Medicolegal Issues

The Downtime Dilemma


How do you spend your time off? Do you neglect your to-do list in favor of rest and relaxation, or do you race around trying to get everything done? How you use your free time affects your energy level and on-the-job enthusiasm. Hospitalists who learn to make the most of their time off reduce their stress and master the elusive work-life balance, and are more likely to avoid burnout. It’s especially true of physicians who work long hours followed by multiple days of downtime.

“I tell hospitalists … that they have to know what a sense of ‘work-life balance’ means to them,” says Iris Grimm, creator of the Balanced Physician program and founder of Marietta, Ga.-based Master Performance Inc. (www.balanced Understanding what you need to lead a healthy, balanced life is crucial to your happiness and well-being on and off the job.

Hospitalists who work long shifts also face extended stretches of time off that are vital to recharging one’s batteries. “One of the challenges they have is to find a routine,” Grimm says. “As human beings, we prefer to have a daily routine, which is a benefit from a health standpoint. These people have different sleep patterns when they’re off, which can throw off their bodies, which in turn has an effect on health and well-being.”

These are intense jobs; they’re high-stress. The good thing about being a hospitalist is that when you’re off, you’re off. But it’s important to be able to compartmentalize.

—Chad Whelan, MD, FHM, assistant professor of medicine, University of Chicago

Plan to Cope

The allure of regular, extended time off—namely, the seven-day-on, seven-day-off schedule model—can factor heavily into a physician’s decision to choose an HM career. A full week off is ideal for some, but not so ideal for others.

Many think the seven-on, seven-off schedule increases the likelihood of physician burnout. Others think the exact opposite. No matter what, the “intense shift” model is not going away anytime soon, says Chad Whelan, MD, FHM, associate professor of medicine and director of the division of hospital medicine at Loyola University Chicago Stritch School of Medicine.

The first step in maximizing your personal time is to accept your schedule. “Whatever schedule you’re working, you’re going to be working when others are not,” Dr. Whelan says. “You have to recognize that, and you have to own it.”

Once you accept the fact that you’ll miss out on some activities—from dinner parties to your child’s Little League baseball games—that fall on your workdays, you can move on to a key component of maximizing your days off: the art of planning.

Planning your days off helps ensure that you don’t end up wasting them. “Your plan could include exercise, visiting with friends, and keeping up with CME,” Grimm says. Dr. Whelan agrees: “You have to do some active planning to schedule things that need to get done.” He knows from personal experience that “the mundane details are easy to drop; instead of grocery shopping, you end up ordering in. I find that if I schedule these things—even at a funky time like late at night—I’ll get them done.”

Planning works both ways. “Part of balance is using time in your off days to prepare for when you’ll be working,” Grimm says. For example, make sure you have food in your refrigerator so that you can have a healthy breakfast and occasionally prepare dinners in advance that you can quickly heat up after your shift.

Focusing your organizational skills and planning on personal “to-dos” will lighten the load of a long workday. “Automate as much as possible—such as paying bills,” Grimm advises, “and delegate what you can. The less you have to keep track of, the less stress you’ll feel and the more energy you’ll find to do what you’re paid to do.”

Time for Self

Physicians, especially those with families, need to remember to make time for themselves “so that you won’t build resentment toward others,” Grimm says. “Doing something for yourself refills your energy tank.” Whether it’s exercising, going fishing, volunteering at the community center, downloading photos from your digital camera, or reading a book, “it’s different for everyone,” Grimm points out. “You have to know what you need.”

Dr. Whelan—who is a runner—focuses on physical activity to relieve stress and re-energize his mind and body. “It’s hard, because people who are serious about exercise, however you define ‘serious,’ are told to exercise on a consistent schedule. Well, we don’t have consistent schedules,” he says. “The key is to recognize that this is a challenge and find a creative way to schedule it, just like we make other decisions creatively. You have to make an upfront commitment.”

Whatever you do to “refill your tank,” there’s a good reason to devote time to it. “The more we do for ourselves, the more we can do for others,” Grimm says. “It’s not an hour-to-hour ratio; you might just need a five-minute meditation at the end of the day. … I always challenge my clients to be aware of what gives them energy and what takes energy away from them. This is essential for work, and essential for life.”

Leave Work Behind

One of the hardest things to learn—a lesson left out of medical school texts—is how to leave the stress and responsibility of the job at the office. “These are intense jobs; they’re high-stress,” Dr. Whelan explains. “The good thing about being a hospitalist is that when you’re off, you’re off. But it’s important to be able to compartmentalize.”

Dr. Whelan learned a couple of simple strategies to help with this concept. “At the end of every work day, after you’ve signed off, dedicate some time to transition. It can be just 10 or 15 minutes. Don’t answer the phone or e-mail; just dedicate that time to transition,” he says. “Run through your day and process each part—whether that’s each patient or each administrative task—emotionally and intellectually. For each one, make a plan for what you’ll do tomorrow. Once you’ve worked through your day this way, you can allow yourself to let it go.”

He also advises hospitalists to use on-the-job time when it’s available, rather than overlapping work and personal time. “There are parts of your business that can be done when you’re not seeing patients, such as reading journals,” Dr. Whelan says. “Try to schedule those things into your [work day], so you don’t end up catching up on them at home.”

Find Your Balance

Make it a point to make the most of your time off. Plan it in advance to ensure you do what you need to do and what you want to do. Think creatively and include all types of activities. And be sure to include time for yourself.

“There are very few of us who can sustain a life made up entirely of work and still be happy,” Dr. Whelan says. “Eventually, you’ll start to resent the work, and that’s the stuff that leads to burnout. You’re also probably not doing as good a job.”

One final piece of advice: Be prepared to change.

“You need to be self-aware, and you need to realize that your definition of balance will shift with age, responsibility, and goals,” Grimm says. TH

Jane Jerrard is a freelance writer based in Chicago.

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