Don't Commit to Overcommit

The Hospitalist. 2007 April;2007(04):

April 1, 2007 | The Hospitalist

“Things sound really good on paper,” she says. “The reality is, the intensity of work is high, and sometimes you forget about that when you’re creating schedules. You might have set yourself up for three overnight shifts in order to compress work hours and expand off-time, and by the end of the second shift, you are really tired.”

Another factor is that employers expect hospitalists to see patients until the end of their shifts, and that’s when the off the clock paperwork occurs. A 40-hour workweek can easily balloon into 50 hours or more.

Physicians may also neglect to build in the emotional toll of their jobs when blocking in future schedules. “Medicine is stressful,” comments Sylvia C.W. McKean, MD, FACP, medical director, Brigham and Women’s Hospital/Faulkner Hospitalist Service in Boston. “It’s stressful to see people suffer and to deal with families who are stressed and sometimes not perfectly functional.”

In addition, she says, “Excellence in teaching and excellence in patient care require communication, and communication takes time. If physicians are up all night taking calls and then working all day so that there is continuity in patient care, you have to grapple with the issue of physician fatigue.”

Triage What’s Important

Most of the hospitalists interviewed for this article advised other hospitalists to learn to effectively weigh the risks and rewards of taking on new commitments. Here are some techniques suggested for stemming overcommitment and avoiding potential burnout:

Dr. Hovan has taken on roles that, in isolation, could be accomplished effectively, but which, when combined with his other responsibilities, became diluted. “There comes a point,” he says, “where you really have to triage what is most vital and most important and say no [to some offers].” He points to the Mayo Clinic’s triple shields logo—“Patient Care, Education and Research”—as a test for his decisions about whether to accept invitations to lecture, to do research projects, or to provide education to residents from another program. “Patient care comes first,” he avers. “Any other commitment must be consistent with the advancement of patient care. That simplifies decisions.”
Dr. Dallas emphasizes synchronization of appointment books. Her pocket PC device is connected with her Outlook calendar so that entries update in real time. To prevent double booking, she advises blocking in social and family commitments, and she advises turning down committee meetings while on shift.
“A hospitalist shift trumps everything, and it’s useless to show up knowing you’ll get paged out of the meeting in two minutes. This frazzles and disrupts you—why do that to yourself?” She also inserts small blocks of travel time between appointments, especially if she is going to another building on the hospital campus, to avoid being late to important meetings.

Dr. Baudendistel believes it is important to have well thought-out reasons when declining project invitations. A young hospitalist can leave the door open while saying no, he advises, by having a Plan B ready. In that way, a hospitalist can explain that the current offer may not be in his or her bailiwick—but that the idea is appealing—and can offer an alternative scenario. It’s crucial, especially early in one’s career, he maintains, that “you project a willingness to participate without foreclosing all options.”
Dr. McKean urges hospitalists to set goals within a three-year framework. “It’s very easy to just say ‘yes’ to everything and then become overwhelmed, working extremely hard, just to stay afloat. But if you instead have a three-year plan, then when you’re asked to do something, you can consciously say to yourself, ‘Is this in accordance with my plan? Is this going to make it easier for me to get to that three-year goal?’ ”—GH