BLOG: Work less to become more effective

ByJohn D. Kelly IV, MD

The data is clear. Burnout rates among physicians are soaring. Orthopedic surgeons are by no means immune to emotional exhaustion with both the prevalence and magnitude of burnout on the rise.

Cited reasons for the decline in physician emotional wellbeing include increasing bureaucracy, loss of autonomy, electronic medical records and recent cataclysmic changes in health care delivery. While these negative influences are not likely to depart anytime soon, one immediate change one can make to combat burnout is to work less.

The evidence is overwhelming. Long-term excessive workhours result in a substantial loss of productivity and exact a toll on our health.

Henry Ford and efficiency

Automaker Henry Ford recognized that his employees were appreciably more efficient when they worked 5 days a week vs. 6 days a week. He further noted that a shift to a 40-hour workweek coupled with higher pay resulted in even greater yield. In other words, he was getting more for his money (productivity) when his workers cut back on hours and were paid more.

Subsequent experiments have substantiated Ford’s observations. Industrial workers, on average, simply have 8 good hours to expend a day. In fact, the most productive interval seems to be between hours 2 and 6 hours of an 8-hour day. More recent studies posit that “knowledge workers” employed in sedentary and more cerebral occupations may have only 6 good hours a day. In fact, knowledge workers are exquisitely sensitive to sleep loss. A U.S. military study demonstrated that loss of 1 hour of sleep per night for 1 week resulted in a cognitive impairment similar to a blood alcohol level of 0.1.

When one compares a 60-hour workweek to the standard 40 hours, productivity does increase initially for the overworking cohort. However, in time (approximately 3 weeks), the yield of longer hours begins to drop below that of 40-hour week workers. In short, workaholic type patterns only work in the short term and will lead to dysfunction in time.

Biopsychosocial model of wellness

Overwork leads to loss of productivity because humans can only function optimally when basic needs are met. The needs for rest, exercise, nutrition, social connection and play must be met for one to maintain happiness. As I have mentioned repeatedly in prior blogs, happy doctors provide better care.

Just one missing element of an unmet need can manifest in illness, depression and burnout. Imagine the folly in getting 4 hours of sleep a night. A well-intentioned surgeon who adopts this lifestyle may not be aware that sleep deprivation leads to weight gain, cognitive decline, diabetes, immune compromise and increased inflammation. In essence, by working more you will be working less in your lifetime as you succumb to illness.

Vacations are a lifesaver

Vacations prolong lifespan. The Framingham heart study concluded women who took more vacations lived longer. No doubt stress reduction explains the data.

Vacations enhance well-being, enhance immune function, lower cortisol levels, strengthen relationships and increase productivity. Germany ranks 25th in the average workhours per week amongst European nations, yet has the second strongest economy. Germans are no stranger to vacations and undoubtedly recognize that a happy, well-rested workforce outperforms an emotionally exhausted one.

Vacations do not have to be a trip to the Riviera. A simple day trip away will do wonders to decompress one’s nervous system and remove from one’s consciousness the familiar.

My wife and I own a modest condominium at the New Jersey shore. I am amazed at how refreshed I feel after 1 weekend away. There are no stacks of journals, MRIs or CDs lying around to remind me of what awaits me in the coming weeks.

Implicit in the value of a mini-vacation is the need for technology breaks. Our nervous system is bombarded with text messages, emails, snap chats and electronic messages. Our minds need a dedicated reprieve from the continual barrage of stimulation. There can be no real rest without creating a solid boundary with technology.

Take the hit

While cutting back on hours sounds like heresy in this reimbursement-strained and overhead-laden medical culture, a mere 5-hour reduction in one’s workweek will yield immeasurable dividends.

Burned-out surgeons provide inferior care, are named in more malpractice suits and have less compliant patients. Happy doctors yield happy patients and enjoy longevity in both life and career. In addition, happy doctors are far less inclined to neglect their loved ones. Burned-out, overworked docs tend to damage families.

The next time you consider a vacation, take it. Long term, your productivity will be greater. In addition, your life may just may depend upon it.

References:

Chapman SJ. The Economic Journal. 1909; 19.75 353-373.

Eaker ED, et al. Am J Epidemiol. 1992; 854-864.

Gump B et al. Psychosom Med. 2000; 62:608–612.

Krueger, GP. Work & Stress 3.2. 1989; 129-141.

Thomas, HR. J. Constr. Eng. Manage 1992;doi:10.1061/(ASCE)0733-9364(1992)118:1(60), 60-76.

Van der Hulst M. Scand J Work Environ Health. 2003;doi:10.5271/sjweh.720.