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Work-life Fit & Wellness
in Medical Education
Rebecca Guest, MD, MPH
Director, Building Resilience Program; Associate Dire...
Learning objectives
• Define work-life balance, burnout, work/life fit, wellness
• Show prevalence & importance of physici...
Physician distress vs. Well-being
Frog in the water – the danger of
the frog boiling
Building resilience – keep stress
fro...
Defining terms
Burnout is an occupational hazard for individuals under constant
pressure or stress over a long period of t...
Defining terms
• Wellness. The term is used to capture the complex nature of
physical, mental, and emotional health. It is...
Why is work-life dissatisfaction and
burnout important?
• Distress to individual providers & their loved ones
Sleep distur...
Are we an “at risk” group? Yes
• Burnout among med students, resident, new doctors vs. the general population*
• Work-life...
Are we at risk?
• Compared with working US adults, physicians were more likely to have symptoms
of burnout (38% vs. 28%) a...
Are we at risk?
• One of the tragic paradoxes of burnout and work-life conflict is that those most
susceptible appear to b...
GREAT MEANING IN WORK BUT
TOO MUCH OF IT
• Oncologists’ pattern of burnout
prevalence, high career
satisfaction, and low w...
WHERE DO WE GO FROM HERE?
“How can we ensure the wellness of our
future workforce? Sustenance for caregivers
should become...
Shouldn’t we have more of a dialogue
on these issues?
• Communication is protective but the topic of burnout and
work-life...
Burnout & Perceptions about workplace
culture among MSK surgical faculty
• 42% of responders met Maslach Burnout Criteria ...
Teaching, learning, and practicing
values of professionalism
“How did we learn to push ourselves so much or to ignore self...
Academic medicine may be challenged
to reconceptualize traditional work
model so as to include colleagues with
alternative...
What does “balance” mean to you?
- A state of equilibrium
- An equal distribution
- Something used to produce equilibrium
...
Work/Life Fit or Work/Life Management
• Eliminates stigma/rigidity/pressure?
• Less stress?
Know thyself
• Ask yourself, What do I want? What
is my vision of success?
• Identify both personal and
professional goals...
Stress Management 101
Exercise
Aerobic is best;
All exercise is good
Stress Management 101
Deep relaxation
Mindfulness Strategies
Moment-to-moment, non-
judgmental awareness
Stress Management 101
Cultivate a positive attitude
• Resilient people approach challenges as
opportunities for growth
The...
Develop a plan & take steps for
physical well-being
Job satisfaction may be protective
• Get in touch with the meaningfulness of your work.
• Working with cancer patients giv...
Compassion – for self & others
• Work/life conflict and physician distress can be normalized
and validated
• Give yourself...
Seek professional expertise when
appropriate
• Do apply your medical judgment.
• Depression, anxiety and alcohol/drug misu...
A Dynamic Tension – the beauty of life’s work
Dynamic tension exists between a culture of productivity, multiple
professio...
Permission to prioritize your own
psychological & physical health is key
• As physicians, we hold a common determination t...
Goal: build an medical culture that
includes caring for the caretaker
Self Care
Available
Supports &
Resources
Healthy
Wor...
Memorial Sloan Kettering Building
Resilience*
• Increasing Transparency – through research, education, discussion
• Lunch ...
Conclusions
• Work/life conflict, burnout, and associated distress are
common and important occupational hazards for physi...
Resources & References – relevant to
physicians
• The AMA Family & Physician Support Program
• The Canadian Medical Associ...
Resources available to you at MSK
• Employee Health & Wellness Services (EH&WS)
• Employee Assistance Program Consortium (...
Resources & References
• Your organizations’ Employee Assistance Program (EAPC)
• Every physician should have a personal p...
Self-improvement
• Cali Williams Yost, Work+Life: Finding the Fit that’s Right for You and Tweak It:
Make What Matters to ...
Select references
Guest R, Bajorin D. Take Care of Yourself: We Need You. J Clin Oncol. 2014 March;32:1-3.
Guest RS, Baser...
Select references
Beckman H. The Role of medical culture in the journey to resilience. Acad Med.2015;90:710-712.
Krasner M...
Select references
Facts about physician depression and suicide. American Foundation for Suicide Prevention website. https:...
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Work life fit and wellness

Work life fit and wellness

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Work life fit and wellness

  1. 1. Work-life Fit & Wellness in Medical Education Rebecca Guest, MD, MPH Director, Building Resilience Program; Associate Director, MSK Employee Wellness Assistant Attending, Dept. of Medicine, Division of Survivorship & Supportive Care Employee Health & Wellness Services Memorial Sloan Kettering Cancer Center August 27, 2015
  2. 2. Learning objectives • Define work-life balance, burnout, work/life fit, wellness • Show prevalence & importance of physician distress vs. well-being • Consider the tension that exists between a culture of productivity and the need for self-care • Where do we go from here? - Building resilience - Work/life fit - Stress management basics - Strategies & resources
  3. 3. Physician distress vs. Well-being Frog in the water – the danger of the frog boiling Building resilience – keep stress from becoming distress
  4. 4. Defining terms Burnout is an occupational hazard for individuals under constant pressure or stress over a long period of time. Maslach Burnout Inventory (MBI-22) A REVERSIBLE STATE - emotional exhaustion - physical exhaustion - depersonalization - a decreased sense of personal accomplishment - decreased effectiveness Work-life balance assessed by the item, “My work schedule leaves me enough time for my personal/family life.” - Individuals who disagree or strongly disagree considered dissatisfied with work-life balance.
  5. 5. Defining terms • Wellness. The term is used to capture the complex nature of physical, mental, and emotional health. It is more that the absence of disease or distress. For physicians, it includes success in personal as well as professional life.
  6. 6. Why is work-life dissatisfaction and burnout important? • Distress to individual providers & their loved ones Sleep disturbances and fatigue; Drug and alcohol addiction, physician impairment; careers in jeopardy; difficult family relationships and divorce; Chronic disease associated with stress (e.g. cardiovascular) and occupational injury (e.g. sharps BBPE); Depression, anxiety, suicide • Physician distress associated with suboptimal patient care Adverse patient events; Increased rate of medical & surgical errors w/ burnout; Poor patient compliance & lack of patient satisfaction with medical care • Potentially reducing supply of cancer care specialists* Dissatisfaction with work-life balance and burnout were the strongest predictors of oncologists’ intent to reduce clinical work hours and leave their current position Decreasing interest among medical students in career with poor lifestyle; Change in specialty; Early retirement among physicians with burnout or work-life conflict *Coincides with projected shortage of oncologists
  7. 7. Are we an “at risk” group? Yes • Burnout among med students, resident, new doctors vs. the general population* • Work-life balance dissatisfaction is common • Stressful working conditions are an occupational hazard for healthcare providers • Physicians have a poor record of self-care • Physician depression and suicide is higher than national averages *Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451. Facts about physician depression and suicide. American Foundation for Suicide Prevention website. Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA.2014;312(17):1725- 1727.
  8. 8. Are we at risk? • Compared with working US adults, physicians were more likely to have symptoms of burnout (38% vs. 28%) and to be dissatisfied with work-life balance (40% vs. 23%) • Those oncologists working more hrs/wk, more night call, more weekends, were most dissatisfied with work-life balance. • Hours/week in direct patient care most dominant predictor of burnout for both academic practice (AP) and private practice (PP). PP were less satisfied than AP; each additional hr/wk imparts greater dissatisfaction. • Dissatisfaction with balance and burnout associated with intention to leave practice. • Granular differences (age, gender, children, family structure, type of practice) Shanafelt TD, et al. Arch Intern Med. 2012 Shanafelt, et al. J Clin Oncol. 2014
  9. 9. Are we at risk? • One of the tragic paradoxes of burnout and work-life conflict is that those most susceptible appear to be the most dedicated, conscientious, responsible, and motivated physicians. • Individuals with these traits are often idealistic and have perfectionistic qualities that may lead them to submerse themselves in their work and devote themselves to it until they have not enough left to devote to their own self-care. • Studies show high association with hectic schedule, a strong achievement orientation, an inability to say no.
  10. 10. GREAT MEANING IN WORK BUT TOO MUCH OF IT • Oncologists’ pattern of burnout prevalence, high career satisfaction, and low work-life balance satisfaction is very similar to surgical specialty profiles.
  11. 11. WHERE DO WE GO FROM HERE? “How can we ensure the wellness of our future workforce? Sustenance for caregivers should become a fundamental part of training and professional development at all levels.” *American Society of Clinical Oncology, Take Care of Yourself: We Need You, Rebecca S. Guest and Dean F. Bajorin, JCO, April 10, 2014.
  12. 12. Shouldn’t we have more of a dialogue on these issues? • Communication is protective but the topic of burnout and work-life conflict traditionally has been taboo in medicine • Identification & use of resources (personal self-care, workplace wellness, community) Up-skilling (e.g. mindfulness based stress reduction, communication skills training, a Building Resilience educational mental health lectureship series) Mentors, concerned colleagues, EAPC, Family, community, religion… Physician assistance programs, Employee Health & Wellness when available Human Resources (i.e. flexible work arrangements, Work/life) Every physician should have their own personal physician
  13. 13. Burnout & Perceptions about workplace culture among MSK surgical faculty • 42% of responders met Maslach Burnout Criteria for burnout; low QOL across 5 domains in 34% • 32% perceived a great need to change the taboo to discuss distress • Positive correlations between burnout, low QOL, and modifiable factors • 58% perceived a low service commitment to prevent burnout • 90% perceived low support for achieving physical fitness • 85% failed to use all annual leave and said that the institutional culture does not encourage use of leave Guest et al. Cancer surgeons' distress and well-being, I: the tension between a culture of productivity and the need for self-care. Ann Surg Oncol. 2011. Guest RS et al. Cancer surgeons' distress and well-being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol. 2011.
  14. 14. Teaching, learning, and practicing values of professionalism “How did we learn to push ourselves so much or to ignore self-care to the point that many of us are experiencing burnout, anxiety, and depression …? An initial step to understanding the problem should be examining our current culture of medicine and the environments in which our trainees and their role models work and function day to day.”* *Beckman H. The role of medical culture in the journey to resilience. Acad Med. 2015
  15. 15. Academic medicine may be challenged to reconceptualize traditional work model so as to include colleagues with alternative models “As increasing numbers of academics seek work-life balance and consider part-time work as a tool to achieve that balance, academic medicine will be challenged to develop creative models for integrating successful part-time physicians, or it will lose that segment of the workforce.”* Harrison, RA, Gregg, JL. A time for change: An exploration of attitudes toward part-time work in academic medicine among women internists and their division chiefs. Acad Med. 2009.
  16. 16. What does “balance” mean to you? - A state of equilibrium - An equal distribution - Something used to produce equilibrium Can we really have balance? Does Balance = No Stress? Does “Should have balance = Yet Another Stressor?
  17. 17. Work/Life Fit or Work/Life Management • Eliminates stigma/rigidity/pressure? • Less stress?
  18. 18. Know thyself • Ask yourself, What do I want? What is my vision of success? • Identify both personal and professional goals. - Become aware of biggest stressors and priorities for YOU - Work/life fit is individual and may change over one’s lifetime - What would you like to be remembered for?
  19. 19. Stress Management 101 Exercise Aerobic is best; All exercise is good
  20. 20. Stress Management 101 Deep relaxation Mindfulness Strategies Moment-to-moment, non- judgmental awareness
  21. 21. Stress Management 101 Cultivate a positive attitude • Resilient people approach challenges as opportunities for growth The attitude that you choose is what you always have control of
  22. 22. Develop a plan & take steps for physical well-being
  23. 23. Job satisfaction may be protective • Get in touch with the meaningfulness of your work. • Working with cancer patients gives oncologists a unique perspective that can enrich life. • Identify what is most rewarding and what is most stressful about your job. Shape your career & life to maximize satisfaction. Shanafelt et al. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006. Kearney et al. Self-care of Physicians Caring for Patients at the End of Life: Being Connected… a Key to My Survival. JAMA. 2009. Ramirez et al. Lancet
  24. 24. Compassion – for self & others • Work/life conflict and physician distress can be normalized and validated • Give yourself permission to acknowledge the challenges and take time/energy to work toward solutions • Check in with a friend or colleague
  25. 25. Seek professional expertise when appropriate • Do apply your medical judgment. • Depression, anxiety and alcohol/drug misuse are common conditions; doctors are not immune. • You may self-refer to EAPC (meet with a counselor confidentially to discuss personal issues). • You may consult with a physician at Employee Health, or, with your personal doctor.
  26. 26. A Dynamic Tension – the beauty of life’s work Dynamic tension exists between a culture of productivity, multiple professional & personal roles, and the need for self-care.
  27. 27. Permission to prioritize your own psychological & physical health is key • As physicians, we hold a common determination to provide the highest standards of care for our patients. • Those standards should similarly apply to providers ourselves, personally as well as professionally.
  28. 28. Goal: build an medical culture that includes caring for the caretaker Self Care Available Supports & Resources Healthy Work Culture/ Environment Occupational medicine – includes workplace culture & physical environment Collaboration across departments, with leadership buy-in and grassroots Champions Permission to prioritize self-care
  29. 29. Memorial Sloan Kettering Building Resilience* • Increasing Transparency – through research, education, discussion • Lunch & Learn topical lectures (sleep, compassion fatigue, relaxation techniques, etc) • Building Resilience through the Arts (Juilliard, MoMA, etc) • Team workshops (tailored to needs of service) • Open door policy / safety net • Collaborative approach Employee Health & Wellness Services in Department of Medicine; Office of Faculty Development GME; Department of Psychiatry & Behavioral Sciences; Social Work; Nursing; Chaplaincy Employee Assistance Program (EAPC); Survivorship & Integrative Medicine (employee access to these Services) Please feel free to contact Rebecca Guest, MD, MPH at guestr@mskcc.org
  30. 30. Conclusions • Work/life conflict, burnout, and associated distress are common and important occupational hazards for physicians. • Dynamic tension exists between a culture of productivity, multiple professional & personal roles, and the need for self- care. • Educational strategies and resources are identified to build resilience. • Permission to prioritize self-care is key. *American Society of Clinical Oncology, Take Care of Yourself: We Need You, Rebecca S. Guest and Dean F. Bajorin, JCO, April 10, 2014.
  31. 31. Resources & References – relevant to physicians • The AMA Family & Physician Support Program • The Canadian Medical Association (CMA has very good website/resources) • The British Medical Association (BMA, The National Clinical Assessment Service) • The International Physician Health Conference (IPHC) • Greater New York Hospital Association, GME, Resident Health & Wellness • The Mayo Clinic Program on Physician Well-being • http://stressfree.org/ • Vanderbilt University Faculty & Physician Wellness Program • Stanford University, Balance in Life program • Harvard School of Public Health, Center for Work, Health, & Well-being • CDC – NIOSH WorkLife • Association for Women In Science (AWIS), Work-Life Satisfaction
  32. 32. Resources available to you at MSK • Employee Health & Wellness Services (EH&WS) • Employee Assistance Program Consortium (EAPC) • GME • MSK Employee Wellness – nutrition/weight loss, exercise/fitness, tobacco cessation, Active Health, stress management, etc. • The Building Resilience Program – individualized consultations, educational lectureship series, Building Resilience through the Arts • Chaplaincy • Social Work • Human Resources - HR business partner • WorkLife • Integrative Medicine
  33. 33. Resources & References • Your organizations’ Employee Assistance Program (EAPC) • Every physician should have a personal physician whose objectivity is not compromised
  34. 34. Self-improvement • Cali Williams Yost, Work+Life: Finding the Fit that’s Right for You and Tweak It: Make What Matters to You Happen Every Day • Jon Kabat-Zinn, Wherever you go, there you are – mindfulness meditation in everyday life • Mindfulness meditation – http://www.buddhanet.net/audio-meditation.htm – http://marc.ucla.edu/body.cfm?id=22 • Stephen R. Covey, First Things First • Martin E.P. Seligman, Learned Optimism – How to change your mind and your life • Stephan Rechtschaffen, Time Shifting – Creating More Time to Enjoy Your life
  35. 35. Select references Guest R, Bajorin D. Take Care of Yourself: We Need You. J Clin Oncol. 2014 March;32:1-3. Guest RS, Baser R, Li Y, et al. Cancer surgeons' distress and well-being, I: the tension between a culture of productivity and the need for self-care. Ann Surg Oncol. 2011;18: 1229-1235. Guest RS, Baser R, Li Y, et al. Cancer surgeons' distress and well-being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol. 2011;18:1236-42. Kearney MK, Weininger RB, Vachon MLS, et al. Self-care of Physicians Caring for Patients at the End of Life: Being Connected… a Key to My Survival. JAMA. 2009. 301:11, 1155-162. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451. Balch CM, Copeland E. Stress and burnout among surgical oncologists: a call for personal wellness and a supportive workplace environment. Ann Surg Oncol. 2007;14: 3029-3032. Shanafelt, T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24:4020-6. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995–1000.12. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1338-85. Shanafelt TD, Raymond M, Horn L, et al. Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into? J Clin Oncol. 2014;32:2991-7. Shanafelt, T: A Career in surgical oncology: Finding meaning, balance, and personal satisfaction. Annals of Surgical Oncology, Feb. 2008.
  36. 36. Select references Beckman H. The Role of medical culture in the journey to resilience. Acad Med.2015;90:710-712. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009; 302:1284-93. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013; 88:382-9. Epstein RM, Krasner MS. Physician resilience: What it means, why it matters, and how to promote it. Acad Med. 2013;88:301-303. Wallace JE, Lemaire JB, Ghali WA. Physician Wellness: A missing quality indicator. Lancet. 2009;374:1714-1721. Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists : challenges to assuring access to oncology services. J Oncol Pract. 2007; 3:79-86. Drybye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89:443-451. Williams, ES, Konrad TR, Scheckler DP. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Health Care Manag Rev. 2001;26:7–19. Gabbard GO, Menninger RW. The Psychology of postponement in the medical marriage. JAMA. 1989; 261:2378-2381. Harrison, RA, Gregg, JL. A Time for Change: An exploration of attitudes toward part-time work in academic medicine among women internists and their division chiefs. Acad Med. 2009;84:80-86. Salles AS, Liebert CA, Greco, RS. Promoting balance in the lives of resident physicians: A call to action. JAMA Surg. 2015;150(7):607- 608. Sood A, Prasad K, Schroeder D, et al. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. J Gen Intern Med. 2011 Aug;26(8):858-61.
  37. 37. Select references Facts about physician depression and suicide. American Foundation for Suicide Prevention website. https://www.afsp.org/preventing- suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide/facts- about-physician-depression-and-suicide. Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA.2014;312(17):1725-1727.

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