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Climate Change for the Medical Workplace

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Climate Change for the Medical Workplace Lessons on physician work-life balance from around the world Janet Dollin MDCM, FCFP Kathleen Gartke, MD, FRCSC – PowerPoint PPT presentation

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Title: Climate Change for the Medical Workplace


1
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

2
Outline
  • 1. Current situation in Canada
  • 2. International Experience
  • 3. Planning for the future

3
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

4
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

5
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

6
Current situation in Canada Gender Distribution
of Physicians, by Physician Type, Canada, 1978 to
2008
7
Current situation in Canada BC 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

8
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

9
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

10
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

11
Trends in the Work Hours of Physicians in the
United States Douglas 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

12
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
13
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

14
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

15
Customizing Personal Balance within Medicine Call
for stories 2008 the 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?

16
Customizing Personal Balance within Medicine Call
for stories 2008 the 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

17
Customizing Personal Balance within Medicine Call
for stories 2008 the 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.

18
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

19
Rationale
  • Is there a problem?
  • Lots of literature nothing Canadian
  • What is our situation?
  • How do we compare?
  • Modeled after an American study (Bristol et al
    2008 top 10 schools (US News World Report
    2006))
  • Advocacy begins by defining the problem

20
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

21
Work-Life Policies at Canadian Medical
Schools
  • Data gathering
  • Web search
  • Email
  • Phone
  • Compilation
  • Legislation
  • Scoring
  • Analysis / Comparison

22
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

23
Work-Life Policies at Canadian Medical
Schools
  • Up to 45 of faculty (USA) have expressed
    thoughts of leaving (often related to concerns
    about balance)
  • Generation X (1963 1981)
  • Ability to control job outweighs salary
    prestige
  • John Hopkins policies to retain more women led
    to increased retention of men (66 57)

24
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

25
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)

26
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

27
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

28
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29
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30
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

31
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

32
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)

33
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

34
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

35
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

36
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

37
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

38
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

39
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

40
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

41
Wonca Singapore 2007
42
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

43
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

44
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

45
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46
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

47
Drivers of Success (1)
  • 1. Working within existing Wonca organizational
    structure (from informal lunch-time meetings to
    Special Interest Group to Working Party)
  • 2. Fostering relationships with like-minded
    physicians from around the world
  • 3. Building capacity and leadership development
    through pre-conferences and special workshops at
    regular meetings, with particular attention to
    needs of younger physicians

48
Drivers of Success (contd)
  • 4. Consistently applying an evidenced-based
    approach
  • 5. Using technology to enhance communication
  • (eg listserve, website, teleconferences by
    SKYPE)
  • 6. Developing creative responses to financial
    inequities (eg bursaries specific to WWPWFM
    travel equalization to enable participation by
    members from developing countries)

49
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

50
3. Planning for the Future
  • Conclusions
  • Where would we like to go?
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