Tipping the Balance of Work and Life: The Employer on the Scale
The idea of blending work and pleasure has never really applied to neurosurgical employment. As sad and wrong as that may sound, physician work-life balance is simply not an employer’s priority. Instead, health-care institutions are built around community service and patient well-being. With similar focus, surgeons often place altruism, ambition and professional commitment ahead of their lifestyles. Neurosurgeons are at high risk for work-life imbalance as their formula for success is bounded by being a limited resource with hard driving work ethic. I will not address the potentially dramatic consequences, personally or professionally, of work-life imbalance. Instead, I will focus my reflections on the impact and weight of the employer on our realities.
The Challenges of Private Practice
Fifteen years ago, my first job was as an employed physician in a five-neurosurgeon, private practice working in two hospitals with a couple of physician extenders. We shared equal call, were nimble and managed our practice with a calculated informality, by consensus. There was mindfulness towards balancing financial responsibility and providing care to a large population. It was brilliant and successful in many ways, but frankly, it was unhealthy in its culture of hard work. One could say that self-employment allowed for autonomy over lifestyle, but this control was a façade, as our work-life balance was at the mercy of the consensus of five driven individuals who I jokingly say had “overactive glands.”
Although we were thriving in many ways, unfortunately, we were also increasingly allocating precious physician time to managing the business, not to being better doctors or family members. Self-employment applied pressures on us that obscured the borders between work and personal space.
Redefining Priorities, Professional and Cultural
While there may be a place for the private practice neurosurgeon, it is dwindling in its appeal to many doctors who are increasingly and transparently prioritizing lifestyle. Despite decades of success, our private practice was challenged to provide comprehensive care to our community and threatened to survive. We struggled to capitalize our growth, were exposed financially and were forced to consider limiting access to patients. We chose to roll our group into a newly expanding multi-specialty physician group owned by our primary hospital, which is a non-profit tertiary referral center.
Our negotiation was a great moment to take inventory and redefine our priorities as professionals and our culture as practitioners. The surgeons prioritized a long-term practice vision and continued their proud tradition of consensus-driven leadership. The hospital administration understood that we required a pay model that fostered productivity, subspecialty program growth and a culture of teamwork. In addition to assuring resourcing around our clinical needs, we required time off from our very busy clinical lives. Many of these “asks” were discordant with other employed physicians’ contracts, but they were each calculated in their value to us professionally and personally.
Aligning Goals Between Institution and Employee
The return to the employer of a contract crafted in favor of physician life should not be underestimated as a tool to improve productivity, retention, culture, camaraderie and physician engagement. With employment, all of our physicians rekindled their professional engagements while being liberated towards more healthy lifestyle opportunities. Each neurosurgeon felt he was getting fair market value reimbursement, time off balanced with time on, attention to a shared practice vision and job security.
The importance of aligning employee and institutional missions was part of reclaiming the ideal of deriving satisfaction from our meaningful and important work. As much as surgeons should recognize it is short-sighted to view material rewards as the primary motivator for our work, the employer must know that it is not adequate to prioritize prestige, productivity or even talent. The power of this negotiation demonstrated that only we surgeons know what we need for our occupational and non-occupational ascendancy.
Our change from private practice to employment has, in total, been a benefit to work-life balance, but we have new stresses that were not entirely predictable or under our control. The lost autonomies, compromised group power, institutional mandates and increased bureaucracy have been palpable. Somehow, however, the ability to focus more on being a clinician feeds positive emotion about being a doctor. Subsequent pride in professionalism has been part of the reward for us in our new paradigm. Although I cannot say that we have more time off, for me this all has translated into less stress and anxiety at work and at home.
The Dynamic Environment of Modern Health Care
We have renewed our contract with the hospital for a long-term commitment — cognizant that the arrangement feels favorable to our professional and personal health. The greatest achievements of this current contract are in its long term and salaried reimbursement. Though these features required a decade of good relationships with the employer and decades of consistent performance by the surgeons, they speak to institutional commitment acting as the underpinning of a workplace that supports career growth, professional ambition and social recognition. These tenants are the elements that define the “work” of work-life balance.
Physical, mental and spiritual health are threatened by the historic culture of neurosurgery and the distance employers keep from our lifestyles. While health care is, by definition, the maintenance and improvement of physical and mental health of people, the health-care system has not optimized these for its workforce. Ownership of this is being addressed by an increasingly pleasant human resource landscape, however, neurosurgeons need to be attentive to advocating for balance between their professional and personal responsibilities.
Creating conditions for successful employment is a blend of philosophy and pragmatism that is only partly expressed in contracting. In the dynamic environment of modern health care, we have certainly evolved with our employer towards a space that speaks to caring about doing the right thing for work-life balance of neurosurgeons, and it is definitely proving mutually beneficial. It is evident that neurosurgeons know what they need and can often verbalize it, but it is the employer with the willingness to listen, show flexibility and be a supportive partner that deserves the credit for providing harmony.
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