Putting the Pieces Together: Finding Balance in a Fragmented System
By Dominique Perkins, Associate Editor, Arizona Physician Magazine
Photography by Denny Collins Photography, dennycollins.com
From Print Issue - Winter 2020
If anyone should have an opinion on maintaining balance, it is Anita Murcko, MD. From starting and closing practices, founding companies, volunteering with medical associations and organizations, this woman has a lot going on. We sat down with her to talk a little bit about how all of these seemingly unrelated endeavors come together in her life to form one continuous fight to improve health and care for all patients.
All Paths Converge in Medicine
Dr. Murcko grew up in a large, close-knit family in Pittsburg, so she had plenty of family around to lend their advice on how she should approach her life. Luckily, she didn’t always listen, particularly to well-meaning voices who assured her that she should find a nice doctor to marry instead of going through all the work and sacrifice to become one herself. In fact, Murcko admits that she is obstinate enough that talk like this just made her dig in harder, rather than give any thought to backing down.
A life devoted to healthcare was a passion that grew in a very organic and natural way for her throughout her life. Family members over multiple generations had served in various aspects of medicine, and she took lessons from each of them, from an aunt who served as a Lieutenant Colonel in the Airforce Psychiatric Ward to her grandmother, who was a pharmacist.
Early volunteer work as a candy striper further exposed her to the inner structure of the healthcare system, and she came to appreciate the value of each aspect of healthcare delivery, from chemotherapy to a carefully made patient bed.
“It’s not a hierarchy, it’s a team,” Murcko said. “And I grew up with this kind of total-person feeling, and that’s what’s permeated my life, really, from the very beginning.”
The view of healthcare as treating the entire person, rather than segmenting off each part, has led Murcko on a rich and varied career path.
All-told she has over 30 years of healthcare experience, more than 20 years of teaching I various settings, and over 15 years of experience in quality improvement and healthcare redesign. She has founded medical practices and consulting businesses, conducted research, served on association boards and committees, treated patients, led teams and educated hundreds of future physicians, researchers, and healthcare providers.
It’s no wonder that occasionally friends and family members can’t help but ask, how do these things possibly fit together? However, the unifying motivation that has propelled these seemingly disparate projects is simple.
“My general trajectory is, okay, how do we deliver better care?” Murcko said. “And we deliver better care if we have the right kind of people, processes, and tools.”
Throughout her years of experience, Murcko sees opportunities to help guide these processes, tools, and people in applications such as electronic health records, prior authorization, and integrated, interactive patient care.
Currently, Murcko is a clinical associate professor in Arizona State University’s College of Health Solutions.
“I’ve been able to kind of help bridge some of the academia informatics gaps with local healthcare community, and help with research projects, and placing students, and overseeing projects that they can see how the skills and knowledge that they are acquiring can be directly applicable and also help them with their job experience and getting jobs,” she said.
A Daily Struggle
With her many years of experience, and new projects and interests presenting themselves all the time, balance is a daily challenge. In the face of maintaining such a busy schedule, Murcko is not the only physician who finds it hard to prioritize her own health. More and more physicians are feeling overwhelmed, exhausted, and hopeless.
Murcko employs a few strategies to try and keep ahead of her frequently daunting “to-do” lists. First, she puts a premium on the daily basics of good food and enough sleep.
“Sleep is when our body repairs and heals itself, and without that, we’re not a lot of good for anybody, or thinking clearly,” Murcko said.
Secondly, she sets a focus for each day – grouping like tasks together and designating a few priorities to accomplish in each. The key here is to be realistic and know you can’t do every single thing every single day. For example, since she teaches on Fridays, Tuesdays are the days when Murcko focuses on preparing for class.
“But if I looked at the rest my project list on that day and tried to get things done on every one, I wouldn’t get through it,” she said.
Murcko also carefully makes time to spend with those she cares about and to participate in hobbies and activities that enrich her life and restore her energy. A key strategy here is to build in a level of accountability into the events. For example, she and her husband maintain a set date night, and one of their favorite activities is to attend musicals and shows. So, they often purchase season tickets. The monetary commitment helps them keep their commitment to the tradition, especially on nights when it would otherwise be so easy to cancel when busy, tired evenings come around.
Murcko implements a similar strategy in her hobbies and personal interests. She loves music and is currently singing with the North Valley Chorale in Phoenix, where she has served as president for the past seven years. Not only is this an activity she enjoys, but it also establishes an expectation of participation.
“If you are going to sing, you need to sing your part properly, so you have some expectations that you will make enough time to prepare so that you are a benefit to the people you are singing with or performing with,” she said.
Watching the Signs
One last piece of advice that Murcko has seen in her own life, and that she would like to pass down to young physicians feeling buried in the struggle to keep on top of their career while also maintaining a sense of resilience and self-identity, is to expect priorities to change.
Balance is a concept that will mean different things to different people and at different points in our lives and careers. Looking back on her life, Murcko can cite specific times that her priorities changed, and she had to step back, reevaluate what she wanted, and make adjustments. Whether that meant stepping back from practice so that she could invest more time in a new project, or taking on more teaching and volunteer hours to be closer to home, she has been able to make necessary changes to meet the ebb and flow of life’s challenges.
To those trying to take the temperature of their own life balance, she recommends keeping an eye on the signs.
“Little but sometimes not so little reminders about where your love is, where your passion is, and how that fits with those that you love,” she said.
Feeling splintered in your time, or feeling bound to one set of expectations while drawn in another direction are definite signs that a reevaluation is needed. While physician burnout is an ever-growing concern, and even classified by some as a public health crisis, Murcko has never cared for the term, “burnout,” feeling it implies fault on the physician side – as though they have given what they have to give and are now floundering due to personal failing.
By contrast, in her experience, a person can be working as hard and as effectively as they can, and it is the environment, not their effort or desires, that causes the fatigue and dissatisfaction we call burnout.
“I think the term is really a symptom of what is happening with the fragmentation and all the distractions that we have,” she said.
What’s more, many of the current solutions and coping mechanisms, while seemingly good and helpful things are mostly superficial.
“Some of those are more like bandages that are on top of a very gaping wound that is the way the system is handling and organizing our workforce,” she said.
Preparing to Take on a Fragmented World
The healthcare landscape is continually changing, and up-and-coming physicians are facing more challenges than ever. While good ideas and possible solutions have been created, they have not been well-executed, creating confusion for patients and frustration for those trying to deliver care efficiently and effectively. Though she feels most providers are still motivated by helping and serving their fellow men, the evolution of the business of healthcare into a corporate and profit-driven system is in direct conflict with this goal.
“With that system has come fraud, has come abuse of information, and greed. And I think that the ability for those types of behavior to creep in have also caused a lot of the issues that we have seen today,” she said.
However, as Murcko sees it, there is plenty of hope for the future. She, and others like her, continue to feel motivated by all the good that can be done, and the responsibility that comes with the knowledge, technology, and research achieved so far. These advances in the hands of an intelligent and innovative generation could be what we need to build a more effective system, provided we can also be cautious, attentive, and ethical.
“Teaching in the graduate as well as the medical school, with ASU and with the various health professions, I kind of trust the wonderful people that are taking our places as we grow older,” she said.