Career Takeaway Themes: Part 4 - Balance and Sustainability

This week, I am finishing out the takeaways from the Careers in FM Blog Series over the past four months, which highlighted 15 fulfilled family physicians with diverse career paths. A couple of weeks ago, I highlighted two major themes that ran through the series – Career Trajectory and Mentorship and then the themes of Finding/Creating Fulfillment and Joy. Last week, I reviewed their recommendations for First Job and Job Pivot Career Decisions. This week, I'm capturing the wealth of advice they gave regarding Balance and Sustainability.

Advice about Balance and Sustainability:

Regarding sustainability, the diverse group of fulfilled family physicians advised a balanced perspective.

“Your career, while eminently valuable and rewarding, is one aspect of life. Continue to make room for things outside of work.”

A few strategies recurred throughout the Careers in Family Medicine Blog Series to help with balance and sustainability. Included in those strategies were connection with patients and within your teams  and setting yourself up for success with a good job fit. 

Boundaries. The most prevalent strategy for physicians to move toward balance in sustainable careers was boundaries to allow time for rest, recovery, renewal, and relationships outside of work.

Boundaries were defined by what you put in place regarding when and how you’re available. They reminded us that boundaries are a choice. Boundaries allow you to block time for your family, friends, community, and self.

Strategies for boundaries included:

1. Prioritize the most important things – both inside and outside of work. 
2. Learn to say no to non-essential commitments.
3. Erect boundaries to protect your priorities. This preserves your time, energy, and attention for the MOST essential things as defined by you."Protect parts of the career that align with your values and passions and can be an active facilitator for personal and professional growth".
4. Communicate those to everyone for clarity, setting expectations, and accountability.
5. Empower your team. Micromanaging and rigid boundaries do not create an environment for your team to thrive. I heard Dr. Jennifer Hunt say once, “If you’re going to delegate, you have to give up tight quality control, so lighten the cognitive load, not just the number of tasks.” Whether that’s your teenager doing dishes or how your MA explains the “BRAT” diet, it behooves you to empower them to do an excellent job with education and autonomy.
6. Be realistic, but leverage communication. Plan for “the long game, appreciate that managing competing priorities is a daily reality, and effective communication is the most important tool we have.”
7. Different types of practices may require varying approaches to setting up boundaries in a way that feels good. One hospitalist felt her work structure made it easy to separate work and home (which, for her, is a priority). She said, “I like to envision my job as a plate, where I consciously protect and prioritize the aspects that are most nurturing to me.” Whereas in some of the smaller or more rural settings, learning to organize a schedule and work more efficiently made the boundary of not taking work home in the form of home notes and in-basket messages more palatable. Then, setting the boundary of being unavailable when not in the office was further improved with an empowered staff and good communication between call partners.

Self-Care

Boundaries allow the other sustainability strategies, such as self-care, which came through almost every one of the interviews. “I try to take time for myself once I leave work. Taking time for yourself is essential for both personal and professional fulfillment,”

Self-care encompasses so many things. I’ll divide them into physical, mental, and social self-care buckets.

Physical Self-Care

The foundational physical needs of sleep, good nutrition, and movement also came through.

“I am very fortunate that our local medical community has prioritized self-care for physicians and other healthcare workers. “

Many commented on regular exercise and sleep. Getting outside for physical self-care was an added bonus.

One mentioned having a “hard stop” at 9 pm to ensure restorative sleep. (Notice the boundary)

Others remarked on things that help them feel better physically, such as regular massages.

Mental/Psychological Self-Care

This is the bucket I’m categorizing into overlapping concepts that came across as best practices and advice from the hard-earned lessons of the highlighted attendings.

 “As we all know, our ability to find and sustain fulfillment and joy is really about managing our thoughts about our circumstances. Making time to reflect, to be intentional about my thoughts, to live in gratitude, and to take care of the basics (sleep, exercise, nutrition, spirituality) is essential. Even on the toughest days, I remind myself how fortunate I am to do this work.”

1. Mindset
   • Find the opportunity in every obstacle.
   • Let go of maladaptive perfection based on unrealistic ideals to decrease unnecessary suffering.
   • Re-approach mistakes with a growth mindset. Instead of “Who is to blame,” shift to “What can I/we learn?”
   • “Work is busy and challenging for me, but very rewarding” (i.e., the mindset is that busy and challenging are not mutually exclusive of rewarding)

2. Self-reflection
   • Appreciative inquiry – start with what’s going well.
   • Allow time to consider what you may want to do differently.
   • Give space for new ideas.
   • This wasn’t plainly stated in the series, but self-reflection is a powerful way to ensure damaging thoughts don’t go unchecked below your radar. A way for you to separate facts from the story about those facts. A way to look for your common thought distortion patterns.

3. Mindfulness and Intention (with selection)

“Mindset and coaching are tremendous strategies to continue one’s work.”.

“I use mindful moments from Positive Intelligence,”  (Recommended read)

“I have a sticky note that says ‘transition well’ on my dashboard.”

“I like to envision my job as a plate, where I consciously protect and prioritize the aspects that are most nurturing to me.” It takes intention.

4. Self-compassion

Compassion is so much more adaptive than beating ourselves up. Talk to yourself like you would a friend.

     5. Humor

Learn to laugh more (even at yourself – that kind of laugh that says, “turns out I’m human.” Not the mean sardonic laugh.)

6. Gratitude

Several mentioned the importance of being grateful.

I just reviewed one of the 3 Good Things studies done by Dr. Brian Sexton out of Duke, which demonstrated the practice (15 nights, just before sleep, reviewing three things that went well, your role in it, and the emotion that comes up when you think of those three) gives lasting benefits for six months – less burnout, better work/life, increased happiness scores.

7. Seasons

Accept that there are seasons – especially when you can’t do everything you want. In some seasons, your evenings will be spent resting or on homework and ballfields; others may have evenings spent volunteering in the community.

Social Self-Care

Most of the interviewees mentioned the importance of connection. Being intentional with connection is healthy. 

Local organizations, healthcare communities, and medical societies offer regular programs, book clubs, meetings, and social events.

Chat with your work teammates.

Intentionally carve out time to spend time with family, pets, and friends.

Remember grace for yourself in different seasons.

Rejuvenation

Finding things in addition to the self-care above to rejuvenate ourselves also came through the physicians’ stories.

1.  Time off

Non-working vacations are essential, even if they are stay-cations.

“My husband and I like always to keep a ‘trip on the books,’ and travel planning is a nice distraction for my brain.”

2. Adaptability for Fulfillment

Try new things and strategies and evaluate how those are going.

You don’t have to live life with ‘or’ (i.e., this OR that); you have the ability to embrace ‘and.’ 

 “(By embracing the ‘and’), my career change didn’t mean I had to give up my passions. I had the ability to connect with them in new ways.”

“My career in family medicine has evolved as my interests have shifted and grown.”

“Just like an adventurous eater, I have tried new things in my professional journey. I approach these new experiences mindfully, paying attention to how they make me feel and assessing if they align with my long-term goals and values. If something resonates with me and brings me fulfillment, I ensure that it remains a part of my ‘plate’ in the long run.”

3. Fun

One family doc asks her patients, “What are you doing for fun? “

“I try to remember to prioritize that myself. Read a book for pleasure for an hour before bed instead of continuing to work on charts.”

"Multiple years ago, I heard a lecture that talked about the requirements to have a rewarding career, and it included only three things: that your job was intellectually challenging, that one had a sense one was helping people/had a purpose, and number three, that it was fun. Physicians are truly blessed in that every day when we go to work with nearly every patient, we have the first two things. And then I think it's up to us to make our environment enjoyable and fun to be in." 

4. Meaning

Finding meaning in your work is helpful. Take an active look for it or create it.

“I’ve found that my medical group is ripe with many opportunities to further connect with meaning and purpose.”

5. Reinvigoration

As last week’s blog highlighted, many found sustainability in being reinvigorated by professional development, contributing in new ways, teaching, leading, advocating, and cultivating fun at work.

Advice on Teams

Many physicians cited being part of good teams as a source of fulfillment and sustainability.

“Try to keep positive energy on your team. Negative energy creates more negative energy.”

“The more we are able to broaden our perspectives and bring a diversity of experience and leadership style to our organizations, the better we can serve our colleagues and our patients. We can do hard things.”

“Listen more, Talk less.”

Owning Your Own Practice Advice and Lessons Learned

“Don’t add partners or APPs too early in your private practice or expand too early.”

“Be extremely cautious about any venture capital investment in your practice or as a source of loans/capital.”

“My DPC wasn’t fiscally viable for me because I underpriced myself. I also took on a partner without doing any due diligence.” Talk to their former colleagues.

“No one will look out for your bottom line like you.” You need to regularly reassess service contracts and supply vendors to look for overhead savings.

“You must have sound business practices. No matter how much you empathize with patients, you must collect when they’re in the office, bill them for the things that they are responsible. Otherwise, you won’t have a practice for them to come to.”

Big Picture of Medicine Perspectives

“Medical school places a lot of influence on making the perfect diagnosis, the perfect treatment choice, or learning to do advanced procedures and implement expensive healthcare technology in care. However, in my experience, health disparities exist because very simple, easy-to-perform, and obviously beneficial treatments don’t reach the people who need them most.  Our health system won’t be fixed by fancier technology.  We need broad implementation of simple, effective screenings and treatments.”

“Value-based care also pays you for your outcomes, which studies suggest is directly proportional to the time you spend with the patient, as it takes time to incentivize people to follow their care plan and make behavior changes. Fee-for-service only pays for volume.” Value-based care

Other Overall Advice

The physicians in the career series offered a lot of other advice:

“Don't let medicine burn you out. If it is happening, take a pause, do a reset, or make a change. Those things can be hard to do when you are in the midst of it, but you aren't alone, and there are a ton of resources and pros out there to help you.“

“Understand and remain true to your core values. Being aware of my values has empowered me to make tough choices when confronted with professional hurdles. It has given me the confidence to distance myself from paths that deviate from my core beliefs.”

“Start saving early and live a balanced life.”

“It is important to be courageous and ask for what you need.”

“Ask for what you need. Be transparent with yourself and others: It's important to be honest about your needs and limitations. Recognize that it's not a sign of weakness to ask for help or support. If you start to feel overwhelmed, take notice of those feelings and proactively reach out for assistance before it becomes unmanageable. Share your challenges and concerns with trusted colleagues, friends, or family members who can provide guidance or lend a helping hand.”

As I look over these takeaways and know many of you that I work with – some of you may be tempted to use this list against yourselves. Please don’t! This isn’t one other list in which to compare yourselves and then set out to check every box. This is the collection of experiences of what works for various individuals. It’s a menu of things to consider and try out. Look for the next area in which you can try out one small strategy.

So many inspiring family physicians from diverse career paths offer so much wisdom. I’d love to know what a good reminder was for you. Any new ideas or insights? Next week, I’ll cover the Grass Isn’t Always Greener piece a bit more in-depth.

Until then - Have a Joy-Filled Week!  Tonya

My Enjoy Life and Thrive in Your Career coaching course for individual physicians walks you through detailed steps of ditching unnecessary suffering, protecting and increasing your energy, and fostering your ideal future. I'm happy to chat with you about it.