Stanford Uses ‘Time Banking’ to Boost EP Morale

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Want to trade that hour you spent in a committee for a car wash? Stanford has a new perks-based approach to battle physician burnout and enhance work-life balance. 

Stanford’s Department of Emergency Medicine compensates otherwise unpaid hours spent on committees, leadership, and mentorship plus favors like picking up shifts on short notice hour for hour with house cleaning, meals, and car services. There is also the option of using credits for work support, like grant writing assistance and speech coaching.

Initially a pilot study funded by a two-year, $250,000 grant for both basic science and clinical faculty, the Department of Emergency Medicine is now the first department to keep funding the program after the grant ended.


The project’s goal was to help change the conception of what constitutes an ‘ideal worker,’ which generally assumes physicians spend long hours at work, well over the typical work week. The habit of constantly prioritizing work often leads to a neglected home life and overall life and job dissatisfaction.

While work-hour policies exist, they were often underused for fear of shifting work unfairly to colleagues, or being viewed as not valuing work, according to The Academic Biomedical Career Customization document Stanford published.

“Our faculty make enough to buy food and hire a house cleaner,” Jennifer Raymond, PhD explained, professor of neurobiology and associate dean who proposed the project. “This program was less about financially enabling faculty and more about encouraging them to focus on work-life balance without worrying about burdening their other coworkers. It also helps our faculty feel rewarded for their often underappreciated sacrifices, like picking up call shifts on short notice.”


After the pilot study, the University has found that in addition to helping faculty, the program also indirectly benefits the University by increasing work productivity, grant writing, and perhaps recruitment, and retainment of faculty. Men in basic science earned16 credits in a month, whereas women earned 35. Men and woman in the clinical faculty earned about the same number of hours, although they tended to use them differently than the basic scientists did.

After using time credits, 84% of faculty said their work-life balance improved, 25% fewer people avoided taking vacation due to lack of time, 39% more faculty volunteered to fill a clinical service on short notice, and job satisfaction of clinical faculty increased by 17%, according to the ABCC document.

Stanford’s program is one of a few programs of its kind in the country, and the University hopes its other departments and other institutions follow suit.

“We hope Stanford and the individual departments will continue funding the program once they recognize the ongoing, positive results like the emergency medicine department did,” Dr. Raymond explained. “I really hope this type of program and culture change will spread to other institutions. By putting the responsibility on the community and on outside services, like house cleaners and food delivery services, faculty feel less guilty asking for help.”


“We had sabbaticals, but they often weren’t used in emergency medicine because the culture didn’t encourage it,” Rebecca Smith-Coggins, MD said, an attending at Stanford’s ED since 1987. “A big aspect of burnout is not feeling appreciated, and I think this program addresses just that. Regardless of the setting, I would absolutely push to implement the program at any hospital,” Dr. Smith-Coggins continued, also a professor and associate dean in the Office of Medical Student Wellness. “Wellness is something that helps decrease physician error, helps physician retainment, and is a potential quality indicator.

Funding is tough no matter what setting you work in, but the time has come for us to not treat it as woo woo. We need physician wellness programs for our medical system to work well.”

While physician wellness has been recently spotlighted following Stanford’s time banking program publicity in the Washington Post, it is not a new concept. Julia M. Huber, MD, Chair of ACEP’s Well-Being Committee said well-being is something every physician should look at when committing to a facility or group. “It’s important for people to start asking ‘Can you tell me about wellness programs?’  before signing the dotted line,” she said. “We all need to take a stand for well-being programs. They may not necessarily fix burnout issues, but they could serve at least to increase career longevity and satisfaction.”

ACEP has both a Wellness Section and Well-Being Committee, each offering resources to members, including residents. Resources include a wellness ebook, resources on burnout detection and treatment, PTSD, shift work and dealing with litigation stress. Also included are resources for each career stage, including retirement and changing jobs. Resources are being developed for EM groups to adopt to improve wellness, including information on childbearing and family, the committee’s chairperson said.

TeamHealth, one of the largest physician groups, is part of a unique cohort of emergency physician employers, as they work as a “middle man,” working between the hospital who hires them and the physician they employ. “With many departments and services to manage, I would imagine it’s challenging for a hospital to focus on one individual department’s wellness,” Wolfram Schynoll, MD said, vice president for performance improvement. “Because we work with literally thousands of emergency physicians across the country, we have a deep understanding of the needs of emergency physicians, and the challenges that are unique to that specialty. I believe wellness and burnout are opposite ends of a spectrum, and when you don’t tend to the physical, emotional and professional wellness of physicians, you get burnout. I’d be lying if I said that we’ve had burnout prevention strategies since day one, 30-plus years ago, but it has been a top priority for us over the past ten years or so, and we are devoting extensive resources to enhance the wellness of our physician community.”


Dr. Lacocque is an EMS & Disaster Medicine Fellow at UCSF-ZSFG and serves as the EMS Section Editor for EM Resident Magazine, EMRA's official publication.

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