Clinical and Health Affairs
Principles to Promote Physician Satisfaction and Work-Life Balance
By Tait D. Shanafelt, M.D., Colin P. West, M.D., Ph.D., Gregory A. Poland, M.D., Nicolas F. LaRusso, M.D., Ronald Menaker, Ed.D., and Rebecca S. Bahn, M.D.
Abstract
Substantial evidence suggests that difficulty balancing their personal and professional life is a major contributor to physician distress. Limited evidence suggests that the mission and policies of health care organizations may relate to physician satisfaction. In this article, we describe principles to promote professional satisfaction and work-life integration developed by the Mayo Clinic department of medicine. These principles can be used to measure and align policies. It is hoped they will serve as a model that can be used by other health care organizations.
We take life so seriously that there is nothing to fill our leisure hours during our working years, and when retirement comes we have nothing to enjoy.
—C. H. Mayo, 1935
Engrossed late and soon in professional cares ... you may so lay waste your powers that you may find, too late, with hearts given away, that there is no place in your habit-stricken souls for those gentler influences which make your life worth living.
—Sir William Osler (1849-1919)
As evidenced by these statements, physicians were aware of the negative effects of overwork long before anyone talked about “stress,” “burnout,” or “work-life balance.” Although we now have terms to describe these issues, physicians continue to wrestle with them. It remains unclear what health care organizations can do to reduce physician distress and cultivate an environment that promotes their satisfaction and well-being.
Like many health care organizations, Mayo Clinic seeks regular feedback from its physician faculty about how it can support its practicing physicians. In 2006 and 2007, results of a physician survey (n=556; response rate=83.6%) and small focus groups indicated faculty members’ desire for formal, written organizational guidelines on work-life balance aimed at increasing professional and personal satisfaction. Based on this feedback, leaders in the department of medicine created a work group charged with developing formal guidelines for promoting faculty satisfaction and work-life balance.
The work group, which was composed of 2 senior faculty members with expertise in professional development, 2 faculty members with expertise in the study of physician health and well-being, and a senior practice administrator, began meeting in the fall of 2007. The group looked at the work-life balance policies of other organizations and reviewed literature on physician satisfaction and work-life balance. At the same time, it established that its goal was to develop principles and guidelines as opposed to an inflexible set of rules or policies.
The group ultimately identified 7 characteristics that promote physician satisfaction and work-life balance in a medical environment and created a draft document that it presented to department of medicine leaders. The document went through several revisions before it was approved by the department chair in the spring of 2008. The guidelines were presented to the faculty in June of that year. The department of medicine currently uses this document to make sure the health and well-being of physicians are considered when setting policy or making decisions.
Principles of Faculty Satisfaction and Work-Life Balance
The document addresses 7 areas the work group deemed important to physician well-being.
♦ Meaningful Work
Meaningful work is characterized by a sense that the best within you is called upon each day. For physicians, helping and being of service to others has particular meaning and leads to a high level of personal satisfaction. Importantly, being able to do meaningful work implies minimizing work that is not consistent with one’s training and abilities. Clerical work and other administrative chores, for example, should not consume a large percentage of faculty members’ working hours and instead should be delegated to other personnel.
♦ Challenges Commensurate with Skills, Interests, and Resources
A work-related challenge can be viewed as exhilarating or insurmountable, depending on the skills and interests of the individual charged with tackling it and the resources provided by the organization. Taking on a challenge for which an individual is adequately trained and supported offers an opportunity for success and accomplishment. However, if a person is asked to do something he or she doesn’t feel qualified to do or that he or she doesn’t have the resources to accomplish, the situation can be stressful and promote anxiety. For those reasons, institutions should select people with the right skills and interests to take on particular challenges and give them the resources they need to do the job.
♦ Opportunities for Professional Development
Faculty members are recruited to Mayo Clinic because of their clinical or scientific expertise. Essential to career satisfaction are opportunities to further develop these talents and to gain expertise in other areas of interest such as leadership, administration, teaching, and research. It is the responsibility of each division chair in conjunction with department leaders to provide opportunities for career development and life-long learning.
In order to do this, department leaders need to provide faculty physicians with the time and resources necessary to advance their skills. They also need to identify mentors who can guide physicians’ development. In addition, because a person’s career interests and aspirations may evolve over time, department leaders need to help faculty develop skills in new areas that complement the changing needs of patients, the department, and Mayo Clinic as a whole. In addition, we recognize that faculty members face daunting external recredentialing requirements (board certification, continuing education for state licensure, etc.). It is therefore a responsibility of the department and the division to help them fulfill these requirements.
♦ A Culture that Cultivates Professionalism and Professional Satisfaction
Professional satisfaction is necessary for faculty to serve patients to the best of their ability, and the environment in which they work plays a role in this. For that reason, the department of medicine is committed to identifying, changing, and eliminating elements within the environment or ways of working that can decrease workplace satisfaction.
♦ Autonomy and Flexible Scheduling
Autonomy and scheduling flexibility have repeatedly been described as critical to physician satisfaction. Although most clinics and medical practices have productivity requirements, physicians should have some control over their schedule. The department of medicine will encourage the development and evaluation of innovative scheduling structures.
♦ A Culture that Values and Encourages Life Outside of Work
Integral to personal and professional satisfaction is having a well-rounded life. This means establishing boundaries between work and the other domains of life. A poor work-life balance affects not only the physician but also his or her family and others. Encouraging and valuing a faculty member’s commitment to family life, community life, spiritual life, hobbies and interests, friends, and colleagues promotes the well-being of the individual, which ultimately affects patient satisfaction and the performance of the organization as a whole.
♦ A Culture of Wellness
Mayo Clinic faculty members are driven, focused, and committed to Mayo’s core value of putting the needs of the patient first. These characteristics often work against the need to care for oneself physically and emotionally. One reason why physicians don’t feel as if they can take time for themselves is because they don’t have role models during their training who show them how to do it. In this regard, the organization and faculty “co-conspire” to promote a work environment that insufficiently emphasizes attention to personal health and well-being. Just as an institution offers assistance with increasing productivity (eg, providing electronic medical record systems and email), so too should it promote holistic health and long-term work-life balance. Development of skills related to maintaining balance, reducing stress, managing time, and optimizing one’s health should be encouraged.
Discussion
Practicing medicine can be stressful for physicians. The manifestations of physician distress include anxiety, burnout, depression, fatigue, and broken or strained relationships.1 Studies suggest that roughly a third of physicians experience burnout at any given point in time.2-6 Additional research suggests that physician burnout and distress may have adverse effects on quality of care, patient satisfaction and compliance, and the frequency of medical errors and malpractice claims.7-15
Numerous studies suggest that difficulty balancing their personal and professional life is a major contributor to physician distress.2,3,5,16 Physicians frequently work nights, weekends, and holidays and often must be available by pager 24/7. In addition, credentialing requirements and the rapidly expanding body of medical knowledge require physicians to devote a substantial amount of time to continuing medical education and recertification—tasks for which they do not get paid. These professional demands can intrude on personal and family time. Data suggest that a large number of physicians now choose a specialty based on how well it fits with their personal life rather than on how well it aligns with their professional interests or the needs of society.17-19
Despite extensive studies documenting the prevalence of physician distress and physicians’ difficulty balancing their work and home lives, little is known about how to create a professional environment that promotes physician satisfaction and helps them successfully integrate their personal and professional obligations.1,6,20-22 Limited evidence does suggest, however, that the policies of health care organizations affect physician satisfaction.23,24
It is our belief that academic medical centers and health care organizations can cultivate environments that promote a balance between work and life and, thus, enhance physician satisfaction. Such efforts should go beyond creating programs to help physicians struggling with depression, substance abuse, behavioral issues, and other problems. Making an effort to promote physician wellness and resilience has the potential to improve both quality of care and physician productivity.1,6
We have described the Mayo Clinic department of medicine’s work to define the key characteristics of such an environment. The guidelines presented are intentionally brief, as we wanted to make them relevant to a variety of specialties and practice settings. We do not consider the principles to be either exhaustive or definitive but rather an important initial step that will require refinement. Alone, they cannot improve physician satisfaction or help anyone achieve work-life balance. However, an institution can use them to evaluate existing policies and help craft new ones. We hope the guidelines can be used by other health care organizations interested in creating an environment that promotes physician satisfaction. MM
Tait Shanafelt is an assistant professor of medicine and director of the Mayo Clinic department of medicine, Colin West is an assistant professor of medicine and biostatistics, Gregory Poland is a professor of medicine, Nicolas LaRusso is a professor of medicine and past chair of the department of medicine, Ronald Menaker is the cardiology administrator, and Rebecca Bahn is a professor of medicine at Mayo Clinic.
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