Can Physicians Really Have It All? Work-life Balance in the Modern Era of Medicine

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In all work circles, work-life balance has become quite the buzzword. We all want to have it all - a satisfying career, enjoyable hobbies, and a fulfilling family life. Yet, physician wellness, in contrast to other professions, is vital in maintaining an optimal health care system and the nation's health at large.  With physicians' commitment to putting patients first and caring for them through highly stressful times in their lives, it is often assumed that our family life, hobbies, and even sleep and self-care will have to be sacrificed. However, this belief is being challenged, and it will take collaboration from the profession as a whole and individual physicians to make and commit to the needed changes.

The value of work-life balance

Whether or not physician work-life balance is possible, it is highly coveted. Younger generations of doctors (those 35 years old and younger) and an increasingly female workforce have spearheaded this movement towards balance. Women make up about half of all medical students and residents and many - along with an increasing number of their male colleagues - value raising a family and pursuing other life interests. While older generations accepted that the calling to become a physician would limit other areas of life, and the medical profession overall has a poor record of self-care, times are changing, and this newer generation is looking for a change.

What are physicians’ concerns?

Medical practice has changed over the last several decades. The changing demographics, electronic revolution and cost, and quality concerns have affected how physicians care for and interact with their patients. Some major challenges include:

1. Work hours - Physicians average 50-60 hours a week excluding call duties, and while this may be less than their predecessors, more than half believe their workload is too heavy. Regardless, the relationship between work hours and medical errors is not always so clear-cut, with some studies showing that physician's self-described sense of burnout and mental quality of life (QOL), rather than the number of hours worked or frequency of overnight call, may play a more significant role.
2. Lack of autonomy - The rapid and recent changes in medical practice - growing bureaucracy, cost control efforts and standardize care protocols- have drastically reduced physician autonomy. While some of these are necessary (and even beneficial), there has been little time for physicians to adjust. Physicians who work under such conditions report more job dissatisfaction and stress and fear that this may negatively affect patient quality of care.
3. Lack of time - Many physicians complain of short patient visits- often squeezed into 15-minute slots- that do not allow adequate time to connect with patients. In addition, the era of electronic medical records, coding, and billing changes have caused physicians to turn from their patients towards a computer screen.
4. The culture of bravado - Physicians are often type-A personalities; they take care of others first and must do so perfectly, sometimes to their own detriment. However, the increasing amount of physician burnout and associated mental health concerns suggest that the medical community must measure and address physician wellness

What do physicians want to change?

In these changing times, physicians want to reconnect with their purpose in medicine, pursue their passions, and enjoy time with their family and loved ones. Many physicians comment that the restriction on clinical practice, an increasingly litigious public and increasing time spent away from loved ones weigh heavily on their mind.

How can physicians achieve their goals?

1. Prioritize your purpose - Many physicians came to medicine to care for patients. We often feel like this is lost in the shuffle of the EMR, billing and short appointment times. Take the opportunity to connect with your patients one-on-one by sharing a joke or spending a few minutes discussing their health goals. Create a congenial workplace that makes you energized to step into the clinic, hospital or operating room. Remember to enjoy life and outside hobbies and realize that it saying “no” is okay and limiting your schedule may be necessary to reconnect with your priorities.
2. Periodically assess your balance - Life equals change, and your level of balance may change, especially during significant life transitions such as the end of training, having children, or contemplating retirement. Honestly evaluate your level of stress and burnout, and always reevaluate if you are satisfied with the amount on your plate. Schedule time regularly to check in with yourself to assess your level of work-life balance.
3. Time management - Work-life balance requires time management skills. We all have 24 hours in the day, and we must use them wisely. Physicians must be purposeful with their time, setting clear short and long-term goals within the confines of time. Examples include utilizing clear and concise EMR templates, delegating simple patient requests to medical staff, outsourcing housework, or meal prepping for the week.
4. Ask for and accept help - Utilize your community. Physicians should access physician assistance programs in their institution as well as local and national specialty organizations. Physicians must talk to one another and reach out to possible mentors for advice in achieving, not only career goals, but a true work-life balance. In addition, the overall profession must commit to benchmarks for physician wellness and make changes when sub-optimal.

Where do we go from here?

Physicians take work home with them, respond to patient emails, write research papers on weekends, or take call every other or third night. In this environment, it seems almost impossible to separate work from life, as they often happen at the same time. While other professionals may have the luxury of turning off their phone as no one's life is literally on the line, this is not the case for physicians.

Some suggest that physicians should focus on work-life integration. The "having it all" mentality may leave physicians with "unrealistic expectations" that add additional stress to an already stressful career. Physicians must have the ability to say "no" to more administrative and clinical duties or hours or take time off. However, the idea of a complete separation of life and work may lead some to feel that one or the other will always come in second place. When physicians are encouraged to honor self-care practices, cultivate an enjoyable workplace, and adhere to wellness indicators, work-life integration can begin.

References

1. American College of Surgeons. Being well and staying competent: challenges for the surgeon. Retrieved at: https://www.facs.org/~/media/files/member%20services/being_well_and_staying_competent.ashx
2. Aymes S. Work-life balance for physicians: the what, the why, and the how. Medical News Today. July 26, 2017. Retrieved at: https://www.medicalnewstoday.com/articles/318087.php
3. Balch C, Shanafelt T. Dynamic tension between success in a surgical career and personal wellness: how can we succeed in a stressful environment and a “culture of bravado?” Ann Surg Oncol. 2011 May; 18(5):1213-1216.
4. Schwingshackl A. The fallacy of chasing after work-life balance. Frontiers in Pediatrics. March 31, 2014. Retrieved at: http://journal.frontiersin.org/article/10.3389/fped.2014.00026/full
5. Shanafelt T, Balch C, Bechamps G et al. Burnout and medical errors among American surgeons. Ann Surg. 2010 Jun; 251(6):995-1000.
6. Wallace J, Lemaire J, Ghali W. Physician wellness: a missing quality indicator. Lancet. 2009 Nov; 374(9702): p1714-1721.