MD & DO Is the chase for “lifestyle” in medicine a new phenomenon or was it always there?

[deleted1139416]

Everrrryyy where I go I see people obsessed with lifestyle. Just the other day I talked to a radiologist who was trying to sell me on radiology having a great 9-5 lifestyle. I see pretty much all of my classmates talking about lifestyle friendly specialties, or how to make specialties lifestyle friendly. I know it sounds silly - but was it always like this? I feel like 20 years ago the chase was always for “prestige” not “lifestyle”.

---

Members don't see this ad.

 

[Dr Meow]

hypothesis:
i've heard that the workload is much worse nowadays. maybe 20+ years ago, you didn't need to consider lifestyle because it was mostly better lifestyle relative to today??

nvm. idk. Don't want to spread misinfo.

 

[Med Ed]

hypothesis:
i've heard that the workload is much worse nowadays. maybe 20+ years ago, you didn't need to consider lifestyle because it was mostly better lifestyle relative to today??

Who have you heard this from, exactly?

This paper is a bit old, but documents that average self-reported work hours for physicians hovered around 55 hours/week from 1977 to 1997, then it marched steadily down to about 51 hours/week by 2005.

Experienced PDs will tell you that things have changed over the years. Everyone wants to have their cake and eat it.

 

[deleted1139416]

Experienced PDs will tell you that things have changed over the years. Everyone wants to have their cake and eat it.

Mind expanding on this?

 

[Kuratz]

There were many boomers who derived a large amount life fulfillment from work. Living at the hospital in 1980 may have made sense with the degree of autonomy, lay respect, and incredibly high pay ceiling.

As medicine has become more corporate with docs taking on more of a “cog-in-the-machine” worker bee type of role, this draw to spend all your time at work just isn’t there for the vast majority of people. No one out in the real world gives a rats ass if you’re a surgeon, the hospital/bureaucracy severely limits your autonomy, and the pay/effort just seem worth the squeeze to grind yourself into the ground for. Medicine seemingly used to be held in unrealistically high regard with many intangible benefits. I’m sure many felt this to be euphoric and were addicted to the professional respect/status. It’s also a self-fulfilling thing in that if you don’t spend time developing your life outside of work you are going to want to spend even more time at work. I see that with many attendings who just kinda linger around the hospital because they have nothing better to do which is very sad. I think as time has progressed and medicine has become more of just a standard but well/paying job people just want to do the minimum amount of work for highest financial yield and have time to develop interests outside of medicine since seeing these older docs with no home life is so terrible. Getting called in at 2am for some stressful, high-liability thing with minimal financial gain and rarely a thank you is a huge cause of moral injury. No ****ing thanks. I’d rather read that persons CT from home.

 

[K-Frog]

Just my perception and, yes, stereotyping:
I think priorities have changed over time just like our country has. Most of the older generations loved to work and considered it a joy and a responsibility. The retired older docs I have known are like that. "Doctor" is who they are.
Most of the younger generation want more time away from work and see their off time more of a joy. "Doctor" is what they do but not necessarily who they are.
I'm not saying that one is right or wrong, just different mindsets.

 

[deleted1139416]

There were many boomers who derived a large amount life fulfillment from work. Living at the hospital in 1980 may have made sense with the degree of autonomy, lay respect, and incredibly high pay ceiling.

As medicine has become more corporate with docs taking on more of a “cog-in-the-machine” worker bee type of role, this draw to spend all your time at work just isn’t there for the vast majority of people. No one out in the real world gives a rats ass if you’re a surgeon, the hospital/bureaucracy severely limits your autonomy, and the pay/effort just seem worth the squeeze to grind yourself into the ground for. Medicine seemingly used to be held in unrealistically high regard with many intangible benefits. I’m sure many felt this to be euphoric and were addicted to the professional respect/status. It’s also a self-fulfilling thing in that if you don’t spend time developing your life outside of work you are going to want to spend even more time at work. I see that with many attendings who just kinda linger around the hospital because they have nothing better to do which is very sad. I think as time has progressed and medicine has become more of just a standard but well/paying job people just want to do the minimum amount of work for highest financial yield and have time to develop interests outside of medicine since seeing these older docs with no home life is so terrible. Getting called in at 2am for some stressful, high-liability thing with minimal financial gain and rarely a thank you is a huge cause of moral injury. No ****ing thanks. I’d rather read that persons CT from home.

Do you think that this could exacerbate the physician shortage? With medicine becoming more complicated and more paperwork per patient but doctors not working as much as they used to?

 

[Lifeblood_20]

I think something else to consider is that the physician/med student populations were predominantly male until fairly recently when women began to outnumber men in medical school. A recently retired doctor I spoke to said that there were 2 women in his 100 student class. Just something to think about since family responsibilities are traditionally disproportionately placed on women.

 

[deleted1139416]

Who have you heard this from, exactly?

This paper is a bit old, but documents that average self-reported work hours for physicians hovered around 55 hours/week from 1977 to 1997, then it marched steadily down to about 51 hours/week by 2005.

Experienced PDs will tell you that things have changed over the years. Everyone wants to have their cake and eat it.

There were many boomers who derived a large amount life fulfillment from work. Living at the hospital in 1980 may have made sense with the degree of autonomy, lay respect, and incredibly high pay ceiling.

As medicine has become more corporate with docs taking on more of a “cog-in-the-machine” worker bee type of role, this draw to spend all your time at work just isn’t there for the vast majority of people. No one out in the real world gives a rats ass if you’re a surgeon, the hospital/bureaucracy severely limits your autonomy, and the pay/effort just seem worth the squeeze to grind yourself into the ground for. Medicine seemingly used to be held in unrealistically high regard with many intangible benefits. I’m sure many felt this to be euphoric and were addicted to the professional respect/status. It’s also a self-fulfilling thing in that if you don’t spend time developing your life outside of work you are going to want to spend even more time at work. I see that with many attendings who just kinda linger around the hospital because they have nothing better to do which is very sad. I think as time has progressed and medicine has become more of just a standard but well/paying job people just want to do the minimum amount of work for highest financial yield and have time to develop interests outside of medicine since seeing these older docs with no home life is so terrible. Getting called in at 2am for some stressful, high-liability thing with minimal financial gain and rarely a thank you is a huge cause of moral injury. No ****ing thanks. I’d rather read that persons CT from home.

Just my perception and, yes, stereotyping:
I think priorities have changed over time just like our country has. Most of the older generations loved to work and considered it a joy and a responsibility. The retired older docs I have known are like that. "Doctor" is who they are.
Most of the younger generation want more time away from work and see their off time more of a joy. "Doctor" is what they do but not necessarily who they are.
I'm not saying that one is right or wrong, just different mindsets.

Have you guys noticed any trends in doctors having more side hustles? I’ve noticed that quite a bit but don’t know if that was always the case.

 

[operaman]

I suspect the lifestyle thing has always been going on but is simply more in the open now. There was probably more of a stigma associated with it in decades past. There’s also the fact the younger generations are taking a more wholistic look at career plans.

I personally have made a number of choices with lifestyle in mind. I’m adjusting my schedule constantly to optimize my time outside of work and I’m lucky to work with a group that feels similarly. Burnout is a real issue and new attendings like me are taking a long view and trying to find a balance that can sustain a career.

In my own situation, I’m also finding a balance so that I can argue for hiring more partners. If I’m working two FTEs, it’s harder to convince bean counters to give more funding, but working 1 FTE and seeing huge patient wait lists and booked months in advance like I am now, it’s easier to argue for more staff.

 

[Neopolymath]

The patients today are more sick and the turnover is higher. Medicolegal issues are ever present in either how you must practice, which goes against what you know is good medicine, and just the stress of making a mistake. The patients are quite unlikeable at times as society decided it's ok to be a loudmouth jerk without embarrassment or remorse anymore. Physicians don't receive near the respect, although they are still respected in some regard. Many young physicians either ignorantly or purposefully take employed positions, exacerbated by private equity.

In the face of a system that seems unsustainable to even optimists at times, a boss that thinks you are a widget, and many unpleasant patients, medicine has become a field suffering from a decrease in ownership and frankly many reasons to give a damn. That's why so many people pursue a good lifestyle gig and make side hustles. They understand that many of the patients aren't worth it, their bosses aren't worth it, and the system might radically change in compensation.

But other than that medicine is truly an amazing career lol. It does subconsciously change how people make decisions though. It's human nature not to try as hard when there is objectively less multifactorial motivation to do so.

 

[Ho0v-man]

Definitely different generational mindsets. Lots of Boomers retire only to find that their job was basically their entire personality. They were also part of a generation when good work ethic actually translated into increased pay, promotions, etc.

However, the corporatization of medicine has removed the financial incentives our predecessors enjoyed from living in the hospital.

 

[Dantes]

Definitely different generational mindsets. Lots of Boomers retire only to find that their job was basically their entire personality. They were also part of a generation when good work ethic actually translated into increased pay, promotions, etc.

However, the corporatization of medicine has removed the financial incentives our predecessors enjoyed from living in the hospital.

And couple that with outrageous tuition increases over the past few decades, it's easy to feel disillusioned.

 

[anesussy]

Who have you heard this from, exactly?

This paper is a bit old, but documents that average self-reported work hours for physicians hovered around 55 hours/week from 1977 to 1997, then it marched steadily down to about 51 hours/week by 2005.

Experienced PDs will tell you that things have changed over the years. Everyone wants to have their cake and eat it.

Using work hours as the sole endpoint is beyond myopic. I can guarantee you that physicians nowadays are working harder during those hours. And still hospital admins want us to work even harder.

I also take offense at your implication that physicians are lazier nowadays.

Maybe people are just getting fed up with the demands of the job, which are much, much worse than they used to be? For example, this internalist who was fired by Indiana University for objecting to 10-minute timeslots for primary care appointments? But he completed IM residency in 1997. Maybe that's too young for you? Maybe he's just so lazy for objecting to 10-minute appointments?

 

[Wordead]

Do you think that this could exacerbate the physician shortage? With medicine becoming more complicated and more paperwork per patient but doctors not working as much as they used to?

Yes and no - yes it will exacerbate the shortage of good physicians. But no worries, there is a push to expand residencies and midlevels will come in to fill in gaps more and more. Care will suffer.

Have you guys noticed any trends in doctors having more side hustles? I’ve noticed that quite a bit but don’t know if that was always the case.

Yes, the FIRE movement has certainly become more mainstream in physician circles. A lot of people recognize that you need income outside of medicine just in case. I don't think a ton of physicians think "oh yeah in 5 years medicine is going to be more enjoyable to practice". All the signs point to it being same or worse. So I keep my lifestyle close to residency levels, save and invest the majority of my paycheck, so that if I reach my breaking point I can always just walk away or go part time or whatever.

Maybe I'm wrong and something will change to allow private practices to proliferate again or the DPC model will expand to other specialties but I'm not going to hold my breath. I think the vast majority of us will just be employed by large systems and told what to do.

 

[ChordaEpiphany]

Who have you heard this from, exactly?

This paper is a bit old, but documents that average self-reported work hours for physicians hovered around 55 hours/week from 1977 to 1997, then it marched steadily down to about 51 hours/week by 2005.

Experienced PDs will tell you that things have changed over the years. Everyone wants to have their cake and eat it.

The trends undeniably show that the focus on lifestyle isn't even remotely new or unique. Physicians who don't have the luxury of an easy home life and a career timeline catered towards their physiology (e.g., women) have been fleeing from poor lifestyle specialties for decades. The gender gap in surgery is so high for a reason. The increased focus on lifestyle is, imo, very clearly driven by a much larger percentage of med students who don't fit into the archetype of a physician in the 70s and 80s.

Millennials don't think about their careers at all similarly to Boomers because they mostly don't have that luxury.

In the 80s a young doctor was most often an upper middle class white man with a homemaker wife. They started med school at 22, finished at 26, and largely just became attendings after residency. Once married, their partners were often happy to stay home and take care of domestic duties, so life at home was easier. Taking care of the kids meant food on the table and sending them out into the neighborhood. It's not a surprise that a workforce that looks like that is more willing to grind 90 hours/week in residency and more hours as an attending.

A doctor today is a man or woman who starts at 24-25 after several gap years to compete in the CV arms race. Then they spend 4-5 years in med school, often taking a research year or doing an additional degree. Then after residency many are pushed into 1-2 year fellowships that didn't even exist in the 80s as job markets get a bit tighter for many specialties or work environments. So this 28-29 year old soon-to-be intern has a working spouse/partner, is probably planning on kids during residency (and kids are now a much larger expected time commitment than in the 80s), and knows that there may be further hoops to jump through even after residency. They're not coming home to a clean house and made dinner knowing their kids are off playing in a nearby park. They're rushing home to pick up kids from their 2x/week fencing lessons and meeting their working spouse with a car full of groceries so they can start cooking dinner.

It's not at all shocking that the life of the physician who lives at the hospital and makes bank is no longer the ideal for most med students.

 

[Med Ed]

Using work hours as the sole endpoint is beyond myopic. I can guarantee you that physicians nowadays are working harder during those hours. And still hospital admins want us to work even harder.

Can you cite some supporting data?

P.S. No need to get worked up.

 

[deleted1139416]

P.S. No need to get worked up.

I see what you did there 😉

 

[Mr.Smile12]

Throwing a log onto the fire: https://www2.deloitte.com/content/d...n-capital/at-gen-z-millennial-survey-2022.pdf .

 

[psyspy]

The trends undeniably show that the focus on lifestyle isn't even remotely new or unique. Physicians who don't have the luxury of an easy home life and a career timeline catered towards their physiology (e.g., women) have been fleeing from poor lifestyle specialties for decades. The gender gap in surgery is so high for a reason. The increased focus on lifestyle is, imo, very clearly driven by a much larger percentage of med students who don't fit into the archetype of a physician in the 70s and 80s.

Millennials don't think about their careers at all similarly to Boomers because they mostly don't have that luxury.

In the 80s a young doctor was most often an upper middle class white man with a homemaker wife. They started med school at 22, finished at 26, and largely just became attendings after residency. Once married, their partners were often happy to stay home and take care of domestic duties, so life at home was easier. Taking care of the kids meant food on the table and sending them out into the neighborhood. It's not a surprise that a workforce that looks like that is more willing to grind 90 hours/week in residency and more hours as an attending.

A doctor today is a man or woman who starts at 24-25 after several gap years to compete in the CV arms race. Then they spend 4-5 years in med school, often taking a research year or doing an additional degree. Then after residency many are pushed into 1-2 year fellowships that didn't even exist in the 80s as job markets get a bit tighter for many specialties or work environments. So this 28-29 year old soon-to-be intern has a working spouse/partner, is probably planning on kids during residency (and kids are now a much larger expected time commitment than in the 80s), and knows that there may be further hoops to jump through even after residency. They're not coming home to a clean house and made dinner knowing their kids are off playing in a nearby park. They're rushing home to pick up kids from their 2x/week fencing lessons and meeting their working spouse with a car full of groceries so they can start cooking dinner.

It's not at all shocking that the life of the physician who lives at the hospital and makes bank is no longer the ideal for most med students.

Lmao Chad 1980’s med student vs virgin 2020’s med student (which, to be honest, is kind of true in a literal sense too LOL)

Ngl, no internet, Netflix, or HD gaming would’ve gotten boring. Even in terms of outdoor activities, planning all of that was a huge pain before smartphones allowed for efficient communication