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Work-life balance in Medicine–Maybe the young are on to something?

I read an interesting story about young doctors today.

American Medical News reported that the changing desires of resident doctors poses recruiting challenges for practices. It’s an eye-opener–a look into the future of healthcare.

It seems young docs want unusual things from their career in Medicine.

The new generation of doctors seek employment, not partnership, a guaranteed salary with productivity and mostly, they want more free time. With admirable brashness they cite the ideal quality of life would be a four-day workweek with no call. Almost half of surveyed residents in 2011 ranked free time as the most important feature of their new job. Two thirds said lifestyle was a top priority.

This stuff makes me grin. It’s beautiful really–as are most things about twenty-somethings.

I can’t tell what intrigues me most: the audacity of the young, or the rancorous response of my generation.

You might assume I am going to take the typical old-doc view. It goes something like this:

As a medical student and resident, I stayed late to see cases. I snuck out of the call room on Internal Medicine rotations to follow the cardiology fellow run around putting Swan-Ganz catheters in heart attack patients (that’s all we could do then). I authored–in pen–my own surgery textbook by re-writing what was already published in textbooks. (Remember, ‘app’ wasn’t a word in the 1990s.)

Then, when I joined a practice, I worked 80 hours per week, took call every third night and ablated all day and most of the night. I didn’t stop counting pacemaker implants until 5000. After finishing in the EP lab at six, there would be 5 more consults to see. Dinner was inhaled right before bedtime.

This formula worked for me–and my colleagues. We are good doctors. Call this the good-doctor formula.

These lazy newbies just don’t want to pay their dues. They won’t be as good as we are. Medicine requires commitment and dedication. Doctors can’t be good at anything else because learning medicine is all consuming—even with iStuff. Forget being a little league coach, reading a good novel or surely racing a bike.

But…Wait a minute.

Maybe, just maybe, the young people are on to something. Do they see reality? For what enticed my generation—handsomely rewarded productivity—is gone. (Or…could they really believe technology might shorten the time it takes to learn new things?)

Isn’t it obvious that young docs are validating one of the tenets of many a medical blogger: that an unintended consequence of declining reimbursement and increasing regulation is the dis-incentive for young doctors to inflame themselves? It’s simply not worth it. Sure, they still see doctoring as noble, but at the going rate, they aren’t willing to give themselves atrial fibrillation over their job.

So they boldly and without apology seek work-life balance. Maybe it’s not that they are lazy and young. Perhaps it is because they are prescient and young.

What’s not settled is whether this is bad or good for patients?

On the one hand, we (patients) are going to have to adjust to less access. Hardest hit will be rural areas and poor neighborhoods. A negative.

But on the other hand, doctors infused with balance, rest and less incentive to chase RVUs might not be so bad. Sure, there will be more wait; but that leaves more time for natural healing to occur. (Disclosure: I am a minimalist. Almost half the time, AF stops with no treatment!)

And consider this confession of a proceduralist: (shhh) my best work happens during regular working hours after a good night of rest.


What will happen as the new generation of doctors displace us ‘olders’ remains to be seen.

It’s hard to bet against balance, adequate rest and young people.

And remember, optimism is clearly heart-healthier than pessimism.


h/t to the SketicalScalpel–whose post got me thinking about how intriguing young people are.

4 replies on “Work-life balance in Medicine–Maybe the young are on to something?”

One of my consultants told me on my first day with his team that he ‘believed heavily in work-life balance’ and encouraged me to take one morning a week to pursue something outside the hospital.

I soon realised that this was only lip service and he actually has had the highest expectations in terms of hours dedicated to trolling the hospital for histories and exams.

I think some of the ‘old-schools’ say it is important, but when push comes to shove they want you suffering like they did.

I firmly believe in balance. A well balanced (and well rested) nperson is a better provider. Ignoring the rest of your life will only lead to problems. (There is a reason the divorce rate is so high among providers.) This also relates to your previous post about the weight and fitness of providers.
For decades being a provider was a lifestyle. The new providers coming on the scene want a job/career. They want to know their children and spouse. They want to be there for the atletic events and music concerts. A previous employer was appalled when I asked to move my schedule earlier so I could volunteer as a coach for my children’s school.
I have always put family first in my life and this was the reason I was fired from my favorite job.

This all may be a reflection of “you get what you pay for.”

I’m no expert on the work habits of the current generation, but I still hear plenty of stories about hard work and long hours. These stories don’t come out of the medical field, but rather areas like high-tech (i.e. Google, Social Media Industries, Tech start ups) and finance (i.e. analysts, investment bankers).

I suspect out brightest and hardest workers are following the inevitable forces of capitalism and heading for greener pastures.

I’m totally in agreement about work/life balance, but let’s be careful to see the line here where it crosses over into laziness and misplaced priorities. When I was in training, the best doctors were the ones efficient enough to get done early and go home. Nowadays, I fear that the docs going home early may be the bad ones.

Don’t forget, our patients are counting on us with their lives and welfare. If you enter into this contract to deliver care, you have an obligation to do it right — even if that means missing time with your family.


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