The whole world knows about the burnout associated with medical school and residency and the good news is change is coming. That was the promise delivered at Grand Rounds at Temple University Hospital today by Dr. Jonathan Ripp, an internist at Mount Sinai in New York City. Hospitals and institutions will need to embrace this change because burnout will and does effect the bottom line, patient safety, and patient satisfaction, all three vital to the health of any hospital. There is also the moral imperative, the well being of the doctor. In the ten years he's been studying this issue, the citations have gone form hundreds to thousands. There is great interest and awareness, and he believes the solution is to incorporate changes -- narrative medicine, reflection, mindfulness, discussion, exercise, and many others still being explored -- into the curriculum of medical schools and residency. Don't make it an add-on, but part of daily life. A true culture change. That is the only way to remedy the extensive problem. He says there is even talk and hope of expanding the big three pillars of health care -- improved population health, higher patient satisfaction and lower health care spending -- with a fourth, better physician well-being. The demands on medical students and young doctors are immense. But as Ripp says, the good news is change is coming.