We have invested blood, sweat, tears, many years and enormous financial resources for the privilege of practicing emergency medicine. We work really hard and make heroic efforts to stave off death, even when failure seems all but certain. When it comes to our own wellness and career longevity, however, we haven’t always applied the same resources and, as we are all aware, EM physicians are suffering from burnout at rates unparalleled in medicine. My group, Emergency Physicians Professional Association (EPPA), embarked on a wellness initiative in 2016 to understand the scope of the problem and ways in which we could support our partners in work-life balance and career longevity. We are a democratic and independent group and have always placed a high value on fairness. Historically, this has manifested in policies that treat everyone equally. It became clear, though, that physicians face different obstacles to wellness and have different needs. As Wendy Laine, our Wellness Director states, “Wellness and job satisfaction mean something different now than in the past.” This was the impetus that led us to create an EPPA women’s group and hold our first EPPA Women’s Conference last year. It was a great success and two of the many action items that came from the conference were to:
- To create and get approval for a policy to improve scheduling around parental leave.
- To create of a parental leave FAQ sheet to be distributed to all candidates and available to all providers to obviate the need to request this information.
I am proud to say that we have accomplished both of those aims and our group adopted a new parental leave scheduling policy and created a FAQ sheet. Allow me to share with you the approach, tools and methods we used, so we can see more, and eventually all, physicians working under improved policies.
The Approach and Process:
- Identify and prioritize the problems to solve.Brainstorm the lists of problems and prioritize the work. Select an owner to lead each effort and assigned realistic due dates for first steps.
We utilized a management consulting framework to prioritize our work based on relative scores for impact/value, ease of implementation and cost. We chose to implement “low hanging fruit” (e.g. a Facebook group) that were easy to implement as well as investing in selected high impact problems such as a parental leave policy. Here is an example from our conference:
- Define and describe the scope of the problem. Define the problem you wish to solve and describe the reasons it is worth solving. Quantify the problem and the benefits of your solution if this is possible. Acknowledge the risks and possible drawbacks, as well, to show that you have taken these into account. Provide strategies for risk mitigation (e.g. limits, policy for instances of abuse, opt-out, etc.)
- Benchmark to identify best practices and norms. Gather data to identify norms and best practices. “Benchmarking” is measuring an organization’s policies, performance, etc and comparing with peers to identify how the organization is performing currently and how or where it can improve performance. This data can be very persuasive to drive change and often helps you improve your proposed solution. Information on similar groups in your geography is most impactful, but don’t forget to look to other industries and professions for ideas as we in medicine tend to lag far behind industry. In preparing our proposal, I posted to FeminEM asking for members to share their parental leave scheduling. It took me a few seconds and I received a wealth of helpful information from providers across the country. Some of the methods we used include:
- Internet searches and websites such as www.glassdoor.com
- Collection of employer direct mailings and journal article advertisements
- Social media “surveys” on Facebook in groups such as FeminEM, PMG and EMDocs
- Email surveys of residency class colleagues
- Survey of friends and family in other comparable industries such as consultants, accountants, lawyers, etc.
- Articles from trade journals such as this excellent article by Kathleen Clem, MD, FACEP.
This is data, even if it is descriptive.
- Make the case: Decide whether you will be more effective submitting a written proposal or creating a powerpoint and presenting in person. Target the audience of decision makers with a succinct and logical presentation. This is the document (link) we drafted which included the problem, proposed solution and benchmarking data.
- Find a champion (or be the champion): “Socialize” your proposal with leaders within your group to build support before you submit it formally. Don’t exclude potential opponents – have the conversation with them to understand their concerns and propose ways you might mitigate perceived risks. Include them if you create a workgroup to develop a proposal. Submit the proposal for consideration to the committee or leader with the power to make the change. Ask for a timeline for consideration of the proposal. Be a steady advocate and remind people if the proposal is languishing.
A few other tips for getting things done:
- Be optimistic: Don’t succumb to nihilism and give up before you even start. You might be surprised at how easy it is to accomplish some of your aims, but it probably won’t happen unless you start. Many goals are harder to accomplish but worth the effort.
- Recognize your power: My group, EPPA, has more than 170 partners with varying opinions but a common goal of enjoying long and fulfilling careers and the power to make choices to support this. There are many different work arrangements but as EM providers, if we work together we actually have great leverage to change the norms and expectations for our profession. Our jobs will never be outsourced abroad and our work can’t be consolidated to a few centers. It takes a lot of sacrifice, hard work and bravery to do our job and our ranks our limited. Most importantly, our work has great value. ED visits continue to increase and now surpass primary care visits. As Dr. Stephen Gau wrote on EMDocs: “WE are the vanguard that society turns to in their hour of greatest need.” Groups like FeminEM, PMG and EMDocs are free and rich sources of information, education and encouragement, and can facilitate revolutionary change by allowing us to share information openly, support one another, build consensus and convince us that we are not alone in our struggles. Get involved in these groups – you can start as a lurker with no commitment but I suspect you soon be inspired to contribute and do more.
- Take a seat at the table: Women need to take on leadership roles. If we don’t step up and involve ourselves, our perspective and concerns will not be heard and we will be poorly positioned to drive the changes that could improve our work and our lives. If you have an internal voice telling you that you aren’t qualified, just ignore it. Do what you did when you mastered your fears about doing your first LP, central line or the multitude of other things you now do without a second thought. If you are at a time in your life when you can’t take on a major role, then actively seek out smaller, defined roles that still allow you to contribute, build trust and understand how your organization works to get things done. If you are already in leadership, actively mentor and encourage other women to get involved. Ask them to consider applying when there is a role they could take on. Suggest women physicians to other leaders when they are recruiting for assistance. These small actions add up and pay dividends.
As a parting thought, don’t underestimate your power and don’t overestimate the challenge. You can do it!
David Marcozzi, Brendan Carr, Alisha Liferidge, Nicole Baehr, Brian Browne. Trends in the Contribution of Emergency Departments to the Provision of Health Care in the USA. International Journal of Health Services, 2017; 002073141773449 DOI: 10.1177/0020731417734498