Mindfulness: Impact and Place in Physician’s Well-being

Healthcare is a complex segment comprising stakeholders across the value chain, working within the premises of an ever-changing regulatory framework to ensure compliance with the standards and better patient care. Although technology has simplified the regulations and prescription monitoring electronically, the sizable increase in the population and co-morbid conditions has further complicated the healthcare system, necessitating extensive reforms. ¹ These reforms are of utmost importance as the complexities that continue to increase in the system at an alarming pace affect the physician’s daily work schedule and their health, including psychological health, as they are at the focal point of patient care. The process of getting operations centralized would result in simplifying tasks and managing volume, thereby impacting improvement in the overall well-being of physicians with respect to other fields.^2,3

Evidence has clearly demonstrated that physicians often experience high patient loads, extended daily working hours (88 hours/week), ⁴ and an increasing burden from administrative tasks, mostly documentation-related and cognitive duties, which are all significant contributors to physician burnout. Organizing practice sessions and training sessions among physicians to better reorganize their work schedules brings proactiveness among physicians. However, it can add a financial burden to the system, which, in the current context, is difficult to bear, and this ultimately can destabilize the physician workforce. ⁵ Further, it makes physicians more susceptible to stress and burnout, compromising their ability to provide quality care and their overall well-being. ⁶

The precise onset and the detection of burnout among physicians make it a significant concern. When it comes to India, it is of great concern as the physician–patient ratio is one of the largest in the world. Hence, timely detection and management should be in place to avoid burnout among physicians. Efforts on prevention strategies should be made for physicians’ continued well-being toward patient care. ⁷ An Indian epidemiological study showed that 45% of physicians recorded high emotional exhaustion, 66% of physicians recorded high depersonalization, 87% of physicians showed low accomplishments, and 11% of physicians demonstrated low satisfaction. ⁸ These findings are consistent with the studies from USA, Canada, and 13 European countries as a part of an EGPRN study group followed by Spanish-speaking Latin American countries. ⁹

Globally, physician wellness and burnout have gained attention in recent years. Efforts and measures were put in place to manage or prevent burnout, along with strategic solutions for addressing burnout and maintaining their well-being along with standard of care. Although several interventions have been identified, research has shown that neither of the single interventions proved to be effective, thereby the emergence of a comprehensive toolkit addressing burnout. This kind of holistic approach rectifies an individual’s social behavior and mental health and creates positive effects within the organizational environment, leading to the improvement and well-being of physicians. Except for a few cross-sectional studies limited to tertiary care hospitals, data from India is limited.

This viewpoint endeavors to suggest a customized solution from the comprehensive toolkit derived from global research information that proves to be useful in managing burnout, improving emotional balance, and controlling work-related stress, exhaustion, and cynicism among physicians, leading to an increase in efficiency of diagnosis, productivity, better quality of life (QoL) for them as well as to patients. ¹⁰

Discussion

Despite being well aware of the consequences of burnout, physicians continue to experience it. Clinical evidence has emphasized the existence of antiquated and inept systems that would allow physicians to conduct consultations outside of their allotted hours, which are numerous but brief. This would compromise the diagnosis at the direction of the organizational leadership, causing physicians to become unhappy and emotionally distressed. ¹¹ Furthermore, physicians must perform additional duties such as administrative work, updating patient data in electronic records, bureaucratic work, and complex patient work with high expectations while managing stress due to this extra work with uninterrupted patient services. This demonstrates the physician’s dedication, moral principles, and passion for the field at the expense of internal disruption in the form of stress, precipitating burnout.

To combat physician burnout, organizations must bring in innovation from time to time, like introducing flexible hours for working, improving compensation, fixing the daily consultation hour schedule with a fixed number of consultations to be completed, followed by respect among colleagues and other cross-functional colleagues, consistent recognition/appreciation and finally adding support staff for undertaking the clerical, data entry, and follow-up works of physicians, thereby offering sufficient time to physicians toward completion of their consultation work toward leading a stress-free QoL. ¹²

Studies assessing the triggering factors for stress and burnout among physicians indicated that there was a noticeable amount of paperwork, test report waiting time, and rigid regulations. In contrast, the strategies to overcome strongly keeping physicians out of this challenge seemed to be focusing on the consumption of nutritious diets, especially Mediterranean diets, developing mindful eating habits, supportive policies and systems in place, spending time with family and friends, and attending Continuing Medical Educations (CMEs) while restricting the number of consultations. ¹³ Studies and systematic reviews specified the introduction of mindfulness modules based on the severity of burnout for physicians addressing their specific needs and wants. The current evidence indicates strategies to manage physician burnout with the implementation of a comprehensive professional training toolkit consisting of mindfulness for stress reduction and to regain focus, connected along with other interventions like cognitive behavioral therapy (CBT), group activities, work-hour limitations as per the recommendations of Accreditation Council for Graduate Medical Education (ACGME) among physicians helped to reduce burnout and increase their productivity in the hospitals. ¹⁴ A systematic review consisting of 12 randomized controlled trials (RCTs) from the USA, UK, and Netherlands further reiterated the effectiveness of various types of interventions from the comprehensive toolkit like behavioral interventions and psychological interventions consisting of yoga, meditation, and mindfulness, which were found to be effective in offering relief from burnout with a positive impact on mental health manifested as improvement in communication skills, and collaboration/coordination skills, ¹⁵ with mindfulness meditation having a positive impact on stress, burnout, and empathy. ¹⁶ Physicians can practice mindfulness consistently, based on their convenience, for at least 15 minutes per day, irrespective of their patient load, which will enhance their well-being and patient care. ¹⁷ Hence, from the comprehensive toolkit, mindfulness emerges as one of the possible solutions, consistently demonstrating a significant improvement in physicians’ well-being and patient care while reinforcing the importance of mindfulness as a part of daily routine.^18,19

A scoping review consisting of 32 studies concluded that the incorporation of mindfulness as an everyday schedule had seen positive reinforcement on physicians’ psychological well-being, making them more empathetic and leading to improvement in patient care and practice. In a 2024 study involving Morocco physicians, mindfulness meditation was found to have a positive effect on their anxiety, cognition, and teamwork. The author concluded that practicing mindfulness meditation during emergent settings can control anxiety and improve cognition and teamwork. ²⁰

Frameworks with categorized strategies were established for maintaining resilience and promoting wellness into three key areas relevant to medical practice: (1) gratification, (2) resilience, and (3) constructive attitudes and self-awareness. ²¹ This has led to the suitability and applicability of mindfulness intervention for five weeks and two hours per day as a rescue for diverse specialist physicians experiencing burnout from eastern Canada. The authors recommended that extending to their patients, colleagues, and the broader healthcare system will be of great utility in the future. ²² Research demonstrated that physicians with high levels of mindfulness and professional fulfillment had lower odds of burnout as assessed by multivariate analysis. The findings suggested that fulfillment at work, working moderate hours, and spending time with family can prevent burnout. Professional fulfillment, as measured by the Professional Fulfillment Index (PFI), is a relatively new measure. However, it has the potential to capture many of the sources of well-being omitted in other popular assessments, such as happiness at work, sense of meaning at work, and professional self-sufficiency. It has shown that a short mind-body skills training (MBST) program aimed at enhancing physician compassion and mindfulness and reduced burnout participants noticed with six hours of training.^23,24 A study performed in the USA to assess the efficacy of app-based mindfulness training in reducing anxiety and its correlation with burnout among 34 physicians from a large healthcare network showed a greater reduction in anxiety, burnout, and cynicism post-treatment and even at three 3-month follow-ups. These findings suggest that app-based mindfulness training may effectively reduce both anxiety and burnout in physicians. ²⁵ Further to this, a systemic review of five clinical studies found the efficacy and effectiveness of mindfulness-based interventions, resulting in significant improvements in depression, anxiety, and stress. ²⁶

Indian research involving 120 medical intern students and 150 undergraduate medical students has also concluded that mindfulness is an adaptive strategy, making it a possible intervention for improving stress, anxiety satisfaction, and well-being, with improvement in QoL followed by improvement in patient services.^27,28 Studies demonstrated improvement in burnout and QoL among 98 healthcare professionals after undergoing 12 weeks of meditation based on yoga and breath. The study has recommended the integration of yoga into healthcare settings for addressing physician’s anxiety, burnout, and depression, with a positive impact on their clinical decision-making and patient outcomes. ²⁹ Mindfulness application in the Indian context is a part of the holistic toolkit, and the current practice guidelines for the assessment and management of psychiatric morbidity among medical professionals indicate the management of physician burnout with individual-level strategies and organization-level strategies. Some of the strategies that have been suggested include mindfulness-based techniques, self-care, stress management techniques, cognitive behavioral techniques, improving communication skills, gratitude interventions, development of interpersonal skills, and development of knowledge and work-related skills to enhance job competence and personal coping strategies. Enhancing control over the work, improving flexibility and work–life integration by focusing on organizational skills, personal efficiency, and personal factors that affect the work–life can also help to reduce physician burnout. ³⁰

Physicians, as respected professionals, deserve priority access to services that ensure their well-being in terms of QoL, work flexibility, and work–life integration-through better organizational skills, personal efficiency, and addressing personal factors—for a significant reduction in burnout leading to better patient care and overall satisfaction. From the comprehensive toolkit, mindfulness has emerged as a potential concept, an adjunct to the existing treatment in offering relief from anxiety and burnout, thereby maintaining the well-being of the physicians. Although studies have proven the benefits of mindfulness globally, its consistent implementation as a part of physician’s daily routine from the graduation level enables them to learn ways to bring up their expertise with the highest degree of coping skills, preventing anxiety and burnout to carrying out both professional and personal responsibilities mindfully.

The Way Forward: Creating Overview Committee (APEX Committee)

We propose a 10-step framework for physicians aimed at increasing their self-awareness about burnout and the need for mindfulness as the solution for leading a successful professional and personal QoL. The steps include;

1. Initiation of a nationwide movement called “Live Life in Present”- The Power to Protect Physicians”

2. The APEX committee will be headed by an 8-member central committee consisting of the National Medical Council (NMC) chairman and secretary, followed by 2 members (president and secretary) each from the societies representing acute, chronic, and niche therapy. All the APEX committee members will report to the principal secretary of the Department of Family and Child Welfare of the Government of India.

3. The APEX Committee team, in coordination with experts in the country, will prepare the Mindfulness Learning Module (MLM) in a concise format ( for physicians having mild to moderate burnout) and an elaborate format ( for physicians having moderate to severe burnout) consisting of a Handbook with content, demonstration of the procedure, Daily schedule, Mindfulness Application Utility, and downloading facility for smooth dissemination of its usage to physicians across India during training sessions.

4. The APEX Committee will put forward its objective, along with the time frame and deliverables, at its national inauguration to all the attendees, mostly consisting of society presidents and secretaries. They will undergo training on MLM, mindfulness mobile application download, briefing on its navigation, understanding its resources and announcements, and daily self-reporting of mindfulness by them in the morning before initiating the professional work.

5. These master trainers will coordinate and cover all the medical college students (preferably final-year students) in their vicinity. Final-year students can train 3rd-year to 1st-year students. With this, daily mindfulness practice sessions for 15 minutes can resemble our childhood prayer sessions before the commencement of classes.

6. These Master Trainers will train the next layer of physicians of their society based in Metros, followed by the new trainers joining hands with master trainers and going further to city-wise/town-wise training.

7. We suggest the central APEX team initiate various awareness programs (digital and print) at least once a month, bringing in light break-through success stories for sharing with all members through the mindfulness application so that physicians can improve awareness of mindfulness interventions’ effectiveness, leading to the development of conviction and confidence, which enable them to own it as a part of daily routine and also can display printouts with the messages on mindfulness in patient waiting area for improving their awareness.

8. We strongly recommend having sessions and stalls for awareness and downloading mindful mobile apps at all national, zonal, and state conferences.

9. To accomplish the goal, it is always fair to collaborate with our partners in forming the value chain. Whenever any organization conducts CMEs / Round Table Meetings (RTMs) and Advisory Board (ADB) meetings on behalf of a society, the event can be initiated with MLM, Mobile application briefing like downloading and resources, followed by the event deliberation. The objective is to create a sense of urgency to adopt mindfulness as a part of daily routine by physicians, which will ensure better health for all.

10. The physician MLM daily implementation report will be accessible to the physicians and their respective presidents of the society (from local to national) for monthly appreciation and sensitization to take appropriate corrective measures in case of low adherence by the physician himself/herself.

The above suggested 10-point frame should be worked out as a detailed plan for improving implementation ease. Based on situational demand and need, the above points can be amended or ratified to make the end result even better. This will meet the objective of the mindfulness movement by APEX team members, which will improve physicians’ well-being. We are sure that activating the mindfulness mobile application can be a great beginning, and consistent follow-up activities can make mindfulness a part of physicians’ daily routines, thereby defeating anxiety, stress, and burnout from physicians’ perspectives.

Conclusions

This viewpoint on the application of mindfulness techniques delved into the importance of keeping healthcare professionals, especially physicians, in mind, although other professionals from the working class are subjected to burnout, which is beyond the scope of this review. In order to have our nation’s, highly qualified and skilled medical fraternity healthy, adopting mindfulness in their daily routine will offer relief from stress, anxiety, and burnout with positive mood and happiness, thereby transforming them to become a better individual with caring, compassionate, approachable, accessible, and helpful to their patients and in their individual life. All of which will have a great positive impact on building a healthy nation.