This is the third in a series of three articles by Dike Drummond, MD, a Mayo-trained family physician, author, speaker and trainer on physician burnout. On Sept. 28, he will lead a five-hour workshop in Indianapolis to help physicians rediscover their joy in medicine. Sign up at www.ismanet.org/HappyMD
PREVENT PHYSICIAN BURNOUT - PART 3
These 4 tools will enhance work-life balance
By Dike Drummond MD
A new study has found that, between 2011 and 2014, the burnout rate among family physicians increased from 45 to 54 percent. Yes, you read that right. Over half of us are experiencing burnout.
In my previous two articles in this series on physician burnout, we learned that burnout occurs when our mental, physical or spiritual energy accounts have a low balance over time. To prevent burnout, we have two options:
- Decrease our energy expenditures by reducing stress (see article two in this series).
- Increase our energy deposits by finding ways to recharge and create more balance in our lives.
In this article, we will discuss the latter – specifically, four tools for creating work-life balance.
To implement the tools effectively, it is important to understand that work-life balance is not a “problem.” Problems have solutions, but there is no simple, one-step solution to work-life balance. Instead, work-life balance is a dilemma. It is something you must attend to regularly using a multipart strategy. If you are not paying attention to it at least twice a month, you will be out of balance very quickly. For many of us, this tendency to be out of balance began as early as our pre-med days.
The reason work and life seem in direct conflict so often is simple. The time and energy required for each comes out of the same pie. Each must take from the other because the pie is finite. Managing this give and take is an ongoing process, but the tools presented in this article can make it easier. We’ll get to those in a minute, but first, let’s address a gorilla.
The 800-pound gorilla
Imagine for a moment that you live in your house with an 800-pound, silverback western lowland gorilla. This is a wild gorilla. He is not a circus animal and doesn’t know a single trick. Imagine how much of your house this gorilla would leave you and your family. You would be relegated to just the outside edges of each room, and he would make a mess wherever and whenever he wanted to.
Here is the metaphor. Your choice to be a physician created this gorilla.
The gorilla is your career.
The house is your life.
Without strong boundaries and good balance habits, your career will tend to crowd out your life, leaving you just scraps and making messes at the most inopportune times. The career that was supposed to enable an extraordinary life now dominates the house, leaving little room for anyone or anything else.
By the way, here are two very important questions to contemplate:
Whose gorilla is this?
Who else has to live with this gorilla?
All is not lost. Gorillas can be house-trained, tamed and shown healthy boundaries. It is your job to do this for your family. It will take a strategy to manage this balancing act. Here are four tools that have been field-tested and found effective. These are the first life-balance techniques I teach all of my coaching clients.
Tool 1: The schedule hack
One of the laws of your work-life balance strategy is “the strongest structure wins.” By “structure,” I mean the calendar you are probably carrying right now.
If I asked you to hand me your calendar, what would I find on it? It would have your work and call schedule, for sure. What else is on your calendar right now?
Would I find any of the following?
- Your spouse or significant other’s schedule?
- Your children’s schedule?
- Your workout schedule?
- Your next date night?
- Your next vacation?
- Some blocked-off free time for yourself to be with friends, take a walk, hike, bike ride, take a yoga or cooking class, practice yoga, nap or read a book for pleasure (heavens, just imagine that for a moment, will you)?
If you have all of those on the calendar you carry at work, congratulations. Take a moment to pat yourself on the back, because I have never seen it happen, and I have asked thousands of doctors what is on their calendar.
Understand this as an actual law of life balance. Anything not on the calendar you are carrying is not going to happen, period. One of the keys to taming the gorilla is to carry your life calendar with you at all times.
The schedule hack is a process to ensure you always have your life calendar in your pocket or purse, without having to purchase or learn any new technology. It only takes 20 minutes a week. This is the first step in showing that gorilla some healthy boundaries.
Schedule hack materials
- The paper calendar you have hanging at home on the side of the fridge. If you don’t have one, they are very inexpensive and just the tool for the job.
- Some colored pens.
- Your cellphone.
Schedule hack procedure
Step one: Build your life calendar for the week ahead.
Pick a time in the week when everyone in your family or household is available. A popular time is on Sunday after church and before football. Pull that paper calendar off the fridge, grab the pens, and put them all on the kitchen table. Gather everyone in the household and build your life calendar for the week ahead.
What do you want in your life, outside of medicine, in the upcoming week? Remember, if you don’t put it on your life calendar right here and now, it will almost certainly not happen.
- Workouts, massage, mani/pedi.
- Free time.
- Coffee with an old friend or a relative.
- Time to read a book.
- A class or hike.
- A date night.
Whatever you want, you must put it down on the calendar. Do it now.
The last thing you put on the calendar is the date and time of your next schedule hack session. Everyone needs to be clear on when you will meet again. If I meet you in the street and ask you to show me your life calendar, it must have your next schedule hack session on it. Agreed?
Step two: Take a picture of your life calendar with your cellphone.
Yes, it really can be that easy. Your Life Calendar can now be in your pocket at all times, right there on your cellphone, probably just a push of a button away from your work calendar.
Step three: Defend your life calendar
Now, you are prepared to say the two-letter magic word of work-life balance. That word is “No.” You will benefit from practicing saying “No.” in front of a mirror until you are comfortable with a phrase or two that work for you.
With your life calendar in hand, if someone at work asks you to cover a few extra hours on Thursday, you can pop your cellphone open and say, “Hang on a second; let me check my calendar.” If you are already booked, you can say, “I’m sorry, I have another commitment at that time. I won’t be able to help out.”
As you read the conversation above, does it make you a little uncomfortable? Most doctors stop breathing when I demonstrate this bit of dialogue. We are horrible at saying no. Our discomfort has several sources.
- We are completely out of practice at saying no. That is okay. Saying no is a skill you can practice. Remember, “practice makes better.”
- You don’t want to be perceived as not being a team player. This is a variation on the prime directive of “never show weakness.”
And, let’s face it – you won’t always say no, even if you have a conflict on your life calendar. Here are several common situations in which you will most likely say “Yes.” instead:
- You owe this person. They covered for you at an earlier date, and you want to settle the debt.
- You want this person to owe you down the road, so you can call on that debt in the future.
- You are not yet confident enough in your ability to say no to give it a shot. Time for more practice.
Role-play with your spouse or significant other. Have them be one of your partners, perhaps the one most likely to ask you to cover for them. You be yourself, and practice saying, “No.” Rehearse until your spouse or significant other gives you at least a B+ for your performance. Have some fun here.
Here is what will drive your discipline. When you carry your life calendar, see a conflict, and say yes anyway, you will know immediately which member of your family you need to get hold of, apologize to and reschedule with because you just threw your plans under the bus.
The schedule hack works every time you use it. You will have a more balanced week if you hack your schedule than if you don’t. This simple process also allows you to live your life in alignment with your complete circle of priorities. This is a key source of happiness and fulfillment.
Schedule hack action steps
Tool 2: Intentional date nights
- Who are the people on your life calendar?
- When is a good time for you all to do the schedule hack together?
- If you need to buy a paper calendar or pens, when will you do that?
- When will you do your first schedule hack? How can you make it fun?
- What things will you put on the calendar just for you?
- When will you practice saying “No.”? (I dare you to practice with your spouse or significant other and find a way to make it fun!)
- Journal about your experience.
If you think being intentional about date nights isn’t a serious issue or has no relation to physician burnout, think again. A healthy relationship can recharge and strengthen you, while an unhealthy relationship can quickly deplete you, and even cause health problems.1
My coaching clients have found the optimum frequency for a quality date night is twice a month, minimum. If it has been more than two months since your last date night, you are way overdue. Date nights are not the only way to strengthen your relationship, but they are critically important, so do not skip them.
If you do not have a significant other, date night could be a date with someone you’d like to know better, time with a friend, or doing something nice or unexpected all by yourself. (Yes, you can take yourself out on date night, too.)
When you are really busy, figuring out what to do on your date night can seem like just another item on your task list. I encourage you to do an attitude check here. What is more important to you – the 800-pound gorilla or some love, romance, adventure and fun? Date night is a chance to break out of survival mode and do something extraordinary.
Date night ideas:
Mandatory first date night action:
- Take turns planning your date nights, but keep your plans a secret. The one who is planning the date only reveals when to be ready and what to wear.
- Each of you put three date night ideas on slips of paper and drop them into a hat. Pick one, raffle style, and go for it.
- Make it a game and set rules. Here is a fun one: Your date night can’t involve calories or money.
On any date night, even before you order drinks or appetizers, your first action is to schedule the next date night. This way you will always have a date night on your calendar. If I meet you on the street and ask you to show me your life calendar, it must have your next date night on it, agreed?
The six pack. Instead of putting just the next date night on your calendar, go for a six pack. That’s right, schedule out six date nights – three months’ worth. Put this article down, walk over to the calendar on the fridge, and mark them out right now. Then, your first date night action is to schedule the next one, so you always have six on your calendar.
Buy them in bunches. Use season tickets to book date nights in bunches. If you have a shared interest and there is a season ticket option, buy them. This will take care of multiple date nights in a single purchase.
Tool 3: Bucket list secrets
Bucket List (noun): The list of things you want to do before you “kick the bucket.”
My clients and I find it very useful to build two bucket lists and use them as additional
work-life balance tools.
1. Your BIG bucket list
Tool 4: The boundary ritual
These are the classic things I must do before I die. The challenge with creating a meaningful BIG bucket list is that most people put way too many things on it. This sets you up to use the BIG bucket list to beat yourself up. If you put too many items on there, you will notice you are never crossing any of them off and feel guilty.
Here is a reality check that will dramatically shorten your BIG bucket list.
Make your BIG bucket list. Write it down. I encourage you to keep it in the folder with your ideal practice description and master plan. Give someone else the list, and have them read your list back to you, one item at a time. Take a moment to imagine failure on each item. Imagine you die before you accomplish this one. How does that feel? Which ones does it break your heart to contemplate leaving undone? Those are your authentic BIG bucket items. If you are like most people, your list just got much shorter.
Now, it is time to get one of these BIG bucket list items on your life calendar. Normally, these are pretty big items that take a significant amount of time, energy and money to accomplish. That is why they lie dormant for so long.
Here are two keys to nailing your next BIG bucket list item.
- Schedule it anyway. Pick your first BIG bucket list item. Look out on your calendar as far as you need to, in order to find a time that will actually work. It could be one, two, three years out or more. Schedule it anyway. Print out a calendar for that year or month, use a brightly colored pen, and mark off the dates. Hang it in a highly visible spot at home. Go into work and block it off your schedule on the work computer as well. Put a stake in the ground now.
- Put skin in the game. The next step is to buy the tickets. Put money down immediately. If there is one thing that will get a doctor to actually take a trip, it is having put money down. If you can’t buy the tickets yet, open a savings account and start putting money away.
Block off the time, and buy the tickets now. Whether it is Machu Picchu, Africa, the running of the bulls in Pamplona, visiting the country of your family’s origin, a Spanish immersion school in Costa Rica or rafting the Grand Canyon, get it scheduled and paid for, and it is highly likely to take place. Afterward, it will take its rightful place in your memories as a peak experience, rather than a heartbreaking regret.
2. Your weekly bucket list
Is there an activity or experience that turns your whole week around every time you do it? It’s the thing that makes you say, “Man, I wish I could do that every week. It would make a huge difference for me.” Most people know what this item is and yet only manage to squeeze it in once in a while. Common examples are a workout, massage, date night, hot yoga, alone time with your children, coffee with an old friend, walking the dog, a nap, meditation and a mani-pedi.
What are two or three of your weekly bucket list items?
The schedule hack is where you make sure these happen. Hacking these weekly bucket list items onto your life calendar is part of carving out time and space for your life in your busy week. Defend these items just as vigorously as you do your work schedule, to show that gorilla some healthy boundaries.
Some people have problems with guilt as they contemplate this concept of doing something just for themselves. A little voice saying, “What makes you think you are so special?” can pop up when you are blocking off time for your own personal use. This is your programming, pure and simple. You can tell that voice, “thank you for sharing,” and do it anyhow. It is only when you are able to experience the pleasant things in your life that you can understand the difference it can make for you, your patients, your team and your family.
One of the keys to being able to recharge when you are not at work is creating a clean, solid, functioning boundary between work and home. This is how you take the white coat off, leave work at work and come all the way home.
Here is how you know you have missed this boundary; when you are sitting at home and thinking about work. You can’t recharge in this situation. Instead of recovery you are still being drained by work stress even though you are not in the office or hospital.
Creating a boundary ritual is a mindfulness skill you can learn and practice. It is the energetic equivalent of an off switch on your role as a doctor. Your boundary ritual marks the transition from the environment where the patient comes first to one where you come first.
Fortunately, we have an excellent role model in creating a boundary ritual: Mr. Rogers.
Yes, that Mr. Rogers, from “Mister Rogers’ Neighborhood,” the children’s television show on PBS.
You really don’t know who Mr. Rogers is before he walks through that door. It only takes a couple of shows to realize he is not the real Mr. Rogers until he has completed his personal three-part boundary ritual. Remember those three steps?
- Put on his zip-up sweater.
- Change his shoes.
- Sing his song, “It’s a beautiful day in the neighborhood, a beautiful day for a neighbor. Would you be mine? . . .”
With his boundary ritual complete, he is the mildly creepy Mr. Rogers we know and love for the rest of the show.
I have heard of physicians who naturally understand the importance of a boundary ritual. One friend’s father, a small-town family doc, would shower and change clothes after coming home every day. He wouldn’t talk to his family until this boundary ritual was complete. After the shower he was just “Dad” again.
I strongly encourage you to develop your own boundary ritual. The most effective rituals involve three things:
- An intention.
- A releasing breath.
- An action.
Here is an example of a boundary ritual if you drive home from work. I encourage you to imagine you are actually driving your car and taking these steps as you read them below.
Park the car. Put your hand on the keys or off button. Say to yourself “With this breath, I am coming all the way home”. Take a deep breath. As you exhale, release all thoughts and feelings about work with your out breath, turn the car off, take the keys and step out of the vehicle.
This is another tool that works every time you use it. You will be more relaxed and thinking less about work if you perform your boundary ritual than if you had not. And, as usual, practice makes better.
Any action can be an effective boundary ritual as long as your intention is to take off the white coat and come all the way home.
- Take a shower.
- Walk the dog.
- Take out your contacts and put on your glasses.
- Mr. Roger’s three-part ritual.
- Make a nice dinner.
What is your boundary ritual, and when will you start practicing?
Pick an idea and act
As discussed in previous articles, it is easy to read an article with multiple suggestions like this one, and get overwhelmed. The key is to take just one step at a time. Pick just one action from the options above and put it into action. That is all. The first step might be to call your family together and create a life calendar for next week.
Once you have taken the first step, the second one will become clearer. You will know exactly what to do next. It might involve taking an afternoon off and thinking about your bucket lists. Whatever it is, just take the next step, and the next, and the next ... to put one of these tools into action in your life. With just these simple actions, you’ll be on your way to a healthier, more balanced life. Constructing a strategy to build and maintain life balance is one of the keys to preventing physician burnout.
Dike Drummond MD is CEO of TheHappyMD.com where he provides burnout prevention and leadership development coaching, training and consulting to individual physicians and health care organizations. He is the creator of the Burnout Prevention MATRIX Report with over 117 ways to prevent physician burnout.
1 Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.