8 ways individual doctors can advocate on work-life balance needs

Physician burnout rates and dissatisfaction persist at alarming levels. Even though the federally declared COVID-19 public health emergency has expired, one in two physicians report burnout. And while the concept of work-life balance has been touted as a solution, integrating “life” into a physician’s career is a far more complex challenge than it appears.

Between 2021 and 2022, physicians’ job satisfaction dropped to 68%. While still relatively high, it remained slightly below the job satisfaction rates of nurse practitioners and physician assistants. On top of that, the average workweek was 56.7 hours—a two-hour increase from previous years, according to an exclusive survey from the AMA.

These extra hours of work can cut into a physician’s time at home, increasing the risk for burnout. It has also raised the question: How can physicians effectively advocate for their own work-life balance and career satisfaction?

While this question goes beyond what was covered in a recent AMA STEPS Forward® webinar that  focused on well-being communication strategies at the organizational level, two physicians took time to provide some solutions for the individual physician to keep in mind.

They are:

• Jill Jin, MD, MPH, an internist at Northwestern Memorial Hospital and clinical associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. She is also a senior physician adviser for the AMA and an associate editor for JAMA^®.
• Jonathan Ripp, MD, MPH, dean of well-being and resilience, and chief wellness officer at Icahn School of Medicine at Mount Sinai in New York City.

“As an individual, it’s very important to think about what element of your work most ‘fills your cup.’ What is it that you’re passionate about?” Dr. Ripp said, noting studies have shown that if you spend at least 20% of your time engaged in an activity that is your main passion, it is “associated with a decrease in burnout.”

“We also know that folks who engage in coaching, for example, where they can identify their own needs and areas that they want to focus on, that too is associated with improved measures of well-being,” he said. “It’s worth the personal investment of asking and answering the question yourself—what is it that’s going to enable me to feel balanced? What is it that I’m passionate about?”

Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.

Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.

It is also “dependent on where you work and the extent to which the culture supports your ability to advocate for your needs,” Dr. Ripp said. “We know, for example, that measures of psychological safety can associate with measures of well-being. In places where people feel empowered to speak up and communicate what their needs are, those are places that also have a greater sense of well-being amongst the community.”

Physicians should assess what their “work environment is like and if they have the capacity to advocate for their needs?” he said, emphasizing that “if you work in a place where you have agency and you have the ability to communicate what your needs are, you’re more likely to experience well-being and perhaps the work-life balance or integration that is associated with it.”

Sometimes having a conversation about well-being can feel awkward and “if you advocate for work-life balance too much or just advocate for your own self too much, it can come across as if you don’t really care about anyone else at the organization,” Dr. Jin said. That is why it is important “to build a relationship prior to all these asks.”

“Whoever your administrator is, actually getting to know them on a personal level … so they know who you are, and they have come to trust you,” she said, emphasizing “it’s building trust. If they trust that you’re not just trying to get away with doing the least amount of work possible and that you are a hard worker and a great doctor, then they’re much more likely to work with you on whatever you’re asking for.”

It is easy to say, “I’m here, missing dinner and not picking up my kids. Why are we working so hard when the triage nurses and medical assistants went home already?”

“But when you’re talking to a leader—your manager or director or VP—it’s important not to frame it that way. Instead, frame it as: I can’t get the work that I want to get done because I’m doing this unnecessary work that’s then cutting into the time I have to see patients,” Dr. Jin said. “It’s framing it in a way that focuses on how you really want to spend time with the patients because that’s what you enjoy doing, but you can’t do that if you’re overwhelmed with unnecessary work which then cuts into your home life.”

“So, frame it in a way that is what you do want, as opposed to what you don’t want—what your ideal state looks like and what it is what you’re hoping to accomplish,” she said.

When the case is made and stakeholders ask how to fix the problem, physicians can come to the table with a host of solutions taken from the AMA STEPS Forward toolkits and playbooks, Dr. Ripp said. For example, these toolkits can help “utilize team-based care and identify best practices in your electronic health record. That has the potential to improve well-being and efficiency.”

“It’s always helpful to come with a solution in hand as opposed to just a problem,” Dr. Jin said. For example, “if you’re staying late finishing up your inbox, adding notes or putting in orders and you think having a consistent medical assistant would help, share that.”

“As with anything, use data when available. The numbers and the metrics are always helpful. Whatever you’re trying to communicate about, it’s good to have data,” Dr. Jin said. “But on the flip side, it’s also really helpful to have a strong personal narrative and that’s where having a relationship comes in.”

“So, if they know you as a person, if they can really understand your story, that also helps as well,” she said. “It’s a balance. Some people might respond better to the data and some people might respond better to the personal narrative. There’s power in both.”

“Trainings that enhance communications among team members perhaps have been associated with improved well-being amongst the team,” Dr. Ripp said, noting “communications training that enhances the functioning of a team would fit in with some of the STEPS Forward toolkits around team-based care.”

“If a team is communicating well, that enables the distribution of work. It allows people to function at the top of their license and it avoids a lot of clerical burden that might land on the physician’s plate,” he said.

“Timing is everything. Sometimes if you ask for something at the wrong time, it’s just going to be shot down, maybe because it’s the end of the week or the end of the fiscal year,” Dr. Jin said. “If that happens, that’s OK, but don’t be afraid to bring it up again.”

“A lot of times, communicating is a mood and timing thing. And if at first you don’t succeed, try, try again,” she said. “If your ask is not out of the realm of possibility, and if you really believe in the cause, don’t be afraid to advocate more than once.”