What “Rent” can teach us about work/life balance.
“525,600…” For those of you have seen the musical “Rent,” one of the play’s iconic songs, “Seasons of Love,” notes the number of minutes in a year. As a physician, you spend the vast majority of your year helping others—a role and a calling that can lead to a physician burnout problem.
Burnout is not merely having a challenging, tough or long day. According to Medscape’s National Physician Burnout, Depression & Suicide Report 2020: The Generational Divide, burnout is long- term, unresolved, job-related stress that leads to exhaustion, cynicism, detachment from job responsibilities, and a physician lacking a sense of personal accomplishment
“How do you measure, measure a year?”
The evolution from quantity outcomes to quality outcomes for a physician may contribute to physician burnout and underscore the importance of work/ life balance.
The COVID pandemic has exposed the frailty of staffing issues and challenges in our health care delivery systems. If a primary care physician can’t see as many patients because there’s not enough staff, or a surgeon can’t perform as many procedures as they are capable of because the OR suite can’t be transitioned fast enough from one patient to the next, the physician has two choices: work longer hours or earn less due to reduced RVUS.
In this case, the physician’s lower compensation is not based on lack of effort; it’s a lack of resources. This disconnect has the real potential to accelerate burnout.
“In daylights, in sunsets, in midnights, in cups of coffee…”
One of the ways more junior physicians can more rapidly build a practice (and perhaps be compensated more) is to take additional call. Though the extra dollars for taking additional call can have multiple appeals, such as adding to retirement savings or paying down student loans, your employment agreement should clearly delineate your minimum and maximum on-call obligations and the additional compensation you can earn by taking more call.
The increase in the number of hospitalists, intensivists, laborists, and the considerable opportunities for many physicians to engage in telemedicine services has created a 24/7 cycle of work for physicians. Clearly articulating the number of day shifts and night shifts and overnight shifts (and the pay differential if any depending upon the type of and number of shifts worked) in your agreement is critically important.
It is important to set realistic compensation expectations. No employer consciously wants a physician to have to consistently burn both ends of the candle.
“In laughter, in strife…”
The Medscape report notes that more than two-thirds of all physicians said their personal relationships have been negatively affected by burnout. Nearly one in five of the physicians surveyed responded they were depressed.
The consequences of burnout can be significant. The Medscape report identified that almost 40 percent of all physicians who report depression say it leads them to be easily exasperated with patients. Moreover, depression can lead to physicians making errors they would not otherwise make.
Importantly, the Medscape report highlighted that half of all physicians said they would take a salary reduction of up to $20,000 per year for reduced hours and morework/life balance. Clearly, money can’t solve every issue.
“How do you measure a year in a life?”
Physicians work hard. Every patient interaction makes a profound difference in that patient’s life. Systemic initiatives are necessary to ensure work/life balance is respected and cherished. A mentally healthy physician will help increase a physician’s productivity and perhaps add efficiency too. Burnout can’t be ignored, minimized or eliminated by offering a physician a few thousand extra dollars a year.
As “Rent” taught us, there are 525,600 minutes in a year. Every minute of the year can’t be spent working. And we can’t measure a physician’s effort solely on howmuch they work, or we will lose many to burnout—and then we all lose. •
BRUCE ARMON (firstname.lastname@example.org) is a chair of the health law group at Saul Ewing (saul.com). He frequently writes for PracticeLink Magazine and regularly speaks to physician groups about the business of medicine and legal issues.