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Physician burnout is an escalating problem receiving little attention from health care leaders. Burnout is a long-term stress reaction which includes emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. Physician burnout rates range from 30–65 % across medical specialties, with the highest rates experienced by those at the front line of care, including emergency medicine and general internal medicine.1 Recruitment of medical students into general internal medicine is worrisomely low, and may relate in part to the perceived stressfulness of a primary care career. Addressing burnout among general internists is a national imperative, as health care reform necessitates greater reliance on primary care.  Burnout poses problems for both health care organizations and patients. While burned-out physicians attempt to maintain quality of care at their own expense, work conditions that result in burnout are associated with poorer care quality.2 Burned out doctors are more likely to leave their practice, thus reducing access to care. Turnover sacrifices continuity, and replacement costs are at least $250,000 per primary care physician. Satisfied role models could make a difference in this steady drain on primary care, but it is getting harder to find them. The situation may be no better for hospitalist physicians, for whom burnout is also common.3 Women physicians in national surveys have a 60 % higher burnout rate than that seen in men, yet the workplace remains largely unmindful of gender as a predictor of burnout. And despite known work condition challenges that contribute to burnout in clinics serving minority patients, few if any changes have occurred to improve this situation. Finally, models to prevent physician burnout are not well documented.  We offer suggestions for addressing these challenges. The fact that burnout is a long-term stress reaction allows time to measure and intervene. To combat burnout, organizations need to identify stress in its earlier stages (Fig. 1), and choose programs to prevent burnout before it occurs. Following this quality improvement (QI) model for organizational self-care can produce a sustainable workplace for clinicians, with high quality and accessible care for patients (see Table 1).    Figure 1.  Conceptual model of Ql feedback loop to prevent stress, burnout and turnover.      Table 1  Ten Steps to Prevent Physician Burnoutᅟ

10 Bold Steps to Prevent Burnout in General Internal Medicine