Years ago I went on a medical service trip to Ecuador.  I led the trip and I had maintained cell phone service in order to coordinate logistics of the trip.  I had arranged to have another physician in my community cover my service while I was out of town.  I was surprised that even after making these arrangements and being remote villages high in the mountains of Ecuador I continued to receive daily phone calls and messages about my patients day and night. I remember feeling frustrated that despite having arranged for coverage the hospital continued to call and demand my attention. I felt like there was no escape from the daily grind expected by the hospital and nursing home.

The most precious non-renewable resource in your life is your time.   Don’t give your time to your employer without payment. If you want to start your own business, you can be on duty all the time if you wish because you are taking all the risk for the potential of all the reward. As an employed physician you must negotiate how the business functions in your absence; otherwise, you are taking an uncompensated risk with your time.

Society still holds physicians to an unsustainable standard. For generations people have expected physicians to work long hours and physicians have been given a place of honor for the level of dedication to their patients. I have worked for over a decade in a rural area with demanding hours.  I recall overhearing multiple conversations my wife has had with others when talking about my job or my schedule as a physician.  At first the other person will be surprised or shocked at the level of commitment or amount of time required, then eventually they all say about the same thing, “Oh, but he’s a doctor.”  For most other employees it’s expected that an employee will generally have reasonable limits to the hours they are asked to work, but physicians are seen as different. People are compassionate to the work hours and demands of physicians, but most still expect physicians to be available at all hours.

Similarly, when speaking with non-physician administrators there is generally a strong expectation that the physicians they have hired will be on call and productive far more than forty hours per week.  I remember voicing concerns to one administrator and being met with frustration as he expressed, “with as much as we pay you physicians, I can’t believe you would complain about anything!”  Obviously, there was an assumption that by being on contract with that hospital I was expected to respond to anything at any time with few exceptions.

The best time to discuss protection of personal time is during contract negotiation.  I had obviously failed to clearly communicate and negotiate clear expectations regarding my time away from work. I had started my job after residency with the incorrect assumption that there would be some reasonable limits on the amount of time I was expected to work, but in practice there are no standardized protections like those in residency. Thus, in most cases, the only person truly interested in protecting your life from being overburdened is you.

I remember in my first couple of years as an employed doctor feeling a strong sense of duty and obligation to my employer who was paying my salary and helping me to build a practice.  While this was a good sentiment, it led me to overlook the times when I was asked to do things for the hospital that were very time consuming and not compensated. I was always truly on call for new admissions from the ER, OB patients, nursing home patients, and inpatients. There was no protected time built into my contract and nobody contractually obligated to cover me when I was gone. I would arrange coverage when I was out of town, but the hospital would still call every day no matter where I went or how long I was gone.  

At my hospital the older doctors that have retired or left the facility were truly available nearly all the time. As the facility has replaced doctors, they have had to hire more staff members to cover the same number of patients or cover the same service. This is probably a good thing for both physicians and patients, but hiring additional doctors presents administrative challenges in an era of physician shortages.  Employers know they need physicians and are prepared to do what it takes to recruit and maintain physicians.

Most employers and new physicians want to talk about the monetary specifics of the contract which serves to define terms of employment and protect both parties in the event of separation.   Most contracts will include something about paid time off and vacation policies and CME allowance.  Those are all good things, but it’s equally important to discuss with an employer and current physicians in the practice how coverage looks when you want to take time off.  Who will cover you when you are not on call?  How often are you expected to take calls from clinic patients, OB patients, nursing home staff, inpatient nurses, and admission from the ER?  Are you paid for being available outside of clinic hours?  Are wRVU or other incentives set up so you can take time off without being financially punished?  Is there a triage service established to help screen calls appropriately? I recommend discussing this with both your future employer and currently employed physicians. It may be in your best interest to pay to have a contract reviewed by a professional to make sure this is properly negotiated.

Physicians are valuable assets to any organization.  It costs a lot to recruit and employ a physician, but it costs an organization even more to recruit and replace physicians. Hospitals would rather get it right the first time from both a cultural fit and contract logistics standpoint. Don’t be afraid of knowing your value as a physician and the value of your personal time. Ask for specific details regarding time management in your contract.   Negotiate to have a scribe, a nurse triage service after hours, an inbox manager for your electronic medical record, or a specific plan of how medical care and communication happen in your absence. In return for these accommodations, you can promise your employer and your patients a physician who is well rested, well rounded, not burned out, and ready to deliver world class service in your area of expertise.

In my experience, burnout comes from feeling overwhelmed with no end in sight.  As I have become more confident and experienced, I have realized that I can negotiate terms that better protect my personal time and my ability to function well as a professional. Nobody else can do it for me and nobody else will have the same interest in protecting my personal time, my family, and my health.  Take control of your life and your time.  Remember to include protected time and efficiency measures in your next contract.