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830-01 RCPE Certified Professional WAN Optimization

The Riverbed® Certified Performance Engineering (RCPE) Professional Application Optimization instructorled course teaches IT professionals how to optimize user traffic between clients and servers and from one site to the next.

Use cases for implementation of datacenter optimization
architectures and how WAN solutions can enhance
digital performance will be reviewed.
Upon completion of this course, participants will be able
to greatly improve user experience across Wide Area
Networks (WANs) through installing and configuring
Riverbed cloud and virtual SteelHead solutions and
implementing related optimization technologies.
The RCPE Professional Level Application Optimization
instructor-led training is a key component of the RCPE
WAN Optimization Track.

After completing this course, participants will be able to:

• Describe the operations TCP performs to ensure the integrity of in-flight data.

• Integrate appliances into your environment using auto discovery.

• Increase system performance using TCP enhancements.

• Configure solutions to mitigate asymmetry issues.

• Compare how optimization affects WAN and LAN traffic.

• Differentiate between the different deployment options.

• Distribute and scale optimized traffic using load balancing solutions.

• Deploy and configure WAN optimization solutions on cloud and virtual environments.

• Optimize network connections over various topologies.

• Manage network traffic and congestion using QoS.

• Use path selection to route applications for optimal performance and bandwidth usage.

• Implement end-to-end traffic encryption using secure transport.

Course Outline
Design Workflow Modules Review

• Describe TCP Operations

• Integrate SteelHeads Using Auto Discovery

• Increase Performance Using SteelHead TCP Enhancements

• Migrate Network Asymmetry Issues

• Visualize the Effects of Optimization

Plan • Review Deployment Options


• Deploy SteelHead Interceptors

• Deploy SteelHead Cloud Solutions


• Build and Configure Topologies

• Implement and Configure QoS

• Enhance Application Performance Using Path Selection

• Encrypt Traffic Using Secure Transport

RCPE Certified Professional WAN Optimization
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830-01 RCPE Certified Professional WAN Optimization

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RCPE Certified Professional WAN Optimization
Question: 193
You are using TCPdumps on the server-side SteelHead to troubleshoot an application
connectivity issue. The following filter is used on the TCPdump:
(host and host ) or (host and host
) or (proto gre and ((ip[40:4] =
And ip[44:4] = ) or (ip[40:4] = and ip[44:4] = server IP>)) or (port 7850) What part of the filter captures the traffic which the
Interceptor has applied NAT to?
A. (ip[40:4] = and ip[44:4] = )
B. (host and host )
C. (proto gre and ((ip[40:4] = and ip[44:4] = )
D. (host and host )
Answer: A
Question: 194
A SteelHead is deployed in a VLAN bridge. Which VLAN ID should be configured
on the in-path interface to support this environment?
A. 1
B. 100
C. 200
D. No configuration is necessary as LAN and WAN interfaces are on access ports
E. It will require an in-path interface for each VLAN
Answer: C
Question: 195
You plan to downgrade a SteelHead from RiOS v9.0.1 (Apr 17 2015) to 8.6.3 (Aug 7
2015). The appliance has not run v8.6.3 previously. Will this be successful?
A. No, downgrades are only permitted if the target version was previously installed.
B. No, it is not possible to downgrade RiOS.
C. Yes, the configuration will be migrated successfully during any downgrade.
D. Yes, v8.6.3 is a chronologically newer version.
Answer: A
Question: 196
The SteelHead REST API connectivity can be used for which of the following?
A. To synchronize layer 7 signatures and QoS configurations with the NetProfiler.
B. To export QoS and other statistics to the SteelCentral Controller for SteelHead
C. To push secure transport configuration from the SCC to the SteelHeads
D. To push topology information to the SteelHeads from the SCC for path selection.
E. To synchronize layer 7 signatures with the NetShark devices.
Answer: B
Question: 197
A customer uses a single URL for a service that uses many servers with different
certificates. What SSL options should be enabled to enhance performance?
A. Passive key derivation
B. SSL proxy support and SNI (Server name indication)
C. SSL advanced mode
D. Early start/late finish
Answer: C
Question: 198
Which deployment options are available to Virtual SteelHead on ESXi?
A. Physical In-path (with Riverbed bypass NIC)
B. Virtual In-path
C. Out-of-path
D. Server-side Out-of-Path
E. All of the above
Answer: A, B, C
Question: 199
A SteelHead is running RiOS v8.6 and has an inpath0_0 IP address of
It is later upgraded from v8.6 to v9.0. As part of an IT project, the inpath0_0 IP
address is changed to and the configuration saved. Some time passes and
the administrator decides to revert to RiOS v 8.6. It hasnt been factory reset. The
appliance boots and the Management Console User Interface is reachable, however,
optimization no longer works. What has happened?
A. The web GUI SSL certificate is no longer trusted and the services require a restart.
B. The licenses are no longer valid and will need to be replaced and the services
C. It is not possible to revert to older versions of RiOS and the optimization service
has stopped as a precaution.
D. The configuration has reverted to the one running under v8.6 and the inpath0_0 IP
address is back to
E. The configuration has been lost and the appliance is running factory default
Answer: D
Question: 200
What is the first step in optimizing an SMTPS session?
A. An unencrypted SMTP connection is intercepted and optimized, before a START-
TLS is issued.
B. START-TLS is issued immediately by the client and intercepted by the client side
C. SteelHeads do not currently support optimizing SMTPS sessions.
D. An SSL client HELLO is sent by the client and intercepted by the client side
Answer: A
Question: 201
What is the purpose of Peer Affinity on the Interceptor?
A. To keep similarly sized SteelHead models peering with each other.
B. To ensure load is distributed evenly throughout the cluster.
C. To maximize the benefits of SDR by maintaining SteelHead peering relationships.
D. To ensure asymmetrically routed connections are optimized.
E. To make sure cluster SteelHeads remain connected to the same Interceptor.
Answer: A
Question: 202
The SteelHead Out of Band splice (OOB) uses which addressing mode? Assume a
default configuration.
A. Always correct addressing.
B. Depends on which addressing mode the first optimized connection uses.
C. Always transparent addressing.
D. Always destination transparency.
Answer: A
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Riverbed Professional study help - BingNews https://killexams.com/pass4sure/exam-detail/830-01 Search results Riverbed Professional study help - BingNews https://killexams.com/pass4sure/exam-detail/830-01 https://killexams.com/exam_list/Riverbed Study support No result found, try new keyword!Bitesize Study support is the go-to place to support you through your studies and other life challenges. With tips and advice to help with revision, exam stress, bullying and more... we've got you. Fri, 06 Oct 2023 16:18:00 -0500 en-GB text/html https://www.bbc.co.uk/bitesize/study-support Riverbed Community Connect Week to Support Dozens of Charities Globally No result found, try new keyword!LinkedIn: Riverbed Community Connect Week to support dozens of charities globally: https://rvbd.ly/49xmWi3 Riverbed Community Connect Week is an extension of Riverbed’s global employee volunteer ... Sun, 12 Nov 2023 18:30:00 -0600 https://www.businesswire.com/news/home/20231113262978/en/Riverbed-Community-Connect-Week-to-Support-Dozens-of-Charities-Globally/ Study Abroad Study Abroad

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ESF Education Abroad is devoted to making transformational international experiences accessible to all ESF students regardless of major, cost, identity, or other defining factors. We do this by working with students on an individual basis to find the opportunities that best fit their personal needs and goals.

ESF students have hundreds of education abroad programs to choose from! Programs vary in length from one week up to a full academic year and are located all over the world, so there is something for everyone! Start to browse programs below, and please reach out to oie@esf.edu with any questions or to start planning your experience abroad.


Program Details
ESF Short-Term Programs Travel abroad with an ESF faculty member and your classmates! Most short-term courses are between one to three weeks in length and take place over spring or summer break.
ESF Exchange Programs Spend a semester or summer abroad with one of ESF's university partners.
ESF Partner Study Abroad Study abroad for a winter, summer, or semester with one of ESF's recommended study abroad providers, any other SUNY institution or through another study abroad program provider. Many of these programs are immersive or field-based opportunities. Short-term, summer, and semester programs are all available!


Quick Tips

Before researching programs, think about your goals for education abroad. What type of experience are you hoping to have and what are you most interested in learning? What type of opportunities do you have limited access to in Syracuse and how might you gain those abroad? Use these questions to help guide you to better understand what it is you want out of your international experience and how you might be able to find a program that fits those criteria.

In addition to thinking about what is important to you, take some time to recognize what is not important to you. When choosing a education abroad program, it can be easier to find a "perfect" match if you understand what you are willing to compromise. Are financials the most the important piece to you? Specific classes for your major? Perhaps a research topic in a specific field? Rank the things that are most important to you so we can help you find that "perfect" opportunity.

You never know where you might find recommendations, advice or input. Ask your classmates, professors, advisors, parents, guardians, coaches, etc. You never know what you might discover. Don't forget to visit OIE as well – we serve as the repository for all of the different opportunities in front of you and can help guide you when you're not sure where to even start.

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How To Become A Direct Support Professional

Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations.

If you enjoy working closely with people and are interested in pursuing a career within healthcare that offers challenging, yet meaningful work, you may want to look into becoming a direct support professional.

Direct support professionals play an integral role in their communities for people with intellectual and developmental disabilities (IDD) by helping them become integrated and engaged members of their community. This article provides an overview of the steps you can take to become a direct support professional, including certification, training and essential skills.

What Does a Direct Support Professional Do?

A direct support professional supports individuals with intellectual and developmental disabilities by equipping them with life skills and habits they need to succeed in their community. They assist their clients by addressing their conditions and behaviors through the implementation of personalized care plans.

DSPs are responsible for a wide range of tasks, including administering and tracking prescribed medications, helping individuals develop appropriate social, housekeeping, and money management skills, and maintaining records of activities and progress.

Direct Support Professional Job Outlook

The U.S. Bureau of Labor Statistics projects that employment opportunities for home health and personal care aides will grow 22% through 2032, which is much faster than the 3% average for all occupations. Nearly 685,000 job openings are projected each year over the next decade. Home health and personal care aides’ median salary was $30,180 in 2022.

Direct Support Professional Educational Requirements

There are no formal education requirements to become a direct support professional. Most employers require a high school diploma at the minimum. Though continuing your education is not necessary, earning a related bachelor’s degree in social work, counseling, psychology or sociology can give you a competitive advantage when applying for jobs.

Top Skills for a Direct Support Professional

Direct support professionals work closely with people of all ages who may have mental, developmental and physical disabilities. Being able to assist patients with sensitivity and compassion requires strong interpersonal skills, such as empathy, patience and understanding. The following is an overview of the type of skills that are key for a successful career as a direct support professional:

  • Verbal and nonverbal communication
  • Emotional intelligence
  • Administrative skills
  • Organization
  • Detail-oriented
  • Observant and attentive
  • Reliable
  • Adaptable

How to Earn Direct Support Professional Certification

The National Alliance for Direct Support Professionals (NADSP) offers a voluntary national certification program for DSPs working in community human services. This certification program provides national recognition for the contributions and competence of DSPs who meet the certification standards. Depending on the employer, cardiopulmonary resuscitation (CPR) and first aid certifications may be required.

Earning Initial Certification

The NADSP offers various levels of certification, which include DSP-I, DSP-II, and DSP-III, through participation in the NADSP E-Badge Academy. Electronic badges are earned by demonstrating core competencies and completing accredited education hours.

Getting Recertified

A renewal application form needs to be completed every two years. In addition to paying a fee, you must also complete and submit 20 hours of training.

Frequently Asked Questions (FAQs)

What is the responsibility of a direct support professional?

The responsibility of a direct support professional can range from offering counseling and crisis intervention to assisting individuals with personal hygiene, housekeeping and other routines. DSPs may also assist with administering medication and developing behavioral management plans.

What are the skills of a direct support professional?

It’s essential for direct support professionals to have strong communication and interpersonal skills to build rapport with clients and ensure they feel safe and comfortable. DSPs are often responsible for maintaining records of their patients’ appointments, medications and other activities. Being organized and detail-oriented ensures all tasks are completed and accurately documented.

What is DSP certification?

DSP certification provides national recognition of the professional skills and competencies of direct support professionals who apply and meet the NADSP standards. NADSP offers three levels of certification, which require at least 50 hours of training. Obtaining a certification can provide a competitive advantage when applying for jobs.

How long is DSP training?

DSP training periods vary by state and employer; some states require DSPs to complete a training program. Employers commonly offer on-the-job training that covers behavior management, occupational safety and CPR. Voluntary NADSP DSP certification requires at least 50 hours of education and 20 hours of continued education every two years.

Mon, 01 Jan 2024 15:51:00 -0600 Mariah St John en-US text/html https://www.forbes.com/advisor/education/become-a-direct-support-professional/
Study Assistance

Improve your study skills with our assistance. We provide many forms of academic help, but studying begins with you. Check out some of these resources about self-management and learning, two areas essential to your academic success.



  • Motivation is the force behind all learning.  Without motivation, you may dread going to class, procrastinate, or your mind may wander during homework.  Try setting goals or learning more about your mindset in order to boost your motivation. 


  • Learning takes time, but you have to make time by blocking out your weekly schedule and finding the best times to study. Use a planner to keep track of daily tasks and activities. Write detailed to-do lists to keep yourself on track in accomplishing your goals. 


  • Focus is imperative for learning, and phones and computers are both a gift and a curse. Use your time wisely by taking frequent brief breaks and avoid multi-tasking.


  • Sleep aids learning. Shoot for 8 hours, although some people need a bit more or less. When you exercise, proteins and hormones are created and released which boost learning power and memory. Eating well is important for learning, and affects sleeping and exercise habits too.


Learning skills

  • Learning takes time and effort; there are no short cuts. Here are tools and techniques to help you apply that time and effort well.


  • Remember, you should MAKE notes, not take notes. notes are most helpful when they involve active listening, and you return to them on a regular basis. Make sure to engage with your notes when reviewing by asking questions, speaking aloud, reorganizing, and discussing with classmates.


  • Professors assign textbooks for a reason. Reading can take time, but ti is worth it to prime your brain to the topics you will discuss during class, and textbooks are an invaluable resource when reviewing for tests.

Test taking

  • Tests are one of the most intimidating aspects of college, but with good preparation and understanding of how testing works, you can come out ahead. Remember to communicate with your professor to know what to expect, and always start studying at least 5 days ahead of the test date.


Sun, 05 Feb 2017 01:34:00 -0600 en text/html https://calvin.edu/offices-services/center-for-student-success/support/study-assistance/index.html
Graduate Certificate in Professional Study

Give Your Teaching Career a Boost with a Professional Study Graduate Certificate

If you would like to advance your professional career by pursuing additional coursework beyond your degree, a Graduate Certificate of Professional Study within the field of education from Southern New Hampshire University can provide you with the opportunity to engage with a broad range of topics. Earning your graduate certificate is a great way to add to your teaching résumé while enhancing your understanding of important educational concepts and strategies.

This field-based certificate program, available through the SNHU Vermont Campus, is ideal for practicing educators seeking applied learning and professional development opportunities within the topic areas of curriculum, assessment and evaluation, education technology, learning and development, and teacher leadership.

Although this program is currently available in a limited number of districts within the state of Vermont, we encourage you to reach out to the SNHU Vermont Campus at info@snhuvt.org if you are interested in participating or learning more.

See Yourself Succeed with a Professional Study Graduate Certificate from SNHU

The field-based Professional Study Graduate Certificate program in education at SNHU allows you to choose from the following five subject areas: Curriculum, Assessment and Evaluation, Education Technology, Learning and Development, and Teacher Leadership. This is a 15-credit program, and you will select five three-credit courses to complete in accordance with your chosen topic.

As a private, nonprofit university, SNHU has one mission - to help you see yourself succeed. The benefits of enrolling in a field-based graduate program at SNHU include:

  • Convenience. Pursue your graduate degree or certificate where you work, and complete international field studies around your teaching schedule.
  • Supportive community. We have a deep understanding of how adults learn best, and we know all of our students personally. Our cohort model allows you to learn with colleagues.
  • Relevance. All course material and assignments apply directly to your classroom practice.
  • Affordability. It’s our mission to make higher education more accessible. That’s why, SNHU is one of the most affordable private, nonprofit universities in New Hampshire. 
  • Constructivist classrooms. Our instructors design the classroom experience so that it begins with your experiences and builds toward exceptional practice in a collaborative manner.

Careers & Outcomes

The Professional Study program is designed to help educators advance their careers without committing to a full master’s degree program. The goal of this program is to produce teachers who are prepared to impact their schools and their students in meaningful ways, both inside and outside of the classroom. Whether your goal is to develop new curriculum, become familiar with new teaching technology, or learn new leadership skills, SNHU can help you take the next step in your career.

Professional Study (Post-Master's Graduate Certificate)

In addition to the standard Professional Study Graduate Certificate in education program, SNHU also offers a Professional Study Post-Master's Graduate Certificate option. This program is similar to the standard graduate certificate version, but is designed for educators who have already earned their Master of Education. This program also features Curriculum, Assessment and Evaluation, Education Technology, Learning and Development, and Teacher Leadership as subject areas; however, many of the courses within the post-master's program cover more advanced topics.


With multiple pathways to choose from, the program will help you develop a deeper understanding of responsive, responsible teaching methods. Participants will plan and deliver purposeful learning opportunities that incorporate current research and best practices to engage students in meaningful ways. SNHU will help you learn to create strengths-based, inclusive, and collaborative learning communities in classrooms and schools. The program will also help you understand the need for professional analysis, innovation, and continually evolving professional strategies while evaluating your own personal growth, teaching practice development, and personal leadership.

Graduate Tuition

Our Manchester campus aims to keep tuition and related costs low for our students so that you can pursue your degree and your goals.

Beyond low tuition rates, we help our students save through transfer credits, credit for prior learning, grants and scholarships, tuition assistance and more.

This certificate is not eligible for federal financial aid. Students seeking alternatives to federal financial aid can explore tuition assistance, grants and scholarships, as well as private loans. To learn more about private loans, visit our Funding Your Education with Student Loans page.

Tue, 19 Dec 2023 09:59:00 -0600 en text/html https://www.snhu.edu/campus-majors/certificates/graduate-professional-study
Study Suggests Horticulture Therapy Could Help Fight Depression No result found, try new keyword!A study suggests that horticulture therapy, which focuses on gardening activities, may help reduce depression symptoms in older adults. The greatest benefits were found when therapy lasted 4-8 ... Thu, 14 Dec 2023 10:00:00 -0600 en-us text/html https://www.msn.com/ Ozempic could help curb alcohol abuse, study reveals

The latest weight loss craze could also help people control their drinking.

Semaglutide treatments such as Ozempic and Wegovy have been shown to reduce the symptoms of alcohol use disorder (AUD), according to a study published in The Journal of Clinical Psychiatry on Nov. 27.

The collaborative study from The University of Oklahoma (OU) and Oklahoma State University (OSU) found a “significant and noteworthy decrease” in the Alcohol Use Disorders Identification Test (AUDIT) scores of six patients who were receiving semaglutide treatment for weight loss.

Lead study author Dr. Jesse Richards, director of obesity medicine and assistant professor of medicine at the OU-TU School of Community Medicine, said the study was inspired by his conversation with Dr. Kyle Simmons, professor of pharmacology and physiology at the OSU Center for Health Sciences.

“I had been hearing from a significant number of patients that their alcohol intake was spontaneously decreasing while [they were] on the medication,” Richards told Fox News Digital.

As a bariatric surgery clinic employee, Richards noted that it’s standard to screen patients for alcohol use.

Studies found that there was a decrease in Alcohol Use Disorders Identification Test (AUDIT) scores for six patients receiving weight-loss treatments. AP

At the clinic, a number of patients tested positive for alcohol consumption, sometimes in concerning amounts.

Later, while on semaglutide medication, they reported reduced alcohol intake.

One of Richards’ patients — who previously drank large amounts of alcohol — shared a new inability to drink more than two cans of beer now because it “just doesn’t sound good.”

After semaglutide medication, a patient who formerly drank beer regularly began to think that alcohol just didn’t “sound good.” Getty Images

This response piqued Richards’ interest in learning more about patients’ aversion to alcohol, which directly correlated to his research.

Research has shown that this effect is “mediated through adjustments in the reward pathway in the brain,” he said.

“The GLP-1s are actually modifying dopamine, decreasing the craving and decreasing the motivation to acquire things in that compulsive intake category.”

The most surprising takeaway from the study, Richards said, was that the same significant treatment response was seen even at very low doses.

“We found that even patients on the lowest dose of semaglutide — a quarter milligram — had a quite significant and relatively … quick onset reduction in alcohol intake,” he said.

Of the six patients studied, all but one were on low doses — from a quarter to a half milligram.

“And that’s very encouraging because we know that the lower doses of these medications are tolerated much better,” said Richards.

While the results seem promising, the doctor said he does not recommend that patients use semaglutide treatments for alcohol use disorder at this time, due to supply and safety issues.

“If patients have [obesity and diabetes] indications for the medication and they also struggle with alcohol intake … having them on this treatment may potentially be beneficial,” Richards said.

Due to medication shortages and a lack of long-term data, it may not be advisable to take Ozempic to target alcoholism specifically. NurPhoto via Getty Images

“But because there has been a global medication shortage, and because we don’t have prospective trials and don’t know what the specific safety is versus the well-established safety data in obesity and diabetes, [I] would not recommend it just for patients who have AUD.”

There are three FDA-approved drugs available for alcoholic use disorder that are currently underused, the doctor noted.

Given that five million people in the U.S. are currently taking semaglutide medications, if it is proven that those drugs have a significant effect on alcohol use disorder, “by default, they are going to become the most widely used drug to improve these symptoms — just by virtue of the fact that so many people are on them for diabetes or obesity,” Richards noted.

Trials are underway to gather more information on the weight-loss medication and its effect on alcohol intake. UCG/Universal Images Group via G

He confirmed that additional research is underway with two ongoing trials.

“Since we were able to show clinically meaningful reductions in alcohol intake and AUD symptomatology in a real-world setting, that bodes very well for these types of medications,” he said.

Looking ahead, Richard said there is a need for higher-quality evidence of the medication’s impact on AUD compared to placebo drugs or environmental factors.

People struggling with alcohol use should speak with their healthcare provider. Getty Images

Even though it’s unclear whether GLP-1 producers will market the medication to AUD patients in the future, Richards said this could become an “established medical practice once the safety and efficacy has been determined.”

For patients who struggle with AUD, Richards recommended they talk to their health care providers about available treatment.

He also alerted patients that if they experience a reduced appetite and usually consume “a bunch of calories” in alcohol, it may be necessary to look into a more balanced diet.

Avantika Waring, 9amHealth’s chief medical officer and a trained physician and endocrinologist in San Francisco, applauded the OU and OSU study findings for further supporting what clinicians “are already seeing in practice,” she told Fox News Digital.

“GLP-1 medications have a lot of effects that we are still learning about, and the ability to decrease cravings and the reward signals related to alcohol use are just some of the benefits,” she said.

“It’s an important starting point for further clinical trials,” she added.

Waring also warned that GLP-1 medications should not be used to treat AUD specifically, as they can cause side effects such as nausea and changes in appetite.

“People struggling with alcohol use disorder should consult with their physicians before starting GLP-1 medications to make sure that they can stay hydrated and safe on therapy,” she said.

Waring noted that if ongoing clinical trials find semaglutide treatments to be effective for AUD, the medical community will “have another tool to help people living with alcohol addiction and we’ll see expanded use of these already popular drugs.”

Fox News Digital reached out to Novo Nordisk for comment on the potential link between semaglutide medications and alcohol use disorder.

Sun, 10 Dec 2023 02:53:00 -0600 en-US text/html https://nypost.com/2023/12/10/lifestyle/ozempic-could-help-curb-alcohol-abuse-study-reveals/
Study reveals burnout and professional dissatisfaction driving physicians to leave their practices

A recent study published in JAMA Network Open explores the prevalence of burnout among physicians, their levels of professional fulfillment, and factors impacting their intention to leave (ITL) their institution or profession.

Study: Well-being parameters and intention to leave current institution among academic physicians. Image Credit: Robert Kneschke / Shutterstock.com Study: Well-being parameters and intention to leave current institution among academic physicians. Image Credit: Robert Kneschke / Shutterstock.com


Recent surveys suggest that 6-7% of American physicians leave their practices each year, with this turnover rate continuing to rise. These departures lead to interruptions in professional and therapeutic relationships and may disrupt the delivery of care within the institution while also increasing the burden on other providers.

Physicians leaving medicine also contributes to shortages in the field, with attrition rates differing between specialties. Work-life imbalance strongly predicts burnout, which is associated with high physician turnover.

Physicians who perceive a mismatch between effort and reward in their professions are likelier to leave their profession, as are those who report ITL. Little is known about factors other than burnout that may contribute to turnover and ITL or how ITL differs between specialties.

About the study

In the current cross-sectional study, researchers used data collected by the Healthcare Professional Well-being Academic Consortium (PWAC) from physicians across 15 organizations. The survey, conducted from October 2019 to July 2023, asked respondents to answer questions regarding burnout, professional fulfillment, and contributing factors. While demographic information was included in the data, it was deidentified to protect the participants' privacy.

According to the principle of reciprocal determinism in social cognitive theory, the well-being of a clinician is achieved by a combination of individual factors, work efficiency, and cultural determinants. The survey included these dimensions by taking measures such as supportive leadership, control over schedule, alignment of personal and organizational values, perceived meaningfulness of work, the effect of work on non-work relationships, peer support, and mental health, including anxiety, sleep impairment, and depression. Work fulfillment was assessed using the Professional Fulfillment Index (PFI), which was the primary outcome measure.

The dataset was analyzed using multivariate logistic regression models that predicted ITL based on professional fulfillment and burnout and adjusted for gender, subspeciality, age, ethnicity, and race. A subsequent analysis assessed the relationships between ITL and determinants of physician well-being.

Study findings

Of the 37,511 attending-level medical specialists who received the survey, 18,719 physicians from across 53 medical specialties were included in the analysis, as they had responded to questions related to at least one of the study outcome measures. In this group, 44.8% were male and 42.9% were female, whereas 56.6% were White and 12.8% were Asian.

Of the 15,890 respondents who answered questions about their ITL, nearly one-third reported a moderate or higher score of three or more on the Likert scale. Men were slightly more likely than women to report this level of ITL at 33% and 31.2%, respectively, while Asian and White physicians were less likely to report greater ITL at 28.9% and 31.2%, respectively than those from other races at 38.9%.

Respondents 60 years and older had the highest probability of reporting ITL at 40.1%. Specialties with high ITL rates included anesthesiology, gastroenterology, thoracic surgery, neurological surgery, critical care, and radiology. Comparatively, pediatric hospital medicine, hospice and palliative care, neuroradiology, physical medicine and rehabilitation, and nuclear medicine had the lowest rates.

Women were more likely than men to report burnout at 42.2% compared to 33%, respectively, and less likely to report professional fulfillment at 34.1% compared to 45.4%. Burnout was lowest among respondents over the age of 60 at 23.2%, while nearly half of the physicians in this age group reported high levels of professional fulfillment at 49.5%. Non-White and non-Asian physicians were most likely to report burnout and least likely to report professional fulfillment.

The multivariate regression models indicated that, after controlling for medical specialty and demographic factors, ITL risk increased by 52% if the burnout score increased by one point. However, increasing the professional fulfillment score by one point reduced ITL probability by 36%.

Controlling for burnout, professional fulfillment, and demographic characteristics, ITL risk was decreased by factors such as supportive leadership behavior, alignment of personal and organizational values, perceived gratitude, and organizational support related to coronavirus disease 2019 (COVID-19). However, measures that were associated with higher ITL risk included depression and the negative impact of work on non-work relationships.


ITL and burnout are pervasive among physicians and differ by gender, age, race, and specialty. The novel insights from the current study can be used to develop initiatives that provide better support for physicians specializing in emergency medicine and other frontline specialties, which will likely face substantial shortages in the future.

Journal reference:

  • Ligibel, J.A., Goularte, N., Berliner, J.I., et al. (2023). Well-being parameters and intention to leave current institution among academic physicians. JAMA Network Open (2023). doi:10.1001/jamanetworkopen.2023.47894
Sun, 31 Dec 2023 10:00:00 -0600 en text/html https://www.news-medical.net/news/20240101/Study-reveals-burnout-and-professional-dissatisfaction-driving-physicians-to-leave-their-practices.aspx
MPA Study Support

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Wed, 07 Feb 2018 10:46:00 -0600 en-GB text/html https://www.lse.ac.uk/school-of-public-policy/mpa/study-support

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