Find joy in your job by acknowledging you can’t do it all
Julie P.Katkin, M.D., FAAP and Susan J.Kressly, M.D., FAAP
This is the last article in a four-part series looking at The Quadruple Aim and how pediatricians should be working on practice transformation from the primary
care and specialist perspectives. It is important to keep in mind that implementing
small, sustainable changes over time is what leads to true practice transformation.
Primary care perspective
For the last decade, there has been much talk about the Triple Aim proposed by the
Institute for Healthcare Improvement: improving the patient experience of care (including
quality and satisfaction), improving the health of populations and reducing the per
capita cost of health care.
Many pediatric practices addressing these issues are finding success by using the
medical home model. Through the process, pediatricians are reporting additional benefits,
including addressing the fourth goal of the Quadruple Aim: improving the work life
of clinicians and staff.
As change accelerates in all aspects of our lives, attention is being directed to
the benefits of finding meaning in your work. Efforts to date have focused on hospital
systems, with one report showing that improving employee satisfaction was associated
with increased patient satisfaction and loyalty as well as improved care quality (http://bit.ly/2sjUldc).
What does this have to do with your practice?
Most health care professionals are drawn to their work out of a desire to make a meaningful
difference in the lives they touch. Pediatricians need to assess how best to structure
their practice teams to allow everyone to feel value and joy in what they do without
feeling a burden to “do it all” at the expense of having a relationship with the patient.
Key considerations include:
working with community partners,
reflecting on what matters and
Much of physician burnout has been attributed to a perception of lack of control.
How can pediatricians “own” what they do in a way that is satisfying? Is there a way
to concede control for a portion of what we do but work to control the relationship
with the family where we add incredible value?
In a 2001 survey of a national sample of 5,704 pediatricians, it was notable that
a higher percentage of pediatric subspecialists reported burnout (67%) than did their
general pediatric peers (52%) (Shugerman R, et al. Pediatrics. 2001;e108). Factors contributing to burnout included longer hours, more time in the
hospital and care of more complex patients.
Interestingly, the 2013 Pediatrician Life and Career Experience Study that analyzed
career satisfaction in newly graduated and early career pediatricians (up to 11 years
out of training) showed that general pediatricians were more likely to feel burnout
than their subspecialty peers (Starmer AJ, et al. Pediatrics. 2016;137:e20153183).
The differences between these two groups of respondents may reflect the greater burden
of family commitments among the younger physicians sampled, a greater burden of academic
commitments among established subspecialists or changes in practice styles and expectations
over the 12 intervening years.
What is clear from both studies is that we all suffer from some degree of work-related
exhaustion and loss of enthusiasm.
Subspecialists often work with complex patients, juggling medical, social and financial
constraints to provide the best possible care. We order complex tests that require
follow-up and documentation. As payment rates continue to fall, we are asked to see
more patients in less time.
Increasingly, we are asked to explain results or answer questions from families through
the electronic medical record. We also are required to review and reorder equipment,
supplies and nursing services. Many of these activities are not billable, effectively
comprising unpaid patient care.
Research funding is increasingly difficult to acquire, especially early in one’s career.
Educational pursuits are almost never funded outside of one’s salary, but pressure
to increase clinical activities that do generate revenue can severely restrict the
time one has to teach, either locally or in wider settings. Administrative support
is dwindling or absent in many offices.
All of these conditions lead to chronic dissatisfaction for many subspecialists. They
also discourage young physicians from entering our fields, even when they have high
levels of interest.
What can we do maintain our joy in our jobs?
First, we should recognize that most of us cannot do everything. Identify your strengths
and interests. Are you happiest teaching, in the lab, performing clinical research
or tackling quality improvement? Many medical schools are establishing promotion paths
to allow physicians to focus and excel in their areas of interest. Check your institution’s
requirements and advocate for this type of pathway, if one is not already available.
Additionally, stay in contact with your professional peers. Attend national meetings,
participate in professional societies and network with others who share your clinical
or research interests. In these settings, we can advocate for ourselves and help define
respectable levels of clinical and academic support needed to excel in and enjoy our
Finally, use your vacation time — all of it. You earned it! Many of us don’t use our
allotted days, or if we do, we don’t separate ourselves from our work during the time
off. Get some uninterrupted time with family and friends; travel, relax, volunteer
or participate in whatever pursuits will help to rejuvenate your sense of purpose
when you return.
Drs. Katkin and Kressly are members of the AAP Task Force on Pediatric Practice Change.