When recounting her HM career, Janet Nagamine, RN, MD, SFHM, often tells people she went from being the chief of everything to the chief of nothing, by choice. She can remember the whirlwind of being a quality-improvement (QI) chief, patient safety officer, risk management team member, and new mother who felt more married to her beeper than to her husband.
“I felt incredibly stressed and pulled in so many different directions,” says Dr. Nagamine, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and an SHM board member. “What really concerned me was that I was starting to feel that I wasn’t doing anything well, that I was dropping balls here and there.”
A revelation came to Dr. Nagamine at a time-management workshop. The speaker asked participants to list the three most important things in their lives, then add up the hours spent doing them.
“There was obviously a disconnect when I looked at the actual waking hours I spent with my family,” says Dr. Nagamine, who placed family at the top of her list. “That’s where I made the decision that I could always come back to doing these leadership things at a later time.”
Now pursuing an MBA, she intends to return to leadership positions to focus on QI, patient safety, and hospitalist work-life issues—for both women and men.
“Work-life balance is a key anchor for us,” says Dr. Nagamine, who helped organize a “Women in Hospital Medicine” session at HM12 last month in San Diego. “Whether you’re male or female, work-life [balance] is a challenge. We need to do better on that.”
In today’s era of ever-increasing healthcare demands, the future of hospitalist practice rests, in no small part, on the work-life satisfaction of its physicians. Recent studies suggest hospitalists are experiencing more stress and burnout now than in the past, a phenomenon HM groups would be wise to address by offering more flexible work options and workload support, regardless of gender, experts say. But individual hospitalists can mitigate strain and dissatisfaction by assessing their life and goals, and developing a work-life balance that is right for them.
“Work-life balance is really not something that is ‘a nice thing to have,’” says Iris Grimm, creator of the Atlanta-based Balanced Physician program, which helps physicians meet work, life, and leadership challenges. “It is a necessity for them if they want to sustain a long-term career.”
So what causes tension between work and life outside of work? The list is long and growing.
“We still define the ideal worker as someone who starts to work in early adulthood and works full time, full force, for 40 years straight, available for overtime as needed,” says Joan Williams, distinguished professor of law, founding director of the Center of WorkLife Law at the University of California’s Hastings College of the Law in San Francisco, and author of “Unbending Gender: Why Family and Work Conflict and What To Do About It.” “That basically describes a man married to a homemaker, and that’s not who the work force is.”
In general, workplaces—including those in the hospital work environment—have been slow to adjust to the changing work force, Williams says. In time, friction arises, which leads to dissatisfied workers.
Work-life balance is when a person can rise above the conflict and align their responsibilities with their values and priorities, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides work-life balance information for professional working mothers and their employers.
“It is being satisfied with one’s entire life, with the work side as well as with the personal side,” Grimm says.
—Janet Nagamine, RN, MD, SFHM, Kaiser Permanente Medical Center, Santa Clara, Calif., SHM board member
Young physicians of both genders view work-life balance as essential, and are willing to risk career advancement to achieve it, according to a 2006 survey of U.S. doctors under age 50 conducted by the Association of American Medical Colleges and the American Medical Association.1 When asked to rate factors that are very important to a desirable position, 71% identified work-life balance. Two out of 3 young physicians said they were not interested in working longer hours for more money—a sharp contrast from previous generations.
“It started in the 1990s, but I think in the early 2000s was when the medical world began to take a much more honest appraisal of the long-term impact of an unbalanced life and what that meant for physicians,” says Erin Stucky Fisher, MD, MHM, medical director for quality at Rady Children’s Hospital San Diego, associate program director for the University of California at San Diego Pediatric Residency Program, and an SHM board member.
Dr. Nagamine agrees the tide has shifted in terms of physician attitudes toward work hours, compensation, and personal time. “Now that we have work-hour rules in residency, the doctors coming out don’t buy that you have to be on 24/7, 365 days a year,” she says.
The Survey Says...
Recent research on hospitalist work-life satisfaction indicates that while hospitalists generally are satisfied with their job and specialty, burnout rates appear higher than the 13% previously reported in 2001.2
Earlier this year, a study in the Journal of General Internal Medicine found that 29.9% of respondents to a national survey of hospitalists reported job burnout symptoms.3 Hospitalists surveyed also reported low satisfaction with personal time (28.3%), autonomy (17.4%), organizational climate (10.7%), and organizational fairness (31.2%). The results are somewhat alarming to longtime hospitalists, in that hospitalist work models might be less flexible and less sustainable than originally thought.
Results from an email survey published in 2011 showed that 67% of academic hospitalists reported high levels of stress, and 23% described some level of burnout.4 Additionally, 57% of the respondents had 20% or less of protected time for scholarly activity—a disconnect between career goals and actual work that could lead to career dissatisfaction. More than half of the academic hospitalists surveyed, however, did express high or somewhat high satisfaction with personal and family time, and control over work schedules.
“Hospital medicine is still a new field, and people are trying to find the right balance in the work,” says Rebecca Harrison, MD, associate professor of medicine and section chief of the division of hospital medicine at Oregon Health & Science University in Portland. “I think we’re in a very critical time now where we have to look at scheduling, patient load, fulfillment factors. A physician’s sense of commitment, happiness, and enjoyment in their work is going to be much higher if you pay attention to the things they want to pursue.”
What Women Really Want
Female physicians are far less able to control their work environments than men, says Mark Linzer, MD. He helped design and conduct the Society of General Internal Medicine’s Physician Work Life Study, which found that aside from less work control, the female doctors surveyed said they faced a more difficult patient mix, more time pressure in patient examinations, and a 60% greater chance of burnout compared with their male counterparts.5
“One of those factors, we think, is what has been called ‘gendered expectations for listening,’” says Dr. Linzer, division director for general internal medicine at Hennepin County Medical Center in Minneapolis and professor of medicine at the University of Minnesota. Patients prefer female doctors because they believe women are better listeners than men, he explains. But listening takes time, and female physicians generally aren’t afforded more time for patient visits than male physicians are.
“This is an issue I see many times with female physicians, with hospitalists in particular,” Grimm says. “They just can’t seem to stay in the time frame that has been given to them for their patients. They think that the more time they spend with their patients, the more the patients appreciate them and feel like they are heard.”
Another factor is extra work outside the office. “If you measure the total number of work hours performed, including work and home, it is considerably higher for women,” Dr. Linzer says.
Even if a working woman has help at home or a spouse who works part time or stays at home, she never really relinquishes responsibility of the home, Bailey says.
“A woman carries social pressures that she needs to—even if she has a career—carry out the role of a traditional wife and mother,” she says.
Regardless of whether they have a spouse and children, women generally feel a responsibility to care for their loved ones’ needs, whether it’s an aging parent, an ailing sibling, or a friend facing a difficult situation, says Jennifer Owens, director of the Working Mother Research Institute in New York City. One thing working in female physicians’ favor, however, is they are less likely to lose their careers due to work-family conflicts than are women in such high-skill professions as finance or law, because part-time work is readily available for female doctors, Williams says.
—Rebecca Harrison, MD, associate professor of medicine, section chief, division of hospital medicine, Oregon Health & Science University, Portland
“The number of hours that women work has been increasing. So there’s incredible stress on women,” says Owens. “Just to have the support that you’re not stigmatized for dialing back and not working a 60-hour-plus work week means a lot.”
The Flip Side
Men also have partners, families, children, and outside interests. Therefore, if hospitalist groups are going to create flexible work opportunities, they have to market them and make them available to everyone, regardless of gender, Dr. Fisher says.
The key work-life balance battle today, Williams says, centers around male workers and the stereotypes surrounding masculinity. Increasing numbers of young men want to participate in the day-to-day caregiving of their children. Most workplaces, however, have been slow to adjust.
“Women have the cultural room to make workplace adjustments to ease work-family conflict, and men often don’t,” Williams says. “The ideas of masculinity are closely intertwined with the idea of being a provider. So if a man leaves work to care for his child or ailing mother, people not only think of him as a poor worker, they often think of him as less of a man. The stereotypes that hit people who make their caregiving responsibilities salient on the job are extremely hostile and even more powerful for men than for women.”
Similarly, if male physicians want to structure their schedules around personal interests or take extended time off to pursue a life passion, they often are viewed unfavorably because the culture of medicine for years has been complete dedication to patients and career over personal needs, Dr. Harrison says.
“For example, a single person or someone who doesn’t have a family might want to go climbing the Himalayas and take three months off. Or perhaps a staff member wants to go part time in order to go back to school for an MBA,” Dr. Nagamine says. “We’re not prepared to deal with those types of requests.”
Stop the Churn
HM groups around the country—big and small, academic and community—deal with work-life balance issues on a regular basis. Some have solved the issue; many have not. Too many hospitalist groups are stuck in a churn cycle: hire hospitalist, fail to meet their needs, see them leave after a year or two, repeat.
“When you see people churning their staff, especially when they’re losing good ones, it’s a financial and human capital drain,” Dr. Nagamine says. “Think about the care that’s being delivered within the system, what’s happening to the other members in the group, the return on investment for keeping your staff happy. We argue over pennies sometimes, but we don’t calculate these types of losses of personnel.”
Dr. Nagamine says hospitalist groups should approach work-life balance not just on a day-to-day or week-to-week basis, but also in terms of extended leave for child or elder care, travel, volunteer work, professional development, etc.
Compensation and workload are used to recruit and retain hospitalists. But recent research suggests that leaders might find more nuanced approaches to improving their hospitalists’ overall satisfaction.6 For example, leaders of local community-based hospitalist groups might find their hospitalists tolerant of heavier workloads, provided they are financially rewarded and given autonomy over their work. And rather than using higher salaries to be competitive, leaders of academic programs might find it more effective to provide their hospitalists with time and training to pursue scholarly work.
“Physicians and faculty are the most valuable commodities for moving the work forward,” Dr. Harrison says, “and good leaders pay attention to this data.”
HM groups should think about surveying their employees to find out where problems exist, Bailey says. Once you determine what work-life benefits and/or flexible employment opportunities will work, train supervisors to manage workplace flexibility, then hold them accountable for executing the policies, Owens says.
“It makes sense to take care of your people,” Dr. Nagamine says. “First, it’s the right thing to do. Second, it’s financially and fiscally a good move. It’s not just work-life balance for the sake of work-life balance; it’s critically important to your operations and your overall success in delivering good care.”
Lisa Ryan is a freelance writer in New Jersey.
- Kirch DG, Salsberg E. The physician workforce challenge: response of the academic community. Ann Surg. 2007;246(4):535-540.
- Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161(6):851-8.
- Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 2012;27(1):28-36.
- Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med. 2011;171(8):782-785.
- McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15(6):372-380.
- Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB. Job characteristics, satisfaction, and burnout across hospitalist practice models. Journal of Hospital Medicine website. Available at: http://onlinelibrary.wiley.com/doi/10.1002/jhm.1907/full. Accessed March 21, 2012.