Healthcare systems face immense economic pressures, workforce challenges, and increased demand for services, culminating in high occupational burnout among physicians. Here, we evaluate how one department tried to navigate these evolving challenges while simultaneously supporting the occupational well-being and work environment characteristics that influence well-being among pathologists. Existing electronic health records data from the Stanford Medicine Department of Pathology and de-identified data collected from the Stanford Doctor Survey™ were used to evaluate caseload sign-out patterns and trends in occupational well-being. Changes over time were modeled using linear regression/linear mixed models. Department caseload and cases signed out after hours increased between 2020 and 2024, and significantly higher on average following the adoption of a new laboratory information system (LIS) (total: b = 1861.0 [95% CI 1567.0, 2155.0] p < 0.0001; after-hours: b = 1165.4 [95% CI 1042.7, 1288.1] p < 0.0001). There was no significant change in the number of cases per pathologist/year, although per-person case complexity increased significantly (b = 670.6 [95% CI 491.5, 849.7] p = 0.004) and the percentage of cases signed out after hours increased by 10%. Despite these increases, measures of occupational well-being improved, including professional fulfillment (2020 vs. 2024: b = 0.78 [0.10-1.47] p < 0.026; 2022 vs. 2024: b = 1.08 [0.39-1.77] p = 0.002) and burnout (2022 vs. 2024: b = -0.77 [-1.38,-0.16] p = 0.013). These improvements appear related to simultaneous improvements in efficiency of clinical practice, supportive leadership behaviors, teamwork climate, helpfulness of electronic health records, self-valuation, and personal-organizational values alignment. Collectively, these data illustrate how a large pathology department simultaneously increased productivity and physician well-being through improvements in these core elements of a supportive work environment.
