1. Survival 101: Work Life Integration & Wellness Jason Liebzeit, MD Assistant Professor Sheryl L. Heron, MD, MPH Associate Professor/Associate Residency Director Assistant Dean Medical Education & Student Affairs – Grady Campus Department of Emergency Medicine Emory University School of Medicine SAEM: Chief Resident Forum – 6/2011

2. Disclosures No commercial financial relationships to disclose

3. Objectives Learners will: Learners will: Describe the concept of work-life integration Describe the concept of work-life integration Recognize burnout and describe strategies to combat it Recognize burnout and describe strategies to combat it Formulate a personal plan for self-care during time as a Chief Resident Formulate a personal plan for self-care during time as a Chief Resident Discuss time management techniques Discuss time management techniques

4. Overview What is work/life integration? What is work/life integration? What’s next? What’s next? Career Demands Career Demands Relationship Demands Relationship Demands Attention to Self Attention to Self The Big Picture The Big Picture

5. Work-Life Balance Integration Work Life/Family

6. The End of the Road (or the Beginning) What’s Next? It’s good to be the Chief What’s Next? It’s good to be the Chief Academic Academic Community Community Fellowship Fellowship Locum Tenems Locum Tenems

7. http://www.nytimes.com/2011/04/02/health/02resident.html

8. Burnout Elevated levels of burnout exist among a substantial percentage of surveyed Emergency Physicians Elevated levels of burnout exist among a substantial percentage of surveyed Emergency Physicians Classified broadly in terms of negative perceptions of self, negative practice habits and attitudes, and unhealthy lifestyle. Classified broadly in terms of negative perceptions of self, negative practice habits and attitudes, and unhealthy lifestyle. Goldberg et al: Acad Emed 1996 -, Vol 3, 1156-1164 Goldberg et al: Acad Emed 1996 -, Vol 3, 1156-1164

9. Burnout Self- recognition of burnout Self- recognition of burnout Lack of job involvement Lack of job involvement Negative self- assessment of productivity Negative self- assessment of productivity Dissatisfaction with career Dissatisfaction with career Goldberg et al: Acad Emed 1996 -, Vol 3, 1156-1164

10. Burnout Correlates Sleep disturbances Sleep disturbances Intent to leave the practice within 10 years Intent to leave the practice within 10 years Higher levels of alcohol consumption Higher levels of alcohol consumption Lower levels of exercise Lower levels of exercise Goldberg et al: Acad Emed 1996 -, Vol 3, 1156-1164

11. Work-Life Culture What exists? What exists? Is it valued? Is it valued? Are there policies? Are there policies?

12. ACEP: Wellness

13. Institution Emory University Department of Emergency Medicine Emory University Department of Emergency Medicine Wellness & Well-Being Committee Wellness & Well-Being Committee Emory University Emory University Work Life Initiative Work Life Initiative Strengthen work-life culture for individual and families Strengthen work-life culture for individual and families FSAP FSAP

14. My Wellness Family Professional Physical MentalSocial Spiritual Financial

15. Relationship Demands You’re almost done, it’s my time now You’re almost done, it’s my time now Prime age to begin/expand families Prime age to begin/expand families Sandwich generation Sandwich generation

16. Realities of Life Residency Training & Pregnancy Residency Training & Pregnancy Personal & Family illness Personal & Family illness Impairment Impairment Sleep Hygiene Sleep Hygiene

17. Time Management Enhances Work-Life Integration by: Enhances Work-Life Integration by: More Control of your life More Control of your life Improved Relationships Improved Relationships Increased Productivity Increased Productivity

18. Attention to Self Organization Organization Prioritization Prioritization Resources Resources

19. Creating a Schedule Prioritization Prioritization Yearly, Monthly, Weekly, Daily Yearly, Monthly, Weekly, Daily Family/Non-negotiables Family/Non-negotiables Vacations, Reunions – 1 st priority Vacations, Reunions – 1 st priority Fill in the Blanks Fill in the Blanks Utilize your Resources Utilize your Resources

20. Resources Family Family Colleagues Colleagues Community Community Administrative Support Administrative Support You You

21. Institutional Resources Human Resources? Human Resources? Dual Career Programs? Dual Career Programs? Family Medical Leave? Family Medical Leave? Mentoring Programs Mentoring Programs Faculty Staff Assistance Program Faculty Staff Assistance Program

22. The Big Picture Keeping the Balls in Motion Keeping the Balls in Motion Monitoring the Balls Monitoring the Balls Dropping the Balls Dropping the Balls

23. What Keeps You Well? Identify what keeps you grounded Identify what keeps you grounded Articulate clearly and often Articulate clearly and often Share them with your family and friends Share them with your family and friends Tap into them Tap into them

24. Benefits of Work-Life Integration To the organization: Measured increases in individual productivity, accountability and commitment Measured increases in individual productivity, accountability and commitment Better teamwork and communication Better teamwork and communication

25. Benefits of Work-Life Integration To the Organization: Improved morale Improved morale Less negative organizational stress Less negative organizational stress

26. Benefits of Work-Life Integration To the individual: More value in your daily life More value in your daily life Increased productivity Increased productivity Improved relationships Improved relationships Reduced stress Reduced stresshttp://www.worklifebalance.com/5steps.html

27. What about us? Survey of 193 ED Physicians (ACEP members) Survey of 193 ED Physicians (ACEP members) Validated measures of career satisfaction, tolerance for uncertainty, and burnout Validated measures of career satisfaction, tolerance for uncertainty, and burnout High level of career burnout High level of career burnout No demographic variables were associated with burnout status No demographic variables were associated with burnout status High anxiety caused by concern for bad outcomes (odds ratio=6.35) was the predictor of burnout High anxiety caused by concern for bad outcomes (odds ratio=6.35) was the strongest predictor of burnout Kuhn et al: Annals EM: Feb 09

28. What about us? 32.1%, exhibited Emotional Exhaustion 32.1%, exhibited Emotional Exhaustion core symptom of burnout core symptom of burnout not related to age or type of practice not related to age or type of practice Physicians did not feel anxiety because of: Physicians did not feel anxiety because of: general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. Kuhn et al: Annals EM: Feb 09

29. The Good News Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine Kuhn et al: Annals EM: Feb 09

30. The Good News Random sampling of 1008 Emergency Physicians Random sampling of 1008 Emergency Physicians 2004 -, while 12.4% EPs reported low career satisfaction (n = 515) 2004 - 65.4% EPs reported high career satisfaction, while 12.4% EPs reported low career satisfaction (n = 515) Cydulka & Korte; 2008 – Acad. EMED – June 2008

31. Career Satisfaction Higher career satisfaction was associated: Higher career satisfaction was associated: Teaching settings, research, publication, leadership positions, belonging to medical organizations/medical politics Teaching settings, research, publication, leadership positions, belonging to medical organizations/medical politics 1/3 rd of respondents (33% in 1994, 32% in 1999, 31% in 2004) reported that burnout was a significant problem. 1/3 rd of respondents (33% in 1994, 32% in 1999, 31% in 2004) reported that burnout was a significant problem. Cydulka & Korte; 2007 – Acad. EMED - Abstract

32. Changing the Conversation Burnout Well-Being/Resiliency Burnout Well-Being/Resiliency Develop a shared definition of physician wellness Develop a shared definition of physician wellness Culture Change Culture Change More positive Educational Environment More positive Educational Environment Raising awareness of burnout and stigma Raising awareness of burnout and stigma Enabling prevention strategies Enabling prevention strategies Ecklberry-Hunt et al: JGME: Dec 2009

33. Changing the Conversation Heron et al. Does a curriculum on wellness affect burnout in an Emergency Medicine Training Program (CORD 2011, SAEM 2011)

34. Heron-Liebzeit Protocol Keep a calendar & honor it Keep a calendar & honor it Learn to say “No” Learn to say “No” It’s okay to be away It’s okay to be away There are 24 hours in each day There are 24 hours in each day

35. Heron-Liebzeit Protocol Get rid of clutter Get rid of clutter Monitor the balance Monitor the balance Self-check Self-check Empower others Empower others Honor who & what keeps you well Honor who & what keeps you well Use your resources Use your resources

36. Summary Work/life integration is realistic and attainable Work/life integration is realistic and attainable Burnout is a reality, but you are well- equipped to combat it Burnout is a reality, but you are well- equipped to combat it Prioritize your time Prioritize your time Utilize your resources Utilize your resources

37. Conclusion Good luck Good luck Remember the Big Picture Remember the Big Picture Congratulations Congratulations