Episode 002: The Balancing Act of Work and Life

Brian F: Hello, and thanks for joining us today. I am here with Dr. Bob Berkompas. I'm Brian Fortenberry. And we're going to be talking about one of the easiest subjects around. This probably will be over in a matter of minutes because we're simply talking about work-life balance for physicians. How are you, Dr. Dr. Berkompas?

Dr. Berkompas: I'm fine, Brian. Good to see you today.

Brian F: Well, thank you. Since we are talking about work and life balance, tell me about your work. Tell me about your practice and the number of years that you've been doing this.

Dr. Berkompas: Sure. I finished medical school in 1986 and did my internal medicine residency training for three years with an additional year as a chief resident, and then joined a large, prominent, multi-specialty, but primarily primary care practice in 1990. So for 25 years I've built and tried to manage a primary care internal medicine practice and enjoyed that very much. But also did some part-time work with a local hospice and helped manage one of the home teams for that hospice and gained some experience around that and came to really enjoy that end-of-life care for my patients and other patients. Eventually, two years ago came on as the full-time Chief Medical Officer for that same hospice, and I've been doing that now for two years, managing some other physicians and nurse practitioners as well as contributing my own personal clinical care.

Brian F: Then I happen to know on top of that you're pretty involved in other organizations, committees and activities outside of just your daily practice as well, aren't you?

Dr. Berkompas: That's right. Around that same time that I started working part-time with the hospice, I also had an opportunity to join a class of fellows at State Volunteer Mutual Insurance Company, SVMIC, and then subsequently was appointed to the underwriting committee, which I enjoy very much. It is physicians taking a look at physicians and applications for insurance as well as policyholders, and we are helping make judgments about those physicians. And I appreciate that. I would want that for me if I were being looked at, and I enjoy doing that for SVMIC. I also am involved in my church. I serve on the session of the church as one of the lay leaders in our church as well.

Brian F: So the work part of the work-life balance seems very full. It's only fitting now that we maybe talk about the life part. Tell me a little bit about your family and what you have going on and activities outside of your work life.

Dr. Berkompas: Well, yeah, that's probably of course even more important in many ways. My wife and I, when we moved for residency, we were already pregnant with our first, and so as an intern I had a new baby girl. I now have three grown children. All of them are married. Two of them live in town here with us, and one lives out of town. No grandchildren yet at this point. So my wife and I are also empty nesters at this point, always looking forward to the opportunity to get together with the family.

Brian F: So you're saying you've got all of this completely figured out, that's what I'm hearing, right?

Dr. Berkompas: That's right. That's why you asked me, I'm sure, is that I'm the expert in work and life balance. My wife actually, when I told her I was going to be doing this, really had a good laugh. But I would say that she's also been one of those has had a great deal of influence on how to handle this mix.

Brian F: So if we start looking at the busy part of life itself, whether it's work or your family outside of there, where would you start with some key components for anyone, physicians in particular, but really anyone, to keep in mind as they're really trying to battle this work-life balance and not get off kilt one way or the other.

Dr. Berkompas: I believe it actually starts once we finish our training with really understanding what it is we want to accomplish in our practice. For some people, being a sole practitioner in a community may by their supreme desire, and more power to them. Others, like myself, I think felt more comfortable in a large medical community with lots of experts available to me and my patients, a large group so I could share call and share the workload, so to speak, in that regard. And also they provided some of the infrastructure and the basics for me to get started in practice. So I felt pretty secure with starting that way. I know that my wife was ... she understood about what it was to be a physician, to be on call to deal with medical emergencies, and that I would have my share of those. That was never really going to be a surprise to her.
However, she did ask me before my first day of practice, she made a request that since we already had started our family, we had two young children at that time, that I would make every effort when not on call and when I had an opportunity, to be home for dinner. She just felt that over the long haul that that was going to be an important thing for our family. And frankly, that dictated a lot of how I put my practice together, my schedule. I didn't see patients all the way up to 5:00, knowing that I was going to have paperwork, or now computer work, after that. I would adjust my schedule to see my last patient maybe 3:00 or 3:30, to be done.
One of the things that made a huge difference was a number of years ago when I finally started using the hospitalists in my practice. When I started I was really running two parallel practices. I had a census of patients in the hospital and made rounds in the morning and afternoon, sometimes midday, to check in on them and manage them. I was getting interruptions from those nurses and people taking care of them, maybe physicians as well, throughout the day, and I had a full clinic that I [crosstalk 00:06:04] schedule. Once I started to use hospitalists, that also freed up a lot of time to improve on the balance part.

Brian F: It sounds like one of the key components might be to have a plan, to have something put in place rather than to say, "We'll just kind of figure it out as we go along."

Dr. Berkompas: That's absolutely true. I think sometimes it's hard to know ahead of time how to do that, but I think speaking to my future colleagues helped. I remember I was coming right out of training and the same time that I was joining the group, and one of the doctors that I was going to be right next to in the clinic said, "You should take a month off before you start your practice. If you can afford it in any way financially, this is going to be probably the last time in your whole career that you don't have to have someone cover for you. You're between training and you don't have a single first patient yet." And I took him up on it. And I was really glad that I did. Now I see in retrospect that was really true for me.
So I got some advice on that. My wife had some requests. And then I started to discover that I had a certain personality where I wanted to be the hero. I wanted to be the guy that was going to solve the problem, make the diagnosis, take care of the patients perfectly. And so all of that really became an issue early on that I had to struggle against that I had to realize that that is a setup for me to end up burning out.

Brian F: That leads me to you mentioned you talked to some colleagues and with your wife. Who are some of maybe even the other key people that you reached out to that would be good for anyone to be able to kind of reach out to that might be struggling with this work-life balance and, as the word you used, burnout? Who would be someone that they could reach out to and feel confident that they would be able to help them through this?

Dr. Berkompas: I think that over time I'd be having conversations with colleagues, and they might not be in my medical group, they might be other physicians or colleagues in the community, and that one of them might describe that he makes a point of having breakfast with his children every morning before they go to school. And I thought, "Well, that's just nuts. I'm already up and out of the home by 6:30, before my kids are even getting up." But somehow he made it work. He was very successful, very busy. And so I began to open my mind then to well, let's look at that. And ironically, when I started to use hospitalists, because I didn't admit patients to the hospital myself, they were admitted to the hospitalist group, I could go by and visit them, but then I didn't have to ask other people to round on my patients in the hospital, so therefore I didn't need to return the favor by rounding on their patients in the hospital.
And so weekends became free from that extra rounding responsibilities as well as during the week. And also I discovered that if I was able to make myself available during the week to my patients, that I could take my own calls from my patients seven days a week, or at least if I was in town. And I didn't get very many phone calls, because they knew they could get a hold of me the next morning if it wasn't an emergency, they could that. And if it was an emergency, I could send them to emergency room and check on them in the morning. It really made it much more satisfying, because I was now taking calls from my own patients. I had a vested interest. I knew them. They knew me, they trusted me. And I was able to manage things to the point where I was getting way fewer phone calls rather than more phone calls when I was covering for other doctors.

Brian F: And a lot of the stuff you hear today, in even a lot of different careers outside of medicine, you do hear about there being an ongoing issue of burnout. It sounds like in the realm of the medical world, certainly for physicians and all that is required and asked of them today, that burnout factor seems to be fairly high. Would you agree with that?

Dr. Berkompas: Yeah, I think that the numbers I see, overall it's in the slight majority of physicians would describe it. And we're not talking about just frustrations with paperwork and EMRs and that kind of thing. That's certainly there, but we're talking about a psychic change. I mean, where there is a lack of ability to concentrate, a lack of ability to do the job and care for oneself, let alone other people. And so that to me is way more serious than griping about something that I'm frustrated with. And in some areas it's even higher than that.
I think that part of what kept me from being in a burnout role after 25 years of primary care was that I concentrated my energy and satisfaction around the patient encounter. Frankly, if it weren't for that examination room and the patients that I took care of in that room, the rest of it really was pretty darned frustrating and unfulfilling. I mean, filling out forms and billing and coding and check boxes and EMRs and notes and all that. So I had to do a couple of things. One was I just kept reminding myself that it was really about the patients. And as long as I could get satisfaction out of getting to know my patients and care for them, then I think I could deal with the rest of that stuff. And I think that was probably the leading thing.

Brian F: Being able to really invest in the patients and that patient encounter. Do you think, with some physicians who are not taking the burnout or the work-life balance seriously enough and they're not addressing it as it is the snowball rolling down the hill, do you think that it can get out of kilter so bad that it could start affecting patient safety or standard of care or things of that nature?

Dr. Berkompas: I think that is precisely what the biggest concern should be. Yes, we do care about the individual who's experiencing the burnout, but unfortunately that can go on for some time while the person continues to practice or attempt to practice, and we're determining that the attention to detail and just some of the lack of really caring, being able to care for someone in an effective way, can be a problem. For me, I was in a situation where I was ... there was one period of time in the early 90s where I was employed by a hospital system, but otherwise ... that was about five years out of the 25 years .. but we went back to being independent.
And I think that having some ability to control my own environment so that if I felt like you know what, I need a vacation every three months, for me that seemed to be my timeframe. If I went much longer than every three months to take a week off ... it didn't have to be out of town, it could just be at home even, but just I had to take that break. If I wanted to do that and I "suffered" economically for that, it was worth it. I figured okay, so I have a lower paycheck the next month because I wasn't there for a week, but we just made adaptations for that.
For some people, and more and physicians who are working for someone else, in a sense, being paid by, employed by someone else, those corporations or hospital systems can make extra demands on a person outside of their control, so to speak. And I think that sense of a lack of control can be part of what that burnout is about. So I think it can be, I believe it can be, built in to the system, the contract that a person signs as to okay, what are their options for this sort of self-care and support. I think they can properly look for that and ask for that and really need to think about that ahead of time instead of just are they going to pay me enough to pay off my student loans. You know?

Brian F: Right. And that does make sense, that you think about that on the front end of a contract, because like you were saying from your own experience, knowing that over a three-month period of time I'm going to need a week off to kind of hit the reset button. And I know for me, hearing experiences and stories and circumstances of other people is often very informational to me and helpful. Do you know if maybe you have had another situation in your own career and life or a colleague or someone you knew of where maybe their work-life balance either got so far out of kilt that they ended up having to give it up or get to the brink of that to the point that they said, "Okay, I've really got to do something now," and maybe how they turned things around.

Dr. Berkompas: I can't think of one specific thing, but I've just seen the toll that it takes on families, in particular, with marriages that are threatened or ended I think as a result of that. And very often it's tied back to the same thing that I experienced where I see a physician feels like they're the only one or the best one, and so the world just can't live for a week without them, or some sort of sense of that. And frankly, it's quite humbling to find out that I could actually take a two-week vacation and people are still okay. And I've tried doing that. I think I finally just get tired of being on vacation. I'm not used to that. But it's really more about the ongoing attitude of I'm special or I'm important. And it can be a very altruistic thing, it's not all selfish. But it comes across as kind of a selfish nature, and that's just harming themselves and those around them.

Brian F: I think if I took a two-week vacation, my work-life balance would be off, my wife would say, "Your life is getting unbalanced. You need to go back to work." Do you know, are there organizations out there that can assist someone who's feeling the pain of this type of work-life balance? Is there any physician organizations? Or would you suggest maybe your community of faith or reaching out to a different group, in your experience?

Dr. Berkompas: In my experience, if I only rely on my physician colleagues for support, it's a very narrow look at things. And so by having a faith community, meeting people within that, other men and other careers, and to have discussions around that, I can realize that I may have a unique career in the way that it's lived out in helping people in very intimate and direct ways, but a lot of the same factors of balance in spiritually, emotionally, physically, financially, all of those things, and career-wise, are very common across careers. And frankly that's helpful. Again, it takes some of that stigma away from well, we physicians, we have everything unique. We're all special. We have to figure it out, and it's been really good for me.
I will say that I've learned, sometimes the hard way, that my wife is very willing to listen to me without necessarily having to fix it, and she's got a good deal of wisdom. She knows me pretty darn well after 32 years of marriage. So why wouldn't I want to trust in her input as well? And we've gotten to the point where she's a primary person for me to be able to share that with. And I think our stage in life now, too, we're looking forward to retirement and how is this going to finish out. I don't think she's going to let me work a day past 65. She's sort of just marked that. But who knows, we'll work it out.

Brian F: And it does sound like that for every person there's probably some individual, some key person in their life, whether it be a spouse or a role model in your life that is probably a good person to have, is almost your plumb line of going to to keep yourself straight, because being a physician there is almost a certain feeling of I should be able to handle this. I should be able to fix it on my own. And everybody needs that outside assistance from time to time. Do you think the environment we have in medicine today is making it more difficult for work-life balance, and if so, what can we do about that?

Dr. Berkompas: I think that's a really good question. I think that there is an increased emphasis on the electronic medical record and communicating electronically of things, and that just of its very nature takes up extra time. A lot of estimates are that for every hour of patient care, I've got two hours of computer work to do. The other is that we're now entering new phases of reimbursement and types of reimbursement. It's based on value-based and all ... and that hasn't even been defined very well yet. And we're just entering it, so there's a lot of uncertainty around how am I going to be compensated, how am I going to bill, how am I going to be valued. That can put an extra strain.
I think that physicians have always over the years, even before I started practice, have had some difficulties as a group with addictions and medicating. And part of that is access to medications. Sometimes I think physicians think that they can figure out how to manipulate those for their own benefit, and they're maybe even well-meaning in that. But we can get into that kind of difficulty. And one of the organizations I've become very familiar with, and in part through SVMIC, is the Tennessee Medical Foundation. And I think most states now have a similar program for physicians. And a physician can self-report that they're having difficulty or just talk to someone there, get an idea of resources for whatever their issues are around burnout, around addiction or concerns about addiction or other compulsive behavior.
And also behavioral difficulties. I think we're seeing more and more physicians who are acting out in a way with tirades or behaviorally. And they have been a tremendous resource and they have a very good track record of helping physicians get back on track, get the help that they need, work through the balance, and then continue to work productively as a physician. And that's really the key thing.

Brian F: You bring up a very good point there, with people trying to self-medicate and self-heal, and then it turns into a whole different issue. Then when you had a problem with work-life balance, now you really have a problem. And that organization, the Tennessee Medical Foundation, I think does some pretty good work in that area.
Dr. Berkompas, we really appreciate you being here today, and thanks for all of your information and your wisdom. And you can tell your wife I think you've got a pretty good grasp on this.

Dr. Berkompas: Thanks to her. Thanks, Brian.

Brian F: Thank you.

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