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Public, private purse & precious Public, private purse & precious people: people:
Survival tips for the busy private Survival tips for the busy private practitionerpractitioner
“Career juggling & balancing” “Career juggling & balancing” Dr Rob Fry
Auckland City Hospital
DisclosureDisclosure
• New Zealand
• Public practice 50%• Private practice 50%
Public PracticePublic Practice
• Government funded, salaried contractual medical practice that provides health care regardless of age, sex, risk factors or ability to pay
• The Free Dictionary
Private PracticePrivate Practice
• A professional health care provider who is (theoretically) independent of economic or policy control by professional peers except for licensing and other legal restrictions.
• Webster’s on line dictionary
Precious PeoplePrecious People
• Patients
• Doctors
“Anaesthetists”
DoctorsDoctors
• Precious commodity• Cost a lot to train – undergraduates alone
– NZ NZ$ 500 000
– Australia A$ 300 000 – 500 000
– USA >US$ 500 000
– HK ?unable to obtain data
– NZ Specialists > NZ$ 1 500 000
Private PracticePrivate Practice
• Medicine generally is NOT big businessMedicine generally is NOT big business
• Private Anaesthetists in particularPrivate Anaesthetists in particular– Rarely employ other doctorsRarely employ other doctors– Have to be on the job to earn their moneyHave to be on the job to earn their money
Public PracticePublic Practice
• Fixed income
• Long contractual hours
DoctorsDoctors
• Characteristically: products of “medical families”
• >20% of doctors have medical parents• “I only saw my father when he was asleep”
• 50% of women doctors marry doctors• “My mother never had time to play with me”
AnaesthetistsAnaesthetists
• Three A’s
• Availability• Affability
• Ability
AnaesthetistsAnaesthetists
• Busy crowded lives
• Service Industry – Little Autonomy
• Career-centric lifestyle
• Defined by our job descriptions
AnaesthetistsAnaesthetists
• Accessibility 24 hours a day
• Mobile phones, Texts, E-mails
• Home and work blurred
• Allow increasing workloads & deadlines
We often lead Frenetic but meaningless lives
Threats to survivalThreats to survival
• Maintenance of personal equilibrium
• low priority
Threats to SurvivalThreats to Survival
• Anaesthetists typically have type A personalities• “Self Critical, time conscious, status uncertainty,
incapable of relaxation…”
–Production pressured
–“Service industry”
• J Occ & Org Psych 1997
Threats to survivalThreats to survival
• Stress proportionately to hours worked• Long hours may be immensely satisfying• >48 hrs/week doubles chance dying from CHD
• Dysfunctional domestic life– Marital problems/Child responsibilities– Poor financial planning……
• J Org & Occ Psych 1997• The Physician Executiv 2006
• NZMC Workforce survey 1990
Threats to survivalThreats to survival
• Majority waking hours at work• Domestic problems unintentionally brought to
workplace – subconsciously processed there• Work is perceived as increasingly stressful &
unpleasant or undesirable environment• Synergistic deterioration in work practices
• BJ Psych 1997
Threats to survivalThreats to survival
• Occupational stress• Personal thresholds vary widely
Once that level of tolerance passed– Perpetual sympathetic bombardment– Serotonin, Steroids, Catecholamines
Low moodAnxietyDepressionPlethora of physical ailments
– European Psychologist 2002
Threats to survivalThreats to survival
• Unmanaged Occupational stress
– Burnout– Reduced patient care– Errors, complaints…
– Alcohol and or substance dependence– Suicide
– Loss of a very precious commodity
• BMJ 2009
Threats to survivalThreats to survival
• Fatigue– Impaired decision making– Prolonged reaction time & attention deficit– Memory impairment– “Microsleeps”– Linked to 3% all critical incidents
• An Int Care 2000
Threats to survivalThreats to survival
• Fatigue• All sleep deprived physicians are affected
As little as < 5 hrs in 24 hrs - Perform on average 1.37 SDs rested
Mood changes (depression)
Reduced cognitive function 36% more errors on 24 hour shifts
24hrs awake = 100mg% C2H5OH (limit 80mg%)
Anaes 2003;58:520-525,
NEJM 2004;351:1838-48
““Anaesthetists have higher rate of Anaesthetists have higher rate of accidents c/f physicians”accidents c/f physicians”
• So what can we do about this state of affairs?
AnaesthetistsAnaesthetists
Time is a rare commodity
We all have the same amount of daily time and the choice of what we want to do with it
Our relationship with time should be bad stuff out good stuff in
AnaesthetistsAnaesthetists
• Research requires unstructured time• for free flow of ideas and lateral thinking
• Play “essential activity” for creativity
• Important to protect/nurture:ourselves
– Maintain safe work practices
– J Cont Ed Health Prof 22:2;127-128
Survival GuideSurvival Guide
Aim for a Healthy
“Life – Work Balance”
• No Magic Formula• Individual decision
Survival GuideSurvival Guide
“Life – Work Balance”
• May be viewed in terms of • Happiness OR Meaningfulness• If one is totally fulfilled, enthused and excited by
one’s work the stress thrown in just becomes part of the success and satisfaction of the job
Survival GuideSurvival Guide
• How can we achieve this?
Survival GuideSurvival Guide
• Foster a feeling of “Well-Being”
• A happy Anaesthetist is safe and successful
50% Genetic (no control)• Science 1990
• Review of General Psychiatry 2005
Survival GuideSurvival Guide
50% under your control
• 10% Circumstantial (home/city/family)
• 40% Daily activities & practices
• Science 1990• Review of General Psychiatry 2005
Survival GuideSurvival Guide
• 10% Circumstantial
• Set realistic financial goals– House, suburb, schools…
EtonEton
Survival GuideSurvival Guide• 10% Circumstantial
• Choose a good life partner….
Survival GuideSurvival Guide• 10% Circumstantial
• Choose a suitable place to work
Survival GuideSurvival Guide
• 10% Circumstantial• Avoid the workplace after hours
Survival GuideSurvival Guide
“Well-Being”
40%
Daily activities & practices
Survival GuideSurvival Guide
• 40% Daily Activities & Practices
• Volitional – Setting and achieving attainable short term Goals
• Behavioural – Initiating enjoyable activities
• Cognitive – Reappraisal of one’s situation and good fortune
Survival GuideSurvival Guide
• 40% Daily Activities & Practices
• Volitional
• Set a few easily attainable Goals– What things do you want more time for?– What things use up your time?– What can you cut out?
• Consider some exciting life changes• Think how you can create some free time
Survival GuideSurvival Guide
• 40% Daily Activities & Practices
• Behavioural• Make time for relaxation
• Cut out unimportant meetings• Learn to delegate (Home & Work)
• Practice Cover (Group Practice – share the load)– Secretarial/PA support
• Consider your surgeons/hospitals/committees(Pass on those that drive you insane)
• Prioritise (use down time at work wisely)
Survival GuideSurvival Guide
• Mark Priestley Chair of examiners• ANZCA Bulletin 2011
Survival GuideSurvival Guide
• 40% Daily Activities & Practices
• Behavioural• Be pleasant – make others happy• Diffuse unpleasant circumstances fast• Cut back unfulfilling social activities• Develop close friends & SEE THEM
• Always have something special to look forward to which you enjoy
Survival GuideSurvival Guide
• Behavioural• Lifestyle choices• “Aim” for 7 – 8 hrs Sleep• Melatonin Boost (Bed by 2230)
– Antioxidant, Premature aging, immunity
• Regular aerobic exercise, laughter, sex– Serotonin & Endorphins
• Elevates mood • JESP 2009• A&IC 2011
Survival GuideSurvival Guide
• Behavioural• Engage regularly in activities you enjoy
– Hobbies/Art/Music/Film/Literature/Philosophy
• Play a sport - exercise regularly– improves your memory– Think how happy that friend is on his golf afternoon
• Take regular short holidays• Collegial Group practice – carefree cover
Survival GuideSurvival Guide
• 40% Daily Activities & Practices
• Cognitive
• Maintain an awareness of your successes• Good fortune• Future adventures or plans
Survival GuideSurvival Guide
40% Daily Activities & Practices
Pursue your goals without compromise
The brain runs on fun
Survival Guide Survival Guide
• Retirement preparation
Up to 30% of one’s life
New career
• A time of “Intellectual re-formatting”
• Low autonomy & High demand reversal
Survival GuideSurvival Guide
• “Old age is full of enjoyment if you know how to use it”
• Anaesthetists are “Action people”
• Ample non earning time
• DEVELOP INTERESTS WHILE YOU WORK
• Seneca Moral Epistles AD 65• ASA Newsletter 2003
Take a careful look at your life and work circumstances and act
Survival GuideSurvival Guide
• Achievable Financial Goals• Insure
– Health– Practice– Life
• Legal Affairs– Wills– Trusts
Keep your cool & Get supportKeep your cool & Get support
Survival GuideSurvival Guide
Disasters do happen
• Anaesthetists – Highly intelligent– Problem solvers
• Financial planner
• Life coach
• Psychologist
• Counsellor
Survival GuideSurvival Guide
• Manage StressThis hinges on:– Identifying cause
• Lack of control of working environment• Difficult professional relationships • Work overload• Work unpredictability• Domestic disharmony
Survival GuideSurvival Guide
• Psychological ill health is amenable to change– Improved professional work culture – Inclusion & autonomy– Risk management training– Reduced work hours– Reduced pressure and work overload
• Occ Environ Med 2003
Survival GuideSurvival Guide
“An achievable life enhanced
intellectually and financially by
medicine and not “ruined” by it.”
CognitiveCognitive - Consider your GOOD - Consider your GOOD FORTUNEFORTUNE
Survival SummarySurvival Summary
• Achievable financial goals• Time creation
– Group practice, P/A, Delegate (work & home)– Prioritise down time (reading/agendas…ipad!)– Disengage problematic surgeons, ineffectual meetings,
unfulfilling social activities, fruitless committees…
• Control 50% personality “foster well-being”– Be positive, laugh, elevate your mood– Give yourself permission to enjoy:
• Recreation, Sport, Hobbies, Music, Film…
• A happy Anaesthetist is successful & safe
You've given up your whole life to You've given up your whole life to be the person you are now. Is it be the person you are now. Is it
worth it?worth it?
Richard Bach (1936 - )
Thank youThank you
