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    Wellness Benefits and Programs

    Jonathan I. Matsui, PhD
    Senior Program Director for Academic Affairs
    Harvard Medical School

    Nina L. Dickerman, MS
    Manager, Work/Life and Recognition
    Dana-Farber Cancer Institute

    This summary reviews the shifting landscape in the workforce related to work/life and the impact it has on benefits, programs, and policies that promote faculty well-being and vitality.

    Workforce demographics at academic medical centers are changing. Women now make up the majority of matriculates at AAMC-member institutions.1 Simultaneously, family structures and individual needs are evolving, and policies must change accordingly. Wellness-oriented and work/life benefits are important for recruiting and retaining faculty, trainees, and staff.

    Note: This summary was written prior to the COVID-19 outbreak, and the working landscape has since shifted. The National Academy of Medicine has a website addressing clinician well-being and resilience that provides COVID-19 pandemic resources.2

    Benefits and Programs

    There are a number of benefits and programs offered to employees at AAMC-member institutions to attract and retain workers. Benefits are often contracted through human resources. This could be through the academic institution (e.g., university), a hospital, or a physicians’ organization. Establishing cross-functional committees to regularly assess and evaluate benefits for specific audiences (e.g., clinicians or scientists) may be necessary. Customizing some programs for stakeholders will better meet their unique needs for better vitality and engagement.

    Institutions need to update policies and benefits to comply with evolving labor laws at the state and federal levels. Recently, six states enacted legislation to make family leave paid leave, and some increased the duration of family leave. Employees may take protected time for family or other medical reasons and still be paid, which requires special attention to faculty and staff members supported by grants. For biomedical researchers, the National Institutes of Health announced in 2020 that junior scientists, such as postdoctoral fellows or scientists who have their first independent NIH grant such as a R01, may be eligible for supplementary grants to allow them to step away from the laboratory for up to one year.3 Organizations will need to develop infrastructure to allow these scientists to reduce their workload while away from the laboratory.

    Employee assistance programs (EAPs) are a work-based benefit often, but not always, managed by an outside vendor that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. Offerings among EAP vendors vary and tend to reflect the culture of the institution they serve. Institutions need to educate faculty about how EAPs work, stressing that all calls are confidential, to increase utilization and decrease stigmas around using the service. Some faculty are sometimes reluctant to use such programs if the EAP is managed internally.

    Caregiving benefit packages, including child care, elder care, and adult care, typically address three components: affordability, accessibility, and quality. Some employers offer scholarships or discounts with specific programs, and some institutions have relationships with programs for priority access. Referrals for child care and elder care support are becoming a standard offering through EAPs. For elder care, on-site consultations and reimbursements for backup and respite care exist. Platforms like Care.com allow employees to search for caregivers with a range of supportive roles in the household (e.g., pet sitting, home concierge services, or tutors). These services also provide support nationally for when faculty travel to a conference or if family members live outside their home state.

    Backup care programs and flexible scheduling are necessary for when life emergencies occur, such as when an aging parent or partner slips and falls or your child has a fever. In cases where employees are planning parental leave, schedules need to be prepared for when a baby arrives early or if there is a miscarriage. Sufficient staffing and protocols to absorb these emergencies outside of the workplace will help alleviate additional work strains.

    Stanford University School of Medicine was one of the first to embrace faculty wellness programs. Physical and mental health needs, such as proper hydration, sleep, and access to bathrooms in the workplace, must be met for a worker to function properly.4 Other institutions, such as Brigham and Women’s Hospital, have developed centers focusing on faculty wellness or improving vitality from a systems perspective, including corporate culture, system operations, and individual wellness.

    Once each institution has determined which polices and practices to enact, a review of those policies can mitigate bias. To create a culture of inclusiveness, several institutions have created polices that target all types of leave instead of promoting leave for a specific class of people. Adopting gender-neutral leave programs puts employees on a level playing field. Reclassifying and renaming these leave programs from “maternal/paternal leave” to “family leave” may also broaden the workers eligible for the leave and reduce resentment from older workers who do not have young children. Having the entire workforce eligible removes stigma often associated with a long maternity leave.5,6Supportive family leave policies help ensure that employees do not have to choose between career and family.

    Costs

    Part of the challenge that employers face when considering benefits programs is the financial burden. Due to finite budgets, any additional program results in implementation costs. Researchers have examined how companies can reduce costs and increase productivity through benefits related to caregiving. Companies incur substantial and recurring costs if they do not account for their employees’ caregiving obligations when designing career paths, job descriptions, and benefit packages.7 There is a strong business case for well-being initiatives. Burnout and depression among clinicians results in enormous costs to a medical institution. Baicker and colleagues conducted a meta-analysis of the literature and noted that for every dollar spent, there is about a $3 return on investment and absenteeism costs drop by about $2.73.8 Shanafelt and colleagues developed a formula using readily available data to determine the financial return on investments to improve vitality and engagement and reduce burnout.9 Researchers at Stanford University have sought to reduce physician dissatisfaction and physicians’ likelihood of leaving to work elsewhere by designing a program to promote a culture of flexibility within their academic medical center and by increasing time for activities deemed worthwhile by the faculty member.10 In Stanford’s program, teaching or mentoring students or serving on an institutional committee accrue credits that can be redeemed for academic support activities, such as manuscript editing, grant writing, or lab management, or for home-support activities, including house cleaning or meal deliveries. While a financial cost is associated with this program (roughly $2,500-$3,000 per participant), this is less expensive than the costs associated with turnover.10

    Leadership

    Institutional leaders need to examine their institution’s culture and assess where to spend limited resources. Different validated instruments (e.g., Mayo Clinic Well-Being Index) can assess employee well-being. Dyrbye and colleagues reviewed these instruments and noted their strengths and weaknesses so leaders can select the best one for their organization.11

    Department leaders who advocate for greater use of employee benefits improve usage amongst employees.12 Moreover, senior leadership needs to demonstrate that using specific benefits (e.g., family leave) will not cause consequences for workers.

    Conclusions

    Faculty and staff report they are more productive and engaged in their work when they are able to balance and integrate the demands of work with other aspects of their lives. Organizations should have clear, consistent, equitable, and transparent policies, benefits, and programs that support employees at different life stages to enhance faculty well-being and vitality.

    References

    1. Kirch DG. A landmark for women in medicine. AAMC News. www.aamc.org/news-insights/insights/landmark-women-medicine. Published Jan. 30, 2018. Accessed July 27, 2018.
    2. National Academy of Medicine. National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience. https://nam.edu/initiatives/clinician-resilience-and-well-being. Accessed Jan. 22, 2021.
    3. Reardon S. US grants target researchers with family commitments. Nature. 2020;578:631-632.
    4. Shapiro DE, Duquette C, Abbott LM, Babineau T, Pearl A, Haidet P. Beyond burnout: a physician wellness hierarchy designed to prioritize interventions at the systems level. Am J Med. 2019;132(5):556-563.
    5. McGregor J. This new paid leave policy may be the smartest perk for families yet. Washington Post. www.washingtonpost.com/news/on-leadership/wp/2016/09/12/this-new-paid-leave-policy-may-be-the-smartest-perk-for-families-yet/?noredirect=on&utm_term=.1360a8dc9bd5. Published Sept. 12, 2016. Accessed July 1, 2019.
    6. Ferrante L, Mody L. 2019 Dual-physician households: strategies for the 21st century. JAMA. 2019;321(22):2161-2162. doi:10.1001/jama.2019.4413.
    7. Fuller JB, Raman M. The Caring Company: How Employers Can Help Employees Manage Their Caregiving Responsibilities While Reducing Costs and Increasing Productivity. Harvard Business School; 2019. https://www.hbs.edu/managing-the-future-of-work/Documents/The_Caring_Company.pdf. Accessed May 20, 2019.
    8. Baiker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Aff. 2010;29(2):1-8.
    9. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826-1832.
    10. Fassiotto M, Simard C, Sandborg C, Valantine H, Raymond J. An integrated career coaching and time-banking system promoting flexibility, wellness, and success: a pilot program at Stanford University School of Medicine. Acad Med. 2018;93(6):881-887.
    11. Dyrbye LN, Meyers D, Ripp J, Dalal N, Bird SB, Sen S. A pragmatic approach for organizations to measure health care professional well-being [discussion paper]. NAM Perspectives. Oct. 1, 2018. https://nam.edu/a-pragmatic-approach-for-organizations-to-measure-health-care-professional-well-being. Accessed July 19, 2019.
    12. Shauman K, Howell LP, Paterniti DA, Beckett LA, Villablanca AC. Barriers to career flexibility in academic medicine: a qualitative analysis of reasons for the underutilization of family-friendly policies, and implications for institutional change and department chair leadership. Acad Med. 2018;93:246-255.
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