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Dr Rob Fry Auckland City Hospital

Public, private purse & precious people: Survival tips for the busy private practitioner “ Career juggling & balancing ”. Dr Rob Fry Auckland City Hospital. Disclosure. New Zealand Public practice 50% Private practice 50%. Public Practice.

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Dr Rob Fry Auckland City Hospital

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  1. Public, private purse & precious people: Survival tips for the busy private practitioner“Career juggling & balancing” Dr Rob Fry Auckland City Hospital

  2. Disclosure • New Zealand • Public practice 50% • Private practice 50%

  3. Public Practice • Government funded, salaried contractual medical practice that provides health care regardless of age, sex, risk factors or ability to pay • The Free Dictionary

  4. Private Practice • A professional health care provider who is (theoretically) independent of economic or policy control by professional peers except for licensing and other legal restrictions. • Webster’s on line dictionary

  5. Precious People • Patients • Doctors “Anaesthetists”

  6. Doctors • Precious commodity • Cost a lot to train – undergraduates alone • NZ NZ$ 500 000 • Australia A$ 300 000 – 500 000 • USA >US$ 500 000 • HK ?unable to obtain data • NZ Specialists > NZ$ 1 500 000

  7. Private Practice • Medicine generally is NOT big business • Private Anaesthetists in particular • Rarely employ other doctors • Have to be on the job to earn their money

  8. Public Practice • Fixed income • Long contractual hours

  9. Doctors • Characteristically: products of “medical families” • >20% of doctors have medical parents • “I only saw my father when he was asleep” • 50% of women doctors marry doctors • “My mother never had time to play with me”

  10. Anaesthetists Three A’s Availability Affability Ability

  11. Anaesthetists • Busy crowded lives • Service Industry – Little Autonomy • Career-centric lifestyle • Defined by our job descriptions

  12. Anaesthetists Accessibility 24 hours a day Mobile phones, Texts, E-mails Home and work blurred Allow increasing workloads & deadlines

  13. We often lead Frenetic but meaningless lives

  14. Threats to survival • Maintenance of personal equilibrium • low priority

  15. Threats to Survival Anaesthetists typically have type A personalities “Self Critical, time conscious, status uncertainty, incapable of relaxation…” Production pressured “Service industry” J Occ & Org Psych 1997

  16. Threats to survival Stress proportionately to hours worked Long hours may be immensely satisfying >48 hrs/week doubles chance dying from CHD Dysfunctional domestic life Marital problems/Child responsibilities Poor financial planning…… J Org & Occ Psych 1997 The Physician Executiv 2006 NZMC Workforce survey 1990

  17. Threats to survival Majority waking hours at work Domestic problems unintentionally brought to workplace – subconsciously processed there Work is perceived as increasingly stressful & unpleasant or undesirable environment Synergistic deterioration in work practices BJ Psych 1997

  18. Threats to survival Occupational stress Personal thresholds vary widely Once that level of tolerance passed Perpetual sympathetic bombardment Serotonin, Steroids, Catecholamines Low mood Anxiety Depression Plethora of physical ailments European Psychologist 2002

  19. Threats to survival Unmanaged Occupational stress Burnout Reduced patient care Errors, complaints… Alcohol and or substance dependence Suicide Loss of a very precious commodity BMJ 2009

  20. Threats to survival Fatigue Impaired decision making Prolonged reaction time & attention deficit Memory impairment “Microsleeps” Linked to 3% all critical incidents An Int Care 2000

  21. Threats to survival • Fatigue • All sleep deprived physicians are affected As little as < 5 hrs in 24 hrs - Perform on average 1.37 SDs rested Mood changes (depression) Reduced cognitive function 36% more errors on 24 hour shifts 24hrs awake = 100mg% C2H5OH (limit 80mg%) Anaes 2003;58:520-525, NEJM 2004;351:1838-48

  22. “Anaesthetists have higher rate of accidents c/f physicians” So what can we do about this state of affairs?

  23. Anaesthetists Time is a rare commodity We all have the same amount of daily time and the choice of what we want to do with it Our relationship with time should be bad stuff out good stuff in

  24. Anaesthetists • Research requires unstructured time • for free flow of ideas and lateral thinking • Play “essential activity” for creativity • Important to protect/nurture:ourselves • Maintain safe work practices • J Cont Ed Health Prof 22:2;127-128

  25. Survival Guide Aim for a Healthy “Life – Work Balance” No Magic Formula Individual decision

  26. Survival Guide “Life – Work Balance” May be viewed in terms of Happiness OR Meaningfulness If one is totally fulfilled, enthused and excited by one’s work the stress thrown in just becomes part of the success and satisfaction of the job

  27. Survival Guide • How can we achieve this?

  28. Survival Guide Foster a feeling of “Well-Being” A happy Anaesthetist is safe and successful 50% Genetic (no control) Science 1990 Review of General Psychiatry 2005

  29. Survival Guide 50% under your control 10% Circumstantial (home/city/family) 40% Daily activities & practices Science 1990 Review of General Psychiatry 2005

  30. Survival Guide 10% Circumstantial Set realistic financial goals House, suburb, schools… Eton

  31. Survival Guide 10% Circumstantial Choose a good life partner….

  32. Survival Guide 10% Circumstantial Choose a suitable place to work

  33. Survival Guide 10% Circumstantial Avoid the workplace after hours

  34. Survival Guide “Well-Being” 40% Daily activities & practices

  35. Survival Guide 40% Daily Activities & Practices Volitional– Setting and achieving attainable short term Goals Behavioural – Initiating enjoyable activities Cognitive– Reappraisal of one’s situation and good fortune

  36. Survival Guide 40% Daily Activities & Practices Volitional Set a few easily attainable Goals What things do you want more time for? What things use up your time? What can you cut out? Consider some exciting life changes Think how you can create some free time

  37. Survival Guide 40% Daily Activities & Practices Behavioural Make time for relaxation Cut out unimportant meetings Learn to delegate (Home & Work) Practice Cover (Group Practice – share the load) Secretarial/PA support Consider your surgeons/hospitals/committees (Pass on those that drive you insane) Prioritise(use down time at work wisely)

  38. Survival Guide • Mark Priestley Chair of examiners • ANZCA Bulletin 2011

  39. Survival Guide 40% Daily Activities & Practices Behavioural Be pleasant – make others happy Diffuse unpleasant circumstances fast Cut back unfulfilling social activities Develop close friends & SEE THEM Always have something special to look forward to which you enjoy

  40. Survival Guide Behavioural Lifestyle choices “Aim” for 7 – 8 hrs Sleep Melatonin Boost (Bed by 2230) Antioxidant, Premature aging, immunity Regular aerobic exercise, laughter, sex Serotonin & Endorphins Elevates mood JESP 2009 A&IC 2011

  41. Survival Guide Behavioural Engage regularly in activities you enjoy Hobbies/Art/Music/Film/Literature/Philosophy Play a sport - exercise regularly improves your memory Think how happy that friend is on his golf afternoon Take regular short holidays Collegial Group practice – carefree cover

  42. Survival Guide 40% Daily Activities & Practices Cognitive Maintain an awareness of your successes Good fortune Future adventures or plans

  43. Survival Guide 40% Daily Activities & Practices Pursue your goals without compromise The brain runs on fun

  44. Survival Guide • Retirement preparation Up to 30% of one’s life New career • A time of “Intellectual re-formatting” • Low autonomy & High demand reversal

  45. Survival Guide • “Old age is full of enjoyment if you know how to use it” • Anaesthetists are “Action people” • Ample non earning time • DEVELOP INTERESTS WHILE YOU WORK • Seneca Moral Epistles AD 65 • ASA Newsletter 2003

  46. Take a careful look at your life and work circumstances and act

  47. Survival Guide • Achievable Financial Goals • Insure • Health • Practice • Life • Legal Affairs • Wills • Trusts

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