning, influencing the resulting qualitative data. Since the task force members and participants were faculty within the same institution, it is possible that they may have known each other prior to the interview/focus group. Additionally, the differences in career stages between the interviewers/focus group leaders and the participants could have introduced bias.

Individual interviews

In the first phase, we conducted individual interviews with key stakeholders at GUMC (n = 16). Two Wellness Task Force members conducted interviews by Zoom (n = 9); for those unable to schedule a Zoom meeting, we collected written asynchronous interview responses with an online survey form (n = 7). Six of nine interviews were recorded and transcribed; we took detailed notes during the remaining three interviews. Following a thematic analysis approach, we began the interviews with a broad question to prompt interviewees to share perspectives on the definition of wellness. We then asked all interviewees (by both Zoom and written form) to respond to open-ended questions (See Table 1). Zoom interviews ranged from 45 to 60 min and written interviews took an estimated 20 min to complete.

Table 1.

Interview questions for individual and written interviews.

What is your definition of wellness?

What factors do you think promote faculty wellness?

What factors undermine faculty wellness?

What are you/your department currently doing to address wellness?

What gaps do you see (if any) in current wellness offerings?

How will we best address Diversity, Equity and Inclusion in wellness initiatives?

Are you/your department collecting any data to track wellness or use of wellness resources?

Focus groups

Two members of the Wellness Task Force developed a semi-structured discussion guide to use during facilitation of the focus groups and trained additional task force members in best practices for focus group facilitation. The Chair of the Wellness Task Force was present for all four focus groups; two additional task force members were present at each group to assist with facilitating and note-taking. All focus groups were conducted virtually by Zoom. The first two focus groups were 45 min; the third and fourth groups were extended to 60 min to allow time for additional discussion. In order to elicit broad input and generate ideas in a short amount of time, we used Google Jamboard (https://jamboard.google.com/) during each focus group. We displayed a digital white board on which participants shared multiple thoughts on digital ‘post-it’ notes related to barriers and facilitators of faculty wellness.

Prior to the start of the focus group, we asked participants to complete a brief demographic questionnaire on Qualtrics (participants’ age, race, ethnicity, gender, GUMC department). Attendees’ academic rank (assistant professor, associate professor, etc.) was extracted from the GUMC faculty directory.

At the start of the focus group, moderators reviewed ‘ground rules’ for the discussion (e.g., maintain confidentiality, use “I” statements, be inclusive and respectful of all perspectives). Moderators notified participants that the focus groups would not be recorded, and information shared would be de-identified. Moderators provided an overview of the goals of the focus groups and asked participants if they had any questions. Moderators provided a demonstration on how to use the Google Jamboard. Participants were given the option to put their thoughts into a private Zoom chat for a Task Force team member to add to the Jamboard. Moderators invited participants to take a few minutes to think of factors that contribute to lack of faculty wellness, then share these factors by writing on an electronic sticky note and adding them to the Jamboard. Then moderators invited focus group members to discuss or expand on any factors that had been added to the Jamboard.

A similar procedure was used to identify solutions to enhance wellness. The moderators informed attendees that these solutions did not have to be related to the factors outlined in the previous section. They were also instructed that “magic wand” solutions could be part of the idea generation– solutions did not need to be something that participants could realistically create themselves nor within a specific budget.

Analysis

We used Dedoose to analyze transcripts and notes from the interviews and focus groups. Following a thematic analysis approach, we first reviewed the transcripts and notes and developed a “start list” of potential themes that we observed. We then created a preliminary codebook and applied it to the qualitative data. As the coding process continued, we iteratively revised the codebook to reflect emergent themes.^28,29 Two members of the research team independently coded two interviews at a time and then met to compare codes. Disagreements were resolved with a third member of the team.³⁰ We used an inductive approach rather than being guided by a theoretical framework. Data were consistent across the interviews and focus groups and thus combined for analyses.

Results

We collected data from 16 interviews (9 by Zoom, 7 written) and 4 focus groups (24 participants). See Table 2 for participant characteristics. We received 25 completed demographic surveys from focus group participants and, because data were de-identified, we were unable to exclude the demographic data of the 1 person who did not attend the focus group. The focus group participants ranged from ages 35–74 and represented 10 departments at the GUMC.

Table 2.

Participant characteristics.

Participant Characteristics	Face-to-face Interviews (N = 9)	Written Interviews (N = 7)	Focus Group Participants (N = 25)
Gender
Women	6 (66.7%)	6 (85.7%)	19 (76.0%)
Men	3 (33.3%)	1 (14.3%)	5 (20.0%)
Prefer not to say	–	–	1 (4.0%)
Race
White	8 (88.9%)	6 (85.7%)	16 (64.0%)
Asian	1 (11.1%)	–	5 (20.0%)
Black	–	1 (14.3%)	2 (8.0%)
Prefer not to say	–	–	2 (8.0%)
Rank
Instructor	1 (11.1%)	–	3 (12.0%)
Assistant Professor	1 (11.1%)	1 (14.3%)	7 (28.0%)
Associate Professor	2 (22.2%)	1 (14.3%)	8 (32.0%)
Professor	4 (44.4%)	3 (42.8%)	6 (24.0%)
Staff	1 (11.1%)	2 (28.6%)	–
Missing	–	–	1 (4.0%)

Note: Participant data was collected anonymously; one individual completed the Focus Group demographic survey but did not attend (Focus Group participants N = 24). We were unable to exclude this individual given the de-identified nature of the survey.

Individual factors contributing to lack of wellness

Individual factors included those factors identified to contribute to lack of wellness at the personal level: challenges with professional and personal balance, lack of connection to colleagues, loss of autonomy, and lack of feeling valued.

Challenges with balance

“Lack of work-life balance,” difficulty balancing different roles and responsibilities within the academic environment, and the time given to others both professionally and personally left faculty limited time to focus on their own wellness. Traditional definitions of “success” in academic environments contributed to external pressures and expectations. Extensive time, workload demands, and the inability to disconnect made balance difficult.

“It comes down to making a choice between making time for wellness, spending time with family, or getting work done. [Faculty] choose family and work and don’t make time for themselves.”

Lack of connection

Academic silos, multiple work sites, and the pandemic were discussed as reasons for faculty feeling less connected. Connections were further diminished by lack of in-person gatherings and meetings, virtual interactions with students and teams, overloaded schedules, and remote locations.

“People are so spread out…coming and going… [faculty] don't interact with each other naturally.”

“Understanding that the first step to making change is recognizing that people feel alone and [there is] no place to channel that.”

Lack of autonomy

Faculty felt that they did not have control over workloads, breaks, or schedules. They wanted the “ability to choose % of work time throughout [their] lifetime – at different points in [their] lives.” They felt that the expectations of things getting done did not match up with necessity.

“[Faculty] worry about their students, they worry about their residents, they worry about their patients, and when they feel like they don't have control over their experience…I think that adds a second layer of stress.”

Lack of feeling valued

Leadership, focus on relative value units (RVU's) rather than individuals, lack of positive feedback, and lack of visible tokens of appreciation contributed to not feeling valued. Participants explained, “this feeling of not feeling appreciated…that's pretty universal among a lot of people I talk to.” They noted that the differences across the institution in whether faculty felt valued resulted in differences in leadership style and messaging.

Another factor that emerged was that clinical faculty's effort and time spent on activities such as service, teaching, and mentoring did not “count” towards productivity measures or play a large enough role in academic advancement criteria.

“My experiences when I am putting efforts towards these things is I don't think that it is being counted towards — the things that I get counted on.”

Organizational factors contributing to lack of wellness

Organizational factors are factors identified by participants to be something that the organizational system in which they are working is responsible for. Though faculty members are part of these systems, organizational factors require input at levels larger than the individual, such as at the departmental or institutional level. (See Table 3) Organizational factors included communication, culture, attention to diversity, equity and inclusion (DEI), lack of resources, leadership, and workload.

Table 3.

Factors identified as contributing to lack of wellness by faculty.

Factors Identified as Contributing to Lack of Wellness	Additional Illustrative Quotes from Participants
Individual Factors
Challenges with Balance	“Lack of time for disconnect to attend to personal life”
	“There are many aspects of life that [faculty] feel unbalanced in, beyond just physical health.”
	“We can put on paper that we promote wellness and a healthy balance of work and life. But the external pressures to succeed and achieve are still there and haven’t changed so if one wants to be ‘successful’ in a more traditionally accepted form and progress in academia, then it really doesn't promote a healthy wellness lifestyle.”
Lack of connection	“not feeling connected to your work or the people you work with”
Lack of connection	“Loss of connection with colleagues, students, and friends”
Lack of autonomy	“Inability to control schedule”
Lack of autonomy	“It's the insistence in how and what and where and when that doesn't necessarily meet reality in terms of the necessity.”
Lack of feeling valued	“Some “nodes” have been able to create a pretty good working environment, but lots of others have not been able to create an environment that is supportive of faculty. What's the difference? The message that you’re valuable and respected, and we will protect your rights. It starts with the leadership in that area.”
Organizational Factors
Communication	“Too many emails, teams, beeper, email, snail mail, medconnect messages, cell messages for providers”
	“Lack of transparency in decision making”
	“Emails after 6:30 or so at night…schedule your response, so it doesn't get sent out so that your staff doesn't think that they have to respond”
	“Lack of a way to express dissatisfaction. (You) have to go through your boss. Difficult if the issue is with your own direct supervisor.”
Culture	“There's a fundamental disconnect…we say a lot about (wellness), but then we put a lot of work, and pressure on people to perform.”
Culture	“This is not what I thought it would be or not what I signed up for…the external pressures are so high, you know kind of the demands to produce, that is, whether it's to publish or whether it's student evaluations.”
Attention to Diversity, Equity and Inclusion	“Recognize the added burden of minority tax in mentoring, service”
Attention to Diversity, Equity and Inclusion	“For diversity and inclusion work…I think one has to recognize that there are different needs in that space, and the overlap and intersection just varies greatly as it relates to wellness.”
Lack of resources	“Financial inequity across various campuses”
Lack of resources	“Cutbacks in support staff”
Leadership	“Clinical productivity, when that becomes the focus, then I think that's stressful to people and it takes us away from (the notion that) we can work really hard and work many, many hours a week, and not get burned out or feel overwhelmed if we love our work and feel like it's meaningful and see that it's making a difference…when it becomes about external demands, I think that is really undermining well-being.”
Leadership	“Leadership is homogenous and fails to recognize challenges for others.”
Workload	“Feeling overwhelmed, no time to catch your breath during the day…juggling too many tasks simultaneously”
Workload	“There are some open faculty positions, so the current faculty are having to share the workload amongst fewer people. (We are) also lacking in admin support.”

Ineffective communication

Email overload, lack of streamlined communication, lack of transparency, and lack of communication boundaries contributed to feeling overwhelmed. “Communication should move to 1–2 platforms and be able to be turned off.” Faculty also discussed negative and inadequate bi-directional feedback loops that lack a way for faculty to express dissatisfaction. Fragmented information and unequal access to information were delineated: “It isn’t the resources, it is the connection [to the resources] and the access.”

Culture

Faculty described an “overwork mentality,” “misalignment of incentives,” and not having time to “disconnect” because of expectations to work nights and weekends to handle workloads. A concerning subtheme was the lack of psychological safety and fear of retaliation with statements such as “I can’t say XYZ because I’m scared of what will happen.” Faculty voiced an incongruence between words of wellness and demands to produce.

“The external pressures are so high, the demands to produce; [wellness] doesn't seem to be valued, even though it's said to be valued. It's a do it on your own time sort of thing.”

Attention to diversity, equity, and inclusion

Interviewees discussed wanting diversity, equity, and inclusion initiatives integrated within wellness initiatives, although this was not a theme in the focus groups. Interviewees also stated the importance of valuing people both individually and collectively and recognizing the varying needs in the space by different groups.

“An arm (of) well-being I think all of us are sensitive to is (DEI)…. It's absolutely linked to well-being…if you don't feel safe and you don't feel valued and you are being discriminated against it's such a source of stress and trauma… We have to roll things out to meet everybody's needs.”

Lack of adequate resources

Faculty reported a lack of resources including shortage of faculty and staff, lack of administrative support, and lack of financial support for educational initiatives. Workforce shortages and cutbacks increased faculty burden and contributed to higher workloads. Participants noted different access to resources across campuses and across clinical settings.

“There's no supplies…it doesn’t make you feel very valued.”

“Decrease in technology resources and support”

Inconsistent leadership styles

The topics related to leadership included participant perceptions of feedback loops, need for greater levels of transparent communication, financial focus of decision-making, focus on short-term rather than long term goals, lack of a formal position/role at the medical center dedicated to wellness, failure to recognize challenges experienced by faculty, inconsistencies in leadership style, and differences across how leaders prioritize or value wellness. Faculty also discussed feeling challenged by perceived lack of adjustment to work expectations during the pandemic despite all the new challenges.

“Some [groups] have been able to create a pretty good working environment…others have not been able to create an environment that is supportive of faculty. What's the difference? The message that you’re valuable and respected, and we will protect your rights. It starts with the leadership in that area.”

Workload

Faculty discussed overloaded schedules, inefficient work environments, administrative burden, vacancies in positions, volume of simultaneous tasks, and electronic medical records. “Being stretched too thin” and “sheer volume of work” were workload issues for the faculty. Participants described they “cannot keep up with work without working on weekends” and “need for pajama rounds to finish work.” Though these circumstances were present before COVID, participants described exacerbations of these situations during the pandemic.

“Do you really need to send me three emails about [something getting] done—it's a matter of how you negotiate urgency with importance…everything can't be urgent and important.”

Individual and organizational factors that promote wellness

Faculty reported factors they perceived to promote wellness. (See Table 4) Some individual (autonomy and connections) and organizational (communication, culture, inclusion, leadership, and resources) factors identified to promote wellness countered those related to lack of wellness.

Table 4.

Factors identified as promoting wellness by faculty.

Factors Identified as Promoting Wellness	Illustrative Examples
Individual Factors
Autonomy	“People have the ability to control their own schedules”
Connections	“Strong collegial relationships with peers”
Connections	“Student interaction and engagement”
Organizational Factors
Communication	“Transparency”
Culture	“Protected time for faculty to practice self-care of their choice”
DEI	“Inclusion”
Leadership	“Leadership that cares about faculty as people, not just on the work they produce”
Resources	“Having access to information and resources for work-life integration and professional success”
	“Administrative support”
	“Adequate staffing”
	“Offices with natural lighting”
	“Good support staff”
	“Faculty support groups”

Additional factors included mentorship, fulfillment at work, meaningful work, opportunities for growth and learning, and cultivating healthy coping skills: self-awareness, positive perspective, mindfulness, exercise, and journaling.

Solutions generated to improve faculty wellness

Participants’ ideas for improving faculty wellness were grouped into 8 themes. (See Table 5)

Table 5.

Solutions generated to improve wellness by faculty.

Solutions Generated to Improve Faculty Wellness	Additional Illustrative Quotes From Participants
Comprehensive, centralized, consistent plan	“And I think that's the piece…to recommend some sort of different approach…let's connect these one-offs together and somehow institutionalize (it).”
Comprehensive, centralized, consistent plan	“Well-being efforts cannot be on the shoulders of volunteers. It will always be an afterthought.”
Culture Change	“I think it is a very worthy and noble goal to create a culture that has balance and I think that working towards that might automatically make people feel a greater sense of well meaning.”
Culture Change	“Physician pay should not be tied to their ability to see patients.”
Incentives	“It seems to me anecdotally I perceive that many of the faculty are well-intentioned and want to do right by not only themselves, but by each other, and so we have taken a lot of service on, even though technically service is whatever percent of our effort…Many go over that and I think that's…do these things, because it's good for you, but you're not going to get credit for it necessarily…and I mean that's not helpful.”
Incentives	“For those who put a lot of effort into what can be perceived as intangibles, I think that's where maybe we can modify (the credit) and I don't know if that's possible or not. There's a difference when it factors into your annual evaluation.”
Increased autonomy	“How is it wise to push to bring everybody back or is it actually going to be to your benefit to let them have some choice?”
Increased feelings of value	“Need an environment of respect and work that is still inspiring for you”
Increased feelings of value	“Administrative and peer support (feeling appreciated, respected and valued)”
Increased resources	“We need systems changes and support for faculty to do their jobs more efficiently- for example, decrease the barriers to resources that are imperative to do our work and [increase] administrative support so we aren’t spending more time doing those functions than we are teaching and mentoring students.”
Increased resources	“An oasis…that has a separate room for prayer and meditation and has a separate room for moms who need to pump”

Comprehensive, centralized, consistent plan

A key theme was a comprehensive, centralized approach to wellness. Participants mentioned wanting a “wellness department” and a “gameplan.” They highlighted the importance of a paid position (e.g., Chief Wellness Officer) responsible for wellness. Wellness efforts cannot solely be led by volunteers.

“I think what we have yet to do is have a systematic programmatic strategy. So all these one-offs disconnected from one another, it's really hard to move the needle…We need concrete steps…to work in concert and synergistically.”

Culture change

Ideas on how to change culture included “protected time for faculty to practice self-care of their choice” and a “fatigue mitigation policy that… [makes] sure fatigue is something we're thinking about in scheduling and in our culture and in the skills and knowledge.” They discussed transparent compensation that is not productivity-based and providing wellness resources where people work–on the floors, in their offices or at pre-existing meetings.

“Creating a culture of wellness–so how do you affect the culture so that people have permission and support to take care of themselves during the workday?”

Incentives

Participants generated ideas for two incentivized systems: one that formalizes the value of wellness and one recognizing the non-revenue generating, meaningful portions of their jobs. They discussed incorporating in “performance management like how are you living, how are you investing in your own well being” and suggested “to make wellness a part of percent effort.” They voiced frustrations that though non-revenue generating activities were expectations, they were not factored into algorithms for advancement and promotion, providing a mixed messaging on the importance and value of these activities.

“Barter system to earn credits for supports like scientific editing, grant writing support, wellness days and more formal celebration of accomplishments.”

Increased autonomy

Faculty members wanted more control with scheduling patients and hiring staff and faculty. They wanted “the ability to control [their] own schedule or FTE [Full-time equivalent],” and protected time for meaningful activities such as teaching, mentoring, and research.

“[We want the] ability to choose % of work time throughout [our] lifetime to be healthy at different points in our lives.”

Increased feelings of value

Participants delineated ways to increase faculty feeling valued: acknowledgement of increased workloads during COVID, supportive words, and small tokens of appreciation.

“Faculty need to feel that people are listening, that positive things are being done, and that they are protected….feeling like [our] voices will be heard and acted on.”

Increased resources

Faculty wanted increased staff and administrative support, wellness resources (recharge stations, peer support groups), environmental upgrades (accessibility to outdoor spaces and food, meditation or prayer space, and a lactation/pumping space. Additionally, participants discussed time for wellness, lunch, or short breaks during the day. One of the clinical faculty commented:

“It sure was nice when I was in the hospital all day long one day, and I was about to leave and it was eight o'clock and —[I thought] I'm going to die and I haven't had lunch and they had their little recharge stations.”

Discussion

In conclusion, recent reports related to faculty and physician well-being, combined with lingering challenges related to the COVID-19 pandemic, highlight the importance of building a comprehensive approach to supporting the wellness of faculty in academic medicine.^23–26 Our study contributes to the prior research on wellness by eliciting the perspectives of faculty from different ranks, departments, disciplines and roles on the individual and organizational level factors that contribute to, or detract from, wellness. These findings align with national recommendations that encourage creating a positive work and learning environment and culture, providing support for wellness by eliminating barriers, addressing barriers that interfere with daily work, engaging with effective technology resources, and institutionalizing well-being as a long-term value.²⁶

In this study, we examined faculty experiences across schools within an academic medical center – schools of medicine, nursing and health – and included clinical, teaching and research faculty. Themes identified are consistent with factors known to increase the odds of burnout including lack of autonomy, values misalignment, workloads, high clerical burden, incentive-based pay.²⁷ Challenges with professional and personal balance discussed by faculty aligns with Marshall and colleagues findings’ that, compared to physicians in private practice, physicians in academic medical centers have more significant challenges with balance.³¹ In addition, faculty discussed the importance of opportunities for mentorship, fulfillment and meaning, growth and learning, and cultivating healthy coping skills in promoting wellness. Though our academic center has wellness offerings for faculty, utilization, access, barriers, and unmet needs are critical elements to understand.

Results suggest that despite increased attention to wellness both within the institution and nationally, faculty at this medical center report unmet needs, within the context of current resources. Specifically, even when some resources are present, faculty are not aware of how to access these resources and therefore do not utilize them. Faculty's perception that lack of protected time on a calendar can make it difficult to use resources aligns with Brandenburg et al. who advocate for structured time for wellness activities.³² Moreover, faculty hold beliefs that even when individual-level resources are available, wellness is not an institutional priority. Though wellness resources build resilience and assist faculty, the long term stress of overwork and fear of retaliation require systems-level change. Thus, a number of challenges appear to remain related to the dissemination and implementation of individual-level resources and necessary systems-level change that produces organizational shifts towards a ‘culture of wellness’.³³

Attention to wellness is salient for all faculty, and particularly important for faculty from groups underrepresented in medicine and science. The connections between wellness and efforts to promote DEI were apparent from participants’ comments and reported experiences and further enhanced the literature on the importance of coordinating DEI and wellness initiatives. As institutions review policies, programming, and hiring practices for equity, it is important to consider how these policies and programs affect concerns about wellness. Perceptions of belonging and feeling valued align with factors that relate to wellness. However, DEI efforts are often disproportionately led by faculty of color; this ‘hidden tax’ is important to acknowledge and address.^34,35 As academic medical centers strive to be more inclusive, these findings support that purposeful attention to diversity, equity, and inclusion by leaders is important within the context of wellness initiatives.³⁶

This study was a result of a charge by the Executive Vice-President who wanted to better understand faculty wellness. Leaders at all levels who model and advocate for wellness, provide transparent communication, and value faculty as individuals are essential. Participants’ reports that inconsistent leadership styles contributed to lack of wellness supports research that shows leaders’ functioning is directly related to faculty well-being.³⁷ Furthermore, leadership at the departmental and supervisor level that supports faculty wellness has been associated with lower odds of burnout.^38,39 Post-COVID budgetary constraints at academic medical centers may contribute to less wellness funds at a time when it is even more crucial for leaders to make these investments. The multi-level factors affecting wellness require a multi-level strategy, and implementation at the organizational level requires leadership beyond individual programming. Investing in organizational strategies reduces burnout and improves fulfillment.⁶ However, Finkelstein and colleagues found that, though chairs of departments described system-level factors, some did not feel they had the knowledge, skills, or resources to address them.⁴⁰ Shanafelt and colleagues present a framework for wellness-centered leadership which includes the importance of a leader's communication, compassion, and emotional intelligence as being crucial for faculty well-being.⁴¹ Equipping leaders and making structural changes often require longer term strategic thinking and commitment of time and resources which can be difficult yet are necessary.

At a physical level, participants described needing accessibility to spaces for time outdoors, meals, meditation, and lactation/pumping. Physical aspects of work space can play a role in well-being at work.⁴² Participants also delineated environmental aspects requiring culture change. Lack of psychological safety that contributes to psychological distress and high stress is linked to higher rates of burnout.⁴³ In Levitt and March's organizational learning framework, “organizations are seen as learning by encoding inferences from history into routines that guide behavior.”⁴⁴ These types of norms, values, and rules are built over time and require well-thought out systemic behavioral shifts beyond individual programming to produce change. Even with the strategy of hiring a Chief Wellness Officer, Ripp and Shanafelt make the case that this role “should focus on larger interventions—like improving the organization's work environment and culture. The goal is to address what is wrong with the system, not simply teach individuals how to better tolerate a system that is broken.”⁴⁵ In order for a CWO to affect change, there needs to be a commitment at a leadership and organizational level so that the consideration of well-being is a proactive, integrated approach that is included in communication, decision-making, data collection, and workflow efficiency.^46,47

Additionally, compensation that is productivity-based is also linked to higher rates of burnout.⁴⁸ Furthermore, non-revenue generating activities such as mentoring and teaching in academic work environments are often satisfying for faculty and support well-being.⁴⁹ Faculty who spend less than 20 percent of their time on meaningful work are at higher risk for burnout.⁵⁰ Though institutions want faculty to serve in a number of ways, service activities are not always included in advancement and promotion criteria. In addition, Babcock et al. found that women were more likely to do these non-promotable tasks.⁵¹ Creating alternative incentivized systems such as education value units at academic medical centers is a way to begin valuing these non-revenue generating activities and the faculty who spend time on these tasks for their institutions.⁵²

Study limitations include homogeneity in terms of race and gender among the interview participants and that ethnicity was not systematically collected. The Task Force identified leaders of groups at GUMC for these individual interviews and the lack of diversity is likely a reflection of the lack of diversity among leadership at academic medical centers.⁵³ Additional demographics such as duration of employment, and school/hospital affiliation were not collected to protect confidentiality for participants. Though the focus groups were diverse in a variety of factors, the responses were elicited on Jamboard and so we were unable to match responses to individual participants. Also, the participants responded to advertisements, and results may therefore be subject to selection bias. Additionally, our results represent the faculty from a single institution, and may not generalize to other academic medical centers.

Though wellness offerings exist, this study examined faculty's perceptions amidst current wellness resources to identify unmet needs, gaps in resources, and barriers to access at our academic medical center. Future studies are necessary to consider a programmatic, multilevel approach to addressing faculty wellness at both the individual and organizational levels.

Footnotes

Acknowledgements

The authors wish to thank Dr Edward Healton, Dr Elliott Crooke, Karen Walters, Dr Aviad Haramati, and the Wellness Task Force members: Dr Jessica Ailani, Dr Edwina Coleman, Dr Diane Davis, Dr Ming-Jung Ho, Dr Neal Horen, Dr Jagmeet Kanwal, Dr LaTasha Seliby Perkins

ORCID iD

Anjali Gupta

Ethical approval

This data was acquired as a quality improvement initiative and was thus deemed exempt by the Georgetown IRB (#00004877) on February 25, 2022.

Informed Consent: Not applicable

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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