Balance is hard for docs to find but vital for success

Healthy psyche, healthy practice

It used to be a "women’s issue" — how to balance the demands of work and the demands of family. And then it was a corporate issue — how companies could attract and keep staff in a competitive job market. But now, work-life balance is becoming an issue in the professions as well, and even physician practices are realizing that sound minds and bodies are needed in today’s changing medical market.

"People used to believe that medicine was a calling," says John Henry Pfifferling, PhD, director of the Center for Professional Well-Being in Durham, NC. "Issues other than work were perceived to be secondary. But now, people are asking questions about the other parts of their lives."

The increased awareness of work-life balance is, in part, due to the increase in the number of women physicians. As they have had to voice concerns over how to juggle work and family, men have chimed in with their concerns, says Pfifferling.

Without some sort of balance, he notes, a practice will suffer. "If you have a bunch of dissatisfied physicians, then that will affect patient care. If patient care is adversely affected, then your managed care contracts will suffer. It’s all related."

How to recognize a problem

Whether you are a practice administrator trying to identify problems your physicians have, or whether you are a doctor in practice, you have to learn to recognize signs of imbalance, says Ahnna Lake, MD, a counselor based in Stowe, VT, who speaks nationally on professional burnout.

"You need a way of detecting when lifestyles become unsustainable," she says. "You have to understand that when you are working at a maximal level, you cannot deal with any crisis over a long period of time."

Lake has devised a method of determining when there is a work-life imbalance. She says you need only look at four areas: general health, work satisfaction, energy level, and close relationships.

"Ask yourself what is the direction of change in each of these," she says, "and how you feel about that change. If your relationships are deteriorating and your energy is down, you need to recognize that something in your life is not working."

Pfifferling lists 12 clues that something is wrong:

• a harried appearance;

• no friendships or relationships outside the workplace;

• a concern that you are "losing it;"

• a lack of time or energy to take advantage of new opportunities;

• a major theme is surviving or getting by;

• no interest in new patients;

• no interest in new ideas;

• no physical energy;

• no sense of humor;

• a lack of concern about one’s health;

• growing financial constraints.

Once you determine there is a problem, Lake says the first step to rectifying it is to make sure you are physically able to do so. "You have to be ready for change," she says. "With burnout, you can often cross over into depression or another physical ailment. Then, the reality has to be addressing that problem."

Pfifferling agrees that physical well-being is vital to achieving a balanced life. He says even eating balanced meals can be one step toward rectifying burnout. "Typical physicians are so overcommitted that they disregard their own self care. They have to know the importance of scheduling some alone time without other commitments and of taking care of their basic necessities," he says.

Once you are physically capable of making changes, Lake says you have to identify the course your case of burnout took so that you don’t repeat any of the same mistakes.

One way to make that determination is to find a facilitator or support group to help you or your practice with the issue, he says. The Center and the related Society for Professional Well-Being [(919) 419-0011] can provide assistance in finding a facilitator in your area, he says. (For a list of resources on work-life balance, see box, p. 121.)

Part of a work-life imbalance involves feeling out of control, Lake says. So one way of fixing the problem is to put an element of control back into your life. "It might just be saying that you won’t take patients after 11:30 a.m. on Tuesdays and Thursdays because it interferes with your lunch," she says. "That may be enough to give you back a sense of control and self-management."

Particularly in an era where managed care is taking power away from physicians and practices, this is a vital element to job satisfaction, she adds.

Lake says learning good time-management skills can also help. That may involve honing computer skills so you can take advantage of time-saving technology, or recognizing that you can’t do everything by yourself. "Physicians have a really hard time with this," she says. "They have to learn to empower others to do tasks themselves and in their own way."

Lastly, Lake says everyone should have a "plan B. If you feel trapped in the current environment, then you are easily overwhelmed with anxiety," she says. "Even if you just have a loose plan — of moving to another place or changing jobs within medicine, or even getting out of it altogether — then you have a sense of more control over the future, and that will decrease anxiety."

Join a practice that understands balance

One way to avoid burnout altogether is to join a practice that places a premium on balance, says Pfifferling. Such a practice will discuss the issue regularly, particularly in conjunction with discussions on practice growth. "You should also recruit partners who say balance is important to them," he says.

Corporate America has recognized imbalance costs them money — be it through increased illness, higher turnover, or losing customers to companies with happier staff, Pfifferling says. "So should physician practices. Less pressure means more creativity, and the complex problems we face demand creativity."

Lake says she doesn’t like to talk about managing personal life and business life. "We have only one life, and we have to look at that one life and learn to make it better," she says.

Ahnna Lake, MD, International Health Consulting Inc., Stowe, VT. Telephone: (802) 253-9369.

John Henry Pfifferling, PhD, Director, Center for Professional Well-Being, Durham, NC. Telephone: (919) 489-9167.