The work hours of medicine

Pre-Med & Medical School Careers in Medicine
1

<p>I've heard so many different things about the kinds of hours physicians practice - that it just lumps into something very ambiguous for me. I've heard physicians have "long hours" and are "woken up at 3 am in the morning to be on call" - even more extreme things like "abysmal family life." But then I've heard people say "I know a doc who has 6 months off", "doctors have great control over the hours the work", and doctors can "vacation whenever they want." </p>

<p>Can somebody just give me the honest truth? Bear in mind that I'm disregarding residency - I actually can glean the consensus it is basically massive sleep deprivation. But what's like after attending? Let's say I'm just a general practitioner - no pursuit of specialties or anything. What are the hours like then? What are the factors that determine them? Are the long hours I keep hearing about self imposed or created by others? How many doctors actually have standard 8 hour days, 40 hour weeks? </p>

<p>Thanks.</p>

2

<p>The hours are largely under your control. For the most part, people who work long hours do so by choice. They may complain, they may suffer, but usually they could reduce their hours. This might mean changing jobs, and would certainly mean less income. </p>

<p>Some jobs have irregular hours built in. In many fields being on call is part of the job. The demands vary by specialty and practice situation. The differences are not obvious to those outside medicine. There are not that many dermatologic emergencies. If you are a trauma surgeon at a busy hospital, you can expect to be up and working all night when you are on call. If you are an anesthesiologist, you will be in the OR along with the surgeon. Yet you hear people assuming surgeons have tough call and anesthesiologists do not. On the other hand, no one puts a gun to your head and forces you to enter these fields, or to work at a busy hospital. In general, even there, you have some ability to determine how much clinical work you do when not on call. If you are hospital based then your flexibility ends when the needs of the hospital, and its ability to attract people who want more hours, conflict.</p>

<p>General internists, family practitioners and pediatricians, people in primary care, have entirely different call. It is usually “telephone call”. So you field calls from worried patients or parents, but if you send them to the hospital then it is the people working there overnight who care for them when they arrive. Here there is a tradeoff. If you are in a large group, then there may be many people in the call rotation so it does not come up that often. But when it does you may be busy most of the night because of the number of people covered by the group. Do you have a day off after a night on call? Depends on the norm for your group, and whether you can afford to work part time.</p>

<p>At least right now there are lots of jobs for people who want to work part time. They do not pay nearly as much, but they let you choose your hours. Since there is usually a high overhead associated with medical practice (equipment, office space, insurance…) one’s expenses may be nearly as high for part time as for full time practice. For this reason someone working, say, 60% of full time may make much less than 60% of a full time income.</p>

<p>People who enter practice rarely leave to enter other careers. Most doctors may not be happy about many things in medicine, and the need to pay back loans may make it impossible to switch careers if they want to, but most would not want a different kind of job.</p>

<p>Try an experiment, but do so carefully. The next time you hear a doctor complain about the long hours, ask “why don’t you quit and go into another line of work?”</p>

3

<p>Hm. I’m less convinced. The truth is that I know a few physicians who are “part time” – and they work something like 40 hours – but other than that I don’t know a single physician who works only 40 hours a week outside of Derm and maybe some Ophtho.</p>

<p>The truth is that while it’s probably theoretically possible to reduce your work hours, the fact that nobody actually does so should be telling. It might be tough to find an appropriate practice group, it might be tough to find a hospital willing to let you work with those constraints, or maybe the hit to income is disproportionate because medical fixed costs (equipment, rent, staff) are so high that reducing your hours by 10% reduces your income by 30%.</p>

<p>I’m not sure exactly why it is, but the bottom line is that when docs talk about specialties with “great hours,” almost none of them are referring to 40 hours a week. They usually mean 60 instead of 70, or 70 instead of 80.</p>

4

<p>Great post afan.</p>

<p>I think it’s important to point out that there is variation between the different specialties but also within particular specialties. As someone who is planning on entering a “high” workload field - Pediatric Intensive Care - I can attest that the possibilities range from taking home call every other night for months on end, to working 120+ hour weeks in house and then getting the next week completely off, to working fairly regular number of hours but alternating between days and nights on a weekly or monthly basis. </p>

<p>The best advice for those trying to figure out their future paths is to keep everything in perspective. It can be very tempting to choose only based on lifestyle. But to do so ignores the importance of interests and passions related to the work that you’ll actually do. Every specialty has a short list of things that they’ll see over and over and over. If you choose a field in which you can’t stand dealing with the same problems most of the time, you’re going to be miserable no matter how much free time you do or don’t have. </p>

<p>Other interests like teaching and research may further push you in certain directions and changing your lifestyle.</p>

<p>@BDM…it depends on the field. Family friendly fields like pediatrics have a lot more possibility. Others like OB/GYN may allow physicians to remove portions of their practice to change their hours - a lot of older GYN’s drop the OB portion in order to get better hours.</p>

5

<p>My husband is in family practice (NOT to be confused with general practice which is rarely done in the US any more). He is full time, works for a medium size group, and has some administrative responsibilities. He is in his office from about 7:30 AM to 6:30 PM, a portion of which is not billable (charting, phone calls, refills), takes call from home once or twice a week. He theoretically has off 1/2 day per week, but he seems to be at the office runway. His income is based on productiion not hours.</p>

<p>I used to work part time for a large specialty group. Part time was based on four hour “units”, and I was paid for 8 units a week. I was usually in the office for at least one unpaid hour per unit. Call was usually from home, but I sometimes had to go in. I left for a part-time private practice, and now “work” (see patients) two half and two whole days a week, but am always “on call”, and I am sometimes doing administrative tasks at home. For while I made move money (but lost valuable benefits); now I make less. Private practice can be very uncertain.</p>

6

<p>I am trauma surgeon</p>

<p>Work 36 hours on and 8 to 10 off and get calls when I am off.</p>

<p>Do get to take vacation when I want and meetings.</p>

<p>Love it</p>

<p>With mandated 80 workweek for residents (maybe 60 soon), the work week of attendings is increasing. Bottom Line. Most attending work more than they did as resident. Most divorces occur as spouses think “it will be easier once the residency is over” - it is not.</p>

7

<p>re part time practice</p>

<p>[Part-Time</a> Practice Trends Intensify Physician Shortage According to AMGA and Cejka… | Reuters](<a href=“http://www.reuters.com/article/pressRelease/idUS134560+10-Mar-2008+PRN20080310]Part-Time”>http://www.reuters.com/article/pressRelease/idUS134560+10-Mar-2008+PRN20080310)</p>

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<p>The AMGA represents private practice groups, so its figures may not be representative of hospital based docs, and definitely not representative of academic docs. </p>

<p>I know lots of people who are part time, in a wide variety of fields. </p>

<p>From the ACP
[ACP:</a> Career Counseling - Part-Time Employment](<a href=“http://www.acponline.org/residents_fellows/career_counseling/part-time.htm]ACP:”>Part-Time Employment | ACP Online)</p>

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<p>Part time is not uncommon, and is increasing.</p>

<p>Medical students make decisions based on what they see in their rotations, giving them a somewhat distorted view of the fields. They do not see much office practice, and, of course, they do not see the attending physicians when they are not there. If the hours are important to you, look carefully at the lifestyles of a cross section of docs in the field, not just those who work at the teaching hospital.</p>

<p>As Princessdad noted, the workload of surgical residencies, once truly brutal, are being brought under control. This will mean less abuse for the residents, and the field opening up to people who have no intention of practicing 100 hours per week. As some hospitals make the adjustment, the work formerly done by residents is shifted to attendings, but an individual has a choice about whether to continue to practice at such a place, and the surgeons collectively can replace some of the resident work by hiring physician extenders- nurse specialists, physicians’ assistants, etc. Of course, their compensation has to come either from the hospital or the docs themselves.</p>

8

<p>A family friend is a nurse who works when she wants. She took off 2 months for a new dog added to the family. I’m thinking it depends on where you work.</p>