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Does work-life balance exist for physicians?

Striving for balance is a thing of the past. Think "integrated" instead.

Yes, work-life balance is possible in medicine. That's the good news. You can have personal life and fulfilling career simultaneously. But unlike in previous generations, when your either working or not working, work and personal lives are now commingled. That's not necessarily bad news, but effective time management becomes the key to feeling like you have time to yourself. 

Work-life balance looks different today than even a few decades ago, says Peter Angood, M.D., CEO of the American Association for Physician Leadership. Where prior generations were able to switch back and forth between their many roles - physician, spouse or partner, parent, child, friend, volunteer, caregiver - today's physicians have to juggle multiple roles. 

Years ago, physicians were much better able to control the amount of work they did. It was possible to move between working and not working, explains Angood. During the times you weren't working, you would spend time with family and friends at home, or enjoy time engaged in your hobbies and outside interests. And at work, there was no outside interference from your personal life. 

Today, its nearly impossible to separate your life into two clearly distinct states of being. "Doctors are more accessible, causing a disproportionate amount of time to be spent on work," says Kyle Etter, vice president/partner at Consilium Staffing in Irving, Texas. 

Consequently, an "integrated lifestyle" is more the possibility than being able to separate from personal life, according to Angood. 

Instead of balance, we need to strive for a better blend. 

Making time for life

Cedric "Jamie" Rutland, M.D., a pulmonary and critical care physician with Pacific Pulmonary Medical Group in Riverside, Calif., estimates that he works more than 100 hours a week, including spending one to two nights a week at the hospital. "Work-life balance? I feel like I have it," he says. Work-life balance, he explains, doesn't necessarily mean that you're spending equal time on both. 

Rutland, who has a wife and two children, may arrive home tired form a long stretch at work, but says "being tired is not an excuse for not doing anything" with his children, who are often excited to see him. So he pushes through, gives his family time and attention when he's home, and sleeps when he can. 

Its a challenge to be both physician and family man, but Rutland feels a personal responsibility to be there when his patients need him. "you take an oath to care for patients," he says, and people get sick 24 hours a day, "If someone gets sick at 5 and my shift is over at 7, I stay," he says. "You have to take care of them."

Setting boundaries

Jill Garripoli, D.O., owner and physician at Healthy Kids Pediatrics in Nutley, New Jersey, says that, "Good people go into medicine to help people." Perhaps for that reason, it's so easy to let work consume all your waking hours. Early in her career, Garripoli believed she needed to be at work all the time. Her thinking has shifted in recent years, especially after hearing about a doctor who got an ulcer after working 12-hour days, six days a week. That was a wake-up call. 

Her typical day involves seeing patients in the morning, taking a lunch break during which she will often run, and then seeing patients in the afternoon and sometimes into the evening. She works five days a week plus alternating Saturdays with her P.A. She'll be at work 8:30am to 5pm most days, but only 2 to 5pm on Wednesdays, so she can have a break from patient care in the morning.

Garripoli defines work-life balance as having enough time to be a good physician and still have enough time to be with her family. And she's made some changes recently to ensure there is a balance of activities outside of work, starting with "giving myself the freedom to say, 'I don't have to be there 24 hours a day.'"

She also surrounded herself with people who help her have a life outside of work. "I found a partner who helps keep me balanced, who forces me to see there is life outside work," she says. She also found a skilled P.A. to share some of the weight of call.

Finally, she asked herself, "what makes me happy?," which, she believes, "is a simple thing to do yet no one thinks about it." Having a demanding and stressful career requires an equally relaxing and rejuvenating time away from work in order to achieve balance. So Garripoli tries to set up things she can look forward to and that make her happy outside of work. This could be a weekend getaway or a monthly massage, she offers as examples. They help motivate her during grueling times at work.

Shifting focus

Balance means something different to each individual, and it can evolve over time. 

For Khadeja Haye, M.D., national medical director for OB/GYN Hospitalists for TeamHealth in Atlanta, "Work-life balance is the flexibility to enjoy life outside of medicine. To be there for your family, to be there for personal events, to pursue interests outside of work... while still having the opportunity to take good care of your patients." Haye's outside interests include yoga, cello (which she recently picked up again after having played in high school) and golf (which she played in college). 

Early on in her career, Haye says that her work-life balance "tipped more toward work." Her focus was on her career and on building a foundation. "It was a conscious choice to work more on my career early on," she says. "I felt fulfilled," she says, and was very comfortable with the decision she made. When she wasn't working, she traveled and spent-time with her friends. 

But now as a wife and mother, Haye has shifted that balance to allow for more time on the personal side of the equation. She made the choice to transition from a role in private practice to a hospitalist with a leadership role. That change also gave her the time to pursue an MBA degree. Now Haye works three to four 24-hour shifts a month, travels about one night a week, and then works as many as 40 to 60 hours a week from home on administrative responsibilities. "Now I have to be more creative in my scheduling, to maximize the time when I'm not working in order to achieve balance," she says.

Finding the right fit

What does balance look like for you? What do you want your schedule to look like? What do you want time for? Do you need blocks of time to compete in downhill ski competitions during the winter, or evenings off so you can tuck your kids into bed? When you're clear about that, it becomes easier to find a position that can offer the mix you seek.

"The key is early conversations," says Etter. During the initial interviews, "Be upfront about your motivations. Emphasize work-life balance. Set expectations and be honest," he advises.

For many physicians, finding the right employment fit is vital to obtaining work-life balance. One way to determine if a position offers enough balance is to ask questions during the interview process to understand the culture, says Eric Dickerson, managing director and senior practice leader, academic medicine, with Kaye/Bassman International in Plano, Texas. Some of the best questions that get at balance and workload expectations are:

  • What is a typical day like here?
  • What's the number-one challenge you're trying to solve by hiring someone in this position?
  • What would you want the person selected for this position to accomplish in the next two to three months? In the next year?
  • Is this a new role or a replacement role? Why did the previous person leave? Or why is the role now needed?

The responses to these questions can help you assess whether you're willing to invest the kind of time and energy that will be necessary to be successful in that role.

"Organizations realize they have to be honest to prevent physicians from leaving quickly," says Dickerson. While only 5 to 7 percent make a career move because the job they were promised is different from what they were given, Dickerson says, the cost to recruit a replacement is significant. And employers want to avoid setting anyone up to be disappointed. Dickerson recommends looking for signs of the organization's culture, such as:

Are people smiling?

Do they greet one another?

Is the interviewer greeting others? Does he or she know everyone?

 "A culture of friendliness is aligned with balance," observes Dickerson, so look for indicators that employees are happy and like each other if balance is important to you.

Haye recommends asking pointed questions about the amount of personal time that will be available to meet your needs. For example:

"I try to travel to see my parents who live overseas once a quarter. What is the amount of vacation time allocated for this position?"

"I'm in the middle of pursuing an MBA. How flexible are the work hours?" 

"I'm also a caregiver for my grandmother. Would I have the ability to work from home part of the week?"

Ideally, the response you hear acknowledges your needs and explains how the hospital or practice can make the situation work. And if you don't hear that, that may be a clue that perhaps a fit does not exist. It's especially helpful, says Dickerson, if you have the opportunity to speak with someone already on staff who is in a similar life stage, since each stage has different needs, and a different definition of balance.

The generational shift underway

When Garripoli was interviewing for her first job 11 or 12 years ago, her potential boss asked about her vacation expectations. "Oh, we can talk about that later," Garripoli replied, fearing that talking about time off would make her sound like she wasn't willing to work hard. That fear seems to be completely gone with the latest crop of physicians, she observes. "Newer doctors are very forthcoming about what they want," she says, and what they want is work-life balance.

Rutland, on the other hand, thinks that discussions about vacation, flex time, and time off shouldn't occur right off the bat. When he interviews a newer physician for an opening and is asked, "How much time do I have to spend at work?" he knows they're not a fit for his particular practice. He recommends staying away from that question altogether. "Medical schools don't teach about business," says Rutland, leading some new physicians to have high salary expectations despite only wanting to work a few hours a week.

That is not true of all newer physicians, of course. Many others, facing huge student loan debt, are more likely to do extra work to supplement their income, says Etter, even working during downtime to make some financial headway.

Understanding your power

Though not all positions can be shaped to fit a physician's personal needs when it comes to work-life balance, many can be. And because of the huge shortage of physicians, it may be possible for organizations to meet specific schedule requests. It depends on the severity of the need and the individual demands being made, Etter explains. For example, if a candidate wants to work three days a week and a client wants them to work five days, there may be room for compromise.

Angood explains that the demand for work-life balance reflects a business cycle. Earlier generations had more patient time, less paperwork, and clear delineation between work and personal life. Then, physicians became overworked, saddled with administrative tasks, hit with huge insurance premiums, and accessible to patients at any hour. The industry, and newer physicians, are now reacting to compensate for all this extra work, says Angood. "The workforce is caught in the middle." "The driver needs to be a focus on quality and efficiency of system performance" in order to be able to provide any type of work-life balance, says Angood.

Balance through the years

While establishing a reputation through hard work early on in one's career seems to be a common experience among many newer physicians, that doesn't mean that work will remain the focus forever. Says Rutland, "It's OK if you don't have balance at the beginning of your career. You work your way up the mountain. You can't expect to start at the peak." That climb also allows you to gain experience you might never have had otherwise.

Now that Rutland is several years into his career, he acknowledges that his goals are shifting. "My goal isn't to work 137 hours a week for the rest of my life." To that end, he and his wife set five goals for the next 18 months that they work toward together. It helps them remember why he is investing so much time right now at work. At the end of 18 months, the duo sits down again to review their progress and to set new ones.

While Garripoli focused heavily on work early in her career, once she was established, she made conscious changes because she recognized she "was losing sight of [her] personal life." Today she is taking steps to delegate more of her workload to her skilled team members.

Haye, too, chose to rebalance her life away from work and more toward a personal life, changing jobs in order to achieve a balance that better met her needs and career goals.

Toward a more integrated lifestyle

We're in a transition phase from the on/off cycle of work to a more integrated lifestyle, says Angood.

Haye is witnessing this evolution. "I'm not sure if it's good or bad," she says. Thanks to technology that connects physicians to work and home 24/7, you can take care of personal tasks while at work. That's in the plus column. "But it's bad when you get emails while on vacation," she points out. Haye believes it's up to the individual to manage the amount of access their work life has to their personal. "It's up to the individual to set boundaries and make it less intrusive."

 

Article Source: PracticeLink Magazine

Written by: Marcia Layton Turner