Physician wellness is increasingly recognized for its importance to patient care practices, to the integrity of the healthcare system, and to the physician workforce. Diminished physician wellness is well documented, with 20% to over 50% of internationally studied physicians reporting “burnout,” an indicator of negative physician wellness characterized by emotional exhaustion and depersonalization [1,2,3,4]. Poor physician wellness increases the risk for negative mental health outcomes and even suicide in physicians and also compromises the quality, safety, and efficiency of medical care for patients [5,6,7,8]. Unwell (e.g., “burned out,” depressed) physicians are more likely to order unnecessary care, commit a medical error, and leave the medical profession early [9, 10]. Patients of burned out physicians may suffer from an increased risk of mortality and longer post-discharge recovery times [7, 11]. Indicators of positive physician wellness such as job satisfaction, self-reported good health, and positive personal health practices are associated with increased patient satisfaction, improved physician-patient communication, and improved patient adherence to medication and health behaviors [12].

Researchers have proposed that healthcare systems systematically monitor physicians and intervene to strengthen well-being due to the risks that poor physician wellness pose to nations’ investments in healthcare quality and to physicians themselves [10, 13, 14]. Despite this, little attention has been paid to defining the construct, resulting in a lack of consensus about how physician wellness (used interchangeably with physician well-being) should be best conceptualized and assessed. In the absence of an explicit definition, meaning is left to be inferred from the plethora of measures used to quantify physician wellness, which range from an absence of burnout to spiritual well-being. Because physician wellness is a matter of national health policy that requires systematic monitoring and intervention, it is vitally important that we arrive at a shared understanding of what it means.

We conducted a systematic review to characterize the conceptualization of physician wellness in the literature by describing definitions of physician wellness and measures used to operationalize the construct. In addition, we explored inferred changes in the conceptualization of physician wellness over time by comparing measures of physician wellness employed in early (1989–2009) versus later (2010–2015) published literature. Using the WHO definition of health [15] as our overarching conceptual framework for defining the broad domains of wellness, we examined the extent to which existing definitions and measures address the multifaceted nature of the construct.

Methods

Search Strategy and Selection Criteria

This review identified eligible papers for inclusion via three search strategies: (1) a PubMed search, (2) a manual reference check of highly cited reviews, and (3) a forward citation search in Web of Science. The PubMed search used MeSH and text word field tags to identify papers published through April 2015. Search terms included a combination of (1) physician descriptors (e.g., “pediatrician”), (2) physician specialty descriptors (e.g., “emergency medicine”), and (3) wellness terms (i.e., “wellness” or “well-being”) (full search methodology and query available upon request from the corresponding author).

Articles eligible for inclusion were studies that focused on quantitatively assessing wellness or well-being within a physician population (including physicians in training), with (1) a wellness term and a physician descriptor in the title, abstract, keyword, and/or MeSH; (2) an indication that the assessment of physician wellness was included in the study foci (as evident in one or more study aim, objective, research question, and/or the study title); and (3) at least 50% physicians in the study sample. Articles were excluded if they focused on medical students, were non-English, were not published in a scholarly journal, or did not meet inclusion criteria 1 through 3. One researcher (K.B.) performed the identification, screening, and eligibility review process.

Data Extraction

Following the identification of papers eligible for inclusion, four researchers (K.B., M.T., C.K., K.R.) extracted the following qualitative data from each paper: (1) if and how the authors defined physician wellness and (2) the stated scale domains, sub-domains, and instrument(s) utilized to assess physician wellness. We used a consensus-based approach to determine which measures were employed to assess physician wellness if it was not made explicit in the paper.

Data Synthesis and Analysis

For papers in which authors wrote a definition, three researchers (K.B., M.T., M.L.M.) independently analyzed and then arrived at consensus on each paper’s stated definitions of physician wellness using a thematic synthesis approach [16].

To characterize the operationalization of physician wellness over time, we classified extracted measures based on three measurement attributes: (a) the primary well-being dimension that the measure aimed to assess (four categories: mental, physical, social, or integrated well-being); (b) the valence of the measure (three categories: positive, negative, or other); and (c) the primary context to which the measure relates (two categories: work-specific or general-life specific). Dimensional and valence categories were broadly informed by the WHO definition of health [15], which defines well-being as having mental, physical, and social dimensions, as well as having a positive and negative valence (i.e., the presence of well-being and the absence of ill-being, respectively).

We added an additional well-being dimension (integrated well-being), an additional valence category (“other”), and a context category to the WHO-informed measurement categories to ensure that we captured key conceptual differences across extracted measures. The integrated well-being dimension was added based on evidence in the literature pointing to the importance of physician fulfillment, meaning in life/work, and a sense of life balance in the promotion of physician wellness [17,18,19,20]. We broadly defined the integrated dimension as representing a higher-order latent construct indicating wellness achieved across multiple domains (mental, social, physical, work, general-life). This includes constructs relating to (a) physicians’ sense of purpose, meaningfulness, calling, sense of work-life balance, and/or spirituality (including both religious and secular definitions of the term) and/or (b) a sense of overall wellness/quality of life (QOL). The “other” valence category included measures with either a (1) neutral or (2) both positive and negative valences. The context category was added to reflect the dichotomy in the literature between physician wellness in the workplace or in general-life. Measures classified as having a “general-life” context were those that primarily assessed an aspect of physician wellness that was not work-specific.

Each measure was independently coded based on its dimensional, valence, and contextual attributes by two researchers (K.B and M.T., C.K., or K.R). Coding was determined by taking into consideration the authors’ description of the measure and the scale items, if provided. When a physician wellness measure was described ambiguously (i.e., its domains and/or content could not be ascertained from the information provided in the paper), we accessed and reviewed the cited instrument(s), if available publicly or in the published literature, in both the extraction and measure classification phases of the study. Disagreements in coding were resolved by a third and final researcher (A.L.).

To explore changes in the conceptualization of physician wellness over time, we assessed how the operationalization (measurement) of physician wellness changed across included papers published in early years (1989–2009) versus recent years (2010–2015). We created binary variables to represent the 24 independent combinations of the measurement attributes used to categorize each measure of physician well-being: four dimensional (physical, mental, social, and integrated well-being), three valences (positive, negative, and other), and two context categories (work-specific and general-life-specific). Using our final dataset of coded measures, we tabulated the proportion of papers that used at least one physician well-being measure within each of the 24 independent measurement attribute categories. If a paper included more than one measure classified within a measurement attribute category, it was only included once in the frequency count for each measurement category. We performed Pearson’s chi-squared tests of independence and two-sided Fisher’s exact tests as appropriate to test for significant changes in the proportion of papers that operationalized physician well-being with one or more measures classified within each of the 24 measurement attribute categories across early (1989–2009) versus recent years (2010–2015). Statistical analyses were conducted with R version 3.2.2 (R Foundation for Statistical Computing, Vienna, Austria; http://www.r-project.org.).

Results

Search Results

A total of 2422 records were initially identified through a PubMed search, with an additional 635 identified through a forward citation search in Web of Science and a manual reference check (see PRISMA Flow Diagram in Fig. 1). Following duplicate removal, a total of 2647 records were screened for eligibility based on their titles and abstracts, of which 216 met the eligibility criteria for full-text review. The final sample included 78 papers published between 1989 and 2015 (Fig. 2); 35 papers (45%) were published in early years (1989–2009), and the remaining 43 (55%) were published in recent years (2010–2015).

Fig. 1
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PRISMA flow diagram

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Fig. 2
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Frequency of included papers by year published

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Data Extraction

Data extraction of physician well-being definitions revealed that only 14.1% of the 78 included papers (11/78) stated an explicit definition of the construct. Despite the large absence of explicit definitions, a total of 415 physician wellness measures (i.e., individual scale and/or sub-scale dimensions, if applicable) were extracted from included papers. The removal of duplicate measures resulted in a final dataset of 171 measures.

Definitions of Physician Wellness

Table 1 presents the results of thematic analysis of the explicit physician wellness definitions found in 11 papers. Our analysis revealed that the conceptualization of physician wellness as a mental construct is reflected in nearly all definitions [3, 21,22,23,24,25,26,27, 29], followed by the inclusion of physical health in the majority of definitions [3, 25, 27,28,29]. Mental constructs most often include emotions, moods, distress, burnout, and depression. Physical well-being constructs include multiple health behaviors that improve physical wellness. Only three definitions include a social well-being domain [3, 23, 28].

Table 1 Extracted definitions and thematically synthesized facets of physician wellness
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The majority of definitions also describe facets of physician wellness that align with our conceptualization of the “integrated well-being” domain, such as life satisfaction, feeling challenged, thriving, authentic expressiveness, and vigor [3, 18, 22,23,24,25,26]. For example, Shanafelt et al. describe well-being as including “feeling challenged, thriving, and achieving success in various aspects of personal and professional life” [22]. Wallace and Lemaire describe well-being as “the extent to which an individual can find meaning, and is authentically expressive of their self, in their life and work” [18]. Two authors include a spiritual component in their definition of physician wellness [23, 26].

A number of authors characterize wellness as experiencing integrated well-being phenomena in both personal and professional lives, pointing to the interconnected nature of the two contextual domains [18, 22, 24, 25]. A few of the definitions characterize physician wellness as including both negative and positive domains, representing the absence of ill-being and the presence of positive well-being, respectively [22, 23, 25]. Remaining definitions characterize well-being as primarily positive in valence. Further, while a number of definitions describe physician wellness primarily as a state-based phenomenon (i.e., affects/experiences), a number of definitions also include explicit or implicit behavioral components [22, 23, 27,28,29]. For example, Thorndike et al. and Lebensohn et al. describe well-being within the context of “healthy behaviors” and healthy “ways of living,” respectively [27, 29].

Measurement of Physician Wellness

Initial concordance between first and second reviewer classifications of papers’ measurement attributes was 78.4%; the third reviewer resolved the discordant 22.6%. Table 2 lists unduplicated physician wellness measures classified within the 24 independent measurement categories across early (1989–2009) versus recent (2010–2015) years. The results are summarized by percentage of unique papers that have one or more measure of physician wellness classified within each of the four overall well-being dimensions and within each of the 24 measurement categories.

Table 2 Frequency of papers that operationalize physician wellness using one or more measure within each measurement attribute category
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Table 1 a clear majority of papers (69/78, 88.5%) operationalized physician wellness with at least one measure classified within the mental well-being dimension, whereas only 50.0% (39/78), 48.7% (38/78), and 37.2% (29/78) operationalized physician wellness with measures of social, physical, and integrated well-being, respectively. Measures of burnout (i.e., overall burnout, emotional exhaustion, depersonalization, and low sense of personal accomplishment) were most commonly used in the assessment of physician wellness. That is, 42% (29/69) and 53.8% (21/39) of the papers that used measures of physician wellness classified within the mental and social well-being dimensions, respectively, operationalized the construct with a measure of burnout. Following measures of burnout, physicians’ mental well-being was most commonly operationalized through measures of depression (20/69, 29.0%), stress/distress (20/69, 29.0%), and work attitudes such as work/job satisfaction, career satisfaction, and organizational/career commitment (20/69, 29.0%). Social well-being was operationalized next frequently with measures relating to physicians’ personal/family relationships (including the impact of work on these relationships) present in 23.1% (9/39) of papers.

Within the physical well-being domain, measures of fatigue, sleep (i.e., sleepiness, sleep problems, sleep quality/hours/patterns), and work-rest balance were most commonly employed. Approximately 42.1% (16/38) of papers measured these constructs, followed by 21.1% (8/38) of papers operationalizing this domain through measures of overall physical health (including physical QOL). Among papers with measures classified within the integrated well-being dimension, the majority (13/29, 44.8%) used measures of overall and spiritual QOL. Constructs that related to overall wellness, meaning in life/work, a sense of balance in life/work, and satisfaction in life were also classified in the integrated well-being dimension. Given the positive conceptualization of the integrated well-being dimension, no measures were classified as negatively valenced in nature. Overall, the majority of measures used to assess integrated and physical well-being dimensions were not specific to work context, whereas the assessment of physicians’ mental and social well-being was dominated by work-specific measures.

Examining changes in the operationalization of physician wellness over time revealed two significant findings. First, we found a significant increase (>twofold) in the proportion of papers with one or more general-life integrated well-being measure (e.g., meaning in life) in recently published papers (19/43, 44.2%) compared to papers published in earlier years (7/35, 20.0%) (X 2 = 5.08, p = 0.0242, not shown in Table 2). Second, we found a significant increase in the proportion of papers that included at least one measure of other valence integrated well-being in general-life from early (1/35, 2.9%) to recent years (12/43, 27.9%) (Fisher’s exact p = 0.0045). An increase in the use of overall QOL measures to operationalize physician wellness accounted for this significant difference. Significant differences were not observed across time in the proportion of papers including one or more measures in any of the remaining independent measurement attribute categories.

Discussion

Poor well-being among physicians is prevalent enough to constitute an international workforce crisis. A clear, consistent conceptualization of physician wellness capable of systematic measurement will allow for improvements in physician QOL and for improvements in quality performance, opportunities for organized interventions, and a strengthened health policy. In light of these benefits for physicians and patients, we conducted a systematic review to uncover how physician wellness is defined and measured in extant literature.

Our review emphasizes a number of significant findings. An overwhelming majority (86%) of included papers quantitatively assessed physician wellness without providing a definition of the construct. Among the 11 papers that include a definition, thematic analysis revealed that conceptualizations of physician wellness vary across dimensional, valence, and contextual attributes. When taken together, authors’ definitions of physician wellness reveal a multifaceted construct that includes mental, physical, social, and spiritual QOL in both physicians’ work and personal lives. Moreover, the literature revealed that physician wellness includes the absence of distress and the presence of positive well-being, including vigor and thriving states and behaviors beyond mere job satisfaction. The inclusion of both positive and negative domains in the conceptualization of wellness mirrors the WHO conceptual model of health [15] and is also supported by research suggesting that the absence of physician distress does not equate with the attainment of positive well-being [20]. Moreover, the conceptualization of wellness as encompassing both states and behaviors is supported by literature in positive psychology, which posits that feeling a sense of meaning, challenge, and personal expressiveness in life is attained by participating in activities that promote these experiences [96, 97].

Analysis of papers’ physician wellness measures, however, revealed that physician wellness is overwhelmingly operationalized as a mental phenomenon with less attention paid to the social, physical, and integrated dimensions of the construct. Across all included papers, measures of burnout (emotional exhaustion and depersonalization) and negative affect (e.g., depression, distress) were used most frequently to operationalize physician wellness, followed by measures of positive work attitudes (e.g., job satisfaction). The operationalization of physician wellness as a primarily mental phenomenon characterized by negative affects (e.g., depression, emotional exhaustion) has remained relatively stable over time. However, Table 2 we found a significant increase in the proportion of papers published over time that operationalized physician wellness using measures of integrated well-being in general-life, such as overall QOL and meaning in life. This finding suggests that integrated well-being measures are increasingly recognized as indicators of physician wellness, despite our finding that measures of integrated well-being were operationalized the least across all studies.

Overall, our findings emphasize the need for a shared, holistic conceptual definition of physician wellness. A shared conceptualization of physician wellness will provide a common basis for the modeling and operationalization of physician wellness states, traits, behaviors, outcomes, and determinants. The continued absence of a shared definition, however, may lead to inaccurate inferences regarding the relationship between measures of physician wellness and the latent construct of physician wellness that the measures represent [98]. In particular, we risk reducing the multifaceted construct of physician wellness to merely a sub-set of the most commonly operationalized constructs, such as burnout and job satisfaction, in which physician wellness subsumes. However, a shared holistic definition of physician wellness that explicitly includes integrated well-being constructs (e.g., purpose, thriving, vigor, work-life balance) along with mental, social, and physical constructs of well-being may stimulate new research elucidating their role in impacting healthcare quality and patient outcomes. A holistic consensus definition may also help establish less commonly assessed constructs of physician wellness (e.g., integrated well-being constructs) as legitimate outcomes in their own right, whereby interventionists, healthcare leaders, and physicians themselves strive to promote practices, policies, and cultures that support outcomes such as meaning in work, work-life balance, and thriving. This is possible because a common definition promotes a shared language through which physician well-being can be understood and discussed by key stakeholders, including physicians, patients, researchers, healthcare leaders, and policymakers. Moreover, a shared definition will improve the quality of physician wellness research by advancing the development of valid and reliable physician wellness measures, improving the consistency by which the construct is operationalized, and increasing the comparability of findings across studies.

Based on our review, we propose the following conceptual definition: Physician wellness (well-being) is defined by quality of life, which includes the absence of ill-being and the presence of positive physical, mental, social, and integrated well-being experienced in connection with activities and environments that allow physicians to develop their full potentials across personal and work-life domains. This definition represents a synthesis of the key components of physician wellness that emerged from this review, combining elements from the WHO conceptual model of health [15] with conceptualizations of well-being from positive psychology [97, 99]. Domains implied by this definition include (1) negative (ill-being) and positive well-being domains; (2) physical, mental, social, and integrated well-being domains; and (3) work-life and personal (non-work or general) life domains.

Consistent with the definitions and measures extracted from our review, the proposed definition includes an explicit connection between physician well-being and “activities” and “environments” that allow physicians to develop their full potentials. This connection is based on eudaimonic well-being literature, which posits that positive well-being states are experienced as a byproduct of engaging in activities that are authentically expressive of oneself [96, 97, 99]. As such, eudaimonic well-being theorists view wellness not only as including positive states (e.g., feelings of satisfaction or purpose) but also as including ways of living or healthy functioning (e.g., behaviors such as frequent exercise, practicing mindfulness, or spending quality time with family) [96, 97, 99]. We incorporate the view that physician wellness also includes healthy ways of living/functioning within our definition. Aside from referring to ways of living/functioning, the term “activities” in this definition can also refer to the work activities in which a physician engages. When “activities” is used to refer to work activities, we view the activities themselves as potential predictors of physician wellness (versus components of physician wellness as a construct). For example, physicians’ provision of patient care or research (work activities) can give rise to feelings of meaning in life/work and autonomy. These feelings of meaning and autonomy are components of physician wellness, but the patient care and research activities themselves are not components of physician wellness. The term “environment” in this definition refers to conditions of physicians’ work environment and is also viewed as a predictor of physician wellness versus as a component of physician wellness itself. Though both work activities and environments are not components of physician wellness as a construct, their critical role in giving rise to (or impeding) physician wellness along with physicians’ own behaviors warrants their inclusion as a complement to this definition.

Models of well-being from positive psychology offer rich theoretical and empirical bases for the explication of the physical, mental, social, and integrated well-being constructs observed within this review and, thus, within the proposed definition of physician wellness. Feeney and Collins’ model of thriving [100], in particular, uniquely marries models of well-being from diverse positive psychology literatures with the literature on social support and close relationships, resulting in a comprehensive, theoretically grounded conceptual framework of well-being. According to their work, thriving (i.e., well-being) includes five components: (1) subjective (hedonic) well-being (life satisfaction; domain satisfactions; and a balance of positive and negative affect); (2) eudaimonic well-being (e.g., “having purpose/meaning in life; having and progressing towards meaningful life goals; mastery/efficacy, control, autonomy/self-determination, personal growth, movement towards full potential”); (3) psychological well-being (e.g., “positive self-regard, self-acceptance, resilience/hardiness, optimism, absence [or reduced incidence] of mental health symptoms/disorders”); (4) social well-being (e.g., “deep and meaningful human connections, positive interpersonal expectancies [including perceived available support], prosocial orientation, faith in others/humanity”); and (5) physical well-being (e.g., “physical fitness [health, weight, and activity levels]; absence (or reduced incidence) of illness and disease; health status above expected baselines; longevity”) [100].

We apply the Feeney and Collins’ components of thriving [100] to the explication of physical, mental, social, and integrated well-being domains within our proposed definition of physician wellness (Table 3). In doing so, we view (1) the mental well-being domain of our proposed definition as encompassing the (a) affective and domain satisfaction facets of subjective (hedonic) well-being (i.e., a balance of positive/negative affect and satisfaction in specific life domains [e.g., work, family], respectively) and (b) the psychological well-being component of thriving; (2) the physical and (3) social well-being domains of the proposed definition as encompassing constructs within the respective physical well-being and social well-being components of thriving; and (4) the integrated well-being domain of the proposed definition as encompassing constructs within the (a) eudaimonic well-being component of thriving, as well as (b) global well-being constructs (e.g., overall well-being or QOL) and (c) spiritual well-being constructs. This conceptualization categorizes the domains of subjective well-being (i.e., positive affect, negative affect, life satisfaction, and domain satisfactions) across the mental and integrated well-being domains within our proposed definition. This taxonomical departure from the Feeney and Collins model of thriving is consistent with our definition of integrated well-being as representing a higher-order latent construct indicating wellness achieved across multiple domains (mental, social, physical, work, general-life). Finally, while most of the constructs used to conceptualize and operationalize physician wellness within this review can be categorized within the existing components of the thriving model, constructs relating to overall well-being/QOL and spiritual well-being/QOL do not fit within the thriving framework. However, we include these constructs within the conceptualization of the integrated well-being domain.

Table 3 Application of the components and indicators (constructs) of thriving to domains of well-being within proposed physician wellness conceptual definition [100]
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The rationale for applying the thriving model to the explication of the well-being dimensions in the definition we propose is twofold. It not only links many of the well-being constructs observed within this review to their relevant theoretical and empirical bases, but it also provides researchers and practitioners with a useful framework for organizing key components of well-being to target for intervention and assessment. Overall, the proposed conceptual definition represents a starting point; continued development of a consensus definition and explication of its relevant constructs is needed to guide the intervention and assessment efforts within this burgeoning field of inquiry.

This study is the first to systematically review definitions and measures of physician wellness. However, our findings should be considered within the context of several limitations. In order to characterize how physician wellness is defined and measured in the literature, we chose to limit our search terms to include only wellness and well-being (in addition to the physician/specialty descriptors described previously). This was a deliberate choice in the design of the review for several reasons. First, there would be no way to evaluate how a study defined and measured physician wellness or well-being if the focus of their assessment was not described using these terms. While terms such as physician “burnout,” “job satisfaction,” and “health” are often equated with physician wellness/well-being, the absence of an explicit connection of these terms to physician wellness/well-being within an article prevents us from drawing inferences regarding authors’ meaning of physician wellness/well-being. Further, we felt that including additional wellness search terms (outside of wellness and well-being) could bias our results towards articles that matched our existing conceptualizations of the construct prior to starting the review. As a result of this limitation, there are other papers that are reasonably considered physician wellness or well-being research that were not included in this review (e.g., see work by Drs. Erica Frank and Mark Linzer [101,102,103]). Although some important work was excluded in our systematic review via application of specified criteria, we believe that definitions and measures extracted from the included studies are a relatively representative sample of observations of the larger literature intent on addressing physician wellness/well-being.

It is also possible that our results may be biased due to misclassification of measures across measurement attribute categories. There are a number of reasons for this possible bias. Definitively classifying wellness measures across the attributes we specified is inherently difficult due to the interconnected nature of the constructs. For example, the construct of fatigue can be characterized as both a physical and mental phenomenon. We chose to categorize measures based on the measurement attribute to which they primarily related (as opposed to classifying the same construct across multiple measurement attributes). This categorization was based on close review of the papers’ descriptions of physician wellness as well as the descriptions of measures (if available). A number of included papers lacked specificity in describing which of their measures operationalized physician wellness, and/or used the term wellness (or well-being) in contradictory ways. In these cases, we used the conceptualization of physician wellness that was most clearly delineated throughout the paper.

In addition to possible misclassification bias due to ambiguously described measures of physician wellness, we may have omitted measures from our study that the authors intended to be included. As a result, we may have also underestimated the frequency of papers that operationalized physician wellness using measures of social, physical, and integrated well-being. To avoid possible underestimation due to omission, we erred on the side of including measures in the analysis when there was some ambiguity. Finally, due to the exploratory nature of our research, we did not statistically correct for multiple comparisons.

In conclusion, elevating physician wellness research at institutional, national, and global levels depends on a strong base of high quality research. The quality of empirical research on physician wellness depends on the conceptual clarity with which the construct of physician wellness is defined. Without conceptual differentiation of the component constructs, future physician wellness research compromises the interpretability, content validity, and comparability of its findings. Failure to develop and employ a multifaceted consensus definition of physician wellness may unintentionally limit its assessment; for example, a limited assessment focused on measurements of burnout inaccurately implies that the absence of burnout equates to wellness.

Few studies have asked, “What is physician wellness?” Much more research has focused on asking, “What affects and is affected by physician wellness?” We believe that in order to truly advance research on this latter question, we must focus on establishing a consensus definition. We propose the development of a holistic definition of physician wellness that integrates existing conceptualizations of physician wellness from over 20 years of literature and highlights a theoretically based conceptual framework that can be used as a foundation for physician wellness assessment. Future research is needed to (a) examine to what extent existing models of wellness, such as the Feeney and Collins model of thriving [100], apply to physician populations, including applicability to physicians’ work contexts; (b) determine the empirical parameters of physician wellness (i.e., what are core components versus proximal correlates); and (c) investigate to what extent understudied measures of physicians’ positive wellness (e.g., personal/professional fulfillment) predict quality and patient outcomes. We conclude that only a holistic definition of physician wellness will adequately improve medical practice. Anything less will merely perpetuate the cultural, organizational, and policy contexts in which physicians are often expected to deny their own wellness in favor of providing consistently compassionate and competent patient care, a situation we find neither beneficent nor efficient.