The traditional expectations for a physician’s workload is one of churning out long hours without complaint, particularly those in the early years of their careers.
But today’s thinking is shifting. With the increased awareness of the dangers of stress and burnout and the importance of work/life balance, both physicians and employers are increasingly more responsive to a schedule that allows for some breathing room.
Physician burnout, as defined by the Agency for Healthcare Research and Quality, is a "long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of a sense of personal accomplishment."
Burnout is a widespread problem. Medscape’s 2019 report states that 44% of physicians reported feeling burned out, 11% were colloquially depressed, and 4% were clinically depressed. It spans the specialties, and is reported slightly more by females (50%) than by males (39%), although a common belief is that males are less apt to discuss emotional problems. Even more worrisome: The report also states that 14% of respondents admit to having had thoughts of - yet have not attempted - suicide.
One of the best ways to alleviate burnout, as well as anxiety-related problems, is to maintain an adequate balance between your personal and professional life. Having enough time to spend with family, to engage in fitness and to simply unplug are important components to everyone’s physical and emotional wellbeing. Yet this is often out of reach for the physician running to uphold a 40-plus-hour work week. Sporadic vacations or personal days can help to periodically tamper mounting stress, but they aren’t long-term solutions.
Today’s physicians are beginning to explore other options. In the 2018 Survey of America’s Physicians by The Physicians Foundation, nearly one-quarter of physician responders - 22.3% - indicated they plan to cut back their hours in the next three years. That’s the largest number recorded since the survey began in 2012. Another 8.5% plan a switch to part-time, and 8.4% will turn to locum tenens. These are just a few of the avenues available to those eager to get a handle on their work hours.
Part time: not a bad career move
Working fewer than 40 hours a week may seem like a dream, but it’s becoming a regular arrangement. And according to the American College of Physicians, if you’re in need of a break, going that route may be better for your career than ceasing work completely.
"It can be difficult to return after a hiatus of as little as six months, since the break in CME credit accumulation, referral patterns and so on is hard to overcome. Working part time allows continuity with the addition of flexibility," states ACP in a report.
Today’s climate is favorable for physicians negotiating for a reduced schedule.
"The impact of having to re-train someone is so significant, both financially and time-wise, that employers are much more interested in retaining good talent, than allowing them to go elsewhere," says Honolulu-based physician Ashish Goyal, M.D. Goyal’s schedule accommodates his own multi-faceted career: he runs PediatricsBoardReview.com, practices clinical medicine and teaches.
Job sharing: finding your other half
If you don’t feel your current employer would accommodate a reduced schedule, consider instead asking to set up a job-share arrangement, in which two part-time physicians split the hours and responsibilities of one full-time position. This situation is potentially favorable to an employer, reports the ACP, since it avoids some of the issues raised with part-time shifts. Because a job-sharing arrangement is the same as employing one full-time provider, it creates minimal, if any, negative impact on the use of staff or office resources.
From the viewpoint of the two physicians involved, the arrangement is similar to a part-time position, with adding the need for routine communications between the two. Initially, the logistics need to spelled out: divvying up hours, shifts, holidays and call. Regular patients need to be informed of each physician’s schedule, and if any patients choose to overlap, both physicians should remain in contact to present unified, consistent care.
Locum tenens: you choose
Locum tenens work is another way to maintain some control over your work hours. With this, you temporarily fill in at different hospitals and/or practice groups for a pre-defined period of time. This may mean covering for a vacationing physician for a few weeks, taking over while someone is on leave, or providing extra help during a period of increased patient loads.
These opportunities are available through locum tenens agencies and exist everywhere, from the hospital a short drive from your home to the large medial group in a completely different state (provided you meet licensing requirements).
While many of the locum assignments are full time, it is still a means of reducing your workload over the course of a calendar year. Because you choose when you’ll work, the option exists to create respites between assignments as needed.
Telemedicine: not so futuristic
Decades ago, a physician working from home simply hung a shingle at their residence. Today, that idea may be obsolete, but the concept of working remotely isn’t. With today’s technology, more and more companies are hiring physicians who regularly consult with patients via mobile technology or video conferencing.
"Telemedicine is very much on the rise, (especially) in remote parts of the country, where patients don’t have access to specialists or even GPS," says Goyal.
In addition to companies that specifically offer virtual encounters, many practices are accommodating such encounters as an enhancement to their routine services. This creates another way to reach a patient, meeting the needs of those with a demanding work schedule, who have mobility or transportation issues, or who are more comfortable in the privacy of their own home. It may be more suitable for certain specialties, such as psychiatry, radiology or follow-up care.
If it works for you and your employer, virtual patient encounters can result in both reduced hours at the office and less stress from commuting.
The idea of a lighter work schedule is almost always appealing, but for most people, it comes down to the numbers. Before you reduce your hours - and income - take a hard look at your minimum expenses, including:
Identify both your "must-haves" as well as those things you could do without if need be. Adjust for how the situation might change after you reduce your hours; for example, you’d likely have a drop in commuting expenses, or less child care.
Also be aware of how your benefits may be affected by a drop from full-time status. Consider how your personal situation may add or subtract from the picture; for example, married physicians may be eligible for certain benefits through their spouse.
"Health insurance may be the biggest area affected," Goyal adds. "(Your employer) may have a tie to full-time employees or those meeting a certain minimum number of hours per week. Other areas potentially affected include malpractice insurance, financial benefits such as 401(k) matching programs, retirement programs, pension or CME stipends."
Another perk: room to grow
When caught up in the daily grind, you can probably think of a million things you’d do with an afternoon all to yourself. But when actually faced with extra free time on a repeat basis, you may find yourself restless or feeling idle. Before you make a schedule change, carefully think about out how you’d spend the time.
After working as a clinical anesthesiologist for 29 years and as an academic anesthesiologist prior to that, Linda B. Hertzberg, M.D., left her full-time position in private practice and switched to part time. While the change proved to be positive, she admits that at first, it was an adjustment.
"Initially, I felt like part of my identity was ripped away, especially since I felt that after all those years of practicing anesthesiology I was at the top of my game," she recalls.
But she soon relished the time available. In addition to enjoying being able to pursue her personal interests, such as skiing, traveling, visiting friends and wine collecting, Hertzberg increased her involvement with professional organizations. She’s been a board member, officer, and (past) president of the California Society of Anesthesiologists (CSA); served as a California delegate to the American Society of Anesthesiologists (ASA) and is currently the ASA Director from California; serves on the ASA Board of Directors; and is the chair of the ASA’s Ad-Hoc Committee on Women in Anesthesia.
"This has always been work that I found professionally rewarding, so it is wonderful to have time to really focus on it," she says.
Appealing to your employer
When you’re ready to negotiate with your employer, first switch your way of thinking. View your proposed arrangement from their perspective, and present it in a way that would highlight why it’s appealing to them. The ACP shares a few suggestions:
The success of making such a switch also depends somewhat on your specialty.
"Anesthesiology definitely lends itself to per diem work, as may other specialties such as emergency medicine, hospitalist medicine, pathology and radiology that do not require an office-based practice, with continuity of patient care," Hertzberg says. "The limiting factor in any specialty may be the overhead costs, and how willing your group or partners are to work out a part-time arrangement."
Unwanted attention: dealing with coworkers
Deviating from the norm almost always invites opinions, so expect to become a topic of workplace conversations. You may face negativity, such as assumptions that you’re not fully committed to your career, that you’re not carrying equal weight. Or, you may hear belittling comments or outward jealousy.
But it may not all be negative. Co-workers who have been entertaining similar notions or feeling frustrated with their careers may applaud you for taking the initiative, and even seek you out for advice, questions, or moral support.
Regardless of the perceptions you face, remember that your business is your own, and you don’t need to explain or defend yourself to anyone aside from your supervisors. Your needs and opinions, and those of your family, are the only ones that really matter. Maintain your standards of professionalism and boundaries, stay committed to your decision, and any chaos among your coworkers will soon subside.
There’s no denying the demands of a physician’s career, and the high level of job dissatisfaction, anxiety and burnout physicians routinely experience. Working toward a more friendly, flexible schedule is one of the best ways to avoid sending your career into a downward spiral.
"It’s critical to find work/life balance so you can still enjoy your life," says Goyal.
With a solid look at your own needs and aspirations, coupled with a careful analysis of your financial situation and your family’s needs, it’s possible for physicians today to create a more comfortable allocation of personal and professional time.