One day off in seven. What do you think that means?
You’re probably thinking you’ll work no more than six days in a row. Anyone would think so. Well, according to the Accreditation Council for Graduate Medical Education (the organization that sets standards for training doctors) you’d be wrong…it’s actually twelve. Some interpretations actually permit working twenty-six days straight. Makes sense, right? Don’t worry, I’m a mathematician and I don’t get it either.
Recently I’ve been talking to some colleagues in medicine, and they mentioned a plague of the field: “burnout,” aka stress, exhaustion, and depression developed among medical professionals throughout their careers. I looked into burnout myself and discovered the following:
- Suicide — More than double that of other professions, at ~34 per 100,000
- It’s Rampant — ~50% of physicians and nurses are burning out
- It’s Costly — Estimated cost = $7,600 per physician, per year
So what is the medical community doing about it?
- Tweeting: Acknowledging the problem, reposting articles, liking Tweets
- Inviting Speakers: Talks on the causes of burnout
- Appointing Chief Wellness Officers: Senior staff who ponder well-being
Clearly, burnout is a hot topic. However, I have yet to see a tangible solution, so I’m proposing one: improved scheduling practices — specifically, algorithmic scheduling: using mathematical modeling to generate schedules automatically. Over a year ago I built an algorithmically-based platform to create fair schedules quickly: SchedJewel.
Here’s my logic on how algorithmic scheduling could reduce burnout:
For Schedule-Creators:
Opportunity Cost & Rest: Medical staff (eg, doctors, nurses, physician’s assistants) are often tasked with making schedules, and their time is valuable. For example, in residency programs, exceptional medical skills and teamwork earn you the coveted honor of “Chief Resident,” and its commensurate responsibility creating block and shift schedules. Less time spent making the schedule means more time for meaningful activities, such as education and clinical work. If scheduling is done in your off-time, algorithmic scheduling would provide more sleep and leisure. Ultimately, we’re talking about increased job-satisfaction for those who make the schedule.
Fairness: Creating the schedule is a balancing act of trying to be fair to everyone while ensuring coverage. Despite your best intentions to honor as many requests as possible, someone will probably still be unhappy. Accusations of favoritism and bias don’t exactly make schedulers feel good, especially after trying their best to be fair to everyone. In contrast, if a computer makes the schedule algorithmically then this conversation is off the table.
For Staff:
Rest Between Shifts: More rest between shifts means better quality-of-life for staff. Why not rapidly generate a schedule that fulfills your requirements while providing more rest, when possible?
Working Fewer Days in a Row: It’s no stretch of the imagination to think working fewer days in a row could mean a better quality-of-life. For example, in residency what if six actually meant six? But this solution isn’t just for medical residencies. An algorithmic approach could generate schedules with different numbers of consecutive days on for different people, based on individual preferences.
Respecting Time-Off Preferences: If more time-off requests are honored, people could be happier in the long-term.
Consistency on Time-of-Day: Switching from working days to working nights messes with circadian rhythms. Staying on one or the other could improve quality-of-life and overall happiness.
The above four points are examples of alternative shift patterns, which beg the question: Why are shifts structured the way they are? Do alternative shift-structures exist that could improve life for medical staff without compromising patient-care? This specific question seems largely unexplored in the burnout literature. The research I did find either experiments with making schedules worse (1, 2)1 or ignores staff well-being altogether. In contrast, an algorithmic approach empowers medical professionals to experiment easily with different shift-patterns, ultimately zeroing in on the pattern that works best for their team.
Is algorithmic scheduling a complete cure? Probably not. But upping your scheduling game has real, immediate impact, and doesn’t take much work to implement. Scheduling impacts residents, attendings, nurses, and any medical staff working shifts. How you schedule can be a catalyst for improving wellness and reducing burnout. If we’re actually looking for solutions, why not start with something tangible we can do today?