Work-life balance for physicians: The what, the why, and the how

Burnout rates and physician dissatisfaction are at an all-time 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, the concept of work-life balance is not so straightforward, as highlighted by Siva Raja, M.D., from Cleveland Clinic Foundation in Ohio, and Sharon Stein, M.D., from University Hospital Case Medical Center also in Cleveland, OH.

"In the three 'A's of physician excellence - able, affable, and available - available is often the easiest to perfect," Dr. Raja wrote.

Defining what work time means is complex in modern medicine. Typical physician duties include patient contact, administrative duties, charting, teaching, meetings, and community outreach activities. And with the addition of mobile technology, 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.

But, as Dr. Raja pointed out, it also includes daily living activities such as household needs, including groceries, laundry, cleaning, and paying bills.

With most physicians working 40 to 60 hours per week and nearly 20 percent reporting 61 to 80 hours each week, after 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?

Is work-life balance just hype?

Arun Saini, M.D. - an assistant professor in the Division of Critical Care Medicine at the University of Tennessee Health Science Center in Memphis - described the reasons for physicians seeking work-life balance as varied and personal, in an opinion article published in Frontiers in Pediatrics.

"Dissatisfaction, depression, and burnout are common in physicians," Dr. Saini wrote. In fact, a recent article on physician burnout published by Medical News Today points to research showing an increase in job dissatisfaction despite a decrease in working hours.

"Most millennial physicians are paying more importance to work-life balance after seeing the first-hand 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 MNT.

An American Medical Association survey noted that 92 percent 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 work-life balance often impacting their career choices.

Although statistics show the increase in the numbers of female physicians in the United States - where 47 percent of medical students and 46 percent of residents are female - research suggests that there has been little change for women in terms of domestic tasks and responsibilities.

Yet some take exception to the concept of work-life balance.

Andreas Schwingshackl, M.D. - an assistant professor in pediatrics at the University of California, Los Angeles, and Mattel Children's Hospital in Los Angeles, CA - suggested in an opinion article published in Frontiers in Pediatrics that the pursuit of work-life balance that can actually worsen a physician's quality of life by "adding additional, often unrealistic, expectations to [their] already stressful lives."

Dr. Schwingshackl suggested that seeking work-life balance 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 suggests 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 explained.

Whatever the definition, what practical advice can physicians follow to avoid dissatisfaction and burnout by achieving the balance that is important to them personally?

Four tips for finding your work-life balance

"In the hustle and bustle of busy work schedules and chores of daily life, young physicians often let themselves operate in autopilot," Dr. Saini pointed out in his paper.

Below are the four elements that he sees as being central to finding work-life balance.

1. Purpose

Young physicians may lose passion or satisfaction with their work because they no longer find meaning in their work or have lost sight of its purpose.

Finding meaning in one's work should also take into account family needs and aligning your own needs with those of your organization.

Lori Bryant, M.D. - a pediatrician at Hyde Park Pediatrics Cincinnati, OH - told MNT, "I intentionally do more of the things that remind me why I went into medicine, call patients/parents at home a few days after visit to check up on them, send cards to kids at home to encourage them or praise them on their school accomplishments, 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 not engaging in time-wasting activities.

Dr. Bryant's time-management skills include having a "huddle" about patients before clinic, preparing electronic health record templates, making clinic checklists, outsourcing housework, batch-cooking meals, staying on top of laundry every day, and treating herself and her family to takeout on long days.

3. Prioritization

Among your various responsibilities, it is important to identify what is important to you. Dr. Bryant, who has 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.

4. Reassessing and resetting

During life transitions such as 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 for him, "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."

This sentiment is echoed by Drs. Raja and Stein 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."

Siva Raja, M.D.