Burnout rates and physician dissatisfaction remain too high. Work-life balance is the buzzword answer often cited to solve these problems, but incorporating “life” into a physician’s career is easier said than done.
The Cambridge dictionary defines work-life balance as “the amount of time you spend doing your job compared with the amount of time you spend with your family and doing things you enjoy.”
For physicians, however, the concept of work-life balance is not so straightforward, as Dr. Siva Raja from the Cleveland Clinic Foundation, OH, and Dr. Sharon Stein from the University Hospital Case Medical Center in Cleveland have highlighted.
“In the three ‘A’s of physician excellence’ — able, affable, and available — available is often the easiest to perfect,” they point out.
Defining what work time means is complex in modern medicine. Typical physician duties include patient contact, administrative tasks, charting, teaching, meetings, and community outreach activities. The addition of mobile technology also means that work time can easily creep into life time.
Even so, the life aspect of work-life balance is more straightforward. Time outside of work can include wellness needs, such as sleep, nutrition, exercise, spiritual pursuits, and interactions with family and friends.
However, as Drs. Raja and Stein note, it also includes daily living activities, such as meeting household needs, which involves shopping for groceries, doing the laundry, cleaning, and paying bills.
Research shows that physicians work an average of 51.4 hours a week, with nearly 1 in 4 (23.5%) working 61–80 hours each week. After factoring in sleep, how easy is it to fit in this elusive “time outside of medicine?” And should all physicians strive for work-life balance, or is a career in medicine incompatible with this concept?
In an opinion article published in Frontiers in Pediatrics, Dr. Arun Saini — an assistant professor in the Division of Critical Care Medicine at the University of Tennessee Health Science Center in Memphis — describes the reasons for physicians seeking a better work-life balance as varied and personal.
“Dissatisfaction, depression, and burnout are common in physicians,” Dr. Saini writes.
“Most millennial physicians are paying more importance to work-life balance after seeing the firsthand effect of burnout in their colleagues and among their family members. There is also a shift in the family dynamics of [the] millennial, as most families have both parents working and limited support from immediate family members. This has put additional pressure on their abilities to manage work-life balance,” Dr. Saini told Medical News Today.
An American Medical Association survey revealed that 92% of physicians aged 35 or younger felt that work-life balance was important.
One respondent noted, “We are focused on maintaining our identities and relationships outside of work, and many older physicians sacrificed having a life to be good doctors.”
Female physicians, in particular, report work-life balance as a significant concern, with the goal of achieving this balance often affecting their career choices.
Statistics show an increase in the numbers of female physicians in the United States — with females representing 52% of medical students and 46% of residents in 2018–2019. However, research suggests that there has been little change for females in terms of domestic tasks and responsibilities.
Yet some take exception to the concept of work-life balance.
Dr. Andreas Schwingshackl — an assistant professor in pediatrics at the University of California, Los Angeles (UCLA), and UCLA’s Mattel Children’s Hospital — suggests in an opinion article that the pursuit of work-life balance can actually worsen physicians’ quality of life by “adding additional, often unrealistic, expectations to [their] already stressful lives.”
Dr. Schwingshackl says that seeking a distinction between work and life implies that “life only occurs whenever we are not at work” and assumes that “life is good, and work is bad.”
To him, this separation means that there is always a conflict. He recommends a different approach instead.
“Once I was able to integrate rather than separate all my daily activities [and] harmonize rather than divide my time, not only between work and life but also between clinical care and research, the pursuit of balance shifted from work-life to life-nature-universe. The result was an overwhelming daily feeling of ‘balance,'” Dr. Schwingshackl explains.
Whatever the definition, what practical advice can physicians follow to avoid dissatisfaction and burnout by achieving the balance that is important to them personally?
“In the hustle and bustle of busy work schedules and chores of daily life, young physicians often let themselves operate in autopilot,” Dr. Saini points out in his paper.
Below are the four elements that he sees as being central to finding work-life balance.
Young physicians may lose passion for or satisfaction with their work because they no longer find meaning in it or have lost sight of its purpose.
Finding meaning in your work should also take into account family needs and aligning your own needs with those of your organization.
Dr. Lori Bryant — a pediatrician at Hyde Park Pediatrics in Cincinnati, OH — told MNT, “I intentionally do more of the things that remind me why I went into medicine: call patients or parents at home a few days after a visit to check up on them, send cards to kids at home to encourage them or praise them on their school accomplishments, [and] treat my staff like friends so we have fun at work.”
2. Time management
Balancing work and life roles requires good time management skills. Effective time management involves setting both long- and short-term goals, planning and organizing, and refraining from engaging in time-wasting activities.
Dr. Bryant’s time management practices include having a “huddle” about patients before clinical hours begin, preparing electronic health record templates, making clinic checklists, outsourcing housework, batch-cooking meals, staying on top of the laundry every day, and treating herself and her family to takeout after long working days.
Among your various responsibilities, it is important to identify what is important to you.
Dr. Bryant, who is part of a dual physician family, said that she puts family first. As a result, she works 3 days per week to stay on top of her family life.
There is good evidence that working fewer hours is associated with a reduced risk of burnout. The Medscape National Physician Burnout, Depression & Suicide Report from 2019 showed that 36% of those working 31–40 hours a week had symptoms of burnout compared with 50% working 61–70 hours and 57% working more than 71 hours.
4. Reassessing and resetting
During life transitions, such as the completion of training, marriage, childbirth, and the death of family members, taking time to reassess and reset both work and life goals can be helpful in creating balance.
“Don’t feel like you always have to say yes. It’s better to say no and succeed at what’s already on your plate than to say yes and perform poorly or worse,” Dr. Bryant suggested.
In his article, Dr. Saini explains that “it is about finding your purpose in life both at work and at home — and striving to fulfill it. The balance is in the motion, so keep the cycle moving.”
Drs. Raja and Stein echo this sentiment in their article:
In researching and writing this article, it has become evident that there is no single standard for work-life balance. Therefore, success is only possible when one seeks his/her own personal work-life balance.