We all agree that the United States has a physician burnout problem, currently running 50 percent to 80 percent depending on whose statistics you want to believe. Yet, we forget that we had burnout at 25 percent even before the EMR problem.
Prior to facing MACRA, MIPS, prior authorizations, and dysfunctional computer systems, we worked ourselves too hard.
A doctor who walks in at 8:30 a.m., takes a half-hour to lunch without working, and walks out at 5 p.m. can lead a normal life and balance it with work. I have heard of such 40-hour work weeks, but I classify them with the tooth fairy, the nuclear family, and Sasquatch: more urban legend than fact.
A doctor’s patients might start at 8:30 a.m., but real physicians start working before and few practices get their docs out on time. Often, too, we face work after clinic. Documentation time counts as time worked, not as moral failure. Most of us start about 8:00 a.m. and go until 5:30 p.m. Few of us actually quit working for lunch and if we do, we only quit for 20 minutes. For the sake of calculation, a light clinic day runs nine hours, giving out-patient-only doctors a 45-hour week.
Most of us need 50 hours of CME yearly, which comes to roughly another hour per week: 45+1=46 hours per week.
If we do hospital work, we come in before or after clinic, or during our lunch hour. And then we face call, but we forget to count it realistically when we talk about our total weekly time commitment. Inpatient adds a minimum of five hours of weekly work (but realistically 10; for the sake of general computation, I'll say five): 46+5=51 hours per week.
An hour on call is an hour of work: we are emotionally unavailable to our loved ones, we cannot run, boat, bicycle, go fishing, go to the gym, have a drink of alcohol, or reliably attend a family event.
If weekday call for a five-doctor practice runs from 5:00 p.m. to 8:00 a.m. Monday through Thursday, it means 12 hours more per week (15x4=60, 60/5=12;), 51+12= 63 hours per week.
A weekend call rotation that runs from 5:00 p.m. Friday to 8:00 p.m. Monday totals 63 hours, divided equally between five doc adds 12.6 hours per week: 63+12.6=75.6 hours/week.
If your group works on New Year’s Day, Memorial Day, July 4, Labor Day, Thanksgiving, and Christmas as holidays to take call, add on another 1.6 hours per week: two holidays at 72 hours each, one at 96 hours, and three that average 60 hours over the years ([72+96+180]/5x52=420/260): 75.6+1.6=77.2 hours/week.
Thus, a full-service, full-time physician works 77.2 hours/week, which is incompatible with a work-life balance. That doctor does not have enough leisure time to afford patience with his or her loved ones.
Some (not all) single people don’t have families and thus do not face inherent time conflicts.
So, please do not fault or judge those docs who have chosen to work part-time. The emergency physician who works three 12-hours shifts a week, the dermatologist who takes Friday afternoon off, or anyone at all who refuses to take call has prioritized life over work in the search for a work-life balance.
Sooner or later, they may be considered normal.
Dr. Steven F. Gordon is a family physician and a 2018–2019 Doximity Author.
