Chief Wellness Officers are administrative leaders tasked with ensuring that organizational culture and executive leadership align to produce a healthy practice of medicine for those tasked with working in the clinical environment. That is a complicated way to say they are supposed to help doctors either like their work more or resent it less.
Structural incentives are important in helping attract qualified physicians. Determining how physician output is measured is critical to creating a specific institutional culture. Is your institution extractive, maximizing productivity at the expense of high turnover and low job satisfaction?
Alternately, is your institution geared toward long-term retention of talented physicians by accounting for entirely predictable life cycle events when determining clinical workload to positively impact career satisfaction.
With that in mind, I thought it might be fascinating to see if a few lessons about creating proper incentives might be gleaned from the 22 current interviews in the Docs Who Cut Back series.
Humans Tend To Mate And Reproduce
Without reviewing the biology of sexual reproduction, humans are surprisingly similar to other species in that we are designed to transmit our genes to the following generation. Strangely, medical culture seldom factors in our biological drive.
What? You're pregnant? Who could possibly have seen that one coming?
As we learned from Dr. Krygowski in her interview, pregnancy creates this desire to spend time nurturing newborn offspring. She felt conflicted about deferring fellowship for one year in order to nurture her newborn, but ultimately decided parental investment in nurturing offspring was a priority.
She was similar to Dr. Baker, who experienced a shift in priorities following a health crisis that caused her to focus on maximizing time with her young daughter.
Wanting to parent well and make time to be present for kids is not solely the domain of females. There was a time in my career when I felt like an airbnb tenant renting one side of a bed who incidentally ran into the home's other occupants - my wife and kids - in the kitchen. I grew significantly happier attending basketball games, volunteering in the classroom, and most recently supplementing distance learning during COVID.
Flexibility Can Matter As Much As Income
New physicians are often young and hungry - many are looking to pay off debt or save up for the down payment on a house. But it would be a mistake to regard them as monolithic in their experience and desires.
Dr. ATC was on an upward academic trajectory when motherhood intervened. She made multiple course corrections - giving up a moonlighting gig, reducing her clinical workload at the academic medical center where she had her appointment down to 0.6 FTE, and still she felt unable to be present at home to the extent she knew was right.
Despite enjoying her academic career, she ultimately carved out a professional life at a community hospital that was able to offer her the flexibility she needed in order to optimize her home life.
As more medical practices adopt flexible scheduling as an organizational tenet, they are finding greater success in recruiting and retaining quality female physicians. Interestingly, large groups offering flexible employee positions have made the greatest inroads with the younger generation of female physicians, as I'd noted in a prior post.
The upshot is that financial remuneration is only one element of an employment package. In some cases it may not be the most heavily weighted. Those practices most willing to embrace innovative thinking may well end up with the lion's share of talent without incurring additional financial expense.
Docs Who Prioritize Wellness Remain Outliers In Medicine
When Dr. Craig announced she was cutting back in her busy OB/GYN practice, one supportive colleague offered to advocate for rehiring her when she came "crawling back." Another patronizingly explained, "It isn't that you can't do this, it is that you don't want to."
Medicine has supported a culture where the psychiatric condition known as folie a deux has scaled so successfully that the profession as a whole has developed a shared delusion that work should come before all other priorities. When we accept jobs that erode at the stability of our marriages or render us strangers to our children, we become complicit in this delusion.
Perhaps a well-respected Chief Wellness Officer can develop a culture where tailoring workload to long-term health is accepted rather than stigmatized.
I suspect that the next generation of physicians, embodied by bold voices like the blog Reflections Of A Millennial Doctor, will eventually demand flexibility to the point that it will reduce our professional pathology.