Negotiating Work-Life Integration

Abstract

Introduction

Integrating work and home domains is a constant challenge for medical professionals. Only half of physicians report positive work-life satisfaction, implying that negotiating the inherent conflicts between work and home may not be intuitive. Early teaching of skills focused on professional sustainability may best prepare physicians to navigate conflicts between work and home domains.

Methods

This interactive workshop targets trainees and junior faculty. It aims to highlight the current state of physician career satisfaction, to bring awareness to the risk of physician burnout, and to apply strategies that promote work-life integration as a lifelong practice for sustained career satisfaction. It includes a detailed presentation with structured resources to reinforce skill development.

Results

This workshop was delivered five times to trainees and junior faculty. Workshop evaluations (n = 50) revealed that all participants believed the information presented was useful, addressed competencies relevant to their training, and increased their knowledge about how to create better work-life integration; all anticipated improvement in their professional work. They all recommended this program to a colleague.

Discussion

This workshop offers an effective way to teach a skill set that enhances physicians' abilities to negotiate conflicting work and life domain boundaries. Our results indicate that learners intend to apply newly acquired strategies for work-life integration so as to improve career satisfaction and wellness. Such skill sets may mitigate physician burnout and promote career sustainability, both critical issues with far-reaching implications for the delivery of safe, high-quality health care at the provider and system levels.

Educational Objectives

By the end of the workshop, participants will be able to:

• 1.Explain the impact of work-life satisfaction on a career in medicine, including career sustainability and physician burnout.
• 2.Discuss the central importance of aligning personal values and prioritized goals in work-life integration.
• 3.Apply methods to negotiate boundaries around work and life domains.
• 4.Compare strategies for improving work-life integration.
• 5.Recognize the value of communicating goals within a personal network.
• 6.Conceptualize work-life integration as a lifelong practice rather than a goal.

Introduction

Integrating work and home domains is a constant challenge for medical professionals. They have commitments to home and to self that compete with professional obligations for limited time and energy. Negotiating the inherent conflicts between work and home domains may not be intuitive to them. Early teaching of skills focused on professional sustainability can best prepare resident and junior faculty physicians to navigate conflicts between work and home. The goal in achieving a healthier integration of work and home domains is to promote wellness and career satisfaction.¹

Work-life satisfaction is a key driver for career satisfaction and physician wellness. Work-life satisfaction has been reported as lower for physicians (~50%) than for the average U.S. worker (~57%).^2–4 When comparing physician career stages, early career physicians report the lowest rate of career satisfaction and the highest frequency of work-life conflicts.³ Emphasis on productivity in studies of predictors of work satisfaction may represent a negative driver of career satisfaction because the physicians studied lacked the skills to maximize productivity via negotiation of conflicting work and life domain boundaries.^2,4 Studies suggest that higher physician work-life satisfaction correlates with lower physician burnout.^2–4 Physician burnout, a well-documented phenomenon prevalent among U.S. physicians, is widely regarded as a significant factor impacting physician workforce attrition. Studies suggest that physician “burnout may erode professionalism, influence quality of care, increase the risk for medical error, and promote early retirement.”^2,5–9 Data also suggest that physician burnout correlates with “adverse personal consequences for physicians, including contributions to broken relationships, substance abuse, and even suicidal ideation.”^2,10–12

If these studies on burnout and career satisfaction indicate the current climate of physician practice in the U.S., then skills for achieving work-life integration are of high value in promoting professional development and sustainability for resident and junior faculty physicians. Educating medical trainees about physician burnout and wellness has been promoted through wellness programs and cultures, but published wellness education literature has not identified a core of specific professional sustainability skills.^13–17

This interactive workshop is an installment in the Fundamentals of Mentoring training series designed to assist mentors and instructors in teaching mentees (i.e., trainees and junior faculty) the core professional sustainability skills that promote work-life integration.¹⁸ Specifically, this session aims to highlight the current state of physician career satisfaction, to bring awareness to the risk of physician burnout, and to explore the importance of utilizing strategies that promote work-life well-being at every career stage.

Methods

Target Audience

The target audience includes resident and junior faculty physicians. At our institution, participants attended the workshop as part of a program-specific professional development series. No prerequisite knowledge, skills, or resources were required to attend the workshop.

Instructor

The instructor should be a physician at the mid- or senior career level who possesses both an understanding of the work-life strategies described in this workshop and firsthand experience of the challenges that arise in managing the work and life domains of a practicing physician.

Setting

We selected the interactive workshop model to enhance learner participation, promote learner introspection, and actively build skills the learner can apply to concrete personal challenges.

Time Line

The intended session length is 90 minutes. Table 1 outlines a suggested time line for this workshop.

Table 1. Suggested Time Line for 90-Minute Workshop.

Time	Item	Presentation Slides and Activities	Appendix	Educational Objective
8 min.	Introduction and background	Slides 1–9. Slide 4 large-group responses. Slide 8 large-group responses.	A	6
10 min.	Career satisfaction and work-life satisfaction	Slides 9–12. Slide 11 large-group responses.	A	1
5 min.	Physician burnout	Slides 13–15. Slide 15 large-group responses.	A	1
5 min.	Gender and generations	Slides 16–18.	A	1, 6
10 min.	Early career physicians	Slides 19–20. Work in groups of 2–3 (pair) to discuss, then share in large group. Record responses on whiteboard.	A
15 min.	Alignment	Slides 21–25. Ask participants to complete worksheet, then discuss.	A, B	2, 5, 6
15 min.	Alignment and boundary control	Slides 26–29. Ask participants to complete. Then share with partner to analyze.	A, C	2-4
15 min.	Work-life integration strategies	Slides 30–37. Work in large group.	A, D	4-6
2 min.	Conclusion	Slides 38–39.	A	5-6
5 min.	Q&A and program evaluation	Open to discussion. Complete evaluation.	E	1–6

Preparation

To prepare for this workshop, the instructor should review all of the resource files and print Appendices B–E for each participant. In order to facilitate the workshop, the instructor should review the PowerPoint presentation (Appendix A) and print the notes sections of the slides, which contain suggested language for delivering the workshop.

Resource Files

Negotiating Work-Life Integration (Appendix A) is the PowerPoint presentation for the workshop. It is a detailed, self-contained presentation designed to be user friendly for the instructor. It provides comprehensive content on the topic of physician work-life integration and covers the educational objectives. The notes section provides the instructor with directions and suggested language to use while delivering each slide. In addition, the presentation contains literature references and image citations. The presentation provides cues to the instructor on when and how to use each of the resource files in the workshop, as well as suggested language and discussion points.

The Work-Life Alignment Worksheet (Appendix B) is designed as an introspection exercise. It is divided into three sections. The first section is entitled “What does ‘Work-Life’ mean to you?” This section focuses the participants' attention on their current work-life domains. Participants explore and record their current roles and responsibilities in the domains of work, home, and self. Trainees and faculty often have very distinct roles in each of these domains. This exercise helps the participants articulate their current status. The second section facilitates the participants in taking an inventory of their values and priorities as they pertain to each work-life domain. It allows participants a time of reflection. Participants are first asked to consider the following questions:

• •What qualities and beliefs are at the core of who I am and how I live?
• •What parts of my work and life truly energize me?
• •When do I feel enthusiastic?
• •What motivates me?
• •When do I feel convinced to get involved?

Participants are then asked to create a list prioritizing their top 10 values and priorities. The third section invites participants to rate their work-life satisfaction today and reflect on where they want to be, using a scale from 1 (unsatisfied, overwhelmed, discontent) to 10 (satisfied, energized, happy). This sets a goal for the remainder of the session and allows thoughtful consideration of the strategies and tips to come.

The Daily Schedule Exercise (Appendix C) is designed to engage participants in a reflective exercise by recording a time line of their own schedule on a busy workday. Next, participants work in teams to analyze their schedules and apply the strategies of alignment and boundary control to their work-life domains. This interactive exchange offers peer feedback with facilitated oversight.

The Work-Life Integration Strategies (Appendix D) accompany the Daily Schedule Exercise and provide more detailed descriptions of strategies that the participants can use both during and after the workshop. Participants are encouraged to communicate their work-life goals and challenges within their personal network.

The Workshop Evaluation Tool (Appendix E) enables instructors to collect participant feedback on the workshop objectives, content, and usefulness. In addition, it allows instructors to adapt future iterations of the workshop and collect interest in other professional development topics.

Results

This workshop was delivered five times to different groups of trainees and junior faculty. Workshop evaluations were collected from a total of 50 workshop participants: 10 trainees and 40 junior faculty. Due to educational program diversity among these audiences, the evaluation instrument was minimally modified for some presentations. Results revealed that all participants agreed or strongly agreed that the information presented was useful to their professional work and that their professional work would improve as a result of attending the workshop. Trainees strongly agreed that the program addressed competencies relevant to their training and agreed or strongly agreed that the program met its stated objectives. Trainees strongly agreed that the program was up-to-date. The majority of surveyed junior faculty did not indicate being very or somewhat familiar with information presented on this topic prior to the workshop, and they agreed or strongly agreed that the program increased their knowledge about how to create better work-life integration. All junior faculty agreed or strongly agreed that the program was a worthwhile investment of their time, and trainees and junior faculty agreed or strongly agreed that they would recommend this program to a colleague. Table 2 summarizes evaluation data from five groups of workshop attendees.

Table 2. Average Work-Life Integration Workshop Evaluation Scores for Five Different Workshops^a.

Evaluation Question	Junior Faculty 2014 (N = 24)	Junior Faculty 2015 (N = 11)	Transitional Interns 2016 (N = 6)	Transitional Interns 2017 (N = 4)	Junior Faculty 2017 (N = 5)
The information presented in this program was useful to my professional work.	4.63	4.45	5.00	4.75	4.60
My professional work will improve as a result of attending this program.	4.54	4.45	5.00	5.00	4.40
The program addressed competencies identified by my specialty or was relevant to my training.	—	—	5.00	5.00	—
As a result of this program, I am more knowledgeable about how to create better work-life integration for myself.	4.50	4.36	—	—	—
This workshop has increased my interest in work-life integration.	—	—	—	—	4.80
By the end of the program, I am better prepared to write my Individual Development Career Plan.	4.25	4.45	—	—	—
I was very familiar with this material before the program.	3.08	3.00	—	—	—
The information presented contributed to and/or expanded my knowledge of the subject.	3.92	4.00	5.00	—	—
Attending this program was a worthwhile investment of my time.	4.54	4.45	—	—	—
The program met its stated objective.	—	—	5.00	4.75	4.80
The program was current and up-to-date.	—	—	5.00	4.75	—
I would recommend this program to a colleague.	—	4.73	—	5.00	4.80

Dash (—) indicates a question not included on a given evaluation.

^aScoring was based on a 5-point Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree).

Reflections From the Instructor

Listening to participants and understanding general audience themes surrounding work-life integration are critically important for workshop success. The instructor can best accomplish this by allocating adequate focus to these needs and by limiting the audience to approximately 20 students to promote meaningful conversation. Additionally, the instructor must be both nimble and flexible in order to adapt the emphasis of the workshop to the participants' unique needs and experiences, which are identified using Appendices A–C. Discussion following each resource can be highly variable depending on the composition of the participants. If the group contains a high percentage of participants who are single and still in training, then the discussion may focus more heavily on their struggles in managing a home by themselves, the challenges of dating or finding a partner, self-care, and expectations of family or friends. If the group contains a high percentage of participants who are married and/or have children, the discussion may center on being a working parent, child care options, and work-home conflicts surrounding these issues. In preparing these resources, we incorporated feedback from the workshop evaluations, including creation of an additional dedicated time-management skills workshop.

Discussion

This workshop on negotiating work-life integration provides mentors and instructors in academic medicine with a method for teaching key skills to assist trainees and junior faculty in achieving wellness by promoting professional sustainability in their work-life integration.

Published positive predictors of physician career satisfaction include control over schedule and fewer total work hours, while published negative predictors of physician career satisfaction include an emphasis on productivity.^2,4 In the setting of demanding careers, where these predictive factors may not be under the control of the physician, it is prudent to be able to manage them to maximize one's personal and professional satisfaction. Teaching a skill set that enhances physician ability to negotiate conflicting work and life domain boundaries may enhance career satisfaction and overall wellness. Evaluation results indicated that learners anticipated workshop attendance would improve both professional work and work-life integration. These results imply learner intent to apply a newly acquired skill set to personal careers with a goal of improved career satisfaction and wellness.

Evaluation results indicated that the target audience was generally not familiar with this particular skill set and that significant knowledge about work-life integration was gained. This suggests that an important educational gap exists. These early career physicians may have lacked important skills to successfully negotiate conflicting boundaries between work and life domains. These data are congruent with existing literature suggesting that early career physicians report the lowest rate of career satisfaction and the highest frequency of work-life conflicts.³ Teaching a skill set that promotes positive drivers of career satisfaction and successful negotiation of conflicting domain boundaries may positively affect these trends documented in the literature.

Limitations/Challenges

Modified workshop evaluation forms were used for different sessions, limiting quantity of data collection for some items. The workshop utilizes the full allotted time, so if additional discussion ensues over topics that excite highly emotional comments from participants (e.g., work-life conflicts, burnout), the instructor might need to redirect the discussion, while being sensitive to the needs of the participants. Possible solutions include offering additional mentoring after the workshop or suggesting contact persons within a department, residency, or school.

This workshop may help to identify important skills by focusing on aligning priorities with both time allocation and domain boundary lines, defining clear strategies for negotiating conflicting work and home domain boundaries, and communicating goals within personal networks. The literature continues to define concrete skill sets that, when mastered, can promote physician career satisfaction and wellness. Such skill sets can also mitigate physician burnout and promote career sustainability, both critical issues with far-reaching implications for the delivery of safe, high-quality health care at the provider and system levels.² The conceptualization of work-life integration as a lifelong practice suggests that longitudinal skills are necessary for physician career sustainability.

Appendices

A. Negotiating Work-Life Integration.pptx

B. Work-Life Alignment Worksheet.docx

C. Daily Schedule Exercise.docx

D. Work-Life Integration Strategies.docx

E. Workshop Evaluation Tool.docx

All appendices are peer reviewed as integral parts of the Original Publication.