Physician Wellness and Turnover at Stanford Hospitals

Approximately 10 % (n = 249) of physicians credentialed at one or both of two Stanford affiliated hospitals were randomly selected from the medical staff and offered a $25 gift certificate to complete the Physician Wellness Survey, of which 162 (65% response rate) did so. In addition to the random sample, 669 (31% response rate) of the remaining 2135 medical staff members from both hospitals completed the subsequent survey of all physicians. All medical staff - including both employed and non-employed (adjunct) faculty (2135) as well as community physicians (249) - were invited to participate in this survey (2135 + 249 = 2384). The overall response rate for this survey was 34.9% ([162 + 669]/2384). Scores on survey measures from the two samples did not differ significantly. For this analysis, we included faculty physicians employed by Stanford University from both samples who consented to retention of their e-mail address, which enabled us to link their survey responses across time and to other data (Fig. 1, n = 472).Fig. 1

Study flow Diagram

The Physician Wellness Survey included previously developed and validated measures to assess self-reported burnout [25 (link)–27 (link)] and intent to leave [23 (link), 32 (link), 33 (link)]. We used the NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Forms to assess sleep-related impairment [34 (link)], depression, and anxiety [35 (link), 36 (link)]. Sleep-related impairment scores range from a minimum of 8 to maximum of 40, and anxiety and depression scores each range from 4 to 20. The NIH PROMIS guidelines can be used to identify T-scores that correspond to raw scores of each scale. T-scores of 50 or higher (with a standard deviation of 10) in these instruments are more likely to represent people with poorer health than the general population [37 –39 ]. Turnover data in 2015 was compiled by a third party custodian of the data using the medical staff directory. The cost of recruitment and start-up costs for new faculty hires was provided by the Stanford School of Medicine Chief Financial Officer.