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Abstract

During residency, the academic curriculum is very well outlined. However, not as much time is spent teaching residents the importance of striking a balance, or at least trying, between their stressful and long work hours and their personal life. Most Graduate Medical Education (GME) offices do offer services to residents that may include sports facilities and corporate discounts, that can be helpful. Many more stress management strategies can be learnt from experienced physicians that may be formally incorporated into medical training (5). Sometimes, the vague transition from work to home can be eased by conscious physical detachment from work. Google ran a program in its Dublin office called “Dublin Goes Dark” where employees were not allowed to take their electronic devices home and had to leave them at work. The forced detachment from work led to more stress-free evenings (6). Many residents struggle not to use home access to electronic medical records to check on how some patients are doing since their last shift or check the clinical census before they start the next shift. Formal training on making sure that we do not remain preoccupied about a child’s suffering once we go back home is vital.
December 2015 | Volume 3 | Article 1151
OPINION
published: 24 December 2015
doi: 10.3389/fped.2015.00115
Frontiers in Pediatrics | www.frontiersin.org
Edited by:
Andreas Schwingshackl,
University of California, Los Angeles,
USA
Reviewed by:
Arun Saini,
University of Tennessee Health
Science Center, USA
*Correspondence:
I. Federico Fernandez Nievas
fernandi@upstate.edu
Specialty section:
This article was submitted to
Pediatric Critical Care,
a section of the journal
Frontiers in Pediatrics
Received: 26October2015
Accepted: 10December2015
Published: 24December2015
Citation:
FernandezNievasIF and ThaverD
(2015) Work–Life Balance: A Different
Scale for Doctors.
Front. Pediatr. 3:115.
doi: 10.3389/fped.2015.00115
Work–Life Balance: A Different Scale
for Doctors
I. Federico Fernandez Nievas* and Danyal Thaver
Division of Critical Care Medicine, Department of Pediatrics, Golisano Children’s Hospital, Upstate University,
Syracuse, NY, USA
Keywords: work–life balance, residency, pediatric intensive care unit, workload, job satisfaction, burnout,
professional
THE RESIDENT PERSPECTIVE
“Hey, do you want to hang out this weekend?”
“Ummmlet me see if I’m on call
is is a conversation every resident goes through almost every month of their training. Despite work
hour regulations, overnight calls and weekend calls dene and shape our life. Every family event,
birthday, and anniversary has to be adjusted around the work schedule. Weekends are traditionally
seen as family time. Not so much during residency. At the start of residency, every intern is promised
that with work hour regulations now in eect (1), more time can be spent at home with family. Little
do they realize that they make up for the reduced duty hours by working more weekends. Even with
compensatory time, family time is unlikely to be recovered (2).
I got married just before starting my residency. At the time, I did not realize how much the
residency would come in the way of my personal life. However, on my days o, I found myself
catching up on lost sleep and regaining the strength to survive another day. Just like most other
chronically sleep-deprived residents (3), even when I woke up, I was grumpy and irritable (4). Let
us just say my wife was not amused.
Starting the second year of residency was a scary thought not just in terms of increased responsi-
bility, but also because it posed the physical challenge of working for 24h straight. e Accreditation
Council for Graduate Medical Education (ACGME) encourages residents to take a “strategic nap
during these shis, which made me think it should not be as bad as I thought. And it was not. A
60–90-min nap seemed sucient to keep me going for 24h. However, during my pediatric intensive
care unit (PICU) rotation, the same strategy did not work. “Strategic naps” were now only 10min
cat naps on a chair. Like with any ICU rotation, there were highs and lows. Although it was a roller-
coaster ride, I thoroughly enjoyed the rotation. e challenge of taking care of the sickest children
in the hospital and the immediate gratication of curing someone kept me going.
While I was engrossed in the sustained chaos in the ICU, I was disconnected from the outside
world. For those 4weeks, I was solely driven by my passion to take care of acutely sick patients. No
matter how physically or mentally tired I might have been, those patients were more precious than
my sleep. I soon realized that this chronic lack of sleep and the mental and emotional fatigue made me
neglect my family and aected my mood. Any other concerns that my friends or family had seemed
less important to me and did not warrant immediate attention compared to acutely ill children hold-
ing on to their lives. is made me question my priorities. Is my triage of responsibilities right? Is my
December 2015 | Volume 3 | Article 1152
Fernandez Nievas and Thaver
Work and Life Balance
Frontiers in Pediatrics | www.frontiersin.org
work schedule aecting my attitude toward non-urgent concerns
outside the hospital? And most importantly, do I want to do this
for the rest of my life?
During residency, the academic curriculum is very well
outlined. However, not as much time is spent teaching residents
the importance of striking a balance, or at least trying, between
their stressful and long work hours and their personal life. Most
Graduate Medical Education (GME) oces do oer services
to residents that may include sports facilities and corporate
discounts, that can be helpful. Many more stress management
strategies can be learnt from experienced physicians that may
be formally incorporated into medical training (5). Sometimes,
the vague transition from work to home can be eased by con-
scious physical detachment from work. Google ran a program
in its Dublin oce called “Dublin Goes Dark” where employees
were not allowed to take their electronic devices home and had
to leave them at work. e forced detachment from work led to
more stress-free evenings (6). Many residents struggle not to use
home access to electronic medical records to check on how some
patients are doing since their last shi or check the clinical census
before they start the next shi. Formal training on making sure
that we do not remain preoccupied about a child’s suering once
we go back home is vital.
I have learned this the hard way. Aer a couple of weeks in
the PICU, I wanted to emotionally blind myself from the hospital
once I was done with my shi and going back home. is may
sound inhumane and insensitive. However, I could not spend
the few hours or a rare weekend that I had o, obsessed with
something I could do nothing about. No matter how much I
wanted to, I could not be in the hospital 24/7. is was my time.
And I had to claim it.
It worked! Time spent outside of work started becoming more
satisfying and enjoyable. I felt more refreshed and less emotionally
exhausted. ere was still one major problem: time. With more
than half of the time in a week spent working, I felt that I was
still neglecting family duties and furthermore neglecting myself.
Time at home was spent studying, preparing for presentations,
and working on research projects. Essentially, still work. I used to
paint and go to the gym regularly. Not anymore. I complained to
myself and my family complained to me. I could not prolong my
week and get an extra day in the week and I felt helpless.
I pondered over this dilemma and realized that the problem
lay within my own expectations. Becoming a doctor came with
a price and I should be ready to pay it. Family life of a doctor
is a dierent “normal.” e sooner I accepted this and lowered
my expectations, the sooner would I be more satised with the
“balance” that I was trying to achieve. I started utilizing my time
wisely. At work, I would squeeze reading assignments into lunch
breaks and tried to work on projects while still in the hospital.
At home, I had to plan weekends, holidays, and free evenings.
Exercise could not be an hour long session, it could still be 15min.
Slowly, my wife started coming to terms with the limited time we
could spend together. We made the most of that quality time that
was otherwise not maximized. We decided to plan each weekend
more than we had ever done.
From medical school to residency to fellowship and eventually
full-time work, life is only going to get more demanding. I did not
want to believe this, but now I do. Caring for acutely sick children
is what I love to do the most. Accepting that this is going to be chal-
lenging and demanding in many ways only helps motivate me and
realize that achieving work–life balance will be a constant struggle.
As long as I know that my work may help a child reach his potential,
I am willing to give up weekends and accept sleepless nights.
“Happiness can only exist in acceptance”–George Orwell
THE ATTENDING PHYSICIAN
PERSPECTIVE
From the moment, we decide to study medicine and work as
physicians, we need to realize that work will absorb a large part
of our life, where long hours and weekend calls are just the tip
of the iceberg. Along with the need to study and continuously
update our knowledge from the current literature, as physicians,
we will have many other career demands, such as Board exams,
Maintenance of Certication, and GME requirements. e sooner
we understand this reality and accept it, the better. Spending time
worrying about how much we are working or how many calls
we have to do would make our job twice as hard, we are getting
stressed thinking about it and we still have to do the work. Do not
get me wrong, I am not advocating we should accept any unfair
work conditions or do not try to improve our quality of life, but
living continuously stressed and dissatised will drain further
our already depleted energy. is vicious cycle could lead to burn
out, depression, addiction, isolation, family problems including
divorce. A study found higher prevalence for burn out in physi-
cians compared to other workers in the United States and a higher
risk among primary care physicians (7). e increased burden
of paperwork, electronic medical records, and the pressure to
see more patients are making physicians leave clinical practice
prematurely and switch to a dierent career path or give up com-
pletely medicine to pursue better work conditions in an entirely
dierent eld. When an experienced physician quits practice, it
is very dicult and costly to replace him. Additionally, there are
data predicting a physician shortage in the next 5–10years, since
the projected increase in physician number will not match the
projected growth demand (8).
ere is an increased focus on the millennial generation of
physicians since it is believed that this group has more expecta-
tions about work hours, exibility, benets, and the importance
of work–life balance. e millennials are described as the “want-
ing all” generation (9). Consequently, eorts must be taken to
improve job satisfaction for the physicians, especially for those
from the Millennial generation, who are going to play an increas-
ingly central role in the Health Care work force as they replace the
soon to retire the Baby Boomer doctors (10, 11).
Dicult work environment and inecient leaders are also
important contributors to job dissatisfaction besides the long
working hours and patient overload. us, when searching
for jobs, attention should be paid to a broad spectrum of work
December 2015 | Volume 3 | Article 1153
Fernandez Nievas and Thaver
Work and Life Balance
Frontiers in Pediatrics | www.frontiersin.org
conditions, and work satisfaction should be considered apriority,
not a mere side eect. is alone will, in the long run, optimize
performance and grant better work–life balance, and ultimately,
maximize career achievements.
In my opinion, considering work and life as two opposite
forces is like dividing ourselves into two pieces that cannot coex-
ist. We are one and we should not isolate the physician from the
person. Each of these aspects of our life contributes to who we
are, to our happiness, and ultimately to our success as physicians
and human beings.
AUTHOR CONTRIBUTIONS
Each author wrote a part of this article. IN also edited and format-
ted. Both authors contributed equally and are rst authors of this
article.
REFERENCES
1. ACGME. Frequently Asked Questions: ACGME Common Duty Hour
Requirements (2014). Available from: https://www.acgme.org/acgmeweb/
2. Hook JL. Working at the weekend: fathers’ t ime with family in the United Kingdom.
J Marriage Fam (2012) 74(4):631–42. doi:10.1111/j.1741-3737.2012.00986.x
3. Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in
resident physicians, work hour limitations, and related outcomes: a systematic
review of the literature. Postgrad Med (2012) 124(4):241–9. doi:10.3810/
pgm.2012.07.2583
4. Gruber R, Casso J. e interplay between sleep and emotion regulation: con-
ceptual framework empirical evidence and future directions. Curr Psychiatry
Rep (2014) 16(11):500. doi:10.1007/s11920-014-0500-x
5. Zwack J, Schweitzer J. If every h physician is aected by burnout, what
about the other four? Resilience strategies of experienced physicians. Acad
Med (2013) 88(3):382–9. doi:10.1097/ACM.0b013e318281696b
6. Bock L. Google’s Scientic Approach to Work-Life Balance (and
Much More) (2014). Available from: https://hbr.org/2014/03/
googles-scientic-approach-to-work-life-balance-and-much-more/
7. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, etal. Burnout
and satisfaction with work-life balance among US physicians relative to the
general US population. Arch Intern Med (2012) 172(18):1377–85. doi:10.1001/
archinternmed.2012.3199
8. Carrier ER, Yee T, Stark L. Matching Supply to Demand: Addressing the U.S.
Primary Care Workforce Shortage. Policy Analysis No. 7. Washington, DC:
National Institute for Health Care Reform (2011).
9. Glicksman E. Wanting It All: A New Generation of Doctors Places Higher Value
on Work-Life Balance. Washington, DC: AAMC Reporter (2013).
10. Wetterneck TB, Linzer M, McMurray JE, Douglas J, Schwartz MD, Bigby J,
etal. Worklife and satisfaction of general internists. Arch Intern Med (2002)
162(6):649–56. doi:10.1001/archinte.162.6.649
11. Chaudhuri E, Mason NC, Newbery N, Goddard AF. Career choices of junior
doctors: is the physician an endangered species? Clin Med (2013) 13(4):330–5.
doi:10.7861/clinmedicine.13-4-330
Conict of Interest Statement: e authors declare that the research was con-
ducted in the absence of any commercial or nancial relationships that could be
construed as a potential conict of interest.
Copyright © 2015 Fernandez Nievas and Thaver. This is an open-access article
distributed under the terms of the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) or licensor are credited and that the original
publication in this journal is cited, in accordance with accepted academic prac-
tice. No use, distribution or reproduction is permitted which does not comply
with these terms.
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Emotions are biologically-based responses that help an organism meet challenges and opportunities, and involve changes in subjective experience, behavior, and physiology. Emotions arise when something important to us is at stake. Although many factors have been associated with healthy emotional regulation, the role of sleep in this process has been largely ignored. Recent studies, however, have begun to delineate how sleep critically affects emotional functioning. Nighttime sleep affects daytime mood, emotional reactivity and the capacity to regulate positive and negative emotions; conversely, daytime experiences affect sleep. Hence, there is a complex interplay between sleep and emotional regulation. The objective of this article is to examine this interplay in adults. This objective is addressed by utilizing a framework that identifies key aspects of the relationship between sleep and emotion. We propose that the connectivity between the emotional centers of the brain - the prefontal cortex and the amygdala - is in part dependent on the homeostatic sleep system such that connectivity between these brain networks is higher when rested and lower when sleep deprived. High connectivity drives more efficient executive functioning, while a disconnect leads to poor executive functioning capacity including emotional reactivity and impulsivity. The cognitive effects of the homeostatic system are couple with the mood regulation effects of the circadian system together dictating the degree to which one experiences emotional regulation or dysregulation. Further, the affective brain systems of individuals with clinical symptomology and/or pathology are suggested to be more vulnerable to homeostatic pressure and circadian lows or misalignment resulting in increased affective clinical symptomology. We review empirical evidence that supports this framework and explore the implications of this framework. Finally, we describe future directions for this type of work.
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Purpose: To identify health-promoting strategies employed by experienced physicians in order to define prototypical resilience processes and key aspects of resilience-fostering preventive actions. Method: From January 2010 to March 2011, the authors conducted 200 semistructured interviews with physicians of different ages, disciplines, and hierarchical status from across Germany. The interview transcripts were analyzed according to the Content Analysis method. Results: Analysis revealed 30 subcodes in three dimensions: (1) job-related gratifications derived from treatment interactions, (2) practices, such as leisure-time activities, self-demarcation, limitation of working hours, and continuous professional development, and (3) attitudes, such as acceptance of professional and personal boundaries, a focus on positive aspects of work, and personal reflexivity. Conclusions: The reported strategies and attitudes helped to develop mental, physical, and social resource pools that fostered effective decision making. Successful coping, in turn, encouraged the maintenance of resilience-promoting abilities. In relation to Conservation of Resources Theory, physician resilience emerged as the ability to invest personal resources in a way that initiates positive resource spirals in spite of stressful working conditions. Enriching traditional stress management approaches with the dynamic of positive as well as negative resource spirals would thus appear to be a promising approach.
Article
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
Article
Background: Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields. Methods: We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored. Results: Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout. Conclusions: Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
Wanting It All: A New Generation of Doctors Places Higher Value on Work-Life Balance
  • E Glicksman
Glicksman E. Wanting It All: A New Generation of Doctors Places Higher Value on Work-Life Balance. Washington, DC: AAMC Reporter (2013).
Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage
  • E R Carrier
  • T Yee
  • L Stark
Carrier ER, Yee T, Stark L. Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage. Policy Analysis No. 7. Washington, DC: National Institute for Health Care Reform (2011).
Google's Scientific Approach to Work-Life Balance (and Much More
  • L Bock
Bock L. Google's Scientific Approach to Work-Life Balance (and Much More) (2014). Available from: https://hbr.org/2014/03/ googles-scientific-approach-to-work-life-balance-and-much-more/