Young Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job.

[SurfingDoctor]

https://www.wsj.com/lifestyle/careers/young-doctors-want-work-life-balance-older-doctors-say-thats-not-the-job-6cb37d48?reflink=desktopwebshare_permalink

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[operaman]

Yeah I think the key underlying issue is the shift toward employed docs rather than independent business owners. The guys I know in truly PP work a lot more hours than I do in an employed position.

I've definitely tried to err on the side of a good work life balance. I'm in a very underserved area so I'm booking new patient over a year out now and my wait list beyond that is close to 2000 patients. For me, I could work more hours and make more money and see more patients, but it wouldn't even make a dent in the need and I would eventually burn out. I'd rather find something sustainable. So for now I usually work <40 hours a week and make more money than I can spend.

That said, I'm definitely guilty of the working while sick thing. It's mostly that I don't want to burden my staff with rescheduling that many patients when there's literally nowhere to put them. It's not like I'd be able to see them the next week or so; it would likely be many months for some which just isn't fair. So, if I can physically get to the office I'll usually go in.

I take issue with the idea that less call and better hours erodes competence. I heard this line in residency from the pre-80 hour old guys as well, and for many fields I think it's just bunk. So much of the time spent on call isn't doing anything educational or meaningful. For ENT, call cases are basically airways, bleeding, H&N pus. The rest can usually wait. There's so much overlap with those cases and bread and butter outpatient stuff that there's no way you lose skills in it. Maybe other fields have cases that only come in on call, but for me most of the truly challenging things I do come from my office.

 

[SurfingDoctor]

Pediatrics is not necessarily the bar to aspire to and only treats the underserved for the most part (let's be honest... nobody give a fu-k about kids).

At the same time, I've never called out sick (except for my daughter being hospitalized and found coverage) and worked while febrile and had rigors. Mostly for the same reasons. If it's not me... it is someone else.

I also work >50 hours/week, mid career... but because I find reasons to enjoy it.

 

[SurfingDoctor]

I'll also be honest.

I cover for colleagues who have to be covered for work life balance (if I can)... but I think they suck at planning. I suppose it could me someday... but still.

Nobody likes someone who can't get their sh-t in order.

 

[RangerBob]

Yeah I think the key underlying issue is the shift toward employed docs rather than independent business owners. The guys I know in truly PP work a lot more hours than I do in an employed position.

I've definitely tried to err on the side of a good work life balance. I'm in a very underserved area so I'm booking new patient over a year out now and my wait list beyond that is close to 2000 patients. For me, I could work more hours and make more money and see more patients, but it wouldn't even make a dent in the need and I would eventually burn out. I'd rather find something sustainable. So for now I usually work <40 hours a week and make more money than I can spend.

That said, I'm definitely guilty of the working while sick thing. It's mostly that I don't want to burden my staff with rescheduling that many patients when there's literally nowhere to put them. It's not like I'd be able to see them the next week or so; it would likely be many months for some which just isn't fair. So, if I can physically get to the office I'll usually go in.

I take issue with the idea that less call and better hours erodes competence. I heard this line in residency from the pre-80 hour old guys as well, and for many fields I think it's just bunk. So much of the time spent on call isn't doing anything educational or meaningful. For ENT, call cases are basically airways, bleeding, H&N pus. The rest can usually wait. There's so much overlap with those cases and bread and butter outpatient stuff that there's no way you lose skills in it. Maybe other fields have cases that only come in on call, but for me most of the truly challenging things I do come from my office.

In our region the employed docs are the most miserable. They’re the ones working the longest hours-often uncompensated MyChart responses, dealing with inefficient front (and back) office staff they have no control over, and doing it for less pay.

The private practice docs/solo practice ones here are happier, have more free/family time, more autonomy, and better pay. Employed PCPs are lasting about a year here, regardless of who they’re employed by.

I was terrified of going into solo/private practice out of residency. It sounded scary. I thought being an employee would be better. I almost took a job that paid 1/3 less and required at least 30% more work because I was that worried about going into practice for myself, figuring out how to bill, etc. I took a risk and couldn’t be happier.

I think physicians would be happier and have better lives if we took the practice of medicine back into our hands. Unfortunately we’ve by and large let corporations (or VC/private equity) led by MBAs take it over and not only are we seeing what that’s doing to our patients, but also what it’s doing to us as physicians.

 

[operaman]

In our region the employed docs are the most miserable. They’re the ones working the longest hours-often uncompensated MyChart responses, dealing with inefficient front (and back) office staff they have no control over, and doing it for less pay.

The private practice docs/solo practice ones here are happier, have more free/family time, more autonomy, and better pay. Employed PCPs are lasting about a year here, regardless of who they’re employed by.

I was terrified of going into solo/private practice out of residency. It sounded scary. I thought being an employee would be better. I almost took a job that paid 1/3 less and required at least 30% more work because I was that worried about going into practice for myself, figuring out how to bill, etc. I took a risk and couldn’t be happier.

I think physicians would be happier and have better lives if we took the practice of medicine back into our hands. Unfortunately we’ve by and large let corporations (or VC/private equity) led by MBAs take it over and not only are we seeing what that’s doing to our patients, but also what it’s doing to us as physicians.

Yeah I definitely realize I’ve found a unicorn of an employed gig. And I’m lucky that my high productivity keeps admin from messing with me too much. At least for now.

I have thought about going solo or starting a small group practice. Biggest hurdle for me is our payor mix here is terrible and costs are very high. Good staff insanely hard to find as well. I worry that I would have to work a lot more to make comparable or even less money. My field fares very well in an RVU system, but I suspect would do less well in terms of actual collections.

I can also tell that at some point my employer is also going to have to change to meet the underlying financial realities. Right now they’re losing money on the docs, though recouping some part of that in other ways. Eventually they’re going to have to cut pay or demand more volume or call or something and then I may pull the trigger on true PP when that day comes. For now, I see them as a buttress against what are rather unfavorable local market forces.

 

[eyeeye_captain]

My take is probably skewed since I’m in a lifestyle field. I work <35 hours a week and have friends and partners telling me I should slow down. I think the majority work 4.5 days or fewer. This is across the board, with mid career docs probably being more likely to pull back, although a recruiter who posts on our board mentioned that some new grads are asking for jobs with 4 days or less right out of the gate.

It’s possible to grind. My friend joined a practice that required coverage at a busy level 1 and called me to vent about having to see all the “clear the globe” consults for drunk guys who got pistol whipped and have a non-op orbital fracture. Pay was garbage. Saw them at a meeting later that year and they were ecstatic - some mid career doc had kids to put through school and was scooping up weeks. Thinking back to residency, I agree with operaman that overnight ER stuff is pretty low yield. Consult number 5 of the night of the scenario above only teaches you how to get good at opening eyelids with paperclips and dodging fists. Then you’re too tired to be effective in clinic the next day when there’s the potential for actual learning.

I’m in somewhat of an underserved area, so my list is long - big patient panel but we can usually squeeze in same day appointments. I go to a satellite on Wednesdays and this year that’s both Christmas and New Year’s. Staff is trying to make it work by either crushing me the week before and after, or my partner who goes out there may pinch hit if they’re not taking time off. If you want that 2 week trip to Europe, it’s not going to be fun before and after. It’s also tough as we have a lot of patients that need regular injections, so getting off schedule can be an issue.

Not many of us are hospital employed, but like in the PCP game the scheduling, inefficient staff, inbox etc would be rough. PE claims they don’t mess with schedules or staff but color me skeptical since their job is to make docs do more with less so the spreadsheet looks pretty. PP lets you set things up in a way that works for you.

 

[Redpancreas]

Surprise.

 

[VA Hopeful Dr]

Pediatrics is not necessarily the bar to aspire to and only treats the underserved for the most part (let's be honest... nobody give a fu-k about kids).

At the same time, I've never called out sick (except for my daughter being hospitalized and found coverage) and worked while febrile and had rigors. Mostly for the same reasons. If it's not me... it is someone else.

I also work >50 hours/week, mid career... but because I find reasons to enjoy it.

Several years ago my wife tore her calf while hiking. Couldn't walk without crutches for about a week. First day to work (while still on crutches mind you) she tested positive for COVID so had to take a full week off and was reasonably sick - high fevers, sore throat, fatigue.

Her first day back after that, she had 3 different patients berate her because they had to reschedule their appointments.

That was the day she basically said "screw this, I'm going to take time off when I want to because these jerks don't care about me at all so why should I sacrifice for them".

 

[Big Time Hoosier]

Several years ago my wife tore her calf while hiking. Couldn't walk without crutches for about a week. First day to work (while still on crutches mind you) she tested positive for COVID so had to take a full week off and was reasonably sick - high fevers, sore throat, fatigue.

Her first day back after that, she had 3 different patients berate her because they had to reschedule their appointments.

That was the day she basically said "screw this, I'm going to take time off when I want to because these jerks don't care about me at all so why should I sacrifice for them".

Pediatric dentist here. My mom was in hospice and I got a call from my brother at lunch that her passing was imminent. I told my front desk to cancel my afternoon patients so I could be by her side. There were quite a few parents that were upset. They could pound sand for all I cared. Maybe if they had just brushed their kids freaking teeth like a responsible parent in the first place their kids wouldn’t have needed to see me.

The best part of being a healthcare provider is the patients. The worst part of being a healthcare provider is the patients.

Big Hoss

 

[sloop]

I’m a forensic psychiatrist. There are many things that are stressful about my job but thankfully time off is not one of them. Assuming I don’t have court, I can pretty much take whenever I want off. Somebody will cover. As there is a mix of locums and state-employed doctors at my hospital, it’s usually the locums who cover when us state doctors are out. Generally I don’t like making work for colleagues, but then again they get paid a ton more than me for the same job and are motivated to do people favors so we keep them around.

This job is stressful enough. There is always a risk to personal safety, and the constant veil of legal entanglement. The patients are often hostile, uncooperative, and severely ill. If I could not just leave this place at a consistent time every day and take time whenever I want, I would probably become a patient myself.

 

[Entadus]

Not sure why "older doctors" need to care or have any input in other (younger) Dr's decisions about work-life balance.

"They don't get a vote", as Dave Ramsey would say. I already paid my dues! We learned more than they did in med school, and residency was a bitch.

I'm working full time (4.5-5 days a week, 8:30-4:30) but that does not include nights, weekends, or call. Plenty of paid holiday time. Plus as a gov't employee, I got 7+ weeks of additional PTO starting in year 1. I take all of it. I spend time with family and dream of cutting back to part time so I can develop some hobbies.

Financial freedom and early retirement are harder than ever to accomplish these days, but of course that's still the goal. I like medicine enough but it's just one part of life and I can't wait to travel extensively, get a pilot's license, etc.

 

[DocWinter]

As mentioned above, the shift from PP to employed is a large driving factor from the view of medicine as vocation vs job.

I'm employed and most in my field are as well. I still view it (and work like it, and get paid like it too) more as a vocation than a simple job. For most in the field, this is one of those careers that requires more than a punch card and personalities who will undergo the grueling training are also likely to be greatly invested in the lifestyle, or lack thereof.

 

[Ho0v-man]

Back then the sacrifices were directly to your benefit because you owned the business. Now some MBA admin who assigns me admin tasks (shouldn’t those be their job?) runs the show.

If I drop dead at work, they’re trying to find my replacement before I’m cold. They don’t care about me and the feelings mutual. Why would I ever make even more sacrifices for someone else’s bottom line?

 

[purpledoc1]

Back then the sacrifices were directly to your benefit because you owned the business. Now some MBA admin who assigns me admin tasks (shouldn’t those be their job?) runs the show.

If I drop dead at work, they’re trying to find my replacement before I’m cold. They don’t care about me and the feelings mutual. Why would I ever make even more sacrifices for someone else’s bottom line?

This is all the more reason to accept cash/credit only.