Promoting physician wellness: the development of a cognitive behavioral therapy intervention for endocrinologists

Abstract

Background: Physician burnout has reached critical levels, with endocrinologists especially affected with a rise in burnout symptoms from 35 to 47% between the years of 2018 and 2019. The purpose of this paper is to describe the development of a cognitive behavioral therapy (CBT) - oriented physician distress intervention for endocrinologists in an academic health setting. Methods: The intervention consisted of four monthly facilitated sessions conducted in 2019 and 2024. Topics included: 1) introduction to physician burnout and the CBT model; 2) communication with staff and introduction to cognitive distortions; 3) communication with patients and introduction to cognitive restructuring/positive psychology and behavioral self-care; and 4) work/life integration and addressing stress with behavioral strategies. The program was analyzed using mixed methodologies (quantitative and qualitative). Participants completed surveys at baseline and post-intervention, including the Maslach Burnout Inventory (MBI) for Healthcare Providers and the Diabetes Related Emotional Attitudes and Distress (DREAD) scale. Focus groups and key informant interviews were conducted in 2021 to gather qualitative feedback about the 2019 program. These interviews were coded for themes using a consensus methodology. Results: In 2019, 16 endocrinologists participated, with 81% completing three or more sessions. Baseline MBI scores indicated high levels of burnout (group mean total score 77.8, S.D. 13.7) which improved post-intervention (group mean 63.5, S.D. 13.4), with statistically significant reductions in MBI total scores (Wilcoxon signed rank test; p <.05). DREAD scores showed a non-significant reduction from baseline to post-intervention and exceeded national physician averages at both time points. Multiple themes were identified from qualitative interviews with a subset of 8 participants from the 2019 program. These included satisfaction with the program, value of social interaction and self-reflection, desire for structured assignments, positive role models for recovery and more programs in the future. In 2024, 10 participants enrolled in the revised program which included take home exercises and an expansion of topics, with 70% completing 3 or more sessions. Elevated MBI scores trended downward from baseline (mean = 76.7, S.D.=14.0), post-intervention (mean = 75.3, S.D.=9.1) to 3-month follow-up (mean = 70.5, S.D. = 6.9). Although the 6.2-point decrease in the mean total score was not statistically significant, a reduction of 1 point in MBI score has been linked to improved health outcomes. Participants reported high levels of satisfaction, improved well-being and willingness to recommend the program to others. Conclusions: Findings demonstrate high levels of engagement, improvement in domains of physician burnout and satisfaction in this CBT- oriented physician distress intervention. These data suggest that future development of this intervention is warranted.