Academic Psychiatry (2023) 47:211–214
https://doi.org/10.1007/s40596-023-01758-w
COMMENTARY
Worrying About the Well‑Being of Well‑Being Leaders
Margaret M. Rea1 · Stuart Slavin2
Received: 17 November 2022 / Accepted: 14 February 2023 / Published online: 1 March 2023
© The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric
Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry 2023
Concern about physician, resident, and medical student
mental health and well-being has existed for more than a
decade. In response, a robust well-being movement has
developed, with organizations such as the Association of
American Medical Colleges (AAMC) [1], the American
Medical Association(AMA) [2], the Accreditation Coun-
cil for Graduate Medical Education (ACGME) [3], and the
National Academy of Medicine (NAM) [4] advocating for
and investing in change. One ongoing trend is a proliferation
of new wellness leadership positions across the medical edu-
cation continuum to direct and provide oversight for well-
being interventions. Most notable, and perhaps most visible,
is the development of the position of Chief Wellness Officer
at many academic medical centers [5]. This trend began and
was jump-started by the appointment of Tait Shanafelt, MD,
to this position in 2017 at Stanford Medical Center [6]. Chief
Wellness Officers are not the only figures in academic medi-
cine, however, who have assumed leadership roles related to
well-being. In the graduate medical education (GME) space,
positions focusing on resident and fellow well-being have
emerged at the institutional and departmental level. Many
medical schools have also identified individuals to not only
manage mental health services for medical students, but to
also oversee wellness initiatives and programming. Some
institutions have also created cadres of departmental well-
ness “champions.”
A wide range of professionals occupy these various lead-
ership roles related to well-being, including physicians from
a variety of medical specialties, as well as mental health
professionals, including psychiatrists, psychologists, and
clinical social workers. In addition, there is tremendous
variation in the scope of activities, time allocated for the
* Margaret M. Rea
mrea@ucdavis.edu
1
University of California Davis School of Medicine,
Sacramento, CA, USA
2
Accreditation Council for Graduate Medical Education,
Chicago, IL, USA
position, and available resources. Many who gravitate to
these roles are driven by the desire to provide needed sup-
port for their stakeholders as they recognize the high levels
of stress that working in healthcare brings. They come to the
role with a deep altruistic desire to ensure the care for the
caregivers. Often, they are also committed to impacting the
culture of medicine by addressing the importance of honor-
ing well-being.
While the role of well-being leader offers great opportu-
nity for professional fulfillment and satisfaction, the position
is also characterized by a set of unique challenges and stress-
ors that can contribute to their own distress and threaten
their own mental health and well-being. These well-being
leaders are dedicated to supporting the well-being of others,
but their own well-being may be significantly overlooked.
In this commentary, the authors will explore the environ-
mental and personal threats to the well-being of wellness
leaders and make recommendations for interventions and
initiatives that can enhance the well-being of those charged
with trying to assure the well-being of medical students,
residents, fellows, and physicians.
The Context They Operate In
To best understand the potential personal well-being chal-
lenges well-being leaders face, it is critical to understand
the context in which they work. These leaders are often
asked to protect and oversee the well-being of their stake-
holders, while often having very little control over, or abil-
ity to influence, the environmental variables that are most
impactful on well-being. For example, GME well-being
leaders might have very little influence on the unique
structural factors that can contribute to burnout and dis-
tress within the training environment. They may lack the
authority within the medical hierarchy and the resources
needed to initiate significant environmental change to
impact well-being. Not having the power, resources, or
time to make a significant impact may in turn negatively
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influence the wellness of well-being leaders themselves.
This is compounded by having to accept that certain ele-
ments in the medical culture and educational learning
environment are subject to slow change, if any at all.
The job duties and intended outcomes for well-being
leaders may, in many situations, be unclear, making it dif-
ficult to determine clearly how well a well-being leader
is performing. Is the desired outcome the happiness of
their stakeholders? Are attrition rates of physicians their
responsibility? Are patient satisfaction scores a driving
variable? Or is the mental health status of their stakehold-
ers the desired outcome variable? If an institution, depart-
ment, or a school sustains a death by suicide, will the well-
being leader be blamed and/or take the loss as a personal
failure of their efforts? This uncertainty in the expected
outcomes can contribute to distress and often contrasts
with their other professional duties, where responsibili-
ties and intended outcomes are substantially clearer. For
example, an internal medicine physician understands quite
clearly the expected outcomes when functioning clinically,
but that same individual who has 35% of their time carved
out for resident well-being efforts, might be very uncertain
about expected outcomes in this latter arena. This context
can lead to professional insecurity about whether they are
performing well, and in these moments, unhealthy impos-
tor thoughts can arise.
Well-being leaders also often function independently, and
as such, they tend to solely carry the cognitive and emotional
load in the work they undertake. This lack of a support-
ive professional community can result in significant isola-
tion as well as leave an individual ripe for self-doubt about
their achievements. These leaders also often feel pressure to
always appear well, in order to model well-being; this can
result in “toxic positivity,” in which their outward-facing
state masks an inner distress. Finally, and importantly, well-
being leaders may face indifference, if not outright hostility,
from those they are trying to serve, and they themselves
can become the focal point, target, and scapegoat for exist-
ing systemic and learning environment issues. They must
absorb the many frustrations, feelings of burnout, hopeless-
ness, anger, and pessimism of the physicians, residents, and
medical students they are trying to help. For example, an
undergraduate medical education (UME) well-being leader
might arrive to lead a workshop on resilience and be faced
with student anger about issues within the learning envi-
ronment that they feel need to be addressed. Students may
resent a discussion of resilience and see it as victim-blam-
ing—placing the burden on them to be well when the system
is what needs to be fixed. Having to absorb and not internal-
ize these negative interactions can weigh heavily on well-
being leaders and further trigger feelings of inadequacy. This
experience can be amplified for those in this role who are
non-MDs, who may be perceived as not truly understanding
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Academic Psychiatry (2023) 47:211–214
the experience of physicians or medical students, leaving the
well-being leader feeling discounted and dismissed.
The pandemic brought increased professional pressure
upon well-being leaders, as many felt a deep responsibility
to do all they could to care for their stakeholders during a
time when supporting well-being was never more critical.
However, how to best support the well-being of others was
not only unclear, but often unachievable given the unique
systems factors of the pandemic. For example, a well-being
leader might have comprehended fully the impact or wor-
ries about personal protective equipment (PPE) or childcare,
but did not have the resources nor the autonomy to address
those needs. Furthermore, these pressures to support others
often coincided with their own personal stresses related to
navigating the pandemic.
Personal Attributes
Individuals who are drawn to work in the well-being sphere
are likely to have personality traits and attributes commonly
found in the caring professions. These leaders often bring
compassionate and optimistic demeanors that are marked
by a genuine desire to ensure their students, trainees, and
colleagues thrive and are well. Many present with outgo-
ing personalities that allow them to connect well with their
communities and are seen as advocates for the well-being of
individuals and systems.
Well-being leaders may also have personal attributes,
however, that can threaten their well-being. One personal-
ity trait common among physicians is conscientiousness [7].
While some studies indicate that this trait may be correlated
with reduced burnout [8, 9], it stands to reason that over
conscientiousness may contribute to problems for some phy-
sicians if it contributes to the tendency to overwork. Over
conscientiousness may be manifest by being relentlessly
hard-working, not setting appropriate boundaries for work
and personal life, making oneself always available, and never
saying “no” to requests for assistance. Well-being leaders
may tend to over conscientiousness, but may also be likely
to embrace a caregiver/rescuer role, not just professionally,
but in their personal lives as well. Accompanying this role
may be a tendency not to seek emotional support and care
from others as well as self-effacement, worrying about oth-
ers’ needs, but not their own. Because of their position in
the well-being sphere, they may also feel pressure to always
appear happy and to be uniformly positive, regardless of
how they are feeling.
In addition to these personality traits, well-being leaders
may also be prone to having mindsets such as maladaptive
perfectionism and impostor phenomenon, which have been
found to be prevalent among medical students, residents, and
practicing physicians and are associated with depression,
Academic Psychiatry (2023) 47:211–214
anxiety, and burnout [10–13]. These mindsets can be par-
ticularly distressing given the intransigence of the well-being
problem in medicine, and the lack of control over many of
the drivers of burnout and depression. This, combined with
the relatively close personal relationships with those they are
trying to help, can leave well-being leaders feeling that they
are coming up short and letting down their stakeholders.
What We Can Do
It seems essential that those who assume the role of a well-
being leader recognize the necessity to address the envi-
ronmental and systems factors that influence their ability
to adequately impact the well-being of their stakeholders.
Identifying and addressing systems issues are crucial to
making meaningful changes to impact well-being, and key
to this process is their relationship with the authority and
resources to influence change. Without this focus and abil-
ity, well-being leaders are often left feeling powerless to
make an impact. In addition, well-being leaders cannot be
so siloed from other offices and leaders within a hospital
or educational system. For example, at the medical school
level, well-being leaders need to collaborate with curricu-
lum leaders to best identify what issues within the learning
environment are impacting the well-being of students. These
leaders in a hospital system need to have a seat at the table
when administrative leaders are addressing issues such as
retention and advancement.
At the same time, although resources and power are key,
well-being leaders will benefit from simultaneously recog-
nizing that change in the system and learning environment
tends to come about slowly, and that this pace does not
reflect their adequacy as a leader. It is also critical for the
individual leader to diffuse the hostility they may encoun-
ter when providing training in individually focused strate-
gies by acknowledging the environmental nature of many
obstacles to well-being. It is also important to clearly define
the job duties and intended outcomes of a well-being leader
position which includes a collaborative and intentional pro-
cess to identify the needs of an institution/school/clinical
environment.
Well-being leaders would benefit from cultivating pro-
fessional communities to counter the isolation that can
come from often being the only one addressing wellness
in their community, while carrying the cognitive and emo-
tional load of ensuring the well-being of their stakehold-
ers. We have seen a surge of more formal initiatives such
as the AAMC Wellness Collaborative, ACGME National
Well-Being Calls, various programs from the Coalition for
Healing and Renewal in Medicine (CHARM), as well as
grass roots efforts such as the Medical Education Wellness
Professionals Listserve aimed at building connection and
213
community. These communities have provided opportuni-
ties to share successes, and—perhaps, more importantly—to
share the struggles that well-being leaders face in the work
they do, especially holding the responsibility to ensure their
colleagues and community are well. Many of these national
communities grew out of, or were expanded and energized,
during the pandemic when well-being leaders were acutely
in need of professional and personal support.
Those leading well-being efforts need to follow and
embrace the advice they often give to students, residents, and
faculty: to engage in self-care activities, set better bounda-
ries, and access mental health resources when needed. Some
have encouraged self-care practices by saying that you need
to put on your own oxygen mask before you put it on those
you care for. While this is true, it risks perpetuating a notion
that you can justify taking care of yourself only as a means
of helping to take care of others. We must acknowledge that
well-being leaders, like clinicians, deserve their own oxygen
mask, and not simply for the sake of providing service to
others.
Utilizing cognitive restructuring techniques to try to man-
age distressing mindsets such as maladaptive perfectionism
and impostor phenomenon can be helpful as can be access-
ing mental health resources for themselves and not waiting
until they are in a crisis before they do so. Indeed, thera-
pists can be immensely helpful in assisting individuals in
examining their thoughts and behaviors even in the absence
of significant depression or anxiety symptoms. Well-being
leaders can also strive to develop support networks of fel-
low well-being leaders locally, regionally, and/or nationally.
Finally, well-being leaders can strive to find and be sustained
by a sense of meaning in their work and the satisfaction that
can come from contributing to and making a difference in
others’ lives.
In conclusion, if we are serious about addressing the men-
tal health/burnout crisis in medicine, we need to ensure that
those charged with promoting trainee and physician well-
being are also well. Steps can be taken both environmentally
and individually to promote the health and well-being of
well-being leaders.
Declarations
Disclosures On behalf of all authors, the corresponding author states
that there is no conflict of interest.
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