Residents want work-life balance, but finding time to preserve your own wellness while successfully caring for your patients requires self-awareness and boundaries, two things many residents struggle to establish amid pressures in training. That’s why one physician created a play as a wellness solution that helps residents tackle tough conversations about balancing family, personal identity and practice. 

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When Bill Thomas (right), MD, sat down to pen the first scene of his play, a blaring trumpet is all that came to mind. He planned to start the play with a brassy trill but didn’t know what would come next. He imagined how one horn would help him capture the physician who hasn’t spoken to his spouse in days, the resident who stopped playing cello or the intern dreaming of a full night’s sleep. He knew he wanted to write an honest play that followed familiar physician stories and a theatrical format any medical team could perform.

After a year of rewrites, what started as a looping sound boomed into Play What’s Not There, a one-act play exploring honest life challenges physicians confront while juggling practice, self-fulfillment and family. AMA Wire® spoke to Dr. Thomas about the play and how the arts can help young physicians discover new ways to boost wellness.

Plus a bonus: AMA Wire readers can host their own free production of the show. Read on for details.

AMA Wire: What prompted you to create Play What’s Not There?

Dr. Thomas: It started after I gave a speech at Harvard University’s Fogg Museum about searching for the balance between work and life. The idea of the speech was that art could be a way of finding balance.

Carl Patow, MD, who is the regional vice president of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Program, called me after the event and said he had this idea that we should do something beyond talking about [work-life balance] and actually try creating some solutions, so Carl ended up commissioning me to write the play.

This was conceived of as being an entirely practical thing. We knew we had some limits we wanted to put on the play: It had to be simple to stage, limited to five characters and … limited to one act.

It took about a year of writing to get the play into good shape, and then we premiered it at the Guthrie Theatre in Minneapolis, which is an unbelievably great theater. Dr. Patow arranged for medical students, residents, faculty members, and attending staff and their families to all come to the show. We filled the auditorium with people who were struggling with the same issues in the play. After each performance, I would come on stage, along with the actors, and we’d do a “talk-back” with the audience [by responding] to their questions. It really made a difference.

AMA Wire: What are your goals for the play?

Dr. Thomas: If there’s one important thing I’ve learned in this process, it’s this: If you have a room full of doctors, and you look at them and say, ‘Let’s talk about your work-life balance,’ you’re going to hit a great big stone wall. But if you put them in a dark theatre, and let them watch a play with characters who are also struggling [with work-life balance ], then these physicians—who are good people but work under tremendous pressure—will be able to discuss issues and ask their questions in terms of the play. This gives them enough distance to really talk about their lives and difficulties without admitting weakness, so to speak.

Medicine has excelled tremendously by understanding life through science, which I embrace, endorse and love. But I think medicine has not done as good a job of using art as a tool for understanding the world, our lives and our place in the world. This play really represents a step in that direction. To really excel at taking care of people, physicians need access to both arts and sciences—and right now the playing field is really tipped one way. That’s part of the reason we do have this problem with burnout and people questioning why they’re [in medicine].

AMA Wire: Related to burnout, can you talk a bit about wellness within the “culture of medicine”? How can young physicians advocate for real work-life balance while grappling with pressures that so many physicians say are intrinsic to the field? Is work-life balance even possible for the modern physician in training?  

Dr. Thomas: I’m an optimist, and I think it is [possible]. One of the things physicians of all ages need to do is start raising the alarm whenever conversations veer toward a purely quantitative expression of worth and value.

Physicians are constantly placed under pressure that is entirely quantitative—how many patients, RVUs, admissions, procedures, etc. There is a place for that, but what happens—and the trap we fall into when life becomes entirely mediated and measured by quantifiable measures—is that physicians begin missing out on the very thing that brought us to medicine in the first place. If we only [cared] about the numbers, we’d probably all be bench scientists in a chemistry lab. But we were drawn into medicine because something appealed to a blend of our humanity and scientific understanding.

When you have people with those inclinations, and you put them in an entirely quantitatively driven system, something gets damaged—and often, it’s that human sensibility. So for young docs [combating burnout], the thing to do is to push back on purely quantifiable measures of worth.

AMA Wire: Your play explores various themes related to resident wellness, especially through its main character, Dr. Beatrice Long, a resident who recently started her program only to struggle with maintaining work-life balance. Can you briefly describe the play and some of the ideas Dr. Long’s character exemplifies?

Dr. Thomas: The play uses a literary technique known as magical realism. In the play, characters encounter Asklepios, the Greek god of medicine, in human form. What’s interesting is that elements of fantasy are introduced into the plot but at the fundamental level. This is a realistic play about people struggling with real problems, such as families and pressures at work.

What we have in this character Beatrice Long is a young person who is very qualified and talented. Really, she has everything we’d all say would make her a great physician, but she hasn’t entered the profession because she’s been so wary of losing herself and her ability to maintain a coherent self outside of medicine. So a very crusty senior chief of medicine gives her one more chance to enter the profession and become an intern. And what follows is that instead of being mentored by the very crusty chief of medicine, she ends up being mentored by Asklepios, the god of medicine. Asklepios helps her see the world and people around her more clearly, and in essence, the audience does the same.

By the end of the play, without giving too much away, Beatrice’s humanity ultimately leads her to make a thoughtful and generous decision at the end of the show that emphasizes the need for life balance.

AMA Wire: What’s next for Play What’s Not There? If residents or programs wish to learn more about the play, what should they do?

Dr. Thomas: If they would like to receive a copy of the script and put on their own staged reading of the show, it’s easy to do: All they have to do is write me. We can provide a copy of the script, and they can perform the play—no charge or obligation. I’m just really interested in allowing physicians to play with these ideas and use them as a spark for conversation.

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