Wellness

Kevin Noreika, MD
Young Physicians Section (YPS) Board of Directors

As we begin this new year, it is important to take a minute to consider wellness. While it is very common for people to make new year's resolutions to lose weight, stop smoking and begin an exercise program, commonly, these well-intentioned plans do not come to fruition. Likewise, as EM physicians, we work in a very fast-paced and stressful environment, and yet despite this, we typically do not spend enough time contemplating issues such as lifestyle considerations. However, if we do not take the time to ensure that we are balancing the stress of our jobs with our family life and personal goals it can lead to significant challenges. Job wellness can encompass many aspects including scheduling and shift distribution, time away from the ED and financial security. As the senior EM residents finish their final year of training, it is important that these aspects are given serious consideration.

EM physicians provide care to the public 24 hours a day, seven days a week without regards to the financial status of the patient-often being the only facility in an area to do so. This is an aspect of the job which is very gratifying, but also leads to a significant amount of stress during shifts. Although you may be accustomed to working frequent long shifts as a resident upon reaching the level of attending, you will soon realize that this is not an ideal schedule to allow for a balanced lifestyle long-term. There are numerous studies that indicate shift work can make a direct impact on our lives; it is even being considered by some as a risk factor for heart disease. In this regard, it is very important to carefully consider the number of shifts, as well as the distribution of day and night shifts per month. There are some groups which have dedicated night shift physicians and others that allow for fewer night shifts as you gain seniority over time. These aspects of your job are very important to consider when searching for a long-term position.

Sleep hygiene is also an important factor. Sleep debt is additive, and unfortunately, unless adequate consideration is made for time to sleep this will lead to increased stress, risk for depression and potential for errors at work. It is important to ensure that the room in which you sleep is consistently quiet, cool and dark. Make sure to turn off your phones, and try to avoid making appointments during the days after night shifts when you should be sleeping. For those that need to complete tasks during the day, try to anchor sleep which entails spending a few hours before and after work sleeping. Your group can also help by scheduling on a circadian friendly progression and by grouping together your night shifts. There are ever-growing resources available on the subject as research continues.

Another appealing aspect of our profession is the lack of on-call time. This allows for time to recover from the stress of the ED and to engage in enjoyed activities. Adequate days off and vacation time are essential to allow for a balanced lifestyle. Spending time with family and friends and pursuing hobbies are invaluable both physically and mentally. Money is, of course, an important factor, and naturally in our profession the more shifts worked equals a higher income. As your income increases dramatically after residency, it is tempting to increase spending in accordance. However, overspending can necessitate working more shifts than is comfortable which places you at higher risk of burnout. This continues to be evidenced by the high numbers of young physicians accepting these positions and then subsequently changing jobs within the first few years of practice. Keeping a careful balance of work load and debt will help you to maintain an enjoyable lifestyle.

Considering a long-term financial plan at the beginning of your practice is also a very important step in providing for overall wellness. Unfortunately, there is not a great deal of time spent during our years of training to begin our foundation in this endeavor. As physicians, we are sometimes not as knowledgeable in regards to financial management, and therefore, finding a professional who is trustworthy and who understands your goals will make this much easier. The importance of life and disability insurance is also a crucial part of this plan as an EM physician. It is best to consider this as a senior resident because of potential discounts for disability insurance that can be applied before you graduate. Developing a plan that provides for continued stability financially throughout your career and security into retirement will also help to reduce stress for both you and your family.

Emergency medicine can be a very rewarding career, but if you do not take time to reflect on balancing your work with your overall life goals, it can lead to significant stress. Wellness encompasses many different aspects of your life and always needs to be an integral factor when evaluating your current and future positions in relation to your ultimate goals.

(For more information, the Young Physician Section will soon be releasing a publication called The Rules of the Road which provides a more in-depth exploration of this and many other topics which are essential to the new EM physician).