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Anderson Spickard, Jr, MD; Steven G. Gabbe, MD; John F. Christensen, PhD

JAMA. 2002;288:1447-1450.

INTRODUCTION
A study of US physicians showed that physicians in 1997 were less satisfied in every aspect of their professional life than those asked similar questions in 1986. They were dissatisfied with the time they have with individual patients and their lack of incentives for high-quality care.¹ Similarly, a 1998 study revealed that two thirds of Canadian physicians have a workload they consider too heavy, and more than half stated their family and personal lives have suffered because they chose medicine as a profession.² Dissatisfaction has been documented in several diverse physician groups, including primary care,³ surgery,⁴ infectious disease specialists,⁵ and anesthesiologists.⁶ The leaders of medical school departments are exposed to similar pressures.⁷ These recent articles highlight the growing discontent of physicians with the increasing complexities of the practice of medicine. Burnout, a term that has moved from colloquial speech into the social and psychological vernacular, describes this phenomenon.

There is a growing awareness within medicine that physicians and other health care professionals are at risk for burnout, which threatens the sustainability of the health care enterprise. Preventing burnout by promoting the well-being of physicians has been the focus of several recent initiatives. The Western Journal of Medicine devoted its entire January 2001 issue to offer guidance in living positive and healthy lives.⁸ In addition, the Joint Commission on Accreditation of Healthcare Organizations has mandated that as of January 1, 2001, all hospitals have a process to address physician well-being, separate from disciplinary processes.⁹

We review the definition of burnout and its sources; examine the interaction of physician personality factors and the unique stressors they encounter in the workplace and at home; and highlight current resources for preventing burnout and promoting well-being in physicians and within their organizations.

Burnout Defined

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Burnout as a syndrome is present in many individuals under constant pressure.¹⁰ Physicians in particular are frequently overloaded with the demands of caring for sick patients within constraints of fewer organizational resources.¹¹ The symptoms and signs of burnout include emotional exhaustion, cynicism, and perceived clinical ineffectiveness, and a sense of depersonalization in relationships with coworkers, patients, or both. Burnout has been associated with impaired job performance and poor health, including headaches, sleep disturbances, irritability, marital difficulties, fatigue, hypertension, anxiety, depression, myocardial infarction, and may contribute to alcoholism and drug addiction.^12-14

Maslach and Leither¹⁰ describe burnout as the index of the dislocation between what people are doing vs what they are expected to do. Burnout represents a deterioration of values, dignity, spirit, and will. They describe this constellation as "an erosion of the soul." Burnout spreads gradually and continuously over time, sending people into a downward spiral from which it is hard to recover.¹⁰ Deterioration of physician well-being from excessive stress has been described as the silent anguish of the healers.¹⁵ The seeds of burnout may be sown in medical school and residency training, where fatigue and emotional exhaustion are often the norm.^16-18 By mid-career, the momentum of burnout is maintained by the subtle reinforcement of the esteem and recognition of one's peers for being a hard worker and placing service to others before self-care.

Research on burnout in the workplace reveals several common themes. The risk of burnout increases in individuals who consistently experience work overload and a perceived lack of control over the extent to which the load exceeds their capacity. Workers who are burned out find their work unrewarding, experience a breakdown in community, believe they are treated unfairly, and are confronted with conflicting values.¹⁰ These conflicts apply to many medical practice situations and may contribute to the general unrest in physicians worldwide.^{1, 19-21}

Symptoms of burnout can lead to physician error, and these errors can in turn contribute to burnout.²² Given the potential human costs of medical mistakes, the emotional impact of actual or perceived errors can be devastating for physicians.²³ Dissatisfaction and distress have significant costs not only for physicians and their families but for patients and health care organizations as well.²¹ One study estimated that the cost of replacing a primary care physician ranged from $236 383 for a family practitioner to $264 345 for a general pediatrician.²⁴

Child Development Factors

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

A longitudinal study of male physicians documented the important role of family backgrounds in the subsequent risk of maladjustment to professional life.¹² Those physicians with the least stable childhood and adolescence were at higher risk for unstable marriages, alcohol and drug use, and the need for psychotherapy. A stable childhood, as defined in this study, included good childhood health; father-child relation seemed warm, encouraging, and conducive both to autonomy and to self-esteem; a home atmosphere that was warm and cohesive; the child was close to at least one sibling; and did well in school both academically and athletically.¹²

Work Stressors

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

There is ample evidence that physicians are caught in a web of pressures including financial deficits, Medicare/Medicaid audits, concern over fraud and abuse, and malpractice suits in which they perceive little control.^{1, 7, 21, 25}

A study of factors that predict professional satisfaction, organizational commitment, and burnout among physicians working for the Kaiser system found that the single most important predictor for these outcomes was a sense of control over the practice environment.²⁶ Three additional factors—perceived work demands, social support from colleagues, and satisfication with resources—predicted these outcomes, which were also related to age and specialty.²⁶ Pediatricians were more satisfied and committed to the health maintenance organization and were less likely to manifest burnout. Older physicians had higher levels of satisfaction and commitment and lower reported levels of burnout.²⁶ Chairs of departments of obstetrics and gynecology were surveyed and reported that burnout decreased with age and the length of service as a chair.⁷ This same age trend was noted in a study of burnout among surgeons, as was the pivotal importance of perceived control and autonomy in one's practice.⁴ The influence of health care organizations on physician well-being has been reviewed, and external factors, such as payment reduction, regulation, and business practices of insurers, were found to contribute to physician stress.²⁷ Factors internal to the organization, such as styles of leadership and management, administrative policies and procedures, and organizational culture, also have powerful effects on physician well-being.²⁷ These observations emphasize that burnout may be as related to physicians' work environments as to their personality traits.

Personality Factors

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Certain personality traits may enhance the risk of burnout by influencing the individual's response to stressors in the workplace. Compulsiveness is a character trait found in many physicians and, although it may be adaptive behavior for the demands of medical education, it can also have an enormous detrimental impact on their professional, personal, and family lives. The compulsive triad of doubt, guilt feelings, and an exaggerated sense of responsibility has been well described.²⁸ Physicians with compulsiveness have chronic feelings of not doing enough, difficulty setting limits, hypertrophied guilt feelings that interfere with the healthy pursuit of pleasure, and the confusion of selfishness with healthy self-interest. A dissociation (diminishing awareness of one's physical and emotional needs) leads to a self-destructive pattern of overwork. A psychology of postponement takes root in which physicians habitually delay attending to their significant relationships and other sources of renewal until all the work is done or the next professional hurdle is achieved.²⁹ Osler noted this self-denying habit of physicians over a century ago when in an address to medical students, he warned:

Engrossed late and soon in professional cares . . . you may so lay waste that you may find, too late, with hearts given way, that there is no place in your habit-stricken souls for those gentler influences which make life worth living.³⁰

Family Stressors

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Marital problems and stresses in the family are causes of serious emotional and behavioral issues in physicians. Myers³² has summarized the relationship problems that can occur in physicians' marriages and urges physicians not to let the practice of medicine disrupt the marriage. A questionnaire to chairs of departments of obstetrics and gynecology revealed that a supportive spouse or partner was important to prevent burnout⁷; other studies have come to the same conclusion.³³

Female Physicians

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Female physicians face unique stressors. The number of women entering medicine continues to grow and in 1998 comprised 23% of all US practicing physicians. By 2010, it is expected that 30% of all physicians and 50% or more of all medical students will be women.³⁴ The Physician Worklife Study, a nationally representative random stratified sample of nearly 6000 physicians in primary and specialty nonsurgical care, assessed US physician burnout.³⁵ Female physicians were 60% more likely than male physicians to report signs or symptoms of burnout. The odds of burnout in women increased 12% to 15% for each additional 5 hours worked per week of more than 40 hours. Female physicians are also more likely to experience sexual harassment from colleagues, patients, or both. At home, female physicians tend to have responsibility for managment of domestic responsibilities and, if they have children, balance the role of mother with career demands.³⁶

Preventing Physician Burnout

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

The best prevention for physician burnout is to promote personal and professional well-being on all levels: physical, emotional, psychological, and spiritual. This must occur throughout the professional life cycle of physicians, from medical school through retirement. It is a challenge not only for individual physicians in their own lives but also for the profession of medicine and the organizations in which physicians work.

The Role of Health Care Organizations

Yamey and Wilkes³⁷ have suggested that the majority of organized medicine's experience with physician health and function has been from work with impaired physicians. As a result, we know much about physicians' disease and despair, their substance misuse, burnout, and dysfunctional relationships but very little about what keeps them feeling well.³⁷

Two key themes that run throughout the Western Journal of Medicine's issue⁸ on physician well-being are the ability of physicians to influence their own happiness through personal values and choices, and the need for some control over their workplace. Physician groups, national associations, and management groups should address these important themes of physician well-being. The Canadian Medical Association adopted a policy, which outlines strategies and recommendations that address a range of health and well-being issues and is generally applicable to all physicians.^38-39

Health care organizations have an economic stake in physician well-being. Workers who are satisfied tend to be more productive.⁴⁰ There is evidence that the well-being of physicians is related to patient satisfaction, a key outcome variable tracked by most organizations.⁴¹ The satisfaction of physicians in an organization will enhance recruitment and retention of staff, saving the enormous cost of staff and physician turnover.^{21, 24, 42-43} Physician well-being prevents burnout and the less frequent but significant problem of physician impairment.^44-45 Furthermore, attention to well-being promotes patient safety and reduces the probability of errors,^{18, 46} thereby diminishing the threat of malpractice litigation.²² It is also expected that satisfied physicians will optimize their utilization patterns. Health system administrators and managers are beginning to study the extent of physician burnout in their settings as a precursor to recommending meaningful organizational changes.^{28, 47-48}

Specific suggestions for health care organizations to promote physician well-being include measurement of intrinsic values, such as the extent to which physicians experience a sense of meaning in their work, in addition to extrinsic values such as productivity; establishment of a physician health committee that has equal status with quality assurance and other committees, whose function is to review corporate decisions and contracts for their impact on physician wellness and measure physician well-being as an outcome; establishment of a mentor program, in which senior physicians guide and support junior members in their career development and in balancing their personal and professional lives; provision of confidential support groups that meet monthly on a voluntary basis with group-generated topics and facilitation by an outside professional; provision of an annual well-being retreat on company time; provision of membership in a fitness center; contractual requirements that all physicians have their own primary care physician; a sabbatical program linked to productivity incentives; provision of periodic continuing medical education programs on various topics related to well-being; flexible scheduling to allow time off for critical family events such as births, deaths, graduations, caring for aging parents, and leaves of absence to pursue travel and avocational interests; paperwork reduction; involvement of physicians in the design and management of their practice environments; and inclusion of questions about physician health and well-being in board certification and recertification examinations.

The Role of Physicians

Weiner et al⁴⁹ studied the methods used by 130 primary care physicians to promote their own well-being. The 6 main practices found were spending time with family and friends, religious or spiritual activity, self-care, finding meaning in work, setting limits at work, and adopting a healthy philosophical outlook, such as being positive or focusing on success.⁴⁹ These data are consistent with the predictors of happiness identified through positive psychology, the discipline that seeks to measure and understand, and then build human strengths and civic virtues.⁵⁰ Ryff and Singer⁵¹ provide an excellent summary of the factors that promote positive psychological functioning: self-acceptance, positive relations with others, autonomy (self-determination and internal locus of self-evaluation), environmental mastery (choosing or creating environments suitable to one's physical conditions), purpose in life, and personal growth (continuing to develop one's potential). Strategies to prevent physician burnout are listed in the BOX.

Box. Strategies to Prevent Physician Burnout Personal Influence happiness through personal values and choices Spending time with family and friends Religious or spiritual activity Self-care (nutrition, exercise) Adopting a healthy philosophical outlook A supportive spouse or partner Work Control over environment: workload Finding meaning in work and setting limits Having a mentor Having adequate administrative support systems RETURN TO TEXT

Personal growth and renewal involve not only the time outside of work (evenings, weekends, or vacations). Comprehensive, sustainable renewal is possible in all spheres of physicians' lives—patient encounters, paperwork, surgery, meetings, research, traveling to and from work, family life, travel, and hobbies. What is required for this renewal is a new way of thinking about one's personal energy—that work is not merely a domain of energy expenditure but also of energy renewal. Physicians can learn to receive support, healing, and meaning while giving of themselves in each activity of the day.^52-53 This awareness of oneself as a locus of energy exchange can be promoted by simple but powerful practices such as mindfulness,^54-56 which involves being fully present and attentive to the moment, to the person, and to the task at hand.

Conclusion

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Burnout is characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. Preventing burnout, a responsibility of all physicians and of the health care systems and organizations in which they work, entails the explicit promotion of physician well-being. Physicians must be guided from the earliest years of training to cultivate methods of personal renewal,⁵⁷ emotional self-awareness,⁵⁸ connection with social support systems,⁵⁹ and a sense of mastery and meaning in their work.⁶⁰ Maintaining these values is the work of a lifetime. It is not incidental to medicine but is at the core of the deepest values of the profession to first, do no harm. Doing no harm begins with one's self.

AUTHOR INFORMATION

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

Corresponding Author and Reprints: Anderson Spickard, Jr, MD, The Center for Professional Health, 1107 Oxford House, Nashville, TN 37232-4300 (e-mail: Anderson.Spickard-Jr{at}vanderbilt.edu).

Author Affilliations: Vanderbilt University Medical Center, Nashville, Tenn (Drs Spickard and Gabbe); and Legacy Health System, Portland, Ore (Dr Christensen).

REFERENCES

Jump to Section  • Top  • Introduction  • Burnout defined  • Child development factors  • Work stressors  • Personality factors  • Family stressors  • Female physicians  • Preventing physician burnout  • Conclusion  • Author information  • References

1. Murray A, Montgomery JE, Chang H, et al. Doctor discontent: a comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:452-459. FULL TEXT | PUBMED 2. Sullivan P, Buske L. Results for CMA's huge 1998 physician survey point to a dispirited profession. CMAJ. 1998;159:525-528. ABSTRACT 3. Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction. J Gen Intern Med. 2000;15:441-450. FULL TEXT | ISI | PUBMED 4. Campbell DA, Sonnad SS, Eckhauser FE, et al. Burnout among American surgeons. Surgery. 2001;130:696-705. FULL TEXT | ISI | PUBMED 5. Deckard GJ, Hicks LL, Hamory BH. The occurrence and distribution of burnout among infectious disease physicians. J Infect Dis. 1992;165:224-228. ISI | PUBMED 6. Jackson SH. The role of stress in anesthetists' health and well-being. Acta Anaesthesiol Scand. 1999;43:583-602. FULL TEXT | ISI | PUBMED 7. Gabbe S, Melville J, Mandel L, Walker E. Burnout in chairs of obstetrics and gyneocology. Am J Obstet Gynecol. 2002;186:601-612. FULL TEXT | ISI | PUBMED 8. WJM online. Available at: http://www.ewjm.com/content/vol174/issue1/. Accessibility verified July 23, 2002. 9. Revisions to Selected Medical Staff Standards. Physician health. Available at: http://www.jcaho.org/. Accessed October 30, 2001. 10. Maslach C, Leither MP. The Truth About Burnout. San Fransisco, Calif: Josey-Bass Publishers; 1997:13-15. 11. McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med. 1982;306:458-463. ISI | PUBMED 12. Vaillant GE, Sobowale NC, McArthur C. Some psychologic vulnerabilities of physicians. N Engl J Med. 1972;287:372-375. ISI | PUBMED 13. Gundersen L. Physician burnout. Ann Intern Med. 2001;135:145-148. FREE FULL TEXT 14. O'Connor PG, Spickard A Jr. Physician impairment by substance abuse. Med Clin North Am. 1997;81:1037-1052. FULL TEXT | ISI | PUBMED 15. Neuwirth ZE. The silent anguish of the healers. Newsweek. 1999;134:79. PUBMED 16. Stress and impairment during residency training: strategies for reduction, identification,and management, Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med. 1988;109:154-161. FREE FULL TEXT 17. Yao DC, Wright SM. National survey of internal medicine residency program directors regarding problem residents. JAMA. 2000;284:1099-1104. FREE FULL TEXT 18. Shanafelt TD, Bradley KA, Wipf JE, Back AC. Burnout and self-reported patient care in internal medicine residency programs. Ann Intern Med. 2002;136:358-367. FREE FULL TEXT 19. Linn LS, Yager J, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA. 1985;254:2775-2782. FREE FULL TEXT 20. Kmietowicz Z. Quarter of GPs want to quit, BMA survey shows. BMJ. 2001;323:887. FREE FULL TEXT 21. Williams ES, Konrad TR, Scheckler DP. Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Health Care Manage Rev. 2001;26:7-19. ISI | PUBMED 22. Crane M. Why burned-out doctors get sued more often. Med Econ. 1998;75:210-218. PUBMED 23. Christensen JF, Levinson W, Dunn PM. The heart of darkness: the impact of perceived mistakes on physicians. J Gen Intern Med. 1992;7:424-431. ISI | PUBMED 24. Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5:1431-1438. ISI | PUBMED 25. Arnetz BB. Psychological challenges facing physicians of today. Soc Sci Med. 2001;52:203-213. FULL TEXT | ISI | PUBMED 26. Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med. 2001;174:13-18. FULL TEXT | ISI | PUBMED 27. Suchman AL. The influence of health care organizations on well-being. West J Med. 2001;174:43-47. FULL TEXT | ISI | PUBMED 28. Gabbard GO. The role of compulsiveness in the normal physician. JAMA. 1985;254:2926-2929. FREE FULL TEXT 29. Gabbard GO, Menninger RW. The psychology of postponement in the medical marriage. JAMA. 1989;261:2378-2381. FREE FULL TEXT 30. Osler W. Address to students of the Albany Medical College, February 1, 1899. Albany Med Ann. 1899;20:307-309. 31. Spickard A Jr, Dodd D, Swiggart W, et al. Physicians who misprescribe controlled substances. Fed Bull. 1998;85:8-19. 32. Myers M. Medical Marriages: A Look at the Problems and Their Solutions. New York, NY: Plenum Medical Book Co; 1994. 33. Warde CE, Moonsinghe K, Allen W, Gelberg L. Marital and parental satisfaction of married physicians with children. J Gen Intern Med. 1999;14:157-165. PUBMED 34. American Medical Women's Association. Available at: http://www.amwa-doc.org/. Accessed July 31, 2002. 35. McMurray JE, Linzer M, Konrad TR, et al. The work lives of women physicians. J Gen Intern Med. 2000;15:372-380. ISI | PUBMED 36. Gautam M. Women in medicine: stresses and solutions. West J Med. 2001;174:37-41. FULL TEXT | ISI | PUBMED 37. Yamey G, Wilkes M. Promoting wellbeing among doctors. BMJ. 2001;322:252-253. FREE FULL TEXT 38. Physician health and well being—CMA Board of Directors. CMAJ. 1998;158:1191-1195. PUBMED 39. Puddester D. The Canadian Medical Association's policy on physician health and well-being. West J Med. 2001;174:5-7. FULL TEXT | ISI | PUBMED 40. Baruch-Feldman C, Brondolo E, Ben-Dayan D, Schwartz J. Sources of social support and burnout, job satisfaction, and productivity. J Occup Health Psychol. 2002;7:84-93. FULL TEXT | PUBMED 41. Haas JS, Cook EF, Puopolo AL, et al. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122-128. FULL TEXT | ISI | PUBMED 42. Crouse BJ. Recruitment and retention of family physicians. Minn Med. 1995;78:29-32. PUBMED 43. Doan-Wiggins L, Zun L, Cooper MA, et al. Practice satisfaction, occupational stress, and attrition of emergency physicians. Acad Emerg Med. 1995;2:556-563. ISI | PUBMED 44. Johnson JV, Hall EM, Ford DE, et al. The psychosocial work environment of physicians. J Occup Environ Med. 1995;37:1151-1159. FULL TEXT | ISI | PUBMED 45. Whitley TW, Allison EJ Jr, Gallery ME, et al. Work-related stress and depression among practicing emergency physicians. Ann Emerg Med. 1994;23:1068-1071. ISI | PUBMED 46. Firth-Cozens J, Greenhalgh J. Doctors' perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017-1022. FULL TEXT | ISI | PUBMED 47. Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: recommendations for HMO managers. HMO Pract. 1994;8:58-63. PUBMED 48. Hirsch G. Physician career management: organizational strategies for the 21st century. Physician Exec. 1999;25:30-35. PUBMED 49. Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physician's own wellness promotion practices. West J Med. 2001;174:19-23. FULL TEXT | ISI | PUBMED 50. Satterfield JM. Happiness, excellence and optimal functioning: review of a special issue of the American Psychologist (2000;55:5-183), Martin E P Seligman and Mihaly Csikszentmihalyi, guest editors. West J Med. 2001;174:26-29. FULL TEXT | ISI | PUBMED 51. Ryff CD, Singer B. Psychological well-being: meaning, measurement, and implications for psychotherapy research. Psychother Psychosom. 1996;65:14-23. ISI | PUBMED 52. McPhee SJ. Letter from the Abbey. West J Med. 2001;174:75-76. FULL TEXT | ISI | PUBMED 53. Christensen JB. Spirituality in everyday life. West J Med. 2001;174:75-76. FULL TEXT | ISI | PUBMED 54. Epstein RM. Mindful practice. JAMA. 1999;282:833-839. FREE FULL TEXT 55. Epstein RM. Just being. West J Med. 2001;174:63-65. FULL TEXT | ISI | PUBMED 56. Christensen JF. Renewal in the present moment. Medical Encounter. 2002;16:20-24. 57. Gardner JW. Personal renewal. West J Med. 1992;157:457-459. ISI | PUBMED 58. Novack DH, Suchman AL, Clark W, et al. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997;278:502-509. FREE FULL TEXT 59. Myers DG. The funds, friends, and faith of happy people. Am Psychol. 2000;55:56-67. FULL TEXT | PUBMED 60. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55:68-78. FULL TEXT | PUBMED

Contempo Updates Section Editor: Janet M. Torpy, MD, Contributing Editor.

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