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Data learned from the survey can then be talked about openly in future meetings, encouraging open processes to solutions. Individual approaches would help those who provide care  be better able to adjust to the residual stress situation. In this context, systems of education and care have to take an active role in trying to help our physician work force. It should start in medical school and residency training programs. Some of the more progressive schools have begun to introduce courses that address the emotional side of training to enhance self-awareness and early detection of stress responses. Many organizations have offered support programs on stress management, time management, conflict management, diversity management to help physicians improve their communication and relationship skills that improve overall clinical efficiency and satisfaction. Some organizations utilize Wellness Committees and/or coaching, mindfulness training at primary, secondary and tertiary levels of prevention as well as counseling services to help support physicians better deal with the consequences of stress and burnout. It is important to clearly name the relevant activity as physician burnout prevention workgroup. Burnout can then be seen as the "disease" to be prevented and eliminated.[39] 6 Conclusions Multiple regulatory agencies, legislators, insurance companies, certification boards, national, state and private financial and regulatory leadership must become cognizant of their downstream cumulative impact of their initiatives, mandates, regulations and law on the healthcare ecosystem where one change impacts other factors. There are a multitude of systemic factors contributing to the increasing levels of stress and burnout in health care providers that can adversely impact physical, cognitive, and emotional wellbeing. These effects can lead to problems with physician and staff wellbeing, work relationships, career choices, and in some cases negatively impact patient outcomes of care. However, this also presents a rich opportunity for potential positive impact from creative interventions of forwardthinking healthcare systems. Physicians and other healthcare staff are a precious resource and should be assisted to work at the top of their license and training. We as a system of healthcare need to keep them happy, energized, and healthy so they can do what they want to do in the first place: practice good medicine.[62, 63] Physician Burnout is real, multifactorial in cause, currently underdiagnosed, and underappreciated in impact on the healthcare workforce and system. Unfortunately it seems to be relegated to low priority status while numerous healthcare reform and financial initiatives abound. Hence, it may be seen as quite inopportune and inconvenient to numerous uncoordinated business and reform missions if impact effects are not realized. A clear call to action is indicated. What is the first critical step that can be taken both by the physician and the healthcare system to begin to unwind the perpetuation of this overlooked but malignant issue? What is the best balance between self-efficacy and "healthcare system" as a key enabler for more balance in the direction of better patient care? Since many forces directly or indirectly influence the life and work of healthcare worker who in turn directly affect the lives of patients, it follows that the Hippocratic Oath taken by physicians: "First, do no harm" must also apply to the individuals, agencies and organizations responsible for the systemic forces on healthcare as well. 

References

 [1] Shanafelt TD, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population Arch Intern Med. 2012; 172(18): 1377-1385. PMid: 22911330. http://dx.doi.org/10.1001/archinternmed.2012.3199 [2] Gold KJ. Available from: http://www.ncbi.nlm.nih .gov/pubmed?term=Gold%20KJ%5BAuthor%5D&cauthor =true&cauthor_uid=23123101. Sen A. Available from: http://www.ncbi.nlm.nih.gov/pubmed?term=Sen%20A %5BAuthor%5D&cauthor=true&cauthor_uid=23123101. Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Available from: http://www.ncbi.nlm.nih.gov/pubmed?term=Schwenk%2 

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