Maintaining work–life balance in general practice

Larissa Dubecki

9/01/2018 2:40:34 PM

Achieving stability between work and other areas of life is never easy for GPs.

Two-thirds of GPs in the RACGP’s ‘General practice: Health of the nation 2017’ report cited the difficulty in maintaining work–life balance as the key challenge when running a practice.
Two-thirds of GPs in the RACGP’s ‘General practice: Health of the nation 2017’ report cited the difficulty in maintaining work–life balance as the key challenge when running a practice.

Australia’s GPs prioritise the care of their patients, but caring for themselves can be a different matter entirely. The often-elusive notion of work–life balance among GPs must be addressed to achieve a flourishing, accessible and high-quality general practice profession.
As indicated by the RACGP’s recent benchmark report, General practice: Health of the nation 2017, 46% of GPs work 40 hours or more a week, with 7% working more than 60 hours. GPs reported high levels of job satisfaction, but their working hours – along with remuneration and recognition – proved a top area of concern.
One more thing
Just one more patient, one more meeting, one more phone call. It is easy for doctors to keep adding that ‘one more’ thing to their day.
What many GPs seem to discover, however, is that doing that little bit extra can be a slippery slope and before they know it, it is all getting on top of them.
‘I think that we don’t really realise it at the time,’ Dr Jonathan Ramachenderan, a procedural GP anaesthetist, told newsGP. ‘We think we’re doing quite well because we’re doing good things, helping out by maybe doing research, being involved in committees, working hard towards a certain qualification.’
Given GPs are often pulled in so many different directions, difficulty in maintaining this type of balance is nothing new for those in general practice. The point was clearly illustrated in General practice: Health of the nation 2017, in which 64% of GPs cited the difficulty in maintaining work–life balance as the key challenge when running a practice.
This is a scenario familiar to Dr Rekha Kumar, a GP in the Melbourne suburb of Dandenong. The former owner of four clinics, Dr Kumar sold them seven years ago in order to work fewer hours when she realised the dual role was leading towards burnout. The move away from ownership has helped her as a practitioner.
‘Initially it was difficult to step away, but now I’m really enjoying it. [Being a GP is] such a satisfying job,’ she told newsGP.
Dr Kumar now works four days a week, but is aware this type of arrangement can have an impact continuity of care.
‘I like my patients to be my patients, not just walk-ins,’ she said. ‘Part-time work can be less satisfying in that respect, but I make sure I don’t take holidays of more than two to three weeks.’
Another issue that Dr Kumar believes can be particularly pertinent to female GPs is that there is a financial disadvantage to spending longer with patients.
‘Around 60–70% of my patients are women and children,’ she explained. ‘[I find] men normally don’t want to talk about their problems, whereas women like to talk and they prefer to see female GPs.’
Under pressure
Dr Mark Morgan, Associate Professor in Health Sciences and Medicine at Bond University, and a member of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that while GPs are meeting the challenges of a demanding job by spending longer hours at work, the equation is not necessarily balanced in the way of remuneration.
‘It’s no longer a wealthy profession to be in; it’s a very middling profession with a very long training package at the beginning,’ he said. ‘The financial pressure, especially the shortfall in the cost of running the business, means doctors are weighing up whether to spend an hour or two longer each day at work or working through their lunch break to keep the business sustainable.’
Dr Columbine Mullins, a GP and a sole practice owner, faced a steep learning curve when she assumed control of her practice. Life has become more manageable with experience, but that does not mean the scales always remain balanced.
‘I am a bit more confident about the processes and have things set up better, but it is a constant reflection process of “am I getting exhausted?”’ she told newsGP.
‘I tend to get to work about an hour before everyone else and run through the emails and things that have come through, then have a chat with the practice manager. Then I will look at all of my results, and I overlook the registrar results.
‘I then dedicate time for seeing my patients. As often happens through the day, I check my emails and try to respond to things quite quickly. If I do that the work gets done, if not it tends to get left. So the day is often interrupted.
‘I will often spend a little bit longer working in the evening on things like payroll and bills. There is always extra bits and pieces, like contracts and things like that that come up.
‘It is a bit of a juggling act.’
Self health
While Dr Mullins tends to maintain her own balances with detailed schedules, timetables and the like, Dr Ramachenderan takes a different, but no less structured, approach.
‘It’s not really about balance but more about self-care,’ he said. ‘Being a doctor means having intense human interactions and learning about people’s secrets and their difficulties, and being put in very stressful situations.
‘I think that to be able to do that over a long period of time, being a GP especially because you’re quite intimately involved in a community, you really do need to design those self-care strategies for yourself and employ them every day.
‘I think it needs to become a habit. I firmly believe that it needs to be built into your day, if not week, if not month, if not year.’
Upon realising he was experiencing burnout and depression, Dr Ramachenderan resolved to make some meaningful changes.
‘I was just living a very distracted life,’ he said. ‘I simplified everything and realised that I needed rest. I decided that I needed to work a nine-day fortnight and try to always have Saturdays off for my family and just to replenish myself. I rested and didn’t do work things. That really helped.’
Dr Mullins has also made efforts towards greater levels of self-care, but admits it can be a challenge.
‘I feel there is always this tightrope to walk as far as making sure my son is getting enough attention and input, and I am getting whatever work needs to be done, done,’ she said.
Encouragingly, Dr Mullins’ efforts to make more time for herself and her son have been met with considerable understanding. Her patients appreciate that she is indeed human.
‘They are often the first people to say, you need a holiday, you should go and do this with your son,’ she said. ‘There has been a lot of goodwill from patients in that regard.’

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