Address Work-Life Integration to Decrease Physician Burnout

An imbalance between work needs and personal needs is common in the medical profession.

Physicians who experience lower work-life integration tend to be women, single, 35 or older, and work more hours and call nights, a recent research article indicates.

Work-life integration—specifically an imbalance between work needs and personal needs—is associated with physician burnout. Physicians reported high levels of burnout before the coronavirus pandemic, and physician burnout has likely worsened during the pandemic.

"Work-life integration is strongly related to burnout—even more so than a lot of the typical demographic factors that are commonly considered drivers of burnout such as gender and age. In contrast to demographic factors, work-life integration directly impacts whether individuals are putting their work needs ahead of their personal needs," Daniel Tawfik, MD, MS, lead author of the recent research article and an instructor in the Department of Pediatrics at Stanford University School of Medicine in Stanford, California, told HealthLeaders.

The research article, which was published by JAMA Network Open, is based on information collected from more than 4,300 physicians. Work-life integration was measured with an 8-item scale, with scores ranging from 0 to 100 and higher scores signifying better work-life integration (WLI).

The study includes several key data points:

• Female physicians had a worse mean WLI score than male physicians (52 versus 57)
   
• A lower work-life integration score was associated with being 35 or older, single, working more hours, and more call nights
   
• Medical specialties associated with low work-life integration included emergency medicine, urology, general surgery, anesthesiology, and family medicine
   
• The largest gender disparities were observed in physicians who were 45 to 54 years old

"Poor WLI may have adverse effects on physicians and their families at multiple levels, highlighting the urgency of addressing these disparities. Women are more likely to experience burnout, which may be largely attributable to differences in professional characteristics and satisfaction with WLI," the research article's co-authors wrote.

Improving work-life integration

There are five actions that healthcare organizations can take to improve physician WLI, the research article says.

1. Increase physician control of scheduling

Although the most appropriate approach to scheduling will vary by healthcare organization, specialty, and work setting, there are some strategies that can be widely successful, Tawfik says.

"One approach is promoting a culture where any non-time-sensitive items can be addressed flexibly—either after hours if that works best for the individual or the next day if that is better for them. For outpatient specialties, there can be improved flexibility for clinic appointments while taking into account the needs of other clinic staff. One other idea is making sure there are sufficient personnel and resources, so that physicians can reduce their work hours when needed without having to worry that they are putting their colleagues under excess burden or putting their patients at risk of not having enough access to care," he says.

2. Improve practice efficiency

To boost WLI, one area that is especially promising is reducing clerical burden for physicians, Tawfik says.

"For example, over the past several years, many clinics have introduced scribes, who are individuals who are specially trained to document clinical encounters. This provides timely documentation of encounters, reduces some of the clerical workload on physicians, and may improve the billing accuracy for clinics. Overall, studies that have looked at the introduction of scribes have been promising at improving physician efficiency and quality," he says.

Electronic health records are another prime opportunity to improve practice efficiency, Tawfik says. "Physicians can customize electronic health records to make EHRs work more efficiently for them. Physicians should also be afforded the time to learn how to use their EHRs most efficiently."

3. Decrease gender disparities in compensation, retention, and promotions

It will take a concerted effort to increase compensation, retention, and promotions for female physicians, Tawfik says.

"Women physicians have an uphill battle for many reasons. The culture of medicine has been male dominated for a long time, plus there are gender disparities in the medical workforce that have existed for a long time. Although there has been some progress made recently, we are still a long way from achieving equity. So, healthcare organizations need to recognize that women physicians are coming from a position of disadvantage and recognize that they need to prioritize women when they are recruiting new physicians and when they are evaluating physicians for promotion," he says.

4. Establish gender-specific mentorship, coaching, and networking

There are interventions that healthcare organizations can implement to level the playing field for female physicians, Tawfik says.

"It will be very important for mentorship, coaching, and networking to go hand-in-hand with promoting women to leadership positions and introducing larger systemic changes. Gender specific mentorship and coaching can provide more rapid benefits than the systemic changes that will take a while to achieve. Some of the important steps will be identifying women physicians who have been successful at navigating the system and advocating for change," he says.

5. Provide childcare

Healthcare organizations can improve physician WLI by offering childcare, the research article's co-authors wrote. "On-site or other readily accessible high quality backup childcare may also reduce gender disparities among physician-parents, particularly for holidays or for prolonged school closures such as experienced during the COVID-19 pandemic in 2020."

Related: National Physician Burnout Expert Shares Insights: 'We Can Certainly Do Better'