Okay. I think we're going to get started. Welcome. We are really excited to be here, to be able to speak with everybody, to exchange ideas, you know, and to discuss plans in which we can find this elusive work-life balance. My name is Erica Trovato. I am Associate Chief Medical Officer at Burke Rehabilitation in White Plains, New York. I am a brain injury physiatrist, and I'm the program director there for the fellowship. I'm joined today by Dr. Monica Rodruzco-Gutierrez. She is from, I'm sorry, she's chair and professor at UT Health, San Antonio. We have Victoria Whitehair, who is the director of the Division of Neurological Rehab and vice chair of PM&R at Metro Health Rehab Institute. And we also have Kristin Wong, who is associate program director of the PM&R Residency Program and director of Inpatient Consults at Delce and Medical Center in Austin, Texas. These are our disclosures. So the objectives of this session today are to identify common challenges faced by women in medicine when it comes between personal and professional aspirations. We're also hoping to help gain insight into experiences of other women in medicine seeking balance, and to develop an action plan to implement changes in personal and professional life to improve work-life balance. How we all kind of came together happened pretty organically from just discussions at other conferences that we felt like there was a gap in addressing this issue and this theme in academic medicine. Several of us also worked together and we got to know one another through PAL, which is the Program for Academic Leadership through AAP. And so we've been really working together to kind of explore this issue and to really not just make this a session where we're complaining or anything along those lines, but really to really empower one another and to learn from one another and to come up with ideas on how we can find some sort of balance so that we can continue to pursue academic medicine. What we do recognize and where I think a lot of our discussions really started from was the different roles that we have as women. All of us have different hats and we wear them oftentimes simultaneously. And so you're never really just holding one hat or wearing one hat. And so what we wanted to start off by doing was really having you self-reflect on what roles do you as an individual have? What are your roles during the day, during the nighttime? Are you a mom? Are you a wife? Are you a husband? Are you a daughter? Anything along those lines. So what we'd like to ask you to do is to scan the QR code and start putting in what you identify yourself with, with what your different roles are. And we'll give you a couple of minutes to do that. There's also that sheet of paper that we distributed. And if you want to, you can write them down for yourself. And so it's sometimes important to be reminded in black and white what it is, all the different roles that we hold. It does look great, we're going to share this with you in a minute. Yeah, we'll get it. Yep, that's what we're gonna do. Okay, so what we have here is it's a huge word cloud and I'm gonna be excited when it is up to share it with everybody, but some of the responses that we're seeing are sibling, person, lifestyle doc, son, cyclist, pet, caregiver, adventurer, traveler, house owner, creator, crocheter, buff, co-chair, brother, all of these different roles and I love this because it's really just spanning everything that we enjoy professionally, personally, and basically all of the different roles that we identify with. And sometimes it feels like we can lose sight of that and that's why we felt like it would be really validating to enter that and then also, you know, if you have your sheet of paper and you want to write it down, it's also a good reminder sometimes of all the different roles that we have. I can advance the slides. So this is what we were seeing. These are all the roles that everyone was putting in, and this is the word cloud. So we see a lot of friend, we see a lot more daughter, sister, wife, physician, but it's really just a beautiful compilation of everyone in the room, and all of the roles that people identify with. Okay, so how did we get to where we are today? Let's really dig down and think about how women as physicians have really cultivated where we are today, and the pioneers that have really gotten us here. So all of us know, I'm sure, of Elizabeth Blackwell, the first female physician, who had received her medical degree back in 1849. Subsequent to that was when Dr. Rebecca Lee Crumpler had obtained her medical degree. She was the first African American woman to obtain her medical degree. And through history, right, whether it was in the US military, whether it was due to social unjust and change, especially in the 1970s with everything that happened with Title IX, feminism, attorney general position, and then with the recognition in 2014 by the AAMC, really kind of saying, okay, now it's time that we have to really address women and strategies to support women in academic medicine, just in medicine in general. What was very staggering to us as we were putting together this presentation was a recent report, which I'm sure most of you saw, if not probably on your social media fields, was the Surgeon General's advisory highlighting stressors that impact women in medicine and parents, and basically saying that we need to really take a look at what we are expecting our parents to give and for our caregivers as well. I think that's also important, just as a side note, when we consider our patients and our caregivers, understanding what their roles are and how that impacts our patients' care. But taking this all the way back from 1849 and thinking about where we are as women in medicine and what roles we have and how they have really changed over time. So what happens when we are now deciding that we wanna become a physician? What do the numbers actually look like? So what's interesting is that when we start out as applying for medical school, there's about a 50% proportion of women in academic medicine. When we go into graduation, there's about 52%. Residency, about 48%, so about a 50-50 slide there. 45% of the numbers of women in academic medicine when you become a full-time faculty. So when you come out of residency training and you start as an attending physician. But something happens. There are obviously a huge change in the numbers when you go from full-time faculty to full professors. And then looking at the subsequent higher administrative roles that women actually have a spot in. Whether that's senior associate deans, in your higher level positions in colleges of medicine, also in healthcare system leaders. There is a significant drop and what happens? So when I think about it, I think about, if you go the very traditional route, you end up being an attending physician usually in your late 20s, early 30s, right? There's a lot of sacrifice that goes into that, right? My least favorite question during an interview was what do you do for fun when you're not at work? I didn't know, I didn't have hobbies or things that I was interested in because my main focus was always in medicine. And along those lines, we sacrifice so much towards the professional part of our career that when we are actually in a position where we financially can afford to look outside and develop different relationships and when we're able to maybe think about milestones that we wanna buy a home or travel and things along those lines. It's at the same exact time point where you have to start thinking about publications. You have to start thinking about committees. You have to start thinking about all of these different types of activities because you also have the pressures from the professional side. You're entering into your early phase of your career. There's a huge learning curve that happens. And so there's so much going on professionally as well as personally and it's really hard to find the balance and that usually starts from the very, very beginning in medicine. When we look at the data, we see that there is a huge divide between men and women when we talk about these higher order administrative positions. So if we look by division and section chiefs by gender between 2013 and 2023, look at the differences between men and women. And although over time we do see some improvements, we go from 24% up to 34% being women, that's still a huge divide. Yes? Is that KMNR specific or is that across? This is across all of medicine, yeah. All medical subspecialties. But we're gonna get into KMNR in just a second. So if we look at this also by department chairs across medicine between 2013 and 2023, again, you see that there is this huge divide and yes, there is seeming to be a closening of the men and women. However, there is still much work to be done in regards to getting back to where as applicants we were more of a 50-50 percentage and now we see this big divide happening. When we look at the literature in regards to trends specifically in KMNR, we're really not all that different. We also see where there is a large divide where we start actually 50-50 between men and women in regards to assistant professors, right? So you start as an assistant professor, typically you would go to associate professor and then full professor. So we start out with 50-50 and then as we advance up to full professorship, we see only 30% of women are advancing to that position. Likewise, if you look at disparities between racial and ethnic groups, these are also quite historical over time and women aren't necessarily always the only group to see increasing disparity with rising academic rank. And we also see that there are similar trends among non-white ethnicities and races. This is also very, what we're finding out now that this is also very prevalent in salary, right? So I think one of the best things that I've seen recently is that there's more transparency at the department level in regards to salary for physicians, which is really making it known what your male or female counterparts are making in regards to salary because there's data that suggests that just based on your gender, you are as a female paid less. So there's some data to suggest 8% less as a woman and then there's also comparisons between academic rank. And so a male at the associate professor level is making the same as a female at the full professor level. So this is just a nice cartoon to kind of show how the barriers are there. They're there from when we're young. The barriers persist no matter what. Society tells us one thing and then the reality is something quite different. So what we're gonna be talking about and what we've highlighted thus far is nothing new, right? We know from almost 10 years ago actually that there are these disparities between men and women. There is gender inequity. We see this in the rise of DEI. We see this in the rise of the Surgeon General putting it on the cover of their magazine. So we know that others know about this. And a lot of what has been proposed is really reaching out and noticing and educating chairs or people in the higher positions to be aware of these biases and making them aware of strategies and ways that we can promote women in these different positions. Don't put them in necessarily committee positions or things that aren't gonna help them advance in regards to their academic career. So at this point, I'm gonna pass this to Kristen who's gonna talk about work-life balance. Thanks, Erika. All right, so thanks everyone for being here. And we saw earlier that big word cloud with all the roles that we play and have and all the hats that we hold. And so knowing that we each have all of these roles, is this idea of work-life balance really just a myth? Is this even something that's possible for any of us to achieve? So what exactly is work-life balance? So work-life balance can be defined as being engaged in life roles, feeling competent and satisfied, and aligning with personal values. Work-life balance is a comfortable relationship between work and other important aspects of life such as family, relationships, social life, and time for oneself. It involves managing time spent at work and outside of work. And a good work-life balance involves minimizing work-related stress and establishing a sustainable way to work while maintaining health and well-being. So the definition seems rather simple, but for working professionals everywhere, we struggle to define it for ourselves, let alone achieve it. All right, so we might try to attempt this again, if not, we'll just wing it. But for many of us, when we hear work-life balance, we start thinking of all the barriers and the reasons why we can't achieve it. So we'd like to hear from you guys what barriers come to your mind, and maybe this will be a little bit of a vent session, but we'll kind of get your input and see what we get here. Oh, here we go, awesome. Thank you so much. Time, time's a big one, yes. Never enough time. And obviously, the bigger the word, that means more people are responding with that answer. Work expectations. Obligations, administrative responsibilities. So there's a ton. All right. So I'll move on to the next. We can revisit this a little bit later, too. You can keep filling things in. So let's talk about a little bit more myths. But first, it turns out that the Dilbert comics actually hold the secrets to work-life balance. A little bit of backstory. I don't know if everyone's familiar with these comics, but Wally, Wally the character here who's making most of these comments here, he's the lazy guy in the group. He does pretty much no work and is paid about the same as everyone else. He's a rich guy and he still comes to work, though, just because he doesn't know how to make his own coffee. So maybe some people know someone similar to Wally, but Wally says that the secret to having a rewarding work-life balance is to have no life. Then it's easy to keep things balanced by doing no work. So simple and it's genius. It was just hiding in plain sight. So balance means equal? No, that's definitely a myth. People incorrectly assume that work-life balance means that the amount of time and energy we spend on work needs to be equal to the amount of time and energy we spend on life. Work-life balance is not a 50-50 split. It's not a one-size-fits-all equation. It's shaped by personal circumstances, aspirations, and individual definitions of fulfillment. Okay, so Cat Burt in the Dilbert comic series, he's the evil director of human resources. So in this meeting, Cat Burt says, we're no longer using the term work-life balance because it implies that your life is important. Now we call it work-life integration. So it's easier to make you work when you would prefer being with loved ones. And I'd like to give a big thanks to those of you who never had a life. It does feel that way sometimes, doesn't it? So is it up to your employer to give you work-life balance? No, that's definitely a myth. Balance doesn't just happen by accident and it's not given to you. Balance is not something you find, it's something you have to create. You have to create that delicate balance between going after your dreams without having everything fall apart, including yourself. You can have it all. Sorry to say, this is also a myth. So the goal of work-life balance is not so that you can have it all. And really, having it all is truly just not possible. We have limited resources like time, energy, money. The graphics shown here shows this idea of a supermom. So a supermom is the archetypal woman who seems to do it all and have it all. She's effortlessly both a successful career woman and a housewife. So this concept of the supermom has led to what's called the supermom syndrome, which is a belief that a mother should be able to do everything for everyone in her life while neglecting her own needs. Similarly, for those of us who are not moms like myself, there's human giver syndrome, which is the concept that some people, aka human givers, which are many times women, are conditioned to believe that they have a moral obligation to fulfill the needs of others, other human beings, at the expense of their own needs. So supermom syndrome and human giver syndrome can lead to unnecessary guilt when you can't get everything done perfectly. Societal pressures on working women to be supermoms and human givers and applauding women who appear to do it all can actually be very damaging. Recent studies have actually shown that those who suffer from supermom syndrome may actually be more depressed, and burnout consistently afflicts a greater percentage of women physiatrists and women physicians overall compared to men. So while on the one hand, we wanna lean into our work and we wanna be leaders, just like Sheryl Sandberg and Bernie Brown have said, and they've empowered us to do so, but because of all these roles that we have to play simultaneously, sometimes it's important maybe just to take the advice of Allie Wong from her Netflix comedy special, and it's okay if you just wanna lie down sometimes. So I'm gonna hand it off to Dr. Gutierrez. All right, I do get the fun part, right, talking about burnout. And so we know, we've seen kind of what are the numbers, and we look at, this is from a Medscape survey, and it shows like what is the percent, where is physical medicine and rehab in this Medscape survey, and it was like 47% of PM&R doctors. This one was in the last one that came out. So okay, it's not the second highest on the list, like it's been before the third highest on the list, but 47% is still really a high percentage. And also like Kristen brought up, is it more men or is it more women? And yes, it's often across the board, more women who are having burnout. So what do we know about what is happening with burnout? So this was something that is like what happened during the pandemic. The pandemic also made it worse and made everything worse. And what were we doing during the pandemic more than just being clinicians? And we were doing all those other roles that we put up at the beginning. And yeah, some of those roles were fun, but some of them, being a family member, a daughter, and making sure your patients were, I mean, making sure your parents were okay and being safe during the pandemic and getting their vaccines and staying away from their friends and those types of things and being a mom. And I'm lucky my kids are older and I didn't have to sit with them so that they can do like kinder online because they're not in kinder. They were old enough to be able to do their own work. So, and then just the pressures of everything that happened. We saw a lot of changes in burnout and satisfaction during the pandemic. And so what else have we looked at with burnout? This is another one of my, or this one is a paper where we looked at what specifically looking at compensation and debt and how that affects stress and burnout. And again, looking at women physiatrists and so we thankfully had 245 women who are willing to do 50 questions and almost 90% had debt. And also they felt that most, if they felt like their work was part of the professional mission, they felt like they would have less burnout and also felt that being undervalued at work was part of their burnout symptoms. The other thing, who had the greatest debt? If you're a black woman physiatrist, fewer years out of training. If you're a practicing general physiatry, if you had inpatient and outpatient responsibilities and this also lent itself. So it was a combination of you had more debt and then you felt like, or you were compensated less than those are the ones who had the most burnout. So it isn't great because a lot of the times women are the ones who are compensated less and you can see there's so much, so, so, so much debt right now. So that combination is not good for burnout as well. This is just kind of what the tables are showing. So there is a tri-organizational project. So AAPMNR, AAP, ABPMNR and we came together and we put our funds together and we had a committee with different members from each of the organizations and we worked with Tate Shannonfelt who's a big guru wellness guy and did a survey of thousands of physiatrists. And so what was the burnout percentage there? It was about 42% of physiatrists who responded and we had a very decent, very, very good response rate even though it wasn't a huge percentage but it's kind of very much aligns with the other surveys that they've done. And so in around 40, 42% and so what was independent drivers of actually having well-being? And it was like for each one of these things that if you controlled for one thing and then if you had one or more and more things then you were more likely to have professional satisfaction. So you can see the list there. Like do you have control over your schedule? Do you feel like you integrate physiatry into your clinical practice? Are you aligned your personal alignments or are your personal values aligned with your organizational values? And do you feel like you're doing meaningful physiatry work? So those are something that really you have to take with you when you have your job. We talked a little bit about healthcare worker burnout and how this was deemed by Dr. Vivek Murthy who's our US Surgeon General as being part of the crisis in healthcare right now. So like I said, COVID pandemic brought out a lot of stress. It brought out a lot more burnout and it is going to impact the care that we give others if we keep on practicing as being burnt out. And so they were saying cause is a burnout. It's not us, we shouldn't blame us. There's usually the systems that we work in. Our workloads, our scheduling, feeling like we don't have support. Definitely a lot more demand than there is supply and needing primary care physicians and also health workers, again, impacting more women and women of color being really impacted by healthcare worker burnout. All right, thank you. All right, hi everybody. We are going to move into a little bit of a different topic now. So we've been talking about the challenges facing us but now we're gonna transition more to actions and solutions. And of course, you know, Dougbert has some really great words to say for us here. You know, welcome to Dougbert's seminar on work-life balance. First, review this list of your priorities. You can take a look at those right there. You have time for three things, work and holidays are two. Please pick the third, right? So I think we do feel that way sometimes. Okay, we're gonna come back around to the barriers. So we had you guys all add things to that big, beautiful word cloud earlier but now this is where you guys are gonna have to do a little bit of work for yourself and that's why those papers are around there. So if you didn't get one, look around. There should be some more around or if you are online, feel free to pull out a notebook. But what we want you to do is really take a moment, think about what are your top three perceived barriers to finding balance and jot those down for yourself. You can do more than three. Are they time constraints? A lot of people had that one. Are they expectations? We saw responsibilities up there, too many roles, limited control over schedule. You know, what are your barriers? So just take a few minutes here. Might be able to pull up that other one. Do you mind pulling up that last one? Thanks. If you need to steal from other people. All right, I see a lot of heads starting to come up. You get to take the paper home, so if you didn't get to finish, feel free to work on it later as well. And we're gonna do some more action now. So we're gonna actually move into a breakout session. What we want you to talk about for this one is to list and discuss ways to improve your time at work. You can consider ideas like remote work, hours, shifts, coverage, telehealth, you know, whatever it is that might improve your time at work. Feel free to kind of play around the edges of this. You know, are there other ideas you can think of? What's worked for you? What are you curious to learn more about? So we are gonna have you guys kind of form into little groups. Just kind of, you know, maybe turn around, find the people around you. These can be smaller, these can be bigger. We have some big notepads that we'll kind of bring around. But feel free to have somebody just write on a piece of paper. If you are at home, you know, take a few minutes and work on this for yourself as well. And then as you guys are talking, I mean, definitely have somebody be a scribe. You know, get a person to stand up and be the scribe. And then we'd love to have you guys share afterwards. So if the scribe or somebody else is willing to be a speaker, we'd love to talk about it as a group. So you guys have about 10 to 15 minutes to do this. So go ahead, turn around, move your bodies, and make some groups. We'll be walking around to help you with this. And we'll leave, oh, wait. Can you come off of that one and go back to the slides? There you go. Thank you for watching! I hate to pull you guys out of your small groups. It sounds like there were some really good conversations happening, although don't move. Do we have any wonderful volunteer groups who'd like to share a few of the things that came up? We have some microphones that'll be walking around the room. Great, we've got a group over here. Okay, we put ability to say no. Okay, okay. We said ability to say no and set boundaries, leaning on others, going outside and grounding yourself, having non-negotiables, and encouraging a culture of positivity. So we talked about that we have to make sleep a priority and not just something that's left over to do at the end of the day when nothing else, when everything else was done and that we had to make it more of a priority and then to kind of do something just for ourselves once in a while and make a point of doing that. We spoke a bit about relying on your support system and your community and how it's okay to rely on the multi-generational household, especially a few of us have our families nearby and so it's okay to ask for help. You don't have to be able to do it all all by yourself if you want to have that balance of work-life balance. That's so great because we're conditioned almost to not ask for help. So when you become comfortable with that and really knowing when it is that you reach that point, it's quite empowering. And I think it also shows others then that it's okay to ask for help too. Anybody else? So kind of along those lines, we talked about delegation. So if they're chores, cleaning the house, cooking, all those types of things, if we can hire help and put money for time, that can be worth it as well, which I think can also go along the lines of asking for help. The other thing I mentioned as well is perfectionism. So something that I didn't even realize I was doing, but my boss and mentor always says don't let great get in the way of good and he tells me that all the time and sometimes it's strategic. He notices I'm doing something and I realize I've gotten so many things going because I of waiting to have the time to do all of the planning I want to do to make it happen. We've got people online, so yeah. Okay, just a couple more that weren't already repeated. One is to deal with decision fatigue. One of our group members recommended having a mutually agreed upon predetermined list of, for example, places to go out and eat or places they're going to do their shopping at, places they're going to travel, and just pulling from a jar. So that's one less decision in the day you have to make. Another thing this person brought up, but a lot of people get burnout from the insurance and the prior auth part of medicine to learning early on to become efficient in that part so you can spend more time on the parts of medicine that bring you joy. I love that you brought up decision fatigue because that really is pervasive into all aspects of life, whether you have to pick out a lighting fixture for your home or if you have to decide on an outfit for your kid for a family photo. You could end up spending hours and then you've wasted all the time, you can't make the decision, and you feel really discouraged. So I think that those ideas about decision fatigue and how to get around it I think could be really, really powerful. So thank you. All right, thanks for that. The next question, it sounds like a lot of you guys already talked about this one. So I'll say what it is and then we'll talk about some instructions. So this next one, we want you to list and discuss ideas to improve life outside of work. And it sounds like you guys already started that discussion, which is great. That means that you're already integrating these ideas. So we want you to think about things like technology, family, we heard in there, hiring help, community resources, whatever it might be. How can you build a fulfilling life outside of work? What are some strategies to maximize life outside work? Can you prioritize your own self-care? And you can consider everything we have up there and more. So I guess I'd say if you guys focused more on this in your discussion, maybe flip and talk about some actual in-work things. And if you talked about in-work things, flip and talk about this. And we'll come back to a large group again after that. So just share away whatever it is. All right, go for it. All right, you guys feeling ready to share again? I don't know if this is social time or not, but I'm cool either way. We'll call this work-life balance, right? Social time during a session also. So whatever you're talking about, awesome. We hope you connected with people. All right, who has another thing they wanted to share? It could be on either of the two topics at this point. Here's one, yeah. So we talked about finding things and knowing the difference between something that is numbing versus something that is helpful. So there's lots of things we do, like all of us scrolling on our phones, that are numbing and help reduce the stress of the moment, but don't actually make you feel better after you are done. So knowing the difference and knowing when you just need to rest and you're numb is fine versus when you're like, I'm stuck in a cycle and I need to do things that actually make me feel better. So knowing that difference. We have one over here. So one thing that we talked about was the use of artificial intelligence. And something that I like to do is use chat GPT and say, you know, I have this much time, make it as productive as possible. These are my tasks. Tell me what I should eat to give me the most energy. And it has like a whole meal plan, schedule for you, and it's really, really helpful and makes you just that much more productive and efficient. You're in really good company. So Monica is like an AI chat GPT queen. We were just talking about that up here too. So you're in very good company because you're doing what she's doing. That's amazing. So we talked about a couple of different things that you could integrate to help kind of maximize this life outside of work. Things like going outside, seeing your friends. Very importantly in all caps, we have pets, which are very cute and fun. Prescheduling your time with people, maintaining boundaries between work and outside activities. And then something that I like to do is especially when it comes to traffic, because I feel like time lost between transitions is a really big thing. So I will prepack my car with my gym clothes or if I have something directly after work. So that way I don't lose 20 to 40 minutes in that little transition. I get to spend more time with people that I care about. And it takes a couple of minutes, but it saves so much more in the whole grand scheme of things. That's great. Thank you. Anybody else want to share? We also talked about prioritizing our own time, whether early in the morning or late at night. Whether waking up to exercise before kids are up or at the end of the day, reading a good book till we fall asleep and kind of having those books. Awesome. Thank you, guys. Those are some really great ideas. We were all talking about how we were taking notes on the things that you shared, too, and we're glad it's recorded so that we can look at them again later. So thank you, guys, for that. So you saw this earlier, right? The idea that balance is not something you find, it's something you create. And that's really one of the big takeaways that we want you to take from this. As Erica said earlier, this is not supposed to be a complaint session. This is supposed to be about how can we actively make things better for us? How can we make that balance for ourselves in whatever way it looks? So one more exercise that — well, we have a few more, but here's another exercise that you guys could consider. For those of you who have sheets in the room, there's actually a blank sheet of this on the back page. It's in the slides that are online. And it's the idea of a way to evaluate your current state. So here we have a chart of my day. This is an actual activity I did a few years ago. Don't judge me for anything on or off of it. But I was looking at how am I spending my time. And I had to do two different charts here. You may be able to do one, but I had to do a busy times at work and a less busy times at work. I was pretty disappointed by what this looked like. And it'll look different for everybody. But essentially what you do with this is — for those who have the sheets, you just write down what are the major things that you spend your time doing during the day and make a list of that. And think about how much time do I actually spend on this and then put it into a pie chart. Some people call this a time audit. So if you're wanting to look for more tools online, you can look up time audit also. Then you need to review it, though. Does this match what you actually want your day to look like? Does it match your priorities? Do you need to make any revisions? Are you missing any full categories? For me, I did have some things I was missing. Exercise went away when I was busy. Completely went away. I didn't even have a social friends category on here. And sleep and family were losing out when work was getting busier. I didn't like that. So then you draw your ideal state. And so for that, I had to pick, well, where do I want to start? And for me, I actually started with sleep. I need seven hours of sleep. That's me. That's not everybody. I need seven. I need seven hours. I wanted to prioritize time with family, so I built that in as three. Needed to add a social category. And then I wanted my priority to be regular exercise. I definitely do not exercise an hour every day, even though I should as a physiatrist. But you put this in here as your ideal, and then what comes out is work at the end. Does my day always look like this? Absolutely not. But it made me take a moment to really think about what are my priorities, and what can I actively do to try to change that? Work does come first sometimes, obviously, but how can I take action there? So try this for yourself. See what it looks like, and make some plans. And along with that, we do also have on the sheet here today, develop your own action plan. So this could be from using ideas from the group or your own ideas. We want you to begin to identify a few actions that you can take to begin to craft your own sense of balance. And so for those who are online, the prompt is, I will take these three action steps to promote balance in my life. We were thinking of having you guys do this here, but we do want to leave some time at the end for discussion. So we'll send you out with these sheets and those online. Make sure to jot that down, or you can do it while we're all talking here in the room. And we didn't have the barriers one, did we? Do we have that? I don't know. I think we missed that one. But there's also on there the three barriers. I can't remember if we did that. But if we didn't do that activity, write your three barriers also, or however many it is. Oh, we did do it. Never mind. Okay. Okay. So that's us. That's our contact information by email. But we want to take a few minutes here, because this was a nice discussion. So what other questions do you guys have, either for us or for each other in the room? Or if you just have more things you didn't get to say that you want to share, now's the time. So, one of the things that I've always kind of objected to is when we don't have work-life balance, it's always kind of put on us that it's our problem and it's our responsibility to figure out something to do about it. And where does the employer fit into this picture? It benefits the employer not to have burned out workers or to have workers who are working for them that are just miserable being there because you'll get more productive workers. So, what is their role into helping us do this? What is the role of combined advocacy so that we get people to speak up for us? From my experience, the only thing that really works to get administrators or hospitals to hear is if you put it in dollars and cents, and that's the only thing they'll listen to, which to me is kind of, that goes against my own ethical beliefs about how a business should be run because I want to take care of patients and do what's best for patients and that's my priority. So, I just want to know if anybody has comments on that or how they feel about that situation. Like why is it our problem or my problem as a woman? All right, I'll start. Okay, this one works then. I do have, I was interested, it was interesting to see because when people talked about like what can they do inside of work and then no one chose the things that were like actually like oh, remote work and get a job share and those types of things, which are really, like you said, that's sometimes not in your control and again, if you don't have that kind of autonomy, then you are going to have more burnout and more dissatisfaction at work. And I also looked at that, myself being a chair and a boss, saying like that sometimes really the institute does really kind of guide those things and so I said, well, what are ways... You're right. Put it into, I think, efficiency, dollars and cents. You know, at one point in my career, I could become a lot more efficient in certain clinics and that gave me more time for academic time so I didn't have to have clinic ten half days a week because I was super efficient with a good team that was helping me do procedures and so I could do it in six half days and then have more time to be a program director and everything else. So how can you make your practice more efficient? How can you show... You know, currently having... I'm looking for pediatric physiatrists, by the way, and some of it was the system problem. Like sure, there might be work for one-ish person, but you're going to run that person to the ground and so also having to go to your institute and saying it's going to cost you more money if you're always having to recruit someone, recruit someone, and lose someone and then burn other people out who are having to cover that person when you don't have a person. So those are just some of my thoughts, but be creative. Don't be afraid as women to talk about money and RVUs and different ways to practice and getting support so you can be more efficient in your work. And you can get the dollars a lot of the time on what that cost is to replace somebody at your system. I promise there is somebody in your hospital system who actually knows what that cost is somewhere. So if you can get a sense of that, that can help there also. I totally agree with you. I've felt that way also, but at the same time, at a certain point, I don't know, it's our lives. Take them back, right? Say no when you need to. Do the things you need to. I think it's a shared responsibility, but that's also why we're here talking about it as a group, right? How do we come up with these ideas? What are the things that work for us? What are the things that can happen at a department level? And even the report that we showed earlier that has those strategies, and it says that males can do for female counterparts, but that's not specific there. That really looks at what can the people in the highest leadership positions do for everybody is really what that comes down to. So take a look at that report. I mean, it's really, that's it, right? It's just that piece of paper, and see, is there anything that you can take higher to advocate at those higher levels? Oh, the last thing, since I have a lot to say. There was an article this week, actually, in the Wall Street Journal, and it kind of was this whole topic of like, older doctors did doctoring, it was because they're calling, and they think that younger doctors are not finding it as a calling, and it was like, okay, there's... I think that if you put someone in a transactional system, then they're going to respond transactionally, and so... And that's kind of how it is with a lot more new physicians being employed rather than going into private practice or building equity into a practice, so we have to learn how to treat people right, and it's maybe not always a calling anymore, and that's okay, because we have our work-life balance. I've noticed that a lot of my friends who are in other careers, like finance or engineering, or maybe work with insurance, that they have a lot of incentives specifically for wellness for their employees, including very young employees. Have y'all noticed a shift in medicine to start helping their employees to afford gym memberships or meal prep services, and the different things that we said really could help us to cut back on some of that time and be a little bit more efficient in some of our goals and what that pie chart would look like. Have y'all noticed any major shifts in medicine to try to offer these services for their employees, especially the people in this room who have so many roles and responsibilities on a day-to-day basis? Yeah, the people can speak to it too, but at our system, there are those perks built in. A lot of people don't always look for them, and each system is going to be different, but I'd say if you don't know what's available at your system, take a look. It's probably on your intranet somewhere, but gym memberships are pretty common, and then even employee assistance programs, obviously, and those can be really great. They can be very solution-oriented. I love the idea of food prep things. I don't have that one, but we have internal wellness committees. I think those are pretty common at this point, so they're there. They're often looking for people to actually be involved with them, to add one more thing to your plate, but if you're passionate. I think it's really important to speak to your employer. I think it's always been where we don't want to show too many of our cards, but I do think that there's more national awareness now, right? This is getting published. There's a lot more attention. I think HR is keenly aware of how expensive it is to recruit physicians. No one wants to lose us, and they're going to fight, typically, to try to keep you, so yes, I'm also seeing things like free gym memberships. We're seeing things with increased availability to food for our residents when they're on a call or for our APPs. We're seeing different strategies at wellness, too. I've seen different models where they look at the number of PTO days, how many CME days does someone get, tuition reimbursement. Maybe as we talk about what's important to our patients, it's also knowing what's important to each one of the physicians, so I think having that good dialogue with administration and making sure that they're keenly aware of what you're looking for and what's important to you, and also knowing what's important to you right now may not be the same in, let's say, five years from now. I do think, actually, that we can have it all. It just may not be right at the same time. There are different phases to your life, and so what matters now may be different, and knowing that is sometimes enough to get you through the storm, if you will, but maintaining that open dialogue, and also within yourself. Getting to know who you are as a person, what matters to you, what your roles are, and how you want your day to look is really important, and holding yourself accountable to that. I think, great point. Don't be afraid to ask. Again, keep that open dialogue. You never know. I mean, what's the worst that's going to happen? They say no. I think just know your value, know your worth, and just over-ask, potentially, and then you might get what you actually wanted. I literally talked to someone last night, a male physician. He asked for three work-from-home days. His commute is one hour each way, so it's a huge difference. He's a father also, and so for him, it makes a difference if he can work from home, walk his kids to school, and pick them up after school. He ended up getting one work-from-home day, and he was like, that's actually what I wanted, but I asked for three, and so you never know unless you ask, and I mean, that's a huge difference to him, not having to commute for one day, two hours round-trip, so yeah, I think don't be afraid to ask. Just one thing is that I just sometimes compare myself with other, you know, my friends working in law or, you know, finance, and I just noticed when I was like associate professor level, the people at that level, they were highly skilled in self-care, highly skilled. Why is it? Because they were given a tool and training. Ever since they go to this, like, whatever the law form is, the first thing is onboarding. You have, like, extensive training of how you take care of yourself, balance life and work, how we say it, but what kind of tool we are giving it to our resident medical student and junior faculty. Seriously, I completely fail. Dr. Trovato, I'm sorry, you're going to work on this. So what I'm telling you is that this kind of session should be more as a curriculum, not just once in a while in the, you know, and then here, amazing lifestyle medicine group right here, and these are a lot of collaborative we can make, and then it has to be something in our curriculum, and then the health care system level, because all the administrators, they were trained in this, but not the physicians, nurses, therapists. Why not, right? Thank you so much, everyone, for being here today. Really thank our co-presenters who are all here, and kind of, you know, I hope you made good connections. I hope you got some good ideas. I hope you take the paper home and, you know, think a little bit more about this, because, you know, work-life balance is not something that you find. It's something that you create. So you have to create this for yourself so that you are, you know, fulfilling your life. So thank you very much.

work-life balance

women in medicine

gender disparities

medical leadership

self-reflection

burnout mitigation

employee wellness

self-advocacy

negotiation

self-care training

personal balance