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Is Physician Work/Life Balance Dead?

Discussion in 'Hospital' started by The Good Doctor, Apr 25, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    The pandemic forever changed many things, including the notion of work-life balance. Remote work arrangements, once somewhat rare, became mainstream overnight, forcing professionals to juggle the career and personal demands in new ways. The shift became an accelerant for ongoing erosion of the separation between work life and personal life, driven by real-time communication technology.

    Physicians, of course, aren’t immune to this tech-driven change. The EHR and the smartphone can make any moment a medical moment. While doctors were largely spared from the remote-work transition, many confronted the life-or-death nature of the pandemic head-on, all the while worrying whether they’d bring the virus home to their spouses and/or children. Specialists on the frontline of care faced the same logistical concerns as the lay population–childcare chief among them. If there’s a salient lesson to be learned here, COVID-19 revealed systemic weaknesses of the American workforce, one of which is work-life balance.

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    The chief problem with work/life balance is that it’s a dated idea, rooted in a workforce that no longer exists. It’s tough to come up with any white-collar jobs that involve a traditional 9 a.m.-5 p.m., 40-hour workweek. For example, a quarter of physicians work between 61 and 80 hours weekly, according to the American Medical Association. About half of those surveyed said they would prefer to work fewer hours.

    Nearly all employees–physicians included–are buffeted by moment-to-moment demands that require an email, phone call, or Zoom session in the so-called off hours. Anywhere there’s an internet connection, work beckons.

    For example, a 2020 Annals of Internal Medicine study found that per patient encounter, the average physician spends 16 minutes and 14 seconds pecking away at an EHR. Chart review accounts for 33% of the time, documentation 24% and ordering 17%. For context, a 2018 Family Medicine study put the mean patient visit length at 35.8 minutes. Total time actually face-to-face with the patient? A mean of 16.5 minutes. About 64% of the time, doctors couldn’t complete documentation during standard work hours. They then spent a mean of 6.9 minutes per patient encounter wrapping up during their personal time.

    What to do

    A new workforce and new work demands require a fresh approach to work/life balance. A 2019 Mayo Clinic Proceedings commentary offers doctors a better approach to the task. The authors suggest using three categories–Work, Yourself, and Others–instead of the traditional work/life binary.

    • Work: This includes job-related tasks at home and in the office, commuting time, and travel for medical conferences, the authors say. It’s helpful to bear in mind that medicine is not simply a job, but a profession. You are and were called to serve the sick. This is at once intrinsically rewarding, and a recipe for overwork.
    • Yourself: Here, the authors place human needs, such as sleep, eating, hygiene, and exercise, as well as personal health and higher-order needs, such as purpose. “Your contentment with life is the most important variable in the life balance equation,” the authors write. That contentment revolves around taking charge of the things you can control, such as your choice of medical practice, where you live, and your employer.
    • Others: This might include your spouse, children, friends, neighbors, colleagues, religious organization, social clubs, or volunteer groups. The authors frame this category as supporting–not competing with–work. “The beauty of medicine … is that with age the experience and wisdom acquired make you more valuable to the institution and patients.”
    The magic number

    Write this down somewhere you won’t misplace it: 168 hours. Any week of the calendar year, that’s the time you have to divide among work, yourself, and others. However, many of us err in this approach to time budgeting, setting ourselves up for failure. We do this by failing to account for Allen Saunders’ quip that “Life is what happens to us while we are making other plans.” We might have an idea of what the perfect balance is. Let’s say it’s 56 hours of sleep weekly. But your teething child, or boss who needs a shift covered, might have other designs.

    We shouldn’t aim for a perfect balance, the study authors caution, but should instead aim to counterbalance.

    “This permits acceptance of situations in which one component will be out of balance, requiring temporary adjustment of the other components,” the authors write. “The components can handle these episodes if eventually compensation occurs and balance is restored.”

    Check out the embedded graph to see an example of how your time budget for each bucket might change under four different circumstances. In all of these situations, the key is to not get so far out of balance that you can’t go back, the authors say.

    To answer the question posed in the title of this post, yes, work/life balance is dead. It was on its way out before the pandemic, and it became another COVID-19 casualty. It’s time to accept that the prevailing trend is an erosion of the traditional barriers between work and private life. That being said, we do not have to surrender to a life of constant work. Rather, we must accept the natural ebb and flow of work, personal, and other-centric demands, striving to constantly counterbalance them.

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