The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists.

OBJECTIVE: This study assesses the association between calling and physician well-being, clinical commitment, and burnout. METHODS: In 2009-2010, a survey was mailed to 1504 primary care physicians (PCPs) and 512 psychiatrists drawn from the American Medical Association Physician Masterfile. The primary independent variable was a single-item measure that assessed physicians' level of calling. Main outcomes were markers of physician well-being (career satisfaction and morale), clinical commitment (intentions to reduce time spent in direct patient care, leave practice in a few years), and experiences of burnout. RESULTS: Adjusted response rates were 63 % (896/1427) for PCPs and 64 % (312/487) for psychiatrists. Forty-two percent of US PCPs and psychiatrists agree strongly that their practice of medicine is a calling. Physicians with a high sense of calling were less likely than those with low to report regret in choosing medicine as a career (18 vs. 38 %; odds ratio 0.3; 95 % confidence interval, 0.2-0.5), wanting to go into a different clinical specialty (28 vs. 49 %; OR 0.4; 95 % CI, 0.2-0.6), or wanting to leave the practice of medicine in the next few years (14 vs. 25 %, OR 0.4; 95 % CI 0.2-0.7). Physicians with a high sense of calling were less likely to report burnout (17 vs. 31 % low calling, OR 0.4; 95 % CI 0.3 to 0.7). CONCLUSIONS: Physicians who reported that medicine was a calling may be experiencing higher levels of career satisfaction, more durable clinical commitments, and resilience from burnout. Though physicians may differ on their understanding of the concept of calling in medicine, this study highlights an important factor that should be investigated further when assessing long-term workforce retention in the fields of primary care and psychiatry.

Pairing motivational interviewing with a nutrition and physical activity assessment and counseling tool in pediatric clinical practice: a pilot study.

BACKGROUND: Recommendations to screen and counsel for lifestyle behaviors can be challenging to implement during well-child visits in the primary care setting. A practice intervention was piloted using the Family Nutrition and Physical Activity (FNPA) Screening Tool paired with a motivational interviewing (MI)-based counseling tool during well-child visits. Acceptability and feasibility of this intervention were assessed. Its impact on parent-reported obesigenic behavior change and provider efficacy in lifestyle counseling were also examined. METHODS: This was an observational study in a pediatric primary care office. During well-child visits of 100 patients (ages 4-16 years), the FNPA tool was implemented and providers counseled patients in an MI-consistent manner based on its results. Duration of implementation, patient satisfaction of the intervention, and success of stated lifestyle goals were measured. Provider self-efficacy and acceptability were also surveyed. RESULTS: The FNPA assessment was efficient to administer, requiring minutes to complete and score. Patient acceptability was high, ranging from 4.0 to 4.8 on a 5-point scale. Provider acceptability was good, with the exception of duration of counseling; self-efficacy in assessing patient "readiness for change" was improved. Parent-reported success of primary lifestyle goal was 68% at 1 month and 46% at 6 months. CONCLUSIONS: The FNPA assessment with an MI-based counseling tool shows promise as an approach to identify and address obesigenic behaviors during pediatric well-child visits. It has the potential to improve provider efficacy in obesity prevention and also influence patient health behaviors, which can possibly impact childhood excessive weight gain. After refinement, this practice intervention will be used in a larger trial.