Reframing conversations around work-life integration: Solutions to systems-based problems
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Gastroenterologists face a unique set of challenges that can significantly affect their work-life integration.
Long hours, demanding procedures and the constant pressure to remain up-to-date with evolving medical and procedural advancements often leave little room for personal life, especially for those with familial responsibilities. Given the systems-based issues, we propose systems-based solutions to improve physician well-being and retention.
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Overcome the Generational Divide
We want to stress that the problems that drive burnout also require systems-based solutions. Physicians who express concern about burnout and wellness are often told to improve their personal resiliency.
This month’s Healio exclusive shares the opinion that residency work hour restrictions mean that today’s residents are not pushed as hard as those who trained in the days without work hour restrictions and are therefore not programmed to endure the difficulty of the medical work environment following graduation.
Work hour restrictions are supported by evidence that unlimited work hours were associated with increased risk for medical errors and fatigue-related harm to physicians’ health. Also, there are many issues related to long hours despite these restrictions. Training and practicing in today’s clinical environment holds different challenges that need to be addressed with solutions adapted to current care models and workforce structure, such as increasing representation of women in medicine.
Our concern is that placing blame on a generational divide may deter systems-based solutions in favor of placing the onus on physicians, which can be counterproductive and may increase already high burnout rates in the current health care workforce.
Implement ‘Robust’ Family-Friendly Policies, Environment
One crucial avenue for achieving work-life integration is through the implementation of robust family-friendly policies within gastroenterology practices and health care institutions.
Ultimately, investing in family-friendly policies is not just a matter of moral imperative but also a strategic imperative for the future of gastroenterology.
Incompatibility with family life and childcare responsibilities is a major deterrent for residents against choosing the field of gastroenterology — and a major driver of physicians leaving clinical practice.
Providing adequate paid parental leave, flexible work schedules and accommodations for pregnancy and lactation are essential to address the undue burden, particularly for female GIs. Coverage models, including gastroenterology hospitalists and advanced practice providers, are important components to consider in creating these solutions.
Apply Technology for Medical Documentation, Communications
Another challenge is the burden of the electronic health record and expectation by patients and staff that GIs be available for communication during and outside of normal business hours.
A systems-based solution might involve AI technologies that promise to reduce the burden of medical documentation, allowing physicians to focus more on patient interactions. Additionally, several health systems have begun billing for electronic health communications, which may improve adequate compensation and allow for protected time for tasks that may fall disproportionately on women physicians.
Prioritize Adequate Staffing, Flexible Hours
The COVID pandemic has deepened distrust of the medical establishment by patients and the general public. While this can certainly create challenges, the major impact on physicians of the COVID pandemic is driven by inadequate staffing and workflow challenges. Understaffing may shift nonphysician tasks to physicians, resulting in longer work hours and more work outside of work.
Furthermore, GIs are faced with choosing between providing high quality patient care and their family responsibilities. An example is that anesthesia shortages may mean that nonurgent inpatient endoscopy cannot start until evening hours, due to limited availability of anesthesia providers. The physician may be forced to decide between delaying a procedure for which a patient has been fasting or participating in the care of their children.
Working in an understaffed system has been shown to result in moral injury, further driving the emotional exhaustion and depersonalization that are hallmarks of burnout. Prioritizing adequate staffing and allowing for flexible work models, including part-time and telemedicine options, are likely to improve physician wellness.
We advocate for systems-based solutions that are appropriately funded and can simultaneously address multiple systems-based issues using innovative technologies. We believe these are imperative to ensure that GIs can thrive both personally and professionally, mitigating burnout and attrition in the field.
- References:
- Abbasi J. JAMA. 2022;doi:10.1001/jama.2022.5074.
- Advani R, et al. Dig Dis Sci. 2022;doi:10.1007/s10620-022-07541-5.
- David YN, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2021.05.053.
- Feld LD, et al. Gastroenterology. 2023;doi: 10.1053/j.gastro.2023.08.014.
- Feld LD. Am J Gastroenterol. 2021;doi:10.14309/ajg.0000000000001145.
- Garcia P, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.3201.
- Gardner JG, et al. Therap Adv Gastroenterol. 2023;doi:10.1177/17562848231173334.
- Harry EM, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.21776.
- Lacy BE, et al. Am J Gastroenterol. 2024;doi:10.14309/ajg.0000000000002663.
- Rabinowitz LG, et al. Acad Med. 2021;doi:10.1097/acm.0000000000004011.
- Rittenberg E, et al. J Gen Intern Med. 2022;doi:10.1007/s11606-021-07298-z.
- West CP, et al. J Intern Med. 2018;doi:10.1111/joim.12752.
- Zakerkish M, et al. PLoS One. 2024;doi:10.1371/journal.pone.0301636.
- For more information:
- Lauren D. Feld, MD, is assistant professor of gastroenterology and hepatology and diversity, equity, inclusion and belonging executive for the department of medicine at UMass Chan Medical School. She can be reached at lauren.feld@umassmed.edu.
- Amy S. Oxentenko, MD, is professor of medicine and vice dean of practice at the Mayo Clinic.
- Loren G. Rabinowitz, MD, is an instructor in medicine at Beth Israel Deaconess Medical Center and Harvard Medical School.
- Julie K. Silver, MD, is associate chair and associate professor in the department of physical medicine and rehabilitation at Harvard Medical School.
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