I recently read Karen S. Sibert's op-ed in the New York Times called, "Don't Quit This Day Job." In it, Sibert, an anesthesiologist, argues that doctors, in particular female doctors, should stop working part-time as there is a shortage of doctors and our education is subsidized.
As an ophthalmologist currently compressing my work week into three long days a week, I disagree with many of her points and would argue that the solution for our overworked health care system is not to overwork physicians themselves. Overworked doctors may suffer health problems themselves and -- as a result -- may offer a lower quality of care than doctors who are free to work a flexible schedule.
The Implications of Less Flexibility
While I know Sibert is not arguing for a law that would mandate full-time work for physicians, even just returning to the expectation that all doctors must work full-time could have severe consequences.
While medicine is a rewarding career, it requires an enormous amount of time, energy and effort. Limiting doctor's work flexibility could be the breaking point where prospective students decide to pursue another career.
Sibert appears to blame female physicians for the physician shortage. But as Linda Brodsky, an advocate for equality in medicine, points out:
The work styles and habits she is attributing to women physicians are not unique to this demographic; in fact, research has shown that the desire for work-life balance is generational, not gendered. It is sought by Gen X and Y, and crosses gender lines. The resulting tension in the health care workplace is a function of the lag time between society's evolving demands and health care institutions' willingness and ability to meet them.
While there are more than enough people vying to get into medical school, we need people of all backgrounds and interests. Female doctors, and doctors with children and other interests, bring a different perspective and set of experiences to the health care field.
Retaining Current Doctors
Sibert quoted research that found that since 2005 the part-time physician workforce has expanded by 62 percent. What Sibert neglects to take into account is that this research was found during the course of the 2010 Physician Retention Survey, conducted by the American Medical Group Association (AMGA) and Cejka Search, a physician recruitment firm. The survey found that flexibility is a key factor in retaining doctors.
The survey also showed that another demographic contributing to the number of part-time doctors is male doctors who are nearing retirement. By being able to work flexible schedules, they are more willing to delay their retirement.
The Physician Retention Survey found that being able to retain doctors by offering job flexibility can save medical groups millions. The cost of replacing a physician is substantial when taking into account the recruiting process, the need to set up a new practice and the loss of downstream revenue.
Lori Schutte, President of Cejka Search says:
The practice of medicine evolves. Flexible and part-time schedules are now possible for many physicians thanks to Electronic Health Records, hospitalist programs and the addition of advance practitioners to the care team. We see evidence that offering physicians work-life balance keeps them in practice at key stages in their career cycles.
Recognizing the desire of some doctors to partially retire, TGS Financial Advisors helps doctors with the financial implications of working part-time through a specific "part-time prescription" financial analysis. While adequate finances may be a concern, investment advisor, David Burd finds that burnout and stress weigh more heavily in the decision making process. Burd urges people to, "think of going part-time in a different light. Not as a moral failure, but an additional option that lets doctors continue to practice. Curing the shortage of doctors is both a function of creating new doctors and identifying ways to retain those currently practicing, even if it means changing their role. "
By dismissing the middle ground of part-time employment and insisting that doctors work full-time or not at all, we will lose doctors of all ages.
Shortage of Doctors
While I recognize that there is a shortage of doctors, the solution is not to overwork our current doctors. If an employee finds himself overloaded with too many responsibilities, the solution is not to keep working overtime and hope that his company eventually hires someone else to share his workload. The company will only reduce the employee's workload if the employee insists on it.
There are many other solutions to the health care crisis (including more efficient practices and overall changes to the health care system) that I will discuss in a follow-up post.
Consequences of Overworked Doctors
Third-year medical student, Nathan Favini recently wrote that he sometimes feels like a hypocrite. In an article for KevinMD.com, he wrote:
I spent much of my time advising my patients on how to take care of themselves, discussing in depth the best ways to care for our bodies and relationships. And yet, the schedule and intensity of my work often prevented me from following my own advice. I was not getting recommended levels of exercise or sleep and I was substituting easy-to-acquire food for healthy homemade food.
Just as the oxygen mask on a plane lesson teaches you to take care of yourself before you can take care of others, doctors must take care of themselves in order to provide quality care for their patients.
Doctors and other health care professionals have high rates of burnout. They work long hours in demanding jobs. Research shows that lack of sleep can lead to higher levels of stress and mistakes in simple cognitive tasks. Stress itself has been linked to high blood pressure, weight gain and certain diseases.
By allowing for flexible and reasonable work schedules, we can reduce the number of doctors on sick leave, which in turn would help lower health care costs.
Quality vs. Quantity of Care
Sibert claims that female doctors are less productive because they see fewer patients. But the quantity of patients a doctor manages to see in a day is not the best measure of care. Perhaps women are more likely to spend more time with their patients and get to the root of the problem. This kind of personalized care may decrease the number of future appointments a patient needs to make.
Dr. Linda Brodsky pointed to research that indicated that female physicians were more likely to be cautious and follow guidelines which led to better patient outcomes.
This is not to say quality of care can be assessed based on the gender of the doctor, but this research does indicate that men and women tend to approach care differently. Measuring effectiveness purely based on the number of patients doctors see, is a vast oversimplification of a complex matter.
Subsidized Education
One of Sibert's main arguments against part-time doctors is that doctors must repay the government for their subsidized education. While it is true that our education is subsidized, that is true of most education. Chiropractic doctor, Jeffrey Cumro, points out that,
"Almost everyone's education is subsidized by the federal government. Whether it be subsidized loans through school, grants or other forms, there is a lot of federal aid available to all students. If you are going to single out one group for this, you must look at the whole of the system."
Despite this subsidization, medical students still graduate with large debt loads and have spent countless hours working for free or working for significantly reduced pay rates.
Radiologist, Stacy Vitiello, argues that:
My personal decision to work fewer hours during a fraction of my career is no one's business aside from my family and my employer. As to the claim that I owe something to the government because Medicare subsidized hospitals during my training, I would remind Dr. Sibert that during six years of internship, residency and fellowship, I was providing cheap labor for the health care system, working a grueling number of hours under tremendous stress at low wages. My "obligation" has been repaid with interest by the indentured servitude of my 20s.
While part-time doctors are not using their education all the time, they are still putting in decades of work. If doctors who choose to work part-time are not putting in enough hours, what about physicians who start medical school later in life?
A recent CNN article, "Never Too Late to Be a Doctor," featured Mike Moore. By the time he finishes medical school, he'll be in his 50s.
While he may be on the older end of medical students, according to the Association of American Medical Colleges, 9 percent of medical school applicants are over the age of 29. By the time they are finished most will be in their 40s. While older medical students may practice for less years, they bring maturity and life experience to their jobs.
By only allowing applicants who would be sure to repay their subsidized education with a certain amount of time in practice, we would be narrowing the field substantially. Some students may need time to find their calling, while others may be forced to work first in order to raise the money necessary for an expensive medical education.
Family Obligations
In a response letter in the New York Times , emergency doctor, Katherine Jenq, wrote that she plans to work part-time after her first child is born. She argues that while doctors have a moral obligation to serve their patients, they also have a moral obligation to their children.
I wholeheartedly agree. I spent over 20 years of my adult life getting my undergraduate degree and going through medical school, five years of residency and over 10 years in practice.
Because of the enormous time commitment to becoming a doctor, I didn't get married until later in life. I then had difficulty getting pregnant, in part, because of my age. I had almost given up any hope when I beat the odds and had my son at 41.
After he was born, I hired a locum doctor and took 15 months off. It was a financial sacrifice but I knew I was never going to get that time back with my child. My patients could be cared for by another doctor, but my son only has one mother.
Another doctor, Amy Baxter, told me that without her two to three month long maternity leaves, she wouldn't have had the stamina needed to complete her two fellowships.
It is unrealistic to suggest that women in health care should not have children -- and when they do, they deserve to have a maternity leave and a flexible schedule.
Part-Time Doctors Can Devote Their Time to Other Causes
By working part-time, doctors can devote their energy to other important causes.
Dr. Amy Baxter works as an emergency pediatrician part-time and also does research. Her research led her to develop an inexpensive product that helps reduce the pain of shots for children.
My own flexible schedule includes compressing my office time and surgery time into three long days and also being on call seven days a week during certain weeks. Although I end up working a full case load, I am able to spend more time with my family and pursue my other passions which include helping other women, entrepreneurs and physicians manage their energy levels for a better work-life balance.
As a cataract surgeon, I can see the important roles that exercise and nutrition play in the aging process. I can only reach so many patients in my office, but by launching Impowerage, an online magazine for the active 50+ population, I can potentially encourage millions of readers to live a healthy and active life.
It's a sentiment echoed by Dr. Dale Peterson who has worked part-time for over a decade. He wrote that working part-time "has enabled me to improve the health of many more individuals through writing and speaking than I could ever have touched working one-on-one in my office."
Other doctors take advantage of their flexible schedule to care for their aging parents, travel overseas on medical missions or start innovative companies.
Doctors who are expected to practice inflexible full-time hours at all times would find it hard to develop their other interests and ideas -- some which may make a huge impact on the health care system itself.
Conclusion
Sibert does have some great ideas about retaining doctors by reforming the malpractice system and offering onsite daycares for health care workers. But her proposed temporary solution that individual doctors must work full-time is a bandaid solution at best, and harmful to doctors, patients and the entirety of the medical field at worst.
Workplace flexibility is the key to decreasing doctor burnout, reducing turnover rates and making medicine an attractive field of study for a diverse group of people. I would encourage all doctors not to "quit this day job" but to find a way to make medicine compatible with the changing realities of personal life.