Creating Climate Change for the Medical Workplace

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Creating Climate Change for the Medical Workplace

• Lessons on physician work-life balance from
  around the world
• CFPC FMF Vancouver October 2010
• Janet Dollin MDCM, FCFP presenter
• Kathleen Gartke, MD, FRCSC
• Barbara Lent MD, FCFP
• Cheryl Levitt MBBCh, FCFP

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1.Current situation in Canada

• Introduction - brief overview of data on women in
  medicine and in med school as it relates to
  Canadian workforce issues
• FMWC Needs Assessment 2008 Customizing Balance
  call for stories- shining the light on
  perceptions of women in the Canadian medical
  workforce-what we want
• Work Life Policies for Canadian Medical Faculty
  2009 FMWC -shining the light on what we now have
  in place

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1. Current situation in Canada Introduction

• Women comprise
• 70 of students in some med schools
• 65 of new Fam Med grads
• 58 of medical students overall
• 50 of all Cdn physicians lt age 35
• 30 of the Canadian medical workforce
• 18 of full professors of medicine
• 13 of department chairs

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Current situation in Canada Women physicians
comprise

• 83 first year trainees in ob/gyn
• 65 first year trainees in family medicine
• 14 first year trainees in cardiac surgery
• 50 of geriatricians
• 48 of pediatricians
• 37 of gp/family physicians
• 7 of orthopedists
• 5 of urologists

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Current situation in Canada Gender Distribution
of Physicians, by Physician Type, Canada, 1978 to
2008
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Current situation in CanadaBC Physician Health
Program Position Statement 2010

• Medicine and Motherhood Can We Talk?
  http//www.physicianhealth.com
• Workplace climate (accommodation) will impact
• Maternal and fetal health.
• Mother and child well-being during pregnancy and
  postpartum.
• Female physicians career progression, career
  choices and practice patterns.
• HHR planning

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1. Current situation in Canada National
Physician Survey 2007

• Major responsibility for children or other
  dependents
• Significant differences (plt0.05) by sex and by
  age for females

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1. Current situation in Canada National
Physician Survey 2007

• In the last year, have you been absent from work
  due to maternity or paternity leave? Men
  2.3
• Women 7.8 ( consider absolute s)
• For men who take parental leave 95lt16 wks
• For the women who do so 75gt16 wks
• We need to plan for that

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1. Current situation in Canada National
Physician Survey 2007

• Hours worked per week by type of dependents
  (excluding on call)
• -No significant difference in work hours for men
  and women when no dependants
• -Having dependent children alters work hours
  differently for men and women
• Overall 4752 hrs FM

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Trends in the Work Hours of Physicians in the
United StatesDouglas O. Staiger, PhD David I.
Auerbach, PhD Peter I. Buerhaus, PhD, RN JAMA.
2010303(8)747-753.

• Change for US Physician hours Between 1996 and
  2008
• All physicians (54.9 hrs-51 hrs) -7.2
  
• Men (54.4-51.7 hrs) -5.0
• Women (46.7-44.4 hrs) -5.1
• Lawyers (45.9-44.9 hrs) -2.4
• Engineers (43.6-43.0 hrs) -1.4
• Registered nurses (36.7-37.3 hrs) 1.6

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Generation Effect?

• ? Boomers (1945-1962)
• -Work hard out of loyalty
• -Expect long-term job
• -Pay dues
• -Self-sacrifice is virtue
• -Respects authority

• ? Generation X (1963-1983)
• -Work hard if balance allowed
• -Expect many job searches
• -Dues not relevant
• -Self-sacrifice may have to be endured,
  occasionally
• -Questions authority

? Millenials (mid 1980s up) -Plugged in
24/7-tech and media savvy -Work hard but demand
flexible schedules and a better work/life
balance -Value teamwork and responsibility,
desire to shape their jobs to fit their lives
rather than adapt their lives to the
workplace -Achievement oriented and confident
but question authority, assertively seek more
feedback
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1.Current situation in Canada FMWC Needs
Assessment 2008

• The FMWC -a unified voice for Canadian female
  physicians
• promote interests of female physicians
• improve management of womens health issues
• The 2008 Needs Assessment was an online survey of
  its members designed to understand the priority
  issues for women in medicine and to aid in design
  of its new website. It offers us a glimpse at the
  concerns these women have about the current
  situation in Canada

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1.Current situation in Canada FMWC Needs
Assessment 2008

• Improve workplace flexibility, job sharing,
  part-time work and ensure this flexibility is
  equitably available across all specialties
• Increase physician resources in Canada and stop
  identifying women in medicine as the cause of
  human health resource problems
• The increasing number of healthcare trainees
  dictate the need for more faculty especially
  women advancing to leadership positions

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Customizing Personal Balance within Medicine Call
for stories 2008the questions

• How have you customized things to balance your
  job and personal life?
• Tell us about your personal experience of less
  than full time work, job sharing, parental leave,
  re-entry experiences, Stop the clock, promotion
  policies, etc.
• What policies within your institutions have
  supported you? What policies have not?
• Was it a personal or group negotiation that got
  you what you needed to create balance?
• What is it about your particular specialty that
  makes it easier or harder to achieve what you
  need?

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Customizing Personal Balance within Medicine Call
for stories 2008the answers by theme

• 1.Balance Was it planning or serendipity?
• Act to not allow our institutions to repeat bad
  experiences. Train for resilience. Mentor seek
  and be a role model. Act to make opting in the
  better choice. Flexible workplaces will keep the
  medical workforce balanced.
• 2.Thoughts on having children
• Attitudes towards raising families while having a
  career in medicine need updating. Workplaces need
  to be more family and caregiver friendly, which
  includes but is not limited to parental and
  caregiving leave, stop the clock advancement
  policies, re-entry support, etc

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Customizing Personal Balance within Medicine Call
for stories 2008the answers by theme

• 3.The importance of personal health
• We all need time for self care, a supportive
  community of friends and work environments that
  can adapt to our health needs as care providers
  and that will support our indirect journeys.
• 4.Thoughts on careers
• Help our institutions to value less than full
  time and flexible work and to create more of
  these lifestyle friendly work opportunities. Act
  to allow women to lead in medicine and use their
  Take charge talents.

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Work-Life Policies at Canadian Medical
Schools(An FMWC CMA Collaborative Project)

• Kathleen Gartke M.D. FRCSC
• Aaron Gropper B.Sc. Hon
• Monika MacClaren M.B.A.
• From the JOURNAL OF WOMENS HEALTH
• Published by Mary Ann Liebert, Inc, New
  Rochelle, NY

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Work-Life Policies at Canadian Medical
Schools

• Maternity Leave
• Paternity Leave
• Adoption Leave
• Extension of Probationary Period for Birth or
  Adoption
• Part time / Reduced Work Load Appointments
• Job Sharing
• Child Care

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Legislation

• Canadian
• Federal
• 17 weeks EI benefits (35 wks unpaid parental)
• Provincial (universities)
• ? 15 weeks EI benefits (35 wks unpaid parental)
• American
• FMLA
• 1993
• 12 weeks of unpaid, job protected leave for
  specific family medical reasons

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Work-Life Policies at Canadian Medical
Schools

• Results
• Canadian schools have much more generous
  maternity, paternity adoption leaves
• Wide variation in these (paid)
• French language schools most generous
• University of Alberta least generous

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Work-Life Policies at Canadian Medical
Schools

• Results
• Extension of probationary period Canadian
  schools more uniformly generous than US
• All offer at least one year extension
• Some allow unlimited repeats, others not
• No Canadian school has eliminated the pre-tenure
  period (gone to merit based promotion)

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Work-Life Policies at Canadian Medical
Schools

• Results
• Part time or work reduction programs available
  at most Universities
• Some offer only to tenured faculty
• American schools slightly better part time or
  work reduction policies
• Job sharing much more common in American schools

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Work-Life Policies at Canadian Medical
Schools

• Results
• Childcare Most have on campus childcare and
  often offer referrals /- financial
• Northern Ont School of Medicine no childcare
• Canadian Schools generally better than American

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Work-Life Policies at Canadian Medical
Schools

• Standouts
• U of Western Ontario
• Highest score
• Has a unique work-life balance section on
  website
• Frequently addresses issues of balance
• Northern Ontario School of Medicine
• Lowest score
• Least generous policies in several areas

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Work-Life Policies at Canadian Medical
Schools

• Conclusions
• Canadian medical schools are committed to helping
  staff achieve work-life balance
• Policies have improved (quality accessibility)
• Further improvement possible desirable
• Culture change
• Attract retain the best

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Although we may define ourselves first by what
we do, it is those personal relationships outside
of work that make us whole

• John Curtis
• (Academe, Nov/Dec 2004)

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2.International Experience

• Making Part Time Work-2008 UK MWF and EU working
  time alliance
• Women DoctorsMaking a Difference-2009 UK MWF
  report
• Achieving gender equity from withinWonca WPWFM
  HER statement Gender Equity Standards for
  Scientific Meetings

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2.International Experience UKMWF Making Part
Time Work-2008

• 1.Recommendations on attitudes to part time
  working
• Systemic attitude changes through role models,
  mentors and case studies as well as formal
  consultation with those doctors trying new work
  plans
• 2.Recommendations on part time career grade posts
• Royal College guidance sought and leadership from
  Medical
• Directors needed to create flexible teaching
  positions
• 3.Recommendations on career development for pt
  doctors
• Formal re-entry after career break, formal
  feedback with those
• who are in part time posts
• 4.Recommendations on part time training posts
• Medical directors should promote innovative job
  design as well
• as informing and supporting those part time
  workers using them
• Colleges and employers must collaborate to ensure
  coverage

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2.International Experience UKMWF Making Part
Time Work-2008

• European Working Time Directive
• In 2008 the maximum working hrs per week
  recommended by the EWTD was 56
• In 2009 it was reduced to 48 (35 in France!)
• Opens debate about the negative impacts of long
  hours on performance vs the needs for putting in
  the hours needed to learn
• Setting a ceiling on maximum work time is only
  part of the story

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2.International Experience-UKMWF Women
DoctorsMaking a Difference-2009

• Previous reports focused on desired outcomes
  rather than the necessary levers of change to
  achieve them
• Narrow and targeted recommendations

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2.International Experience UKMWF Women
DoctorsMaking a Difference-2009

1. Improve existing structures so that there is
   better advancement to certain critical career
   turning points as well as different ways of
   working
2. Ensuring that new processes (such as
   revalidation) have the flexibility and capacity
   to accommodate doctors who may not be conforming
   to the usual work patterns
3. Providing additional support for the practical
   realities of caring for a child or dependent
   relative

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2.International Experience UKMWF Women
DoctorsMaking a Difference-2009

1. Improve access to mentoring and career advice
2. Encourage women in leadership
3. Improve access to part time working and flexible
   training
4. Ensure that the arrangements for revalidation are
   clear and explicit
5. Women should be encouraged to apply for Clinical
   Excellence Awards
6. Ensure medical workforce planning apparatus takes
   account of increasing number of women in the
   medical profession
7. Improve access to childcare
8. Improve support for carers
9. Strenuous efforts should be made to ensure that
   these recommendations are enacted through the
   identification of champions

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Sir Liam Donaldson Chief Medical Officer,England

• The issues raised are not new, nor perhaps are
  they unexpected. But to tackle them is going to
  require a step change in how the medical
  workforce as a whole behaves. It will require an
  acceptance of alternative and differing patterns
  of working and training for all medical staff,
  not just women

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2.International Experience Achieving gender
equity from within Successes and challenges
in promoting the perspective of the Wonca Working
Party on Women and Family Medicine Barbara
Lent Cheryl Levitt

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Goals

• To describe how a small group of very committed
  women family physicians from around the world
  came together worked from within to ensure
  their international, organized body better
  reflected their experiences
• To delineate key successes
• To describe the factors that helped to make their
  efforts successful
• To discuss lessons learned from this work

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Background

• Individually and in informal small groups, women
  family doctors recognize that organized medicine
  (particularly, family medicine)
• Lacked adequate representation of women in
  leadership positions
• Did not provide them with adequate
  education/training to address their women
  patients concerns
• Did not accommodate their family/household
  responsibilities well
• Convened scientific meetings with few women
  physicians as experts and few sessions addressing
  clinical issues from a gender issues perspective

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Key Accomplishments

• The HER statement (Hamilton Equity
  Recommendations)
• addresses governance issues within Wonca
• 10 Steps to Gender Equity in Health
• describes fundamental issues, taking into account
  particular social circumstances facing women
• Gender Equity Statement for Scientific Meetings
• articulates key principles for organizing
  committees to consider
• Monograph/Literature Review
• a comprehensive review of articles in
  international scientific literature addressing
  particular issues facing women physicians/medical
  trainees in educational, clinical and
  organizational settings

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(No Transcript)
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Publications

• Peer-reviewed professional journals (scientific
  articles, news items, commentary)
• relevant professional newsletters (Wonca News
  newsletter of Federation of Medical Women of
  Canada)
• Website womenandfamilymedicine.com
• Self-publication large brochure distributed to
  colleagues to highlight groups
  activities/successes

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Drivers of Success

• Working within existing Wonca organizational
  structure
• Fostering relationships with like-minded
  physicians from around the world
• Building capacity and leadership development
  through pre-conferences and special workshops at
  regular meetings, with particular attention to
  needs of younger physicians
• Consistently applying an evidenced-based approach
• Using technology to enhance communication (eg
  listserve, website, teleconferences by SKYPE)
• Developing creative responses to financial
  inequities (eg bursaries specific to WWPWFM
  travel equalization to enable participation by
  members from developing countries)

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Lessons Learned

• Use a bottom-up approach so that new
  initiatives reflect physicians experiences with
  patients, in organizations, with colleagues
• Pursue a slow, consistent, persistent approach!
• Collaborate with like-minded colleagues,
  recognizing that the sum is greater than parts
• Build on the energy and commitment that comes
  from long-term relationships with like-minded
  colleagues
• Bring relevant info/perspective from non-medical
  organizations
• Follow/copy the path of other successful groups
• Frame discussion of gender issues in a way that
  is relevant to the parent organization

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References
National Physician Survey http//www.nation
alphysiciansurvey.ca/nps/home-e.asp Medicine and
Motherhood Can We Talk? http//www.physicia
nhealth.com Canadian Institute for Health
Information www.cihi.ca American Association
of Medical Colleges http//www.aamc.org/members/g
wims/statistics/stats05/start.htm Trends in the
Work Hours of Physicians in the United
StatesDouglas O. Staiger, PhD David I.
Auerbach, PhD Peter I. Buerhaus, PhD, RN JAMA.
2010303(8)747-753. FMWC 2008 Needs Assessment
http//www.fmwc.ca/index.php?page395 FMWC
Customizing Personal Balance http//www.fmwc.ca/i
ndex.php?page100 Work-Life Policies at Canadian
Medical Schools Kathleen Gartke M.D. FRCSC,
Aaron Gropper B.Sc. Hon, Monika MacClaren M.B.A.
JWH, Mary Ann Liebert, NY Making Part-Time Work
2008 - UK Medical Women's Federation
www.medicalwomensfederation.org.uk/makingpart
timework/ Women DoctorsMaking a Difference-2009
- UK Medical Women's Federation
http//www.dh.gov.uk/en/Publicationsandstatistics
/Publications/PublicationsPolicyAndGuidance/DH_106
894 Wonca Working Party on Women and Family
Medicine http//womenandfamilymedicine.com/ Webi
nar- Canadian Womens Health Network
http//www.cwhn.ca/en Creating Climate Change for
the Medical Workplace Lessons on physician
work-life balance from around the world Janet
Dollin MDCM, FCFP,Kathleen Gartke, MD, FRCSC,
Barbara Lent MD, FCFP, Cheryl Levitt MBBCh,
FCFP.