Joy In Work
Author: David Chung, Vice President RCEM Scotland
12/9/18
Can you hack it until you’re 68?
“Work Life Balance” has been a constant theme through my working life. Survey after survey of doctors of all specialty, of all grades seem to throw it up as one of the most, if not the single most important issue in choosing careers or leaving a job.
More recently the concept of a “sustainable career” has gained more traction, and within that “work life balance” is also a reasonably large component.
I’ve always found it difficult to pin down what “work life balance” actually means. It’s in the surveys, but it’s never clearly defined. It means different things to different people. Some people are quite up front that to them it means only working within an envelope of Monday to Friday, 9-5 and preferably only in School Term time. A few years ago most FY2s on their way into the (then popular) GP training programme would say that no evenings or weekends were the main reason for that career path. Things have changed, that isn’t enough, and the GP training programmes can’t fill their places.
Historically, Medicine solved this problem by having a “consumable” workforce. Junior Doctors worked horrendous hours, but for a finite time, with the pay off being that once you were over 40 (or earlier), it was very likely that your work life balance would be much better for the remainder of your career. There were fewer Consultants, because most of the work was done by the “consumable workforce”. As the system was designed to have “natural wastage” and the number of jobs was limited there wasn’t really the need to do serious workforce planning.
That has all changed for the better, but the lack of workforce planning, and the changing nature of the workforce and its expectations, means we are struggling to keep up. The workforce of today are demanding a career break (or more than one), and increasingly not just for child related reasons. None of this has been factored into planning. If at any one time 10-20% of your workforce establishment is absent, how do you keep things going? Simple, build in prospective cover. Real prospective cover.
Typically the answer has been to “sweat the assets” to use a phrase beloved of execs. However, this inevitably leads to burnout and further staffing crises, which is what we are seeing now in many areas.
Emergency Medicine has been pretty forward thinking compared to many other areas of medicine, it had many more LTFT trainees compared to other Hospital Specialties, and when I look at my own ED Consultants the gender split is pretty equal. EM also acknowledged early that “on call” as a system is not ideal. It was mainly used as an excuse to pay people less for working (juniors), or for getting paid for no work (seniors at home). As a Specialty we have embraced the fact that medicine is a business involving evenings and weekends and we want to be there for our patients and colleagues. We just want some recognition that we are doing something most others aren’t, or indeed won’t. We’ve learned that by working out of hours, things are easier, as you end up doing less work overall. It’s easier to give advice or see a patient at the time rather than deal with an SAER, complaint or similar. It’s easier to have no backlog develop than try and catch up with one. It’s obviously better for the patient too.
So, what’s the answer? It seems, from what I see written, to be lots of career breaks, sabbaticals, and portfolio careers. I’m not sure that’s right in isolation. EM is a difficult and complex job, and like anything of that nature, the more you do the easier it is. I don’t think we should be ashamed to admit that. There is always the danger that long periods away from the coal face will be noticed by employers who will ask (as I have often heard) “what do EM Consultants actually do?”. It may not sound fair, but it’s how it is.
Some Consultants are now saying to me that they’d rather have more of them around and have a better time at work, perhaps a higher frequency of weekends or evenings, than be single handed but do less of these “onerous shifts”. I must say that appeals to me more. If my working environment is appropriate, I will enjoy my job.
No Exit Block, a decent amount of staff, including a proper multidisciplinary team (such as physio, clinical support staff, adult support type resources) would actually mean that I am functioning as what I am, an experienced and effective decision maker, who isn’t overloaded by having to do non-medical and some more “junior” tasks.
Think about it. On a ward, do you see other “senior” doctors answering phones, taking bloods, portering, or even cleaning? Perhaps we might need to shift away from the “peoples republic of EM” that I have traditionally been proud of. We are a team, and we must all help each other but it is simply insane to pay a Consultants hourly rate for a task which could be done more cheaply (and just as well) by someone else.
I think we should fully support things we see in other countries, such as mandatory paid sabbaticals at 7 years, and long service breaks after decade intervals. These make people feel valued, and more inclined to work for longer, rather than trying to find an exit whilst still getting paid to be a clinical consultant. It’s simply cheaper, and better value for society to do this, and facing facts that’s an argument we will always need to win first.
“Joy in Work” is an awful phrase, conjuring up images of medicated drones in a matrix style dystopia (at least in my mind). I am pretty certain though, that if my job was slightly better when I was there, with a bit of creative thinking, some decent support staff, no Exit Block and the odd shame free break then I reckon I am actually good until my Sixties after all if my health permits.