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Phillip Pierorazio: Good afternoon. I'm Phil Pierorazio, a urologist from the University of Pennsylvania. I'm sorry I couldn't be there with you in person, but I'm thrilled to have five minutes of your time to talk about cultivating wellness and resilience in your individual life and your practice.

We've all been touched personally by the ongoing crisis in work-related stress in healthcare, and my hope is that over the next few minutes, I can give you both a better understanding of how those stresses affect us and provide practical strategies you can bring home to facilitate a long, sustainable career in medicine and surgery. If you remember nothing else from this short talk, I want you to remember two things about the number 20%. First, remember that only 20% of the stresses related to healthcare are within our control as individuals. That way, we can focus our energy and our efforts on the 20% we control, and we don't waste energy and stress on the 80% that we do not.

We can modify our daily clinic schedule. We can choose what days we are in the operating room and not, what operations we do, what time we want to get home to see our families. We can also control what we eat, when we sleep, and work out, remembering that our own personal health is the foundation for good healthcare for others and for ourselves. And if there are external stresses that are getting to you outside of that 20%, then we can climb the administrative and leadership ranks and make changes to the systems that are affecting us. Scribes, AI, better turnover, after-hours coverage—these are all strategies that improve the physician experience. But if you have no interest in the administration or those systematic changes, then you're wasting your own valuable time and energy complaining about them.

The second reason to remember 20% is that we only need 20% of our dedicated time to activities that bring us joy to truly be considered happy. These data come from both the sociology literature and a number of industries outside of healthcare. The most notable example is Google, where each employee is given one day a week to pursue activities of their choice, whether or not they have to do with the current Google project they are on. And what Google noticed was that productivity, efficiency, creativity, retention, and happiness all went up in the workplace.

I tell this to you so that you don't set the expectation that 100% of your time at work needs to be doing the things you love. It's just not attainable, and you're setting yourself up for failure. But if you can set yourself up so that a minimum 20% of your week, or just one day, is dedicated to what you truly enjoy, you'll be confident and you'll feel happier and more content in your existence. This could be clinic if you love clinic. This could be the operating room. It could be research or the finances of your practice. Yes, it can be pursuits outside of medicine as well. It could be working out. It could be golf, tennis, reading, gardening, cooking. It's all okay. And we should be aiming for more than 20%, but it's very rare that we can allow 100% of our time in these endeavors.

In the last part of this talk, I'd like to address how we find that 20% that truly brings us joy or happiness. This 20% is our purpose. It's the why behind what we're doing what we're doing, or it's our identity, and it's critical to our success in both healthcare and life that we understand who we are. It's one of the first things I work on with the people I coach, the mentees in the hospital or the school of medicine, or anyone I encounter who's struggling in healthcare.

There are several specific tasks you can do to discover your purpose. You can evaluate your values, think about your heroes. You can think about the way you want to be remembered in or out of the workplace. But the foundation is who you are and what motivates your behaviors, why you are in healthcare, and what brings you joy in life. For many of us, that foundation is helping other people. But for some people, it could be financial well-being, it may be the cognitive challenges of medicine, or it may just be the personal interactions in a high-energy environment. None of these value systems or purposes are better or worse than another, but understanding your own personal motivating factors will help you coordinate and create your schedule in a manner that aligns with your individual purpose and goals.

And on the flip side, many of us consider our own personal experiences and struggles, or we may see colleagues in whom we see a struggle in which they are having a conflict with their own personal identity and with their identity within the institutional workplace. For instance, somebody may consider themselves a big whack surgeon or a high-volume roboticist, and that's not who they are or how their practice views them. Someone may find clinic time loathsome where their institution really needs someone to be in clinic four or five days a week. The conflict between who we see ourselves as and how the institution views us is called cognitive dissonance, and it's one of the major causes of burnout in medicine.

So whether you are on the individual side and sensing cognitive dissonance in your own life or on the leadership side and seeing this conflict in one of your colleagues or peers, the framework I just described may help you move forward towards a more healthy, resilient, and sustainable relationship between your individual and institutional identity. I'd like to thank you for your time and look forward to speaking with many of you. I'm happy to help you craft specific strategies that will work for you as an individual or in your practice. Feel free to reach out to me through email, phone, or social media. All of that information will be provided. And remember to focus on the 20% that you control and purpose-driven happiness at work.