Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Public Health (DrPH)


Andrew Springer

Second Advisor

Dennis Andrulis

Third Advisor

Catherine Troisi


Introduction: Affecting 42% of physicians in the United States, “physician burnout” is considered a public health crisis with adverse impacts for personal providers, patients and organizations. Though much research has been devoted to the existence and causes of burnout, to date few studies have been conducted to identify factors associated with physician fulfillment. Aims: This dissertation research was intended to increase and improve knowledge of factors effective in contributing to physician professional fulfillment utilizing a Positive Deviance based approach. To that end, two studies were conducted: the first, a narrative review of the literature to identify specific correlates of physician fulfillment and lower burnout; and second, a qualitative analysis of physician identified protective factors from burnout, and quantitative analysis of demographic and practice characteristics and their association with fulfillment and burnout from a survey of Arizona physicians. Methods: In the narrative review, a four-phased approach was utilized. Guided by a Positive Deviance informed Social-Ecological framework, the review examined existing literature, including study design, setting, populations, positive and protective factors, key fulfillment outcomes, association of factors with outcomes and social ecological dimensions. In the qualitative study, physician beliefs about self-protection from burnout were categorized by three thematic nodes, and emerging nodes by the inductive analysis, as well as subnodes. In the quantitative study, demographic data and practice characteristics were analyzed in which professional fulfillment and burnout were identified. A Chi squared test of significance and multiple logistic regression was conducted to identify associations between demographic data and practice characteristics with professional fulfillment and burnout. Results: The narrative review identified 18 articles, which showed promising intervention strategies, especially through collaborative approaches across dimensions of the model, for physician fulfillment at: the individual level through mindfulness programs, coping strategies and resilience training; the interpersonal level through team building, strengthening support systems and mentorship; and the organizational level through expanding administrative support, changing incentive structures and workload alleviation. The qualitative analysis found that respondents perceived the most protective factors from burnout to be time away from clinical practice, physician-initiated solutions, reduced clinical effort, professional autonomy and control over clinical practice. An emergent node, “No Knowledge/lack of Awareness” had almost 14 percent of respondents. Quantitative findings suggest that physicians who self-identify as male, are older, own their clinical practice and several years of clinical practice experience have more professional fulfillment, and younger physicians and inpatient physicians have more burnout. Conclusion: Narrative review findings suggest that correlates and strategies aimed at reducing burnout and increasing physician fulfillment focused on lower levels of the ecological model, representing missed opportunities for examining higher population based levels of the model and indicating a need for future research to fill this gap. The qualitative analysis findings suggest a need for future research of promising strategy approaches at the individual physician and peer interpersonal levels, and how those approaches may be incorporated into organizational based interventions. Quantitative findings can serve as a foundation to direct future research on causes of professional fulfillment and burnout.