Chief Wellness Officers are administrative leaders tasked with ensuring that organizational culture and executive leadership align to produce a healthy practice of medicine for those tasked with working in the clinical environment. That is a complicated way to say they are supposed to help doctors either like their work more or resent it less.
Structural incentives are important in helping attract qualified physicians. Determining how physician output is measured is critical to creating a specific institutional culture. Is your institution extractive, maximizing productivity at the expense of high turnover and low job satisfaction?
Alternately, is your institution geared toward long-term retention of talented physicians by accounting for entirely predictable life cycle events when determining clinical workload to positively impact career satisfaction.
With that in mind, I thought it might be fascinating to see if a few lessons about creating proper incentives might be gleaned from the 22 current interviews in the Docs Who Cut Back series.
Humans Tend To Mate And Reproduce
Without reviewing the biology of sexual reproduction, humans are surprisingly similar to other species in that we are designed to transmit our genes to the following generation. Strangely, medical culture seldom factors in our biological drive.
What? You're pregnant? Who could possibly have seen that one coming?
As we learned from Dr. Krygowski in her interview, pregnancy creates this desire to spend time nurturing newborn offspring. She felt conflicted about deferring fellowship for one year in order to nurture her newborn, but ultimately decided parental investment in nurturing offspring was a priority.
She was similar to Dr. Baker, who experienced a shift in priorities following a health crisis that caused her to focus on maximizing time with her young daughter.
Wanting to parent well and make time to be present for kids is not solely the domain of females. There was a time in my career when I felt like an airbnb tenant renting one side of a bed who incidentally ran into the home's other occupants - my wife and kids - in the kitchen. I grew significantly happier attending basketball games, volunteering in the classroom, and most recently supplementing distance learning during COVID.
Flexibility Can Matter As Much As Income
New physicians are often young and hungry - many are looking to pay off debt or save up for the down payment on a house. But it would be a mistake to regard them as monolithic in their experience and desires.
Dr. ATC was on an upward academic trajectory when motherhood intervened. She made multiple course corrections - giving up a moonlighting gig, reducing her clinical workload at the academic medical center where she had her appointment down to 0.6 FTE, and still she felt unable to be present at home to the extent she knew was right.
Despite enjoying her academic career, she ultimately carved out a professional life at a community hospital that was able to offer her the flexibility she needed in order to optimize her home life.
As more medical practices adopt flexible scheduling as an organizational tenet, they are finding greater success in recruiting and retaining quality female physicians. Interestingly, large groups offering flexible employee positions have made the greatest inroads with the younger generation of female physicians, as I'd noted in a prior post.
The upshot is that financial remuneration is only one element of an employment package. In some cases it may not be the most heavily weighted. Those practices most willing to embrace innovative thinking may well end up with the lion's share of talent without incurring additional financial expense.
Docs Who Prioritize Wellness Remain Outliers In Medicine
When Dr. Craig announced she was cutting back in her busy OB/GYN practice, one supportive colleague offered to advocate for rehiring her when she came "crawling back." Another patronizingly explained, "It isn't that you can't do this, it is that you don't want to."
Medicine has supported a culture where the psychiatric condition known as folie a deux has scaled so successfully that the profession as a whole has developed a shared delusion that work should come before all other priorities. When we accept jobs that erode at the stability of our marriages or render us strangers to our children, we become complicit in this delusion.
Perhaps a well-respected Chief Wellness Officer can develop a culture where tailoring workload to long-term health is accepted rather than stigmatized.
I suspect that the next generation of physicians, embodied by bold voices like the blog Reflections Of A Millennial Doctor, will eventually demand flexibility to the point that it will reduce our professional pathology.
Comments 7
How do “part timers” deal w/ malpractice insurance? The last time I looked into this, I was told that part time is 20 hours and full time is 40 hours a week BUT on call hours are counted for part time coverage, not for full time coverage, so … one night of being on call immediately makes a person run over the 20 hours a week and prevents a part time policy.
Author
Conleth,
You make an excellent point, and my personal experience is admittedly limited to group rather than individual malpractice. We remain on the group policy even after cutting back to part-time.
Intuitively, you can’t be the first to deal with this issue in light of how many places employ per diem physicians who are part-timers at their institution.
May I suggest you google and reach out to Paul Kivela, an ER doc in California who got his MBA and has gone into med mal insurance as his second act beyond medicine. I suspect he’d be able to provide you with insight on how to avoid that cliff you refer to that charges you full-time rates for part-time practice. To be clear, Paul and I have no relationship and he could not pick me out of a lineup, I just know that he’s wise in these matters and I’d trust what he had to say on the matter.
Hope that helps,
CD
Very well written! I couldn’t agree more. I think when you do this you also value your patients more.
Author
Hi Deborah,
Accommodating physicians as humans with needs instead of widgets is how you transition from vicious to virtuous cycle.
Thanks for stopping by,
CD
CD,
Thanks for the unexpected, kind shout out. It was enough to pull me out of my solitary confinement to comment!
I have many thoughts on your post, but chiefly the system IS NOT prepared to handle a new generation of doctors that easily rejects the notion that our worth and value to society is solely wrapped up in our work.
Medical students are older and wiser these days – the average age of matriculation at my local med school is 26. They’ve done more things, seen more of the world and more of our healthcare systems’ flaws exposed during that time (especially with the pandemic). They come in with the expectation that they will be able to have a life outside of medicine, along with proper vacation time and family leave because they see their non-medical peers doing so.
Healthcare systems will need to bend to their will or resign themselves to the fact that once the Boomer and Gen X attendings retire, their mode d’etre will collapse as these new docs flock to and/or create systems that will cater to their preferences.
It’ll certainly be fascinating to see what happens to medicine in my lifetime, especially the next 2-3 years once the pandemic settles down. I expect a full reckoning via a mass exodus of physicians and other healthcare workers, but maybe that’s a little fatalistic.
Fondly,
M
Author
M,
What a pleasant surprise, she lives!
It’s a delight to hear from you, as always, and your insights are incisive. I look forward to the activists in the next generation of physicians devising solutions to the problem of work-life balance, and using their additional life experience to play medicine as a long game.
My hope is that the systems they create will keep them in the driver’s seat of their professions instead of turning it over to outside hands to manage, as the temptation to take a clock-in, clock-out job seems to check the boxes for work-life balance on the initial perusal, but often fails physicians over the long haul.
As I anticipate being part of the geriatric exodus around the time these greater changes take place, I’ll look to your cohort of idealistic (jaded?) youngsters to take care of me…
With appreciation,
CD
This was such a great compilation of your series. Thank you for the mention, and the reminders!