Work and Life: Integration vs. Balance

They took me by surprise during a recent visit over a holiday weekend.

I have two 20-something daughters whom I had not seen face-to-face in more than 18 months. The visit was terrific and reinforced the joy of family.

During one of the conversations, however, the younger daughter began sharing the array of deep thoughts she had been having about life during the past few months…and then the older one quickly offered up a series of similar comments.

Both are kind, caring, and compassionate individuals who care deeply about our world and the people within, so perhaps I should not have been surprised. But I was, and it created a moment for us to more profoundly reflect about how almost everyone, at some level and regardless of age, is having similar types of thoughts. Not just thoughts about how to survive the pandemic, but thoughts about what they should do with their lives as a result of the pandemic’s influences.

Where have your thoughts been in this regard?

An April 22, 2021, Washington Post article by William Wan states, “As the country’s healthcare system has become increasingly dysfunctional in recent decades, the bulk of that dysfunction has landed on health workers — resulting in long hours, mounting paperwork and bureaucratic hurdles, fear of malpractice lawsuits and insufficient resources.” The article goes on to describe the personal situations for a few physicians and the changes in thought that many in healthcare are struggling to clarify for themselves. As a result, almost 30% have considered leaving our industry!

Similarly, the Jackson Physician Search firm surveyed 400 physicians in late 2020, including 85 healthcare administrators who responded to questions about physician retention programs. Its white paper “On the Verge of a Physician Turnover Epidemic: Physician Retention Survey Results” has five key takeaways:

1. Sixty-nine percent of physician respondents reported being actively disengaged from employers. (The survey asked whether physicians felt engaged by their employer, whether there was effective two-way communication with administrators, and whether they had access to leadership training and career advancement to measure engagement.)

2. Fifty-four percent of respondents said COVID-19 changed their employment plans.

3. Half of the respondents who plan to change their employment plans said they would consider leaving for a new employer.

4. Twenty-one percent of respondents who plan to change their employment plans said they are considering early retirement.

5. Fifteen percent of respondents who plan to change their employment plans said they might leave medicine.

Kurt Mosley, vice president for strategic alliances at the recruiting firm Merritt Hawkins, shared in a December 2020 AMA online article that the job market for physicians has gone from a seller’s market to a buyer’s market and that his firm has had more calls from physicians during the past six months than they’ve had at any time in recent history.

Before the pandemic, physicians’ job search priorities were “sort of like real estate — it was all about location, location, location,” Mosley says. “More recently, we’ve seen that emphasis shift to lifestyle. Now, it has become much more about what an employer can do for you. Is it a larger organization? Can they weather the storm? Can they provide child care? It’s changing overnight.”

We are all aware of the stress factors, increased anxieties, prevalence of burnout, and incidence of suicidality in healthcare. More recently, what has caught my attention is the number of healthcare workers who wish to leave the workforce entirely. The number who want to retire early and find nonclinical jobs and non-industry jobs seems to escalate.

Couple these data with projections for global shortages in both the physician and nursing workforces, and we have a significant potential problem for our industry…and for the care of the general population across continents.

Paradoxically, and apparently due to the pandemic, there also appears to be an increased interest by recent high school graduates to pursue healthcare across various positions and professions. After witnessing firsthand some of the horrors of illness, disability, and death so early in their lives, they have a desire to solve scientific problems, become epidemiologists or public health experts, and serve as frontline clinical providers.

The onus (in my opinion) is upon us as physician leaders to take responsibility for addressing both aspects of this paradox. We must continue to attend to the constellation of issues related to improving the wellness of our current workforce. Simultaneously, we must better prepare the existing healthcare environment to receive energetic, highly motivated, early-career stage individuals into the industry. If we don’t urgently address this latter issue, we run the risk of missing a unique opportunity to leverage the motivations of a younger workforce.

Unfortunately, the industry is already at risk of not being able to keep the younger generation of healthcare workers healthy. A Washington Post-Kaiser Family Foundation poll of 1,327 U.S. healthcare workers in 2021 indicated that 69% of healthcare workers ages 18–29 and 61% of healthcare workers ages 30–39 indicated they felt burned out.

Many of us have viewed our professional lives as separate from our personal lives. Relatively recently, there has been much talk about balancing work and life, family and friends. Unfortunately, many older workers find striking this balance difficult because they see their profession as their identity. Defining a balance is difficult and, subsequently, there is the potential for feeling like a failure if the balance is not reached.

The May 27, 2021, issue of JAMA Network Open has a well-written article by Tawfik, Shanafelt (an AAPL Honorary Fellow), and others entitled “Personal and Professional Factors Associated with Work-Life Integration Among U.S. Physicians.” It addresses the issues of work-life integration in the physician workforce. Although the primary outcome data focus on disparities for women in medicine, the article does a nice job of describing the complexities of work-life balance in our overall workforce.

For many years, I have endeavored to achieve this so-called integrated work-life lifestyle. Certainly, the advent of digital devices and the ongoing expansion of technology opportunities make this lifestyle somewhat simpler, but make no mistake, you must be proactive to make this approach work — not just for yourself, but for your partner, family, and friends as well. My daughters definitely helped me.

The rise of numerous secondary influences (think telehealth, videoconferencing, remote work, etc.) is perhaps a silver lining from the past 18 months. The existing technologies will undoubtedly continue to expand in their capabilities. The workforce across all industries will continue to explore how best to approach remote work. And our clinical delivery systems will continue to adjust to integrate telehealth as a significant portion of patient care.

Therefore, the healthcare workforce must become even more proactive with its pursuits of innovative ways that better address workforce wellness for the existing workforce and for those soon to be entering our workforce. Developing systems and processes that facilitate a simpler approach to an integrated work-life lifestyle will be imperative for many — especially the younger generations. Providing full-time dedication to the profession while still creating the risks of burnout or suicide, increasing family discourse or dissolution, or perpetuating gender or racial inequities in the workforce is too difficult a path. We already recognize it is an unsuccessful pathway for many in these changing times.

Finding a simple balance between work and life is not so simple. Let’s now think in different ways and address the opportunities at hand in a creative fashion. An integration strategy may work better, but time will tell if we begin to promulgate these approaches. Let’s not miss this rare moment in history for us as physician leaders to help make this happen.

Remember, leading and creating significant change in healthcare is our overall intent as physicians; therefore, AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines healthcare delivery internationally.

We must all continue to seek deeper levels of professional and personal development, and to recognize ways we can each generate constructive influence for one another at all levels. As physician leaders, let us become more engaged, stay engaged, and help others to become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.

ADDITIONAL READING

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