“Physicians have no autonomy.” I read and hear versions of this every day, expressed with anger, resignation, or both. It’s also called agency, control, and power (as in feeling empowered).
I’m the first one to admit that physicians have way less autonomy than in the ten decades that preceded this one. Moving from private practice to employed models, heightened focus on productivity, compensation via RVUs, and mergers have shifted the power dynamics. And I’m the first to say this is not ideal for physicians or for patients. As someone whose trajectory in medicine was snagged by burnout, I know how toxic the current system can be.
Yet, at the same time, as a work-life coach and consultant, I have watched the physicians I work with find places where they have some agency. They make small changes, and … WOW! I’ve been awed over and over by the impact these small changes have on their day-to-day lives. I feel so inspired as I see them invest in themselves and create sustainable careers by changing what they can.
I believe there are a few key secrets physicians need to know about launching impactful change:
See what’s what clearly. Invest the time and energy in surveying your landscape to see what is not working, personally and professionally. Be courageous and honest with yourself. If looking feels really bad, know that, like the phoenix, you can rise again—if you prioritize yourself. (If you are currently in survival mode, you may need help delegating, cutting back, and setting boundaries so that you have the time and bandwidth to do this surveying. I often help physicians address documentation issues first because Work Outside of Work is such an energy and time drain.)
Identify where you have agency. To my mind, there are three places: who you show up as every day, how you lead, and how effectively you advocate for change. And, remembering Maslow’s hierarchy of needs, you must start with the first. What is foundational to your being your best self? At least 90% of the physicians I work with identify sleep as the number one precondition to being their best self.
Be bold and take small steps. Here’s where the rubber hits the road. Don’t give up, saying, for example, that you can’t revamp your life to get more sleep. Instead, commit to a very small action step to try out: set a timer as a reminder to shut down electronics, aim to get in bed 20 minutes earlier, or simplify your evenings in some small way. After a week or two, reassess. What did you learn? Did the change help? If not, why not? Or if you didn’t follow through, what obstacles got in the way? Without giving up or beating yourself up, try again.
You might say that getting more sleep won’t stop the myriad problems at work: disgruntled patients, frustrating mandates handed down by top leaders, daily inefficiencies, staff shortages, not enough time with patients. But getting more sleep is just one small step in shoring up you as a person. It is the first step to reclaiming your life, your career, and your autonomy. Don’t knock it before you try. And know that trying something new and hoping for better is one of the most courageous things you can do. Give yourself the gift of hope and find yourself again.