No disclosures, so we'll jump right into this. Objectives for this talk, work-life satisfaction, which has become a very passionate topic for me, for physicians, and for advanced practice providers. I don't think we work on this enough. We'll have a few slides on burnout, and then we'll really get into what I think is important for a good work-life satisfaction for APPs. First polling question, burnout means the provider is depressed. True or false? Ah, very good. It is false. That's very good. 90%. There is hope for all of us. Let's have our second question, please, Eden. APPs with appropriate mentors and work schedule can achieve work-life satisfaction. True or false? Excellent, excellent. And the goal of these questions was not to be tricky. It's really to get into this topic that is so very important to all of us, and that is our work happiness. All right, quickly, a definition on burnout. Burnout is very simply, in medicine, more than anything, compassion fatigue, which obviously is a big problem because compassion is at the heart of what we do. There's exhaustion, there's cynicism, there's inefficiency, and we'll talk more about these in the next slide. Burnout is not, and this is important, burnout is not depression. That's a separate clinical diagnosis. It certainly could be part of a problem, but it is not burnout. We all can have high work stress from time to time, so burnout is not high work stress, and burnout is not job dissatisfaction. That's another separate entity. There are three pillars of burnout that we talk about. Emotional exhaustion, depersonalization, and low sense of personal accomplishment. Emotional exhaustion is when we have this emotional feeling that we are worn out, we're just exhausted from the stress of work or our home life or both. Depersonalization is slightly, in my opinion, a little bit more disturbing than the emotional exhaustion, and that's where we have this distant or indifferent attitude towards people. Unfortunately, that occurs to our patients and to our colleagues, and I think that is a very concerning finding and something we clearly would need to work on. The one that's actually saddest to me is low sense of personal accomplishment. As you've heard many times already, and you will hear many times throughout this talk, we are talking, the faculty is talking to a very high intellectual crowd. Those of you who are NPs have gone through nursing school and have gone through a master's degree, and so you are a high academic achiever. Those of you who are PAs went through a rigorous undergrad program, not easy to get into PA school, and once again, are high academic achievers. We should have great sense of personal accomplishment and a great sense of confidence, not an ego, but a great sense of confidence in who we are and what we do. That one is certainly one that I find personally sad. There are complex medical tools that we can use, measurement tools that we can use. They're not very practical. There's a two-question questionnaire that seems to be helpful. One question is I feel burned out by my work, understanding those definitions, or I've become more callous towards people since I took this job. So that callousness, that cynicism that falls under depersonalization, those can be very helpful. So last slide on burnout, and that's really how are you doing? How are our APP colleagues doing? And we do care about you. The results are mixed. Unfortunately, we don't have a lot of data in any particular field, and there's very little data that's really good evidence-based data in GI. So this comes from the best stuff that I can find. As far as NPs, and these, again, are overall NPs, not just GI, 64% of NPs have a high sense of personal accomplishment. That's very good, but I think that needs to be higher. That, in my mind, should be a minimum 80% or higher, so still work to do. 32% of NPs have high depersonalization, so they're meeting criteria for burnout. Again, that's a high number. I'd like to see that number come down. As far as PAs, about 34% of PAs in one study, and I thought it was a pretty good study, met criteria for burnout. Again, a higher number than I like. I'm an optimist. If you start to flip some of these numbers around, it's not discouraging. I think there's reason to be optimistic, but definitely work to do. In the past, I've spoken about, to physicians and advanced practice providers, about work-life balance. However, last summer, I heard really the best talk I've ever heard on burnout, and it was entitled Work-Life Satisfaction. And I think work-life balance is really not an accurate description. We really can't achieve that balance, even most of the time, of having that perfect balance between work and home. However, I really do think we can achieve that sense of being content, being happy, and having that work-life satisfaction. So I think that should be the definition we use. That should be our goal. I think it's a more accurate description of how we want our work to bring us great joy, and how we want the combination of our work and home to bring us great joy. It is absolutely achievable. And as Vivek mentioned, we, our APPs, our organization leaders, physicians, nurse leaders, and administrative leaders, need to work together to achieve work-life satisfaction. I like this perspective as we start to think about work. Satisfaction of one's curiosity is one of the greatest sources of happiness in life. And this is from one of the science world's great minds, and that's Linus Pauling. We are curious people. That is why we're in medicine. That is why we became APPs and physicians. And we should seek to fulfill that curiosity at work so that it makes us happy at work, and that can spill over into our personal lives. I do like that quote. Big picture from the organization. What can they do to create a positive environment that leads to happiness? First, create a culture that focuses on delivering high-quality patient care. That goes a long way to keeping us happy, making the patient practice-centric, providing high care, not skipping corners. Doing it right is very important. We absolutely have to create a culture that embraces APPs as colleagues. You will hear us say that all the time throughout the next few days. You are our colleagues. You are not my scribe. You are not there to make my day more financially lucrative. You are not there to make my day happier or better. You are there with me to make our entire team happier, to make our workday happier. I can tell you the best thing that happened to my professional career was to work in teams and work with APPs. It has really made my life much more happier. I learn as much from you as you may learn from me, and you've made me a better thinker. So we have to embrace you as colleagues and as team members. Nothing short of that. We have to understand that the needs of APPs may be different. If you look at the data, 95% of APPs are female. 97% or more of APPs are female at different times in their lives or perhaps at a lengthy period of their work lives. You may have some different needs. So we have to work in a culture that recognize that you need flexible work schedules that work best for you and can be productive for the practice. And through vacation and through other things that we'll talk about, we need to create a culture that enhances your personal life. We can't cross the line of getting into your personal life, but we have to provide the tools that may help make your personal life happy, and that would have a positive impact on work-life satisfaction. So some simple strategies we can focus on. Do you want to be a clinic APP? Do you want to be a hospitalist? Do you want to be a hybrid? When organizations are looking for jobs or APPs, maybe we think we're looking for a clinic spot, but if we find that right person, a person that we think is going to be a great fit, it may be a different model. So let's work with you to get that right fit so that you can take care of your patients. Do you want to become a subspecialist within GI? Andrea is a subspecialist at the Mayo Clinic. It can happen. It doesn't have to happen only in academics. It can happen in the private world. Maybe you're a liver subspecialist or an IBD subspecialist in the practice world. Even if it's not 100% of your practice, if it's 50%, 60%, that may bring you satisfaction at work. How can we expand your roles beyond patient care? I think doing other things beyond patient care definitely adds to our work-life satisfaction. Do you have an interest in administration? Sarah is the lead APP for hospitalists at her institution. Do you want to be part of some of the committees at your organization? Do you want to get involved at the ASGE and get involved with some of our work with APPs or other societies? Are you interested in teaching? There's a ton of opportunity for teaching for both PAs and NPs at your local schools and universities. Our APPs are involved in teaching nurse practitioners from our local nurse practitioner program. Great source of satisfaction and joy. And do you want to get involved in research? And you certainly heard plenty about research. You must clearly define your work schedule and the organization must clearly define your work schedule and you need to be on the same page. You should not be running to help me in the endoscopy center, Aaron in the clinic and be running around and being pushed around like a ping pong ball. You should have a well-defined, clearly elucidated work schedule. It is my recommendation and the recommendation of other experts that it should be a minimum 30-minute slot in the clinic and we'll talk about the clinic first. I like the idea of having a 30-minute catch-up slot throughout your day. One of the things we don't want you doing is taking work at home. I think that's one of the negatives of the pandemic. We got used to perhaps taking stuff home. I think that's a mistake and we'll talk more about that. But define those clinic spots. During your workday in the clinic, you should have access to your physician colleagues. Not necessarily running around to make their day easier, but access to you for any intellectual needs, recommendations you may need to help you in the clinic to make your clinic day efficient. You should clearly define whether you want a four, 10-hour workday or a five, eight-hour workday. And groups should work with you to make your schedule happen. I personally like the four, 10-hour workday, giving you opportunities at home to do things you need to do at home and to make your work life better. Sorry, your home life better. And we should be very open to part-time scheduling. There is a great shortage of gastroenterologists. I think we're down about 2,500, 2,600. You are indispensable to the world of gastroenterology. We should be looking for ways to be creative and strategic in your work life. For the hospitalist, I think some things that can make your day better and more happy is to have a morning huddle, whether it's official or unofficial. When you get in, have that conversation with your team, with your collaborating physician to make sure you start the plan for the day. I think you need dedicated time where you are working on record review, data collection, organizing the day. That should be in the morning. Yes, you have your beeper, but you shouldn't be holding your collaborating physician's beeper. You should be tending towards nursing needs and duties. This should be your dedicated time to plan your day so that it's efficient. And again, you can enjoy your day. Also, direct access to your collaborating physician at all times. They may be doing an ERCP, maybe in a tough colonoscopy, but they can always take your questions. So access to the collaborating physician. Four 10-hour days and five eight-hour days are also very doable in the hospital system. And so that's certainly on the table as an option to meet your needs. If you work weekends, then you should, in my opinion, you should have compensatory time during the week off, whether it's the next week or at some time. So if you work those two days during the weekend, there should be some compensatory time off to make up for that weekend. And if you do take call, and I hope you do not, but if you do take call, you need to be compensated for that in some shape or form. In addition to providing the environment that makes us more productive and happy, we need to provide, the organization needs to provide a learning environment that is ongoing. So find a mentor, a physician, an APB, or preferably both that will help you, as Vivek said in his talk, grow. Those early years are very important. So find a way to grow. Get the support staff that you need so that your day is productive and efficient. So a triage nurse, and there's opportunity for you to teach your triage nurse and for you to learn from your triage nurse and dedicated staff. Make sure that you're part of the quality program and understand the quality program at your organization and make sure administration pushes forward with continuous education, perpetual learning. Again, it comes down to culture, culture, culture. We want that culture to promote education platforms from onboarding to direct access to physician colleagues, journals, journal clubs, podcasts, and different society tools that we're all working to make sure we have for you to use and these tools are efficient and then attend courses like this to continue that education process. You can become the cognitive equivalent of a physician when it comes to expertise. There's no doubt about it if the right learning environment is provided. Finances, very important part. We shouldn't be embarrassed to talk about finances. Again, you are highly educated. You should practice at the top of your education degree. So you must be compensated fairly. And I want you to think about total compensation, the total compensation package, salary, salary and bonus if it applies and making sure that you're paid according to MGMA data or other data at or near the top of your scale. Make sure that the financial packages includes health, dental malpractice, medical malpractice insurance. That's all part of this financial package. 401k, 403b, profit sharing, defined benefit. You need to start building your future wealth now and it should be part of the conversation and part of your happiness. You will be high income earners and you can really build a good life and a good future for you and your family. Vacation, really important one for me. It should be very important to you. How much? It does vary. So it's very hard to tell you exactly how much. I believe five to six weeks should be our goal. That excludes CME. I think if you're getting five or six weeks, CME should be separate. If you're getting more than six weeks, it's okay to include CME as part of that. I think sick leave should be separate. Personal leave, personal time should be separate from those five to six weeks of vacation. One of the things I think we have learned from the pandemic is that we have to be very careful how we use sick leave with our employees because that sick leave, if the employees have children, can go away very, very quickly or take up a lot of vacation other times. So I think we have to be very smart and very cognizant that sick leave has to be viewed differently when it comes to APPs. I think we need to be creative and start accepting new models. There are other evolving models that we need to consider about how we creatively use sick leave and vacation time to build that collaborative relationship with our APPs. Organizations must do everything we can to support and maintain a happy and productive culture. As I said, you've become indispensable. We want to retain, retain, retain. We have a huge shortage of gastroenterologists, and we need you. It is exhausting, expensive, and emotionally exhausting for turnover. So we should be avoiding turnover, building that team, building that culture that retains, retains, retains. On a personal note, we tend to forget that happiness, this is a great quote from Frederick Koning that I like, we tend to forget that happiness doesn't come as a result of getting something we don't have, but rather of recognizing and appreciating what we do have. And I really liked that quote to help us think about happiness. I am now a convert to managing your energy and not your time. So on a personal and organizational note, we need to do that. Organizations need to shift their emphasis from getting more out of people to investing in them. And that's a completely different view. So we need to invest in our people. And you, the individual, need to recognize that the cost of energy depleting behaviors and change. So if you are doing things that over and over are draining, emotionally draining, physically draining, we have to identify what those are and change and really start to focus on managing our energy and how that can be more productive and not just managing every 30 minute block. And we can achieve that with organizational and personal communication. So communicate, communicate, communicate. Personal strategies, priority, your individual and family responsibilities and interest. I think this is really important. Start with what's most important. You list those interests and try to work with your organization to get those top two or three that are important. Build a positive social support system around you. I think this is really, really important. I know at times it's tough to have transparent conversations with the important people in our life, but we must, we must communicate what we need in our work and home lives to make us happy at both of those places. We're gonna have to compromise at home, there's no doubt. And I know this is a tough one. Remove or reduce time with negative people and negative actions in your life. Again, manage your energy. Don't manage your time so much and remove those negative influences in your life. I think that'll help you become more happy at home and more happy at work. And remember, both with work and your home life, you can have almost anything you want, you just can't have everything. So prioritize what is most important to you. Again, list those responsibilities that you have, create a manageable list and look at those stresses at home that could be related to work. Look at ones you can solve and solve them and keep working on those strategies at home to try to remove those stresses that can be impacted both at work and at home. You have to take real vacations, no work on vacations. Take them with your family, take them with your friends, long weekends count. I like, excuse me, I like full weeks better, but no work on vacations. Occasionally you have to be selfish, get your proper rest, get that proper nutrition. If you like to go to the gym or some orange theory or whatever it may be, go there and get your exercise. If it's reading, learning a new language, yoga, whatever it may be, again, sailing, be selfish from time to time. That is important for mental health and mental happiness at home. Do not take your work at home. It may be hard to avoid, but you've got to leave your work at work, get the work done and then go home. I think that's where that catch-up time helps. And as much as you can, at the end of the day, unplug from your devices. If you have family, spend time with your family. If you have a spouse or a partner, spend time with them. Unplug from the devices and build those personal relationships. And finally, small acts of kindness matter. Work organized social events really count. Parties, employee celebrations, APP social gatherings, one big group office instead of individual offices. And I'll give our example. We have one big office, we call it the bullpen. It's a baseball reference. The APPs and docs sit in the clinic. I sat near APPs. We could talk about anything. They could ask questions. It was a very friendly and fun environment. The APPs go out to dinner a couple of times a year on the organization. And one of the best things we've ever did, we bought an espresso machine. Those of you who've heard me talk on a similar topic in the past, we bought an espresso machine. It's become a great source of happiness and fun. Occasionally we buy pastries. And it's just a way of kind of humanizing everybody and enjoying our workday. Some pearls, work-life satisfaction is a must. It is achievable. And we have to continue to focus on this. We need organization and personal buy-in. Happiness is definitely a two-way street. It just can't be the individual. It just can't be the organization. It has to be both. And I'll leave you with advice from my mom. My mom did not have the opportunity to go beyond high school for her education, but she's a very bright lady. She always reminded me how fortunate I was to be a physician. And at the end of medical school, she told me, she said, and in a typical Italian mom fashion, she used my full first name. She said, remember, Joseph, you don't take care of patients. And I sat for a moment and thought, and I thought, man, I'm confused. What did I do the last four years? You take care of people. I think we have to look at our patients as people and only as people. Helping people should be our passion, not our work. And in the end, I think we do very honorable and noble work. And we should let that be a great source of happiness for us. Thank you. And I will pass this over to Jill.

work-life satisfaction

burnout

compassion fatigue

NPs

PAs

positive work environment