Focus on Physicians:
Insights, Ideas, and Strategies
Rethinking Work-Life Integration: When Work Takes Over Your Personal Life
With the rise of EHRs and telemedicine, the term "work-life integration" rapidly has become an administrative buzzword. However, for physicians who are expected to be always on duty, this approach can paradoxically increase stress and decrease balance.
In this article, I’ll explore why work-life integration might not be the promised panacea for getting it all done.
With the rise of EHRs and telemedicine, the term "work-life integration" has rapidly become an administrative buzzword.
Initially proposed as an alternative to the traditional "work-life balance" concept, the term encourages blending your professional responsibilities with your personal life. However, for physicians who are expected to be always on duty, this approach can paradoxically increase stress and decrease balance.
In this article, I’ll explore why work-life integration might not be the promised panacea for getting it all done.
The Myth of Seamless Integration
Despite the corporate happy-speak, work-life integration often translates to being ceaselessly connected.
For physicians, this means being perpetually available for patient queries, administrative tasks, training modules, and continuing education. This expectation of constant and immediate connectivity can lead to burnout and decreased job satisfaction
By definition, personal time is for the parts of your life that cannot be fulfilled at work.
Childcare, working out, maintaining relationships-- the list of things that pull on your personal time is endless. For the most part, these responsibilities and more require your full engagement.
But a focus on work-life integration can create an expectation of multitasking. This hits solidly against the basic tenets of the medical profession, which demands focus and precision.
Multitasking, as we all know by now, is a misnomer. Beyond the mental stress of juggling multiple tasks simultaneously, the unwieldy cognitive load can impair a physician’s ability to provide high-quality care.
The Impact on Personal Life
When work infiltrates all aspects of your life, personal time is often the first casualty. It’s common for physicians to find themselves checking emails during family time or thinking about patient care while trying to unwind.
Ultimately, you’re neither fully there for your patients nor for yourself and your loved ones.
While work-life integration is often hailed for its flexibility, it can lead to longer working hours under the guise of convenience.
Let’s be clear. You’re probably not bringing your toddler or your elderly mother to your office. And you’re not taking a walk with your EHR.
As someone whose parents were both full-time physicians well before the days of the internet, I can tell you from experience that it’s very unlikely that your home life is being integrated into the workday. A few furtive emails and rushed phone calls hardly count as connection.
Professional Implications
The stress and fatigue resulting from a lack of clear boundaries between work and personal life can increase the risk of medical errors. A tired and overworked physician is more prone to making mistakes, which can have serious consequences for both patients and the healthcare system.
But the threat of serious medical errors isn’t the only potential drawback of the constriction of your personal life. The consequences are not usually so blatantly obvious. Although it may be uncomfortable to admit, continuous engagement with work-related activities can lead to emotional exhaustion, reducing your ability to empathize with and care about your patients.
This diminished capacity for empathy and engagement can adversely affect patient satisfaction and trust, as well as outcomes.
The Bottom Line
For those in administration, creating a culture that supports and empowers physicians to do their best work is crucial. It’s time to go beyond talking points and take action. Removing unnecessary and burdensome “click work” is one way to reduce a physician’s load. Allowing support staff to handle simple messages and requests is another.
For physicians, establishing clear boundaries between your personal and professional lives can help to maintain your mental well-being, ensure the delivery of quality care, and support a fulfilling and sustainable personal life.
Despite the popular business-speak narrative around work-life integration, true balance often requires a clear separation of work and personal life, so that both may flourish.
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Maximize Efficiency and Achieve Work-Life Balance: The Time Priority Matrix for Physicians
Do you ever finish the day feeling as if the time raced by, but instead of making progress on your goals, you’ve just been putting out fires? With a constant surge of urgent issues, combined with daily responsibilities and opportunities, it can be challenging to prioritize effectively.
Using the Time Priority Matrix (or Eisenhower Matrix) can help you to visualize not only where but how you are spending your time. By categorizing your daily activities, you will discover how your attention is being directed, and where you might be able to streamline and optimize the way you use this most valuable and limited resource.
Do you ever finish the day feeling as if the time raced by, but instead of making progress on your goals, you’ve just been putting out fires?
With a constant surge of urgent issues, combined with daily responsibilities and opportunities, it can be challenging to prioritize effectively.
Using the Time Priority Matrix can help you to visualize not only where but how you are spending your time. By categorizing your daily activities, you will discover how your attention is being directed, and where you might be able to streamline and optimize the way you use this most valuable and limited resource.
This tool is also known as the Eisenhower Matrix. Former US President Dwight D. Eisenhower didn’t create the idea, but he famously referenced Dr. Roscoe Miller, a former president of Northwestern University, when he said: "I have two kinds of problems: the urgent and the important. The urgent are not important, and the important are never urgent.”
The matrix was subsequently popularized by Stephen Covey in his landmark book The 7 Habits of Highly Effective People. It’s something that’s often taught to business leaders, but the concepts can easily be applied to physicians and anyone else seeking to take back some control of time and attention.
Quadrant I tasks are both urgent and important. Ideally these are limited, but as a physician, these tasks are part of daily life.
The critically ill patient, the urgent report, the call from a worried family member. Often these issues are out of your control. But sometimes there is a way to mitigate the urgency, and that's where Quadrant II comes into play.
Quadrant II: Preparation, planning, and prevention fall into Quadrant II. By working in this quadrant, you anticipate and trouble shoot before trouble arises. That's what preventive care is all about.
You can also apply this idea to your own life. For example, if you're studying for your boards, taking a set amount of time every day for a few months will get you much farther ahead than waiting until the last couple of weeks to study. And learning a new skill or technique and making the time to practice it will ensure that when you need it, you'll be more confident and prepared.
Building trusting relationships with patients and colleagues also falls into Quadrant II. By taking the time and putting in the work at the outset, you’ll build trust and confidence. Ultimately that will enhance your ability to provide care more efficiently and collaboratively.
Work in this quadrant might not always be exciting or immediately fulfilling, but it will keep you on track to accomplish the goals that are meaningful to you.
You can apply Quadrant II ideas to your personal life as well. Think about your relationships, family, and other interests. What can you do to ensure that the things that matter to you outside of work are cared for and able to flourish?
Quadrant III is more problematic. In this quadrant, you're dealing with things that are not particularly important, but which require some urgency to complete.
As a physician, you're probably all too familiar with this quadrant. Interruptions, EHR redundancies and pre-authorization inefficiencies that have to be addressed are daily if not hourly occurrences. Some meetings and much email fall into this category.
Sometimes it can help to work on these things in "chunks" so that your attention is focused and you can be more efficient. This is known as task batching, and it can be a highly effective way to clear out some of the clutter that routinely piles up. Making it clear that these non-urgent issues will only be addressed on a certain day at a given time is one way to not only set boundaries but to limit interruptions.
Delegating whenever possible is an important aspect of Quadrant III management. For example, can someone else be assigned to fill out routine paperwork, leaving only the physician-specific sections for you to complete? Perhaps staff can be empowered to respond to simple patient requests for notes or documentation, or to schedule a visit when it’s clear that a non-urgent call or message requires more than a simple response.
Quadrant IV is where you have the greatest likelihood of clearing out some time and space. Mindless scrolling, low-value emails, watching random TV shows, and stressing over social media are good examples of this quadrant's activities.
Sometimes you need a little downtime, but being cognizant of how you are spending it may help you to gain some well-earned margin for the things that matter most to you.
It can be a great thought exercise to think through the way you are using your time. The Time Priority Matrix is a valuable tool that can help you to manage your workload and your personal life more effectively. By identifying and prioritizing tasks based on urgency and importance, you can enhance your productivity, improve patient care, and achieve a healthier and more fulfilling work-life balance.
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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
And if you’d like to schedule a complimentary introductory meeting with me, click the link below.
Why Are We Afraid to Talk About Work-Life Balance?
For many physicians, work-life balance (WLB) is the elephant in the room. In 2022, 85% of physicians finishing residency cited work-life balance as their number one consideration when choosing a job.
Dissatisfaction with WLB is strongly correlated with burnout, and is a common reason that many physicians choose to leave their current practice. Although women physicians tend to rate WLB as somewhat more important than men, among millennials it is a top priority for both genders. Yet physicians often avoid raising this crucial issue with potential employers and even colleagues for fear of being judged.
In this article I’ll give you nine ways to create your own version of work-life balance.
This article originally appeared on Doximity, where I am a 2022-2023 Op-Med Fellow.
For many physicians, work-life balance (WLB) is the elephant in the room. According to CHG Healthcare, in 2018, 63% of physicians finishing residency programs cited WLB as their number one consideration when choosing a job. In 2022, it was 85%.
Dissatisfaction with WLB is strongly correlated with burnout, and is a common reason that many physicians choose to leave their current practice.
Although women physicians tend to rate WLB as somewhat more important than men, among millennials it is a top priority for both genders.
Yet physicians often avoid raising this crucial issue with potential employers and even colleagues for fear of being judged.
This fear of judgment is based in reality: providing the best and most timely care to patients often requires self-sacrifice. We all know that medicine is demanding; we must expect to occasionally, or even often, put personal needs aside in order to care for patients whose needs can’t wait.
But it’s not uncommon for physicians to fall prey to the notion that consistently putting aside their own, or their family’s, well-being is necessary to answer the “calling” of medicine. Perhaps in taking on this mantle of self-sacrifice, the idea of wanting something more, or even something different, can seem disrespectful to the “priesthood” of medicine.
For physicians whose work requires collaboration and partnership with others in the profession, openly wanting more from life may also stir up fears of being perceived as weak, lazy, or not a team player.
While respecting these valid concerns, I believe that if you conquer the angst of admitting that you want more out of life and make an effort to seek WLB, you will find that your relationships, your sense of fulfillment, and ultimately the care you give your patients can flourish.
Research shows that not only do people who make time for family, hobbies, and health feel a greater sense of balance, but they may also become better physicians for it.
A British study found that employees who engaged in creative activities were more likely to discover creative solutions to problems at work.
A study of nearly 300 ICU staff members, including physicians, found that those who engaged in hobbies experienced less post-traumatic stress.
And a Duke study found that higher WLB measures among hospital staff, including physicians, correlated with greater patient safety and improved teamwork.
On the opposite end of the spectrum, not attending to life outside of work can have serious effects on both. A study of members of the American College of Surgeons published in 2012 found that those with conflicts between work and home life were more than twice as likely to experience burnout and depression. In this study, “home” was defined broadly as “personal responsibilities,” and included personal relationships, parental responsibilities, and spousal factors. Experiencing this conflict also meant that the surgeons surveyed were more likely to leave their current practice. Although work-home conflicts might be considered a subset of work-life balance, the implications of this type of conflict are significant.
And yet, balancing your life is easier said than done.
Each of us has a different story. Personally, as a cardiologist I was able to find WLB, although it required a substantial degree of focus and dedication. While in practice, I wrote four books (admittedly health related), became a yoga teacher, and competed successfully with my horses. I also made time to travel and hike around the world.
However, these efforts were not without sacrifice: I had to give up significant income in order to take a half day off a week to train with my horses. And I usually chose to take most of my allotted (uncompensated) vacation time.
Finally, though I was fortunate enough to have an organized system of cross-coverage with my partners, the time off nevertheless meant that I was often catching up on EHR responsibilities late into the evening, sometimes even from the other side of the world.
Still, I believe the loss of income and long nights catching up on charts was worth it. Not only was my life richer, but my diverse experiences and friendships made me a more compassionate and open-minded physician. My patients were always curious about my adventures, and often felt more connected to me when they realized that I shared some of their own interests. And having the opportunity to “fill my cup” gave me more energy and enthusiasm for my work.
Your personal definition of WLB may change over time, depending on your personal commitments.
Admittedly, part of my ability to find WLB earlier in my professional life may be attributed to my decision not to have children, a situation that likely differs from that of many readers. My mother, a physician and parent of five, had a far more difficult time finding balance, and in truth I don’t believe that she was ever able to achieve it.
In the 21st century, there are more options for parents, but it’s still a complicated balancing act. If you’re a parent of young children, there are likely some hobbies and experiences that will need to be put on hold until the little ones are older. Instead, WLB for you may mean finding a way to create and protect family time.
So, how do you get started?
First, realize that there’s no shame in wanting or needing more. You signed up to be a doctor, but you may also be a friend, a spouse, a parent, or a curious human being who craves something new.
Next, create a plan that can get you the time and space that you need, while continuing to serve your patients and collaborate with your colleagues.
Below, I offer some things to consider while embarking on your new path:
Think about where you are in your practice. If you’re in training, achieving WLB for the duration of the program may not be a priority. If you are just beginning your career, it may take a few years to find your footing, and that’s normal. Whether or not they admit it, most physicians feel a little out of their depth when they first start out. Over time, you are likely to develop a range of practical skills that will make your day more efficient, leaving you with more personal time.
Realize that you might need to take a pay cut, or even a new position. If you need to take a regular day off, or even half a day, it may cut into your productivity. If you are not available, work may be shifted to your colleagues. Sometimes that’s welcomed, but many times it may not be. Weigh the risks, benefits, and the possible outcomes and make your decision from there.
Get help. It might cost you something, but could you benefit from a personal assistant, a babysitter, or a scribe? Just a few hours of help each week could free up important blocks of time that you could use to pursue a passion project, or to be more present for your family.
Consider your commute. Could you be using the time to enjoy an audiobook, catch up on CME, or learn something new? Or maybe even consider moving closer to work to create more free time in your day.
Learn to say no. Sometimes being on that committee or taking on a new project may be just the thing to move you forward professionally. But if you find yourself taking on more responsibilities than you must, realize that you are giving up the precious commodity of time.
Give up your perfectionism. Take just 10-15 minutes a day to get started on a new hobby, a quick yoga class on your iPad, or a morning walking meditation. You don’t have to go all in all at once.
Figure out where you’re wasting time. If you actually enjoy mindlessly scrolling your social media feeds, then maybe there’s no reason to stop. But if this feels like a compulsion, train yourself to put the phone away whenever possible and pick up a new project, go for a walk, or just sit with your family and read a book.
Sign up for a workshop. Take a couple of phone-free hours to learn something new about photography, bread baking, canoeing, knitting, bird watching, or anything else that catches your attention. No one will expect you to know what you’re doing, and you might discover a new passion and a new community.
Book a trip. Just go ahead and set a date perhaps six months out, put it on the calendar, and buy your ticket. The first step is often the hardest, but once you start, it’s easier for the rest to fall into place.
No matter what work-life balance means to you, realize that an ideal balance looks different for each person. It can change over the course of a lifetime.
The most important way to achieve it is to put your ideas into action. Your life will be so much richer if you consciously put in the effort, often in ways that you might not anticipate today. And you may find that in the process, you generate more joy, creativity, and resilience in your medical practice.
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
And if you’d like to schedule a complimentary coaching discovery session, click the button below.
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