Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study

Anthony C Waddimba; Monica M Bennett; Michelle Fresnedo; Thomas G Ledbetter; Ann Marie Warren

doi:10.1016/j.mayocpiqo.2021.08.009

Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study

Mayo Clin Proc Innov Qual Outcomes. 2021 Sep 17;5(5):928-945. doi: 10.1016/j.mayocpiqo.2021.08.009. eCollection 2021 Oct.

Authors

Anthony C Waddimba^{1

2}, Monica M Bennett¹, Michelle Fresnedo^{1

3}, Thomas G Ledbetter⁴, Ann Marie Warren^{1

3}

Affiliations

¹ Baylor Scott and White Research Institute, Dallas, TX.
² Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX.
³ Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX.
⁴ Chief Medical Office, Baylor Scott and White Medical Center, Waxahachie, TX.

Abstract

Objective: To investigate structural relationships of latent constructs such as occupational wellbeing, resilience, work meaningfulness, and psychological empowerment with affective and cognitive clinical empathy among a community of physicians and advanced practice providers.

Methods: We conducted a cross-sectional observational study. We gathered data by an anonymous self-administered multidimensional questionnaire disseminated electronically between March and May 2016. Participants were physicians and advanced practice providers belonging to the Health Texas Provider Network, a group private practice affiliated with the Baylor Scott and White Health system. We excluded allied health care staff (eg, nurses) and trainees (eg, residents, medical students). We pursued a 3-step strategy: (1) confirmatory factor analysis of a theory-driven measurement model, (2) a modified structural equation model from which pathways with nonsignificant path coefficients were deleted, and (3) multigroup analyses of the modified model.

Results: Cognitive empathy was the strongest predictor of affective empathy. We observed modest positive associations of resilience with cognitive and affective empathy and of well-being and meaning with affective but not with cognitive empathy. Resilience, meaning, and psychological empowerment were surprisingly negatively associated with well-being, suggesting diminished self-care among practitioners. Effects of psychological empowerment on empathy and well-being were mediated by resilience and meaning.

Conclusion: Cognitive empathy directly influenced affective empathy; well-being and meaningfulness exerted direct positive effects on affective but not on cognitive empathy, whereas resilience had direct positive associations with both empathy dimensions. Resilience and meaning manifested direct, negative associations with well-being, revealing clinicians' disproportionate focus on patient care at the expense of self-care.

Keywords: APP, advanced practice provider; AVE, average variance extracted; BIC, Bayesian information criterion; CD-RISC, Connor-Davidson Resilience Scale; CD-RISC-10, 10-item short form of the Connor-Davidson Resilience Scale; CFA, confirmatory factor analysis; CFI, comparative fit index; GFI, goodness of fit index; HTPN, Health Texas Provider Network; IRI, Interpersonal Reactivity Index; LPA, latent profile analysis; MCPWBI, Mayo Clinic Physician Well-being Index; PEI, Psychological Empowerment Instrument; RMSEA, root mean square error of approximation; SE, standard error; SRMR, standardized root mean square residual; TIPI, 10-Item Personality Inventory; TLI, Tucker-Lewis Index.