Twenty-five years after the quality movement changed the culture of medicine forever, a new movement is taking shape around physician well-being.
At the center of these efforts are chief wellness officers (CWOs), senior-level hospital leaders tasked with monitoring the professional well-being of the workforce and scrutinizing the work conditions that can contribute to burnout and the loss of professional fulfillment.
“Many people think that the role is focused on teaching people mindfulness-based stress reduction or resilience training, or physician-heal-thyself messages. That’s not at all what it is,” said Tait Shanafelt, MD, a hematologist-oncologist and associate dean at Stanford School of Medicine in California, who was the first health care CWO in the country.
“The health care CWO is very much focused on the work environment, the systems, the workflows, the leadership behaviors, whether people have voice and agency in organizational decision-making. We are addressing the pain points like electronic health record (EHR)-related work burden, suboptimal teamwork, and staffing issues,” he said.
Surveys suggest that physicians — and hematologists and oncologists in particular — are experiencing an increase in burnout. A survey of 328 oncologists conducted in 2023 found that 59% had symptoms of burnout, with 57% reporting high levels of emotional exhaustion and 34% showing high levels of depersonalization. This is a significant increase over 2013, when 45% of oncologists reported experiencing burnout, and levels of emotional exhaustion and depersonalization were 38% and 25%, respectively.1,2
Similarly, a survey of 411 hematologists and oncologists conducted in 2019 found that more than a third reported burnout, with 12% reporting a high level of burnout. Physicians whose compensation was based solely on relative value unit generation were more likely to experience high levels of burnout in both academic and community practice settings, the study found.3
ASH Clinical News spoke with CWOs and experts on physician well-being to find out what initiatives are underway to address burnout, how these efforts are being measured, and whether the focus on well-being is likely to continue in the face of financial cutbacks in health care.
Emergence of the CWO
CWOs have been around at large companies outside health care for years. These positions have traditionally been human resources–type roles promoting yoga and mindfulness, smoking cessation, and a healthy lifestyle. The difference, Dr. Shanafelt said, is that most of those efforts focused on “healthy living” aimed at reducing health insurance costs for employers. In contrast, the health care CWO is focused on addressing the characteristics of the practice and work environment that drive occupational burnout in the health care workforce.
The first health care CWOs were appointed by vanguard organizations in 2017, before the COVID-19 pandemic. But COVID-19 expanded awareness of the pressures health care workers faced, the consequences of burnout, and the need for organizational action. The death of emergency medicine physician Lorna Breen, MD, by suicide in 2020 expanded the national conversation about the working conditions of physicians and the culture of silence around mental health problems.4
“During the pandemic, all organizations wrestled with workforce challenges. In many cases, they had limited ability to fully staff their hospitals and care for patients,” Dr. Shanafelt said. “It quickly became apparent how foundational the well-being of the workforce was to organizations’ abilities to care for patients.”
The first CWOs built the role, said Stefanie Simmons, MD, an emergency medicine physician and chief medical officer for the Dr. Lorna Breen Heroes’ Foundation. “People started doing the work in this field because of the perceived need,” she said. “They were looking at the people around them and saying, ‘My colleagues are suffering, they’re struggling. There has to be a better way to do this.’”
A successful CWO role needs to be built around the correct understanding of the systemic drivers of professional well-being, not simply out of a desire for a more resilient workforce, Dr. Simmons said. Mental health and peer support programs are valuable, but they need to be coupled with an understanding of the drivers of burnout, including administrative burden, poor leadership culture, poor training of frontline leaders, and global factors that affect how health care is paid for and what health care workers need to do to get reimbursement.
“Health care workers are already some of the most resilient people out there, and if you just work at making them more resilient, that misses the systemic focus,” Dr. Simmons said.
Today, there are approximately 70 CWOs who meet a strict definition of the role, meaning that they are senior-level leaders with a staff and independent budget who devote at least half their time to the work. Data from the Joint Commission indicate that, at the beginning of 2022, about a quarter of health care organizations with 500-bed hospitals had appointed a CWO, and overall, about 10% of hospitals had someone in that role.5
“It’s staggering to me that one in four large health systems had a CWO by 2022 because none had one five years earlier,” Dr. Shanafelt said.
Measurement and Influence
One of those early CWOs is Jonathan Ripp, MD, MPH, CWO and dean for well-being and resilience at the Icahn School of Medicine at Mount Sinai in New York. For the most part, CWOs leverage their expertise in measurement to assess how different cohorts of employees are doing, using well-established survey-based instruments that measure job satisfaction and indicators of burnout in various departments and roles, he said.
“Not only do we need to measure how well people are doing, but we need to understand the varying drivers that affect those well-being outcomes for a variety of constituents,” Dr. Ripp said. “And then we analyze those data and deliver them to the local representatives who oversee a given cohort.”
Dr. Ripp and his team then work with the local champions on specific improvement projects aimed at optimizing well-being and mitigating burnout. “Much like with quality work, the hope is the summation of lots of local-level well-being work will lead to global improvement across an organization,” he said.
The CWO also works on systemwide changes that have the potential to benefit all workers in the system. In addition to coordinating more than 100 different unit-level improvement initiatives over the last several years, Dr. Shanafelt said he’s also been involved in numerous system-level projects, including efforts to reduce EHR inbox burden, efforts to enhance support for lactating health care workers, and prevention and support efforts to address verbal abuse and harassment of health care workers by patients’ families and visitors.
Another key part of the CWO’s role is influence, building relationships with other senior operational leaders like the chief medical officer, chief operating officer, chief quality officer, chief medical information officer, or the health IT teams, Dr. Shanafelt said. The CWO is at the table for important organizational decisions to represent the voice of physicians, advanced practice providers, nurses, and the entirety of the clinical workforce.
“We wouldn’t make any major organizational decision without having the chief financial officer providing input on finances or the patient experience people providing perspective on what it means for patients,” Dr. Shanafelt said. “The involvement of the CWO ensures the well-being of the workforce is considered and helps shape such decisions.”
Canary in the Coal Mine
Heather Farley, MD, MHCDS, the chief well-being officer at the Medical University of South Carolina in Charleston, favors the three-pronged approach to well-being work that includes personal well-being, a culture of well-being, and efficiency of the workplace. She likens the issue of clinician well-being to the well-known analogy of the canary in the coal mine.
“You can’t take the canary out of the coal mine, teach it to be more resilient, and then shove it back in the same coal mine and expect it to survive. You’ve got to actually change the coal mine,” Dr. Farley said. “Health systems have been very well meaning and had great intentions of improving and supporting the well-being of the workforce, focusing on the personal resilience component, but we really need to attend to that coal mine and to the environment around our health care workforce.”
The U.S. Surgeon General’s framework for workplace mental health and well-being provides a great starting point for creating a good workplace culture, Dr. Farley said. That report defines the culture of well-being as a place where employees feel like they have a voice and can influence their work environment, are protected from physical and psychological harm, feel like their work matters, and have a sense of connection with coworkers.6
Dr. Farley said the culture piece can be the hardest to change, but it’s the efficiency of work component — the administrative burdens and hassles — that many clinicians would like to see addressed more often.
Reducing Practice Pain Points
It is the work component that is squeezing hematologists and oncologists, said Kenneth Adler, MD, an attending hematologist at Morristown Medical Center in New Jersey and a member of the American Society of Hematology Committee on Practice. While the use of scribes was meant to offset the documentation burden of the EHR, it fell short because scribes can’t handle preauthorization requests and phone calls to benefit managers. The recent proliferation of patient portals has required physicians to be available 24/7, and hematologists, who order many labs, are constantly hearing from patients who receive results through the portal, he said.
A recent analysis of EHR metadata for U.S. oncology physicians found that the message volume in the EHR inbox rose 19% for oncologists between July 2019 and April 2022, patient-initiated messages rose 34%, and EHR time increased 16%. When looking at the various oncology subspecialties, medical oncologist-hematologists had the highest inbox volume, patient-message volume, and EHR time.7
“In hematology, where there’s such high levels of acuity, it’s just really wearing people down,” Dr. Adler said.
Dr. Ripp and his team identified the same problem with physicians being overwhelmed by patient portal messages, many of which were about rescheduling appointments or billing issues that are unrelated to the physician’s responsibilities. The Mount Sinai team created pools of employees to manage the non-clinical questions coming through the patient portals.
“We realized we could divert a lot of those messages away from the physician, decrease the amount of time they were spending answering those messages, and basically decrease the clerical and administrative burden over the course of the day,” he said.
They piloted the pool approach in a single practice, and it was effective, so they have rolled it out across most of the ambulatory practices in the system. The change has helped to decrease the time physicians spend on EHRs outside the workday, but it won’t necessarily translate into a global improvement on well-being, Dr. Ripp said, because there may be other factors — personal and professional — that influence overall well-being.
“It can sometimes be one of the challenges of our work that we can improve a single driver, but we don’t always see improvement on the global well-being outcome,” he said.
Metrics of Success
One of the challenges for CWOs is figuring out how to measure success. Burnout, which includes emotional exhaustion and depersonalization, is an important metric but not the only one worth measuring, Dr. Ripp said. At Mount Sinai, they also consider the flip side of burnout: measurements of professional fulfillment. Additionally, they evaluate mental health outcomes like anxiety and depression to try to create a global picture of how the health care workforce is faring.
Burnout and turnover are lagging indicators, meaning it can take years to show an impact, Dr. Farley said. Measuring leading indicators — such as a clinician’s sense of belonging or psychological safety — can be more helpful for identifying problems and focusing improvement efforts.
It’s also important to separate organizational performance metrics from the assessment of the effectiveness of the CWO and the wellness team, Dr. Shanafelt said. Professional fulfillment, burnout, values alignment, leader behavior scores, and practice efficiency are metrics for the whole organization that must be owned by every senior leader. The CWO and their team are accountable for creating a strategy to drive improvement, engaging leaders around the organization, providing guidance regarding evidence-informed interventions, and performing assessments to ensure that everyone is making progress.
Organizational Motivators
There is evidence to show that making an investment in the well-being of the health care workforce will yield a financial return by improving retention and decreasing turnover, and there are even some models that have linked well-being to productivity, Dr. Ripp said. There’s also a case to be made that well-being can translate into an improved patient experience and even fewer malpractice claims.
“There are plenty of arguments that could be made. They may or may not resonate with the leaders who you’re asking to invest in the program because health care is a profession that is priority rich,” Dr. Ripp said. “There are many things that need to be attended to.”
Other organizations may see an ethical case for well-being work, or they see it as having a reputational advantage by improving their standing with prospective employees and outside groups. “For different organizations, the driving force for why they are making this investment may be different, but there are several clear motivators,” Dr. Farley said.
Post-COVID Well-Being Push
A shaky economy and rising costs could put some of the progress of the clinician well-being movement at risk.
“We’re at a juncture where there’s been a lot of attention to the well-being of the health care workforce, but I don’t think we’ve really figured out how to ensure that it remains integrated as a priority,” Dr. Ripp said.
Dr. Adler said he sees many well-being efforts being phased out as health care moves into the post-COVID-19 era, especially at smaller hospital systems. And even when there are CWOs or other well-being leaders in an organization, there isn’t always awareness at the physician level.
“It’s disappointing. People in health were being applauded for the courage they showed during COVID,” he said. “Nurses and doctors are still struggling, but to be honest, it’s being ignored by these health systems.”
Dr. Shanafelt said he has heard from colleagues about their funding being scaled back due to tight budgets. But he is encouraged that health systems aren’t eliminating their programs entirely and that the cuts are being made equally to other parts of the system. Many of the most important actions of CWOs are not expensive programs but influencing other organizational initiatives and making sure the clinicians’ voice is heard when it comes to organizational decisions.
“The economic realities in health care are going to affect all organizational initiatives, and efforts to improve workforce well-being won’t be immune. Despite that, the importance of workforce well-being is now entrenched as a core value at many leading organizations, and the work will continue,” he said.
Not all organizations are big enough or well-resourced enough to hire a CWO and build a team around them. In those cases, the well-being work can be shared between chief medical and nursing officers, human resource officers, and other clinical leadership, Dr. Simmons said. For instance, hospitals can ensure that there are a variety of ways that health care workers can voice concerns to leadership.
Overall, Dr. Shanafelt is optimistic about the future of clinician well-being efforts. “I think we’ve reached critical mass. The evidence that clinician well-being affects quality of care, patient experience, and the cost of care is overwhelming, and more and more organizations are seeing the value and importance of addressing this domain. Like the quality movement, there were early adopters and there were skeptics. As the early adopters started to have success, others said, ‘It’s working; let’s follow the path that they’re creating.’”
References
- Schenkel C, Levit LA, Kirkwood K, et al. State of professional well-being, satisfaction, and career plans among US oncologists in 2023. JCO Oncol Adv. 2025;2(1):e2400010.
- Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014;32(7):678-686.
- Lee AI, Masselink LE, De Castro LM, et al. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv. 2023;7(13):3058-3068.
- Knoll C, Watkins A, Rothfeld M. “I couldn’t do anything”: the virus and an E.R. doctor’s suicide. New York Times. July 11, 2020. Accessed March 28, 2025. https://www.nytimes.com/2020/07/11/nyregion/lorna-breen-suicide-coronavirus.html.
- Longo BA, Schmaltz SP, Williams SC, et al. Clinician well-being assessment and interventions in Joint Commission-accredited hospitals and federally qualified health centers. Jt Comm J Qual Patient Saf. 2023;49(10):511-520.
- U.S. Surgeon General. U.S. Surgeon General’s framework for workplace mental health & well-being. 2022. Accessed March 28, 2025. https://www.hhs.gov/sites/default/files/workplace-mental-health-well-being.pdf.
- Holmgren AJ, Apathy NC, Crews J, et al. National trends in oncology specialists’ EHR inbox work, 2019-2022 [published online ahead of print, 2025 March 3]. J Natl Cancer Inst. doi: 10.1093/jnci/djaf052.
- Accreditation Council for Graduate Medical Education. Improving physician well-being, restoring meaning in medicine. Accessed March 28, 2025. https://www.acgme.org/education-and-resources/physician-well-being/.
- Lorna Breen Heroes’ Foundation. Remove barriers to mental health care for health workers. Accessed March 28, 2025. https://drlornabreen.org/removebarriers/.
