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The High Cost of Volunteering

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I have two volunteer jobs: I work once a week at a school-based health clinic at a middle school about a mile from my house. I see awkward 12- and 13-year-olds for sports physicals, colds, and an occasional concussion. I am armed with birth control should anyone ever need it, but no one ever has, I'm happy to say. I love the time I spend volunteering there and feel I am doing something of value to the community. I have told my paying job that they can't have me on those mornings.

I also help with our school's Nordic ski team. One afternoon a week I drive the bus and teach a few drills. For my efforts, I get a trail pass, a sweet hat, and a few hours zooming around the trails with a bunch of enthusiastic teenagers. I would actually pay for the experience.

What I don't volunteer to do is heavy lifting for an organization that could pay me but chooses not to. There is a certain amount of unpaid participation that physicians are expected to do—quality improvement work, administrative tasks—that benefits both us and our organizations in the long run. And we all work off the clock to give our patients care. I'm talking about jobs that anyone outside of medicine would expect to be paid for.

I have a colleague who, in addition to her full-time clinical practice, runs a longitudinal clerkship program for third- and fourth-year medical students. As a volunteer. She has all the responsibilities of a medical school dean, and she doesn't get paid for any of it. The private medical school that sends her these students charges upwards of $60,000 per year in tuition. I'm sure their budget is tight, but it should include paying physician faculty.

On that note, the hospital that hosts the students rationalizes the many costs associated with their education as an investment in future physician recruitment, but I am afraid that students graduating with that kind of debt won't be able to afford to stay in the area. They probably shouldn't consider Primary Care—and I say that as a diehard PCP.

I hope my colleague, the volunteer director of medical education, gets many intangible benefits from her efforts, but I fear she is only making herself unhappy. Hours of uncompensated work on top of a demanding clinical career is not sustainable. She is selling herself short—and honestly, selling the rest of us short as well.

Every time a physician says, "sure, I'll do [insert time-intensive committee work/supervision of NP students/project start-up] on my own time," that physician reinforces the belief that we physicians are tireless workhorses. Or suckers. It reinforces the idea hat we can and will take on tasks that an organization would reasonably expect to pay someone to do.

If we are willing to work without pay—out of guilt or obligation—we hamstring our colleagues who try to negotiate fair compensation. An employer, hospital, or medical school will never pay for work that they can get someone else to do gratis.

We can and should expect to be paid for our time. This could be in the form of adjusted productivity expectations, "capturing" the RVUs of the mid-level physicians and residents we supervise, or straight-up salary. We should save our volunteerism for projects that are truly in need or that bring us joy. For everything else, we should expect more than a hat.

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