Reducing Work Hours as a Physician

[4X4MD]

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So I may have posted this in the wrong section, but here it goes.

I am so tired of trying to convince myself to travel down the path of other professions (dentistry, pharmacy, etc) do to the ungodly work hours I have seen that physicians must put up with.

so...

If I have a true love for medicine AND I want to spend time with my family/etc, is it possible to limit my work week indefinitely?

I am talking ~40 hours a week. Say, if I owned my own practice, can I just cut my week short and quit taking in patients when I feel I am at capacity?

I just refuse to spend 80 hours a week working for the rest of my life. I'm sure I can put up with a few years of residency, but I certainly want to explore all life has to offer one day.

 

[eatsleeprepeat]

So I may have posted this in the wrong section, but here it goes.

I am so tired of trying to convince myself to travel down the path of other professions (dentistry, pharmacy, etc) do to the ungodly work hours I have seen that physicians must put up with.

so...

If I have a true love for medicine AND I want to spend time with my family/etc, is it possible to limit my work week indefinitely?

I am talking ~40 hours a week. Say, if I owned my own practice, can I just cut my week short and quit taking in patients when I feel I am at capacity?

I just refuse to spend 80 hours a week working for the rest of my life. I'm sure I can put up with a few years of residency, but I certainly want to explore all life has to offer one day.

EDIT: apparently it's a secret =)

 

[morning]

There are lots of paths (including Path ) with good hours, although "good hours" for a physician is not always "good hours" for regular people. And you will usually take a pay cut (lifestyle for me indicates good hours, not money...I don't care very much about cash)

http://forums.studentdoctor.net/showpost.php?p=9277257&postcount=8

Not that I'm the most knowledgeable on the subject but there's another post about it. I considered this for awhile and did a lot of research before committing myself to the life of a pre-med.

Of particular interest is hospitalist work, which will make things easier for primary care physicians...hospitalists have good hours and take over things that used to drag down PCPs, like endless rounds on admitted patients. People are less willing to work the brutal hours of the past, and medicine IS adjusting a bit to accomodate that.

 

[45408]

Sure, but not in some specialties. You could do it in psychiatry, PM&R, emergency medicine, hospitalist, and a few others.

 

[tremulousNeedle]

It is difficult to work few hours as a primary care provider (family medicine, internal medicine, pediatrics) because of the overhead associated with operating a practice. In order to be profitable, you need to see a set number of patients, which usually leads to longer hours, but obviously you can work less for less pay.

Specialties with reasonable or flexible hours:
Emergency Medicine (my chosen specialty), Internal medicine (as a hospitalist or urgent care provider), Dermatology, Pathology, Radiology, Anesthesia.

Specialties with longer hours (generally any procedurally based specialty):
All general and subspecialty surgery, interventional radiology, interventional neurology, interventional cardiology.

-senior medical student

 

[7starmantis]

go into EM and set low hours.

Shut it!! Your letting out the secret!

 

[4X4MD]

It is difficult to work few hours as a primary care provider (family medicine, internal medicine, pediatrics) because of the overhead associated with operating a practice. In order to be profitable, you need to see a set number of patients, which usually leads to longer hours, but obviously you can work less for less pay.

Specialties with reasonable or flexible hours:
Emergency Medicine (my chosen specialty), Internal medicine (as a hospitalist or urgent care provider), Dermatology, Pathology, Radiology, Anesthesia.

Specialties with longer hours (generally any procedurally based specialty):
All general and subspecialty surgery, interventional radiology, interventional neurology, interventional cardiology.

-senior medical student

thanks for the respond...i dont see myself being very interested in procedural specialties...ive always seen myself as more of a diagnostician. hopefully it works out in my favor...ive always found EM a good choice...i guess id have to wait about 5 years and be in clincial rotations during third year to really decide...

 

[morning]

thanks for the respond...i dont see myself being very interested in procedural specialties...ive always seen myself as more of a diagnostician. hopefully it works out in my favor...ive always found EM a good choice...i guess id have to wait about 5 years and be in clincial rotations during third year to really decide...

Shadow! And then shadow some more. There's only so much you can learn from shadowing, but it's a hell of a lot better than waiting until 3rd year and realizing you hate medicine. I'm sure you already have some shadowing down, but not enough IMO, if you're still wondering all this.

EM is really interesting...it's a lot of primary care mixed with trauma mixed with peds mixed with psych. Definitely on my radar.

 

[eatsleeprepeat]

Shut it!! Your letting out the secret!

fixed 😳
now you need to get rid of the evidence

ps great avatar

 

[MonkeyNuts!]

EmERGENCY MED YOU CAN WORK 40 HRS OR LESS

 

[4X4MD]

uh oh...seems like EM is right up my alley😀

i read of alot of burnout in the ER tho. Ive actually been in the pediatric ER at our local hospital doing volunteer work for awhile. Now, working with peds has not always been the ideal situation to me (and i needed this experience to figure that out), but the doctors certainly seemed satisfied with their jobs. the resident was really cool and even almost MADE me follow him around after he found out i was pre-med.

i guess ill start branching out from where im at and figure it out now instead of later...i definitely think medicine is for me. im a true thinker and problem solver, but i am not much for delicate, procedural type stuff. im sure incorporating it somewhat into a profession gives you some variety, but i definitely dont see myself as a surgeon.

everyone i know who isnt a pre-med is screaming anesthesiology. i guess this sounds great, but these guys seem to work 60+ hours on average from what ive read (no shadowing). does this seem accurate?

ive always thought pm&r was a cool idea but id have to look further into it.

as far as psyc goes...ive read ALOT about this field, and how neurology is "bound to take it over". now i know this sounds ridiculous, and i think it is as well, but what does everyone think about psyc? i havent shadowed any psychiatrist, but ive had alot of experience with them and i believe in their credibility. is this field headed in the wrong direction? ive also heard that psyc gets lets prestige, but i can honestly say that i dont give a rat's ass

thoughts/opinions

😀😀😀

 

[Catalystik]

If you have your own office, you can set your own hours. Practically speaking, due to fixed overhead costs (rent, utilities, malpractice insurance, staff), you will probably need to work more hours when you first enter a practice to pay off your loans, pay off your house, save for your kids' college educations, but then you can slack off and work as little as you like. Or hire physicin extenders to do the work while you run the business. You can also have a daycare on the premises for your kids and staff, so you don't feel like you're missing out. There are lots of ways to have a real life and be a doc too.

 

[4X4MD]

bump.


as far as psyc goes...ive read ALOT about this field, and how neurology is "bound to take it over". now i know this sounds ridiculous, and i think it is as well, but what does everyone think about psyc? i havent shadowed any psychiatrist, but ive had alot of experience with them and i believe in their credibility. is this field headed in the wrong direction? ive also heard that psyc gets lets prestige, but i can honestly say that i dont give a rat's ass

thoughts/opinions

😀😀😀

 

[WildcatsDoc]

You can also consider working for the VA. Those docs tend to have a better lifestyle (with a corresponding drop in income). Not always, but it's a trend.

 

[Law2Doc]

thanks for the respond...i dont see myself being very interested in procedural specialties.....ive always found EM a good choice.....

I'm not sure EM would qualify as a "nonprocedural specialty". You will be doing LPs, central lines, I&Ds, intubations etc pretty regularly as an ED physician.

 

[Law2Doc]

If you have your own office, you can set your own hours. Practically speaking, due to fixed overhead costs (rent, utilities, malpractice insurance, staff), you will probably need to work more hours when you first enter a practice to pay off your loans, pay off your house, save for your kids' college educations, but then you can slack off and work as little as you like. Or hire physicin extenders to do the work while you run the business. You can also have a daycare on the premises for your kids and staff, so you don't feel like you're missing out. There are lots of ways to have a real life and be a doc too.

Not so much. In most cases patients get upset if they can never get an appointment and will flee to someone who provides better service. Others may have health issues that can only be dealt with on a very regular basis, so you will have someone depending on you to be there pretty regularly. So you can't just shut down the practice and take time off whenever you want. Further, the way reimbursements work, you often have to work more hours in the subsequent year just to make the same income of the prior year. Meaning if you sign on to a certain level of mortgage, tuition for kids etc based on one income, the next year you are going to be locked in to work more hours to earn that same income. That's why FP has gone from a lifestyle field to anything but. Now, there may be possibilities to work in a practice where you have colleagues who cross cover, but then each person has to have the same goals, because if the other wants the practice to work more hours to make more money, then he will provide a big disincentive to you taking more time off. As for just hiring folks to run the business and stepping away, that sounds better on paper than reality. It usually takes YEARS of working with employees before you realistically should feel comfortable letting them function autonomously, if ever. Since major liability and licensing is involved, you really can't just hire someone to see patients while you are gone like you might hire a manager to run your Burger King franchise. doesn't work that way.

There are some part time options, and some more lifestyle friendly fields. Very few are going to be in the 40 hour range, except perhaps EM, and even there it's not going to be the 40 hours you necessarily would want until you are very senior. All the other "lifestyle" fields tend to have average hours in the 50s-60s/week range. And on top of this, if you want to stay competent, you have to always be reading up on things in your spare time. Medicine isn't a field you can really dabble in, it's a profession.

 

[st2205]

bump.


as far as psyc goes...ive read ALOT about this field, and how neurology is "bound to take it over". now i know this sounds ridiculous, and i think it is as well, but what does everyone think about psyc? i havent shadowed any psychiatrist, but ive had alot of experience with them and i believe in their credibility. is this field headed in the wrong direction? ive also heard that psyc gets lets prestige, but i can honestly say that i dont give a rat's ass

thoughts/opinions

😀😀😀

I'd spend some time perusing the psych board here. The field is really broad, and there are a lot of different avenues you can take as a psychiatrist. Great specialty for lifestyle, too. If you broke it down per hour, you make a significant amount.

 

[morning]

bump.


as far as psyc goes...ive read ALOT about this field, and how neurology is "bound to take it over". now i know this sounds ridiculous, and i think it is as well, but what does everyone think about psyc? i havent shadowed any psychiatrist, but ive had alot of experience with them and i believe in their credibility. is this field headed in the wrong direction? ive also heard that psyc gets lets prestige, but i can honestly say that i dont give a rat's ass

thoughts/opinions

😀😀😀

You could always do a neuro/psych residency...but I don't see neuro taking it over, or else you wouldn't see psychiatric nurse practitioners making over 100k...demand is high.

 

[LizzyM]

EM does have regular hours but as a 24/7 business, you are bound to work shifts on days when many doctors' offices are closed and those docs are home with their families.

Anesthesiology is shift work but again, demand is 24/7 particularly in obstetrical anesthesiology -- those babies don't have clocks or calendars.

 

[Law2Doc]

...
Anesthesiology is shift work but again, demand is 24/7 particularly in obstetrical anesthesiology -- those babies don't have clocks or calendars.

Actually in most cases I've seen anesthesia is not the lifestyle field it once was. Someone has to be manning the gas whenever a surgeon is working and since surgeons work crazy hours, often times anesthesia has to follow suit. They do work in shifts, but those shifts can be frequent and long -- nothing like the 4-5 times per week EM is trying to get away with. I'd say 60+ hours per week is very much the norm in this field post-residency, and practices where 70+ is typical would not surprise me.

 

[shiftingmirage]

If I have a true love for medicine AND I want to spend time with my family/etc, is it possible to limit my work week indefinitely?

During residency, not so much. After that, yes. You can work as little as you want but be aware that a) docs that work 10 hrs a day aren't as desired as those who work 40, and b) paycheck will go down. But 40 hr work week is totally possible post residency.

 

[airplanes]

During residency, not so much. After that, yes. You can work as little as you want but be aware that a) docs that work 10 hrs a day aren't as desired as those who work 40, and b) paycheck will go down. But 40 hr work week is totally possible post residency.

I don't know any docs who work 40 hrs a day. I re-read that line a few times and I'm still not sure what you mean.

 

[randombetch]

I don't know any docs who work 40 hrs a day. I re-read that line a few times and I'm still not sure what you mean.

That's what I was thinking. Guess working 12 hours a day is a joke compared to the guy who works 40 hours a day.

 

[4X4MD]

That's what I was thinking. Guess working 12 hours a day is a joke compared to the guy who works 40 hours a day.

lol...that would be a semi-god centaur like creature that i have heard sometimes peruses the forums of SDN.

i am VERY interested in psyc. i will definitely look into it. especially psyc/neuro... sounds like a good combo

 

[lrkoehle]

I pasted this quote in another thread a few weeks back, but I'll post it again. Its from an orthopod talking about the hours he works:

" Family life will be determined by practice selection and not necessarily subspecialty. For example, I am a sports doc/arthroscopist. I have two full clinic days a week which keep me busy starting at 8 and usually home by 5 or 5:30. I operate two days a week and usually try to get out of the hospital around 3. I also have a day off every week. In addition, I practice out of a hospital that takes very little trauma. So my call days are usually benign. An occasional trip to the ER, an occasional evening case. But I only take call about 3 or 4 days a month and one weekend every other month."

Here's the link to the rest of the thread: http://orthogate.org/forums/viewtopic.php?t=2872

He says it depends on the practice you join. This is just one example.

 

[shiftingmirage]

I don't know any docs who work 40 hrs a day. I re-read that line a few times and I'm still not sure what you mean.

Sorry, I meant week. My point was that a given medical provider (hospital, private practice) would rather have 4 full time docs than 8 part time ones.

 

[st2205]

lol...that would be a semi-god centaur like creature that i have heard sometimes peruses the forums of SDN.

i am VERY interested in psyc. i will definitely look into it. especially psyc/neuro... sounds like a good combo

The psych/neuro programs are very limited (I think there are 8 programs that each probably have 1 spot/year). These programs (except for one or two, I think) are 6 year residencies (psych is 4 and neuro is either 4 or 5). There are fellowships in neuropsychiatry that you can do after psych residency, but you then treat more things that overlap into the realm of neurology (obviously) like dementia, alzheimer's, etc. If that's your thing, then that's cool, but there is quite a bit of neuroscience involved in psychiatry/psychopharmacology, and though the field may gravitate academically toward this, I don't think this will be engulfed by neurology as neurology is a completely different patient base.

 

[circulus vitios]

I am talking ~40 hours a week. Say, if I owned my own practice, can I just cut my week short and quit taking in patients when I feel I am at capacity?

If you run your own practice then you will have fixed costs like malpractice insurance, rent, electricity, and so on. I don't know anything about the real costs involved, but you might be better off working at a hospital or joining an existing private practice group? That way you won't have to worry about fixed costs as much.

 

[4X4MD]

i have never really researched neurology; i was initially one of those pre-meds gung-ho with surgical specialties earning in the top percentile...now that i have spent some time reading about it, neurology is definitely right up my alley. i suppose id have to begin clinical rotations before i could decide whether psychiatry or neurology would be a better fit, but both seem like a good choice for my interests. its great that it works out that way because a neurologists just came to speak at one of my club meetings (had an MPH from JohnH and a fellow from Harvard as a foreign med school graduate from Ecuador...wat a BAMF)

needless to say, id love to shadow him

 

[tremulousNeedle]

i have never really researched neurology; i was initially one of those pre-meds gung-ho with surgical specialties earning in the top percentile...now that i have spent some time reading about it, neurology is definitely right up my alley. i suppose id have to begin clinical rotations before i could decide whether psychiatry or neurology would be a better fit, but both seem like a good choice for my interests. its great that it works out that way because a neurologists just came to speak at one of my club meetings (had an MPH from JohnH and a fellow from Harvard as a foreign med school graduate from Ecuador...wat a BAMF)

needless to say, id love to shadow him

If you like the idea of doing procedures, do some research on interventional neurology.

 

[4X4MD]

If you like the idea of doing procedures, do some research on interventional neurology.

depends on the procedure...im afraid my manual dexterity will not accompany me long into my educational years...i already get somewhat extensive pain in my fingers when writing for a long period of time, etc

 

[tremulousNeedle]

depends on the procedure...im afraid my manual dexterity will not accompany me long into my educational years...i already get somewhat extensive pain in my fingers when writing for a long period of time, etc

A doctor should look at that, possibly treatable. 🙂

 

[4X4MD]

A doctor should look at that, possibly treatable. 🙂

id hate to add another medication to my list...

my PCP is currently treating me for very low free testosterone levels and vitamin D insufficiency. there are ALOT of symptoms that I have reported to him (joint pain), that he feels may be alleviated with some treatment for these. after a a few months, if it doesnt get better, ill be banging on his door more often 😀

 

[Morsetlis]

Pathology, Psychiatry, and EM are two non-competitive specialties that have pretty good hours.

 

[tremulousNeedle]

Pathology, Psychiatry, and EM are two non-competitive specialties that have pretty good hours.

Sounds like three specialties.

Though it’s not like radiology, orthopedics, or plastic surgery, Emergency Medicine is actually competitive and is becoming more so every year. It is true that most EM residency applicants get into a residency. The competition lies in getting into a high quality established program rather than a new program that has only graduated a few classes (or none at all). While I love EM for the broad mix of thinking and procedures, the majority of its increase in competitiveness lies in the relatively awesome lifestyle.

-EM resident in about 4 months

 

[Morsetlis]

Sorry I haven't graduated kindergarten.

No, it's true, I skipped kindergarten.

🙁

 

[45408]

Actually in most cases I've seen anesthesia is not the lifestyle field it once was. Someone has to be manning the gas whenever a surgeon is working and since surgeons work crazy hours, often times anesthesia has to follow suit. They do work in shifts, but those shifts can be frequent and long -- nothing like the 4-5 times per week EM is trying to get away with. I'd say 60+ hours per week is very much the norm in this field post-residency, and practices where 70+ is typical would not surprise me.

Shoot, EM is trying to get away with a lot less than that. One of my buddies just signed a contract with an EM group in the Rockies, and he said he'll be working 16 shifts a month (9 hour shifts), and after 1.5 years of being with the group, it drops down to 12 shifts or so. And he's being paid an absolutely absurd amount of money, and it goes up when his shift requirement goes down.

 

[Morsetlis]

I'm telling you EM is the best thing since sliced bread.

We mustn't let the secret get out of this forum though.

 

[DrBowtie]

I'm telling you EM is the best thing since sliced bread.

We mustn't let the secret get out of this forum though.

Except the patient population.

 

[tremulousNeedle]

Except the patient population.

Obviously EM is not for you. I love the patient population associated with EM. Any day of the week, I would rather take care of the average Joe than an elite snob.

 

[DrBowtie]

Obviously EM is not for you. I love the patient population associated with EM. Any day of the week, I would rather take care of the average Joe than an elite snob.

Drug seeking criminals give me fulfillment. They don't have to be elite, just genuinely sick.

 

[tremulousNeedle]

Drug seeking criminals give me fulfillment. They don't have to be elite, just genuinely sick.

Not to get off track from the original post, but not all EM patients are criminals and drug seekers (not even most). Not to mention that drug seekers find their way into nearly every specialty out there. Unless you're going into pathology, derm, or radiology, they'll be knocking at your door and you'll have to help them because you're their doctor. 🙂

Nice patients are always easier to take care of. It's the difficult or mean one's that are the real challenge.

 

[morning]

Obviously EM is not for you. I love the patient population associated with EM. Any day of the week, I would rather take care of the average Joe than an elite snob.

The fact that EM treats the indigent and is actually PAID for it is something that appeals to me as well. I have tremendous respect for EM docs and I think most people outside medicine feel the same way. Weird that they get no love from a lot of other physicians.

 

[CarpeDium]

Become a dentist, work 30 hrs/wk, and make 250+K per yr, if you are concerned about having time for having a life.

 

[Law2Doc]

Not to get off track from the original post, but not all EM patients are criminals and drug seekers (not even most). ...

I would say that while it's a small minority, in a big city ED setting, you will see enough of such folks that it will make you somewhat jaded about many of your other patient's motivations. You really can't work in an ED long without becoming a cynic, I would think.

 

[Morsetlis]

Drug seeking criminals give me fulfillment. They don't have to be elite, just genuinely sick.

That reminds me of a conversation I had today.

"Hmm I recognize that name, wasn't she in the hospital last week.. and the week before that?"

"Yep. Worst patient EVER."

"Are we gonna see her?"

"No... I'm gonna discharge her and hope she leaves."

"She can choose not to leave?"

"Yup."

 

[4X4MD]

Become a dentist, work 30 hrs/wk, and make 250+K per yr, if you are concerned about having time for having a life.

i cant imagine myself enjoying some aspects of dentistry, although i am artistically inclined...unfortunately, im having problems with my hands/fingers early, and i dont know how that would affect me later down the road.

but then again, i KNOW i wouldnt enjoy working myself to death even if i loved my job

 

[Morsetlis]

Look at it this way. If you can't burn out while volunteering your 500 hours in the ER cleaning up bodily fluids and changing diapers, how can you get burnt out as a doctor? 😛

 

[Hope2008]

Ophthalmology, in which I am extremely interested.

 

[7starmantis]

Shoot, EM is trying to get away with a lot less than that. One of my buddies just signed a contract with an EM group in the Rockies, and he said he'll be working 16 shifts a month (9 hour shifts), and after 1.5 years of being with the group, it drops down to 12 shifts or so. And he's being paid an absolutely absurd amount of money, and it goes up when his shift requirement goes down.

Yeah so go ahead and shoot me the contact information for that group!!

Sounds like a dream to me! 🙂