Published in the November 2016 issue of Today’s Hospitalist
WHEN IT COMES TO achieving work-life balance, hospitalists can reach that goal—but it takes a lot of work. For doctors and groups aiming to improve work-life balance, the process requires transparency, individualized solutions and a willingness to be creative.
That was the message delivered by a panel of hospitalist leaders and professional advisors at this spring’s Society of Hospital Medicine conference. While their solutions were no panacea, panelists offered tips on how hospitalist programs can help make physicians’ work lives more agreeable.
“We are convinced that if you improve people’s satisfaction with the job, you will also improve their sense of work-life balance and their willingness to tolerate some tension in it,” explained Leslie Flores, a partner in the La Quinta, Calif.-based Nelson Flores Hospital Medicine Consultants.
“You’re trying to reach the sweet spot where you are spending just the right amount of time on the things you love to do and as little time as possible on the things you don’t.”
The key to doing that, said panelists, is ﬁrst accepting and then addressing some common dissatisﬁers in hospital medicine: chronic understaffing that leads to overwork, inﬂexible schedules and compensation systems, and increasing pressure to take on nonclinical work on top of patient care.
Panelist Margaret Fang, MD, a hospitalist-researcher with the University of California, San Francisco, pointed out that such dissatisﬁers are a key component of physician burnout. Studies show that burnout may affect more than 50% of U.S. physicians.
According to Dr. Fang, more than one-third of hospitalists speciﬁcally have this to say: “Their work schedule left insufficient time for personal or family time.” Strategies that can turn such complaints around, she added, will go a long way to improving hospitalists’ willingness to withstand work-life imbalance.
“You’re trying to reach the sweet spot where you are spending just the right amount of time on the things you love to do,” Dr. Fang said, “and as little time as possible on the things you don’t.”
Imbalance, after all, does not equal unsustainable. As Joseph Ming Wah Li, MD, Boston’s Beth Israel Deaconess Medical Center hospitalist director, explained, “I don’t see anything in work-life balance that says anything about time speciﬁcally. If you are unhappy doing something, then maybe an hour of it is too much, whereas if you are thrilled, you could spend all day and night. There are people who are perfectly happy spending 14 hours in the hospital every day, whereas there are others who if they spend more than 10 hours are incredibly unhappy.”
Dr. Li said that’s why his group focuses on creating a group culture that allows for maximum ﬂexibility and individualization. “What I have found is that there is no one-size-ﬁts-all,” he said.
For instance, hospitalist practices that insist on a rigid seven-on/seven-off schedule, Ms. Flores said, sometimes struggle with group unhappiness and, ultimately, turnover. She admitted that as someone who sees seven-on/seven-off as not sustainable, she “might be in the minority.” But “hospitalist groups need to adopt a mindset where they are building the schedule around people’s lives,” she noted, “rather than requiring people to build their lives around a schedule.”
“Sometimes ‘no’ is the right answer.”
~ Kris P. Rehm, MD, Vanderbilt University
Flexibility also helps increase hospitalists’ sense that they have some control over their work lives and over how they balance (or don’t) work and life outside of work. That also relates to the commonly expressed dissatisﬁer of extra nonclinical work that clinicians have to do more and more of, from documentation to process improvement work.
“Sometimes ‘no’ is the right answer,” said Kris P. Rehm, MD, division director of hospital medicine pediatrics at Vanderbilt University. “It is a complete sentence, and it doesn’t require further justiﬁcation.”
During her decade in the profession, Dr. Rehm said she has come to view her job as division director as largely that of a “negotiator between the hospital and the hospitalists” trying “to get everyone to a schedule that is close to what they are looking for.”
Her advice for hospitalists is to carefully choose the group they join. “Such an important part of work-life balance is surrounding yourself with people you want to be with.”
Customizing your career
Tolerating work-life imbalance can also be easier if compensation matches the job. Groups should think about ways to vary compensation along with different types of work, panelists said. For instance, funding quality improvement/process improvement activities—even in non-academic, community hospital practices—could be smart in the long run.
In addition, paying attention to both provider well-being and enhancing group culture activities can help people value their time more at work, said Ms. Flores. “Social activities build social connections and a sense of teamwork or groupness.”
These can be simple things, like Dr. Li’s lunch table, where BIDMC hospitalists meet every day at 12:30 to “try to spend an hour together,” or a weight loss contest Ms. Flores said she saw one hospitalist group run that not only promoted healthy lifestyle, but had “the side beneﬁt of creating more group cohesion and social connections.” She has also seen programs undertake community outreach together as a group, “giving people something different to focus on beside their clinical work.”
Janet Nagamine, MD, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., said she thinks hospitalists could learn from other industries and “align the workplace with the workforce,” rather than the other way around. Currently, the workplace “is perfectly designed for the 1960s, when 10% of mothers worked and 10% of couples divorced,” she said. But that’s a far cry from the 21st century, “when 70% of children come from households where both parents work and 25% of families have elder-care duties.”
An example of a corporate model that could be transported into medical practice is known as “mass-career customization.” This strategy restructures the “corporate ladder” into a more ﬂexible “corporate lattice” to allow employees to dial their careers up or down to meet work-and-family needs at different points in their life.
Dr. Nagamine described how the academic physicians at Stanford University have instituted such a model, based on their career pace, workload, schedule, roles and work-life demands now vs. where they see themselves being in three to ﬁve years. Such a system allows for “customized career trajectories,” she said, and is already producing a more satisﬁed workforce and a better promotion rate for women faculty there.
“We can talk about individual solutions, and that is great, but we need to look systematically at programs too if we really want to move the needle on hospitalist satisfaction across the country,” Dr. Nagamine said. “We all have individual challenges, but they are becoming universal and predictable.”
Deborah Gesensway is a freelance writer who covers U.S. health care from Toronto.