Happy 2024!
Let’s talk about some potential resolutions!
As a department chair, I find the new year brings an opportunity, or a necessity, for me to wrap up the book of business from last year and focus on goals for the current year. As an emergency physician, husband, and father, I find that it also gives me reason to reflect on ways to achieve work life balance, improve my health, and find ways to help me get to the retirement finish line that is in the future.
Some years I have better success with New Year’s resolutions than others. But after consulting with some of my experienced colleagues and recognizing that as department leaders, we need to find suggestions to help our teams succeed, below are a collection of ideas that I offer you to consider for resolutions for this upcoming year. I’m hopeful that you’ll find at least one that works for you.
Let’s start the elephant in the room—Burnout. We heard a lot about burnout this year. Emergency medicine appears to lead the field in burned out physicians compared to our colleagues in other specialties.
Burnout is most often caused by not feeling like you have control in your work. Although it may not be intuitive to spend more time at work, if you work to get some control, by joining a committee, you can and will make a difference in your working environment.
Typically, ED leaders have less burnout than their teams. This may be because we work less clinically but it also is likely related to having more control of our schedule and working on projects where we understand what’s going on and we’re trying to make things better. While you may not be able to jump into an administrative role immediately, all of us started by joining committees and getting involved.
It’s often said that participating in a medical mission is the antidote to compassion fatigue or burnout. My hospital does an annual medical mission trip. Although they do not take emergency physicians on this trip anymore, the surgeons and other specialists who go are always so thankful for the opportunity they have to provide medical care to grateful patients without some of the administrative hassles associated with EMRs, office management, and insurance companies. There are plenty of ways to feel good about the work that you do. This could include volunteering to help at a local free clinic to going on a medical mission trip.
Consider volunteering for a local organization (maybe even outside of medicine). This could be at your local a place of worship, community food bank, or for your kids’ sports teams. I’ve served on a variety of boards ranging from an organization that provides healthcare to the underinsured to our local lacrosse club. This is a great chance to get out of the house once a month, develop some skills different from your routine skill set, and meet some interesting people outside of medicine.
I’ve also been involved with the state chapter of ACEP for over 25 years which is a great way to not only network, but help your specialty, and ultimately make the emergency medicine world in your state better as well. Volunteering to give back to your community is about making you feel good for the work you’re doing. Recently, I decided to become an ATLS instructor. For me, it’s a chance to teach and give back to our medical community. Volunteering provides a different feeling of satisfaction than we typically get by doing a shift in the ED.
Reconnect with colleagues. Most emergency physicians I know are pretty social. However, between COVID and increasing demands at work, I’ve seen many people get comfortable staying at home and not getting together with friends. I went out with some colleagues that I worked with almost 20 years ago recently and when I got I home, my wife said she hadn’t seen me smile like that in a long time. But it’s not just our former colleagues we should be making time to see socially, it’s also our current colleagues.
I would challenge each of us to do something social with a department colleague every few months. If you’re up for a bigger challenge, I would suggest doing something social with a colleague from outside of the department every so often. The last few summers I’ve been able to get together with one of my hospitalists when we’re both on our beach vacation. Building these relationships will make our hospital community smaller and more fun to be around. And it certainly makes some of my admissions that much smoother.
Along those lines, keeping in touch with friends and family can also help you feel connected to life outside of work. Phone calls and even short text messages let others know you are thinking about them, and they aren’t alone.
There is no doubt in my mind that some of our burnout is related to the stress of the job. It’s very clear that as emergency physicians we need to be comfortable with the uncomfortable. However, we can also work to make the things that we find uncomfortable, more comfortable. I would highly recommend taking a CME course on something that stresses you out.
For many of my friends that are not just out of residency, the highest return on investment seems to be ultrasound education and how it’s used for assessing the critically ill patient.
Embrace your role as top of the food chain – and never let them see you sweat. Let who see you sweat? Everyone. Our job is to be the calm leader in charge of the emergency department (recognizing that we clearly share that role with our charge nurse). More importantly than sweating is how you behave. Showing frustration is not a good leadership trait. Consider taking a timeout before you might express frustration.
Most of the frustrating things in life are forgotten in a day or two. When you think about it, not many people enjoy hearing others complain. Throwing negative energy out to the universe (or to family/co-workers) doesn’t do anyone any good. Outside of the clinical area is when we work on the things that cause us frustration within the clinical area. Often calmer minds prevail in these situations, and we can accomplish things as a group that improve the ED. And as part of your role as leader, I would encourage you to smile more. I remind my kids of this all the time. Whether they’re in class, at practice, or sitting on the bench, a smile goes a long way towards success and how you are perceived. It’s amazing how just smiling at someone can change their mood toward you and everyone else.
Don’t sweat the metrics. Yep, I said it. They’re important and can’t be ignored but don’t let them get you down on a minute to minute or day to day basis. We’re all going to have good days and bad days. Ultimately, to have a winning record, we need more good days than bad. For example, I want to average two patients an hour for my productivity. There are clearly some shifts I can do that because everything is flowing well, and the patient volume is there. However, there are also shifts where I get bogged down with one or two particularly sick patients and/or the flow isn’t right and there’s no way I’m going to hit this “target.”
I’ve always taken pride in my productivity metrics and having these days used to frustrate me. But through the years, I’ve learned that there are going to be busier days where I can be more successful, and these will balance out the days where I don’t feel like I’ve done as well. The same can be true for flow metrics. I’ve had plenty of days where I’ve seen patients within minutes of arrival and had them discharged quickly.
I’ve had other days where it felt like I was walking through molasses and couldn’t make a decision to send anyone home. But at the end of the day, I recognize that I’m doing the best I can and since historically I’ve had a winning record, I expect to get back to that level of success.
While we’re not sweating the metrics, if we can find some easy wins, we should use them. Sitting is an easy way to Improve your patient satisfaction. It helps you take a load off your feet, and the patient feels like you are spending a lot more time with them. Win-Win
With all of that said, there are a small percentage of physicians who consistently underachieve on metrics. Sometimes medical directors will put these physicians on a performance improvement plan and those doctors risk losing their job if they do not improve. If this applies to you, this is exactly when you should sweat the metrics and work with your medical director to learn the skill set to be successful.
Remember your “why.” We all went into medicine for a particular reason. It was probably to help people. You may not love every patient or every case you have, but you are taking care of patients and serving the overall community. This is an incredibly important service you provide and should be a great source of pride and satisfaction. For those interested in administration and wondering why it’s worth dealing with some of the crummy parts of the job, it’s because as an ED leader, you can feel like you’re impacting thousands of patients at a time.
Update your CV and LinkedIn profile. In a recent Medscape survey, it was reported that almost a quarter of physicians are considering leaving clinical practice. I’m seeing people leave emergency medicine and sometimes I’m thinking they should be just leaving their hospital and finding a better situation. I’m all in favor of trying to protect our workforce and find ways to keep docs in emergency medicine. However, if you’re considering any sort of change, getting your CV and LinkedIn profile up to date, makes it much easier to seek out that next opportunity.
Control your calendar. I don’t mean make your scheduler hate you with an obnoxious list of requests. Time is our most precious commodity, so schedule time for family, hobbies, and dating your partner. Put it on the calendar so it gets done, otherwise you will just binge the next season of The Office/Seinfeld. As an ED chair, I really live off my calendar, but I’m surprised how many of the ER docs I know don’t use their calendar routinely. I’ve had some shoulder issues this year and without my calendar, there’s no way I would have been able to make it to PT.
I’m hoping to take it the next step in 2024 and block off time to get to the gym regularly. I’ve been meeting with another ED chair quarterly for a while to discuss work and life. We plan three months in advance so we can plan other meetings and work around it. My wife and I subscribe to a series at the theater. It’s about seven shows a year but at least I know we have some nice dates lined up in advance and since they’re on my calendar, I can keep track of them for schedule requests. While you’re blocking family time, now is that time to plan that summer vacation and those key summer weekends you need off for sports tournaments.
Making a to-do list each day can help improve your productivity. It’s also incredibly satisfying to check things off your list. I make my lists on notecards and my phone depending on where I am and what I’m doing. I like the notecard on my desk at work to keep me on track for the bigger things I need to get done. Consider dividing up your list into two categories—top three things to work on and a quick five things to get done. My top three may be updating an order set, building meeting slides, and writing a letter of recommendation while my quick five might include following up with an intensivist about a case, reviewing a complaint, booking a flight for a conference, and scheduling a meeting with the CMO. I differentiate them between tasks that may take hours to days versus those that I can generally get done in one sitting—minutes to an hour.
Financial Check in–Let’s face it, financial concerns contribute to stress. My daughter graduated college and got a real job. We spent probably too much time talking about her budget, including budgeting for retirement contributions and Roth IRAs. But the closer I get to retirement, the more I wish I had spent more time focused on building my retirement account when I was younger. Make sure you use a financial planner.
For as smart as we think we are as doctors, we’re experts in medicine and not likely experts in retirement planning. I’ve always had a financial planner and she’s done well by me for the most part. However, in the last year, I also got two second opinions. One was a longtime friend who is a successful financial planner, and the other was a free financial review my company provides as part of retirement planning.
Both meetings were very good and informative. They also generally were reassuring I was on the right path. However, it’s clear to me as I look back, that I wasn’t as involved, attentive and knowledgeable 15-20 years ago as I should have been. Had I been, I would have done a few things differently.
Conclusions
Resolutions are not meant to be easy. But they can help us identify an area where we would like to improve. Making the resolution is the first step towards making a positive change in our life. I hope you have a wonderful year ahead.
I’d like to thank Drs Michael Bond, Jon Falck, Darren Morris, Kevin Scruggs, William Sullivan and JJ Sverha for their contributions to this article.
