Does Working Part-Time Make You A Better Doctor?

crispydoc Uncategorized 16 Comments

Today’s guest post is by Vagabond MD, the radiologist whose interview inaugurated the Docs Who Cut Back series. His contributions to the physician financial literacy and wellness sphere have graced numerous blogs and podcasts, and his status is best summarized in the title conferred on a guest post he wrote for fellow celebrity blogger Hatton1: “Vagabond Speaks, I Listen.”

Does working part time make you a better doctor? I do not know the answer, but I have suggested it in the past (including my guest post here), and I have seen others suggest the same. I think that it is widely accepted that working part-time as a doctor is part of the recipe for eliminating burnout, recapturing the joy of practicing medicine, and reestablishing a healthy work-life balance.

This past week, I had an experience that might provide some support to the “better doctor” hypothesis. Perhaps this anecdote will shed some light on the matter, and, no doubt, my fellow part-timers have similar stories of their own.

For background, our hospital recently purchased a new, fancy schmancy CT scanner, with ALL of the bells and whistles, including an automated post-processing option that does the work previously done by technologists, with near perfection, and in seconds, rather than the ten to fifteen minutes previously required to do by hand and only when the tech caught a break between scanning patients. Since the computer does not need a break in the action to get this work done, the step-up in efficiency is breathtaking.

At any rate, we received an email from our Chief that there would be a required training for this post-processing software this past week, Wednesday through Friday, and we were asked to sign up for a one hour slot to receive our training. As expected, most of my partners signed up during the work day, to leave their service to get their training, and then return back to work.

Having the luxury of free time during the week, I signed up for training on my off day. I woke not to an alarm but to dogs nudging me around 7:00A. I fed them and took them for an extended walk, hit my spinning class at 9:00A, the flower shop to pick up Valentine’s Day flowers for my wife and daughter, came home, had lunch at home, and headed over to the hospital for my appointment.

I then attacked the training process with the same vigor that I attacked spinning class a few hours earlier. It took about 15 minutes to learn the primary objective of this class, to learn how to identify a recent stroke and to quantify the penumbra. Upon reaching that point, most of my colleagues left the training and went back to work. You see, they were not given time off for training, but just a break in their schedule to work in the training, check the box, and get back to their stations. Their work did not stop while they were training; it was piling up. I have been in previous training sessions under similar circumstances, and that had been my approach. Get

in, check the box, and get back. It’s hard to concentrate on learning something new while you know that your day’s work is not getting done.

However, today I was here on my own time, and I wanted to learn as much as possible about the new software and its capabilities, and I looked at every single vascular case in the sample directory. It is a very powerful tool, and I learned how to use it thoroughly. I also looked at some lung and musculoskeletal cases, too, well beyond the intended scope of the training and our immediate use for the product.

The trainer was impressed with my enthusiasm as we went over the allotted hour and much deeper than he typically goes with training clients, and the hospital’s lead CT technologist complimented me for my tech savviness. The fact is that the only thing special about me was that I my brain was not already half-fried from work, there were no distractions, and I was not pressed for time.

This certainly does not prove that being part-time makes you a better doctor, but being part-time allowed me to get the most out of this training module, far more than any of my colleagues, and I actually enjoyed geeking out on the new capabilities. If you extrapolate this to other learning opportunities and the overall increased bandwidth and mental freshness at work, you can make the argument that part time physician work can certainly lay the groundwork for better patient care and outcomes. It would be an interesting study to do, perhaps in the ER environment where there are multiple metrics and patient satisfaction scores that are measurable.

Comments 16

  1. Great post, Vagabond MD.

    I think you are spot on. Part-time work allows us to have the freedom to put our time into the things that we enjoy, and to learn on our own time. I think that autonomy is what makes people happier and healthier.

    I, for one, know that a lot of my burnout comes when I lack that autonomy because some older faculty member thinks they know how my career should go. Having the part-time option to design a day like the one you describe goes a long way to deal with that!

    TPP

    1. So true. Lack of autonomy is probably the root of many of the evils of the physician career and a major contributor to burnout.

  2. You are spot on Vagabond about having to attend a mandatory training session/etc while you are “still on the clock.”

    Even when I am in the session, the back of my mind I am envisioning all these studies piling up and waiting for me as I “waste” this nonclinical time. Thus the information presented doesn’t fully sink in (although I am a quick understudy and usually pick it up on the fly anyway through my trial by fire implementation of said upgrade, etc).

    I do think part-time docs have that advantage plus the fact that they are not as burnt out as their colleagues.

    1. It’s a lot easier to learn when your mind is fresh and undistracted. This ain’t rocket science (or brain surgery).

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  3. Excellent observations Vagabond. I had the same experience when the EMR system was implemented at the surgicenter where I work. While all EMRs have their inherent frustrations for the user, I was more willing to stop and play around with the system to find the shortcuts and how to use the system efficiently. The full-time docs were more frustrated because they had limited time and multiple job sites to cover, each with their own different EMR system. The main difference is that your new CT scanner actually enhances patient care. I don’t think I can make that statement regarding the EMR, but at least I have been able to incorporate it into my workflow with minimal annoyance.

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      GasFIRE, you’ve perfectly captured the advantage of volunteering to be in the beta test group before any official EMR rollout or upgrade. It’s an added hour or two up front, which ultimately is recouped with interested considering you essentially get a private IT tutor present in a small group (or even individually) willing to sit with you and witness your workflow, then suggest how the EMR might enhance it.

      As you observe, sometimes the advantage is less about improving your efficiency than limiting negative impact, which is a perverse sort of win. If Kurt Vonnegut had been a physician, this absurd system would have been transformed into Dr. Yossarian’s Code 22.

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      Although as you observe, Vagabond, for most it is a rushed affair intended to check off a compliance box rather than a fresh look at how a new tool might enhance the diagnostic armamentarium.

  4. The question might be re-framed “does over working and schedule overload make you a poorer doctor?” Clearly in an environment where you are doing 2 diverse tasks simultaneously neither task receives adequate attention.

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      Task switching has been on my mind lately. A colleague suggested I choose a computer slightly further (about 20 feet) from the RN work stations, and the simple act of requiring more effort to reach me has cut down significantly on interruptions. It’s less social, but more productive.

  5. A profession relating to health and medical career is a rewarding job but, also a tough one. It is important to know where you are passionate and pursue that dream of yours! Thank you for sharing this helpful information.

  6. Okay, not to be negative, but what the hell? I’m part-time and love it. It saved my career. However, volunteering your time to do something that you should be paid to do is BS! You are selling yourself out. The employer should pay you for the time spent training. Doing this on your own time harks back to the good old days of independent practice. Please be cognizant of your time or the mission creep / push to get you to do more in your ‘off time’ will devour all the benefits of part-time work. Value your time and ensure you are compensated appropriately. If you want to volunteer do it separate from your job.

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      Point well-taken, Renard, although I might suggest that there can be alternate ways of framing a mandatory inservice. For hospital-based groups like radiology, EM and anesthesia, who in many cases serve at the pleasure of administration, the latter often has the ability to dismiss a group at will wtih 30 days’ notice. In a good hospital with a desirable payor mix, learning to play well with admin is a key skill and this may not be the best battle to pick.

      When it comes to technology upgrades, attending training can be a matter of successfully adapting workflow or getting killed by the upgrade. If that train has left the station, and I have the choice of being in it or under it, I inevitably volunteer to be part of the first group to learn it because that increases the odds of being in it.

      Another reason docs might not fight it is because in many cases they are not employees, but rather business owners. An independently run group that manages its own business operations with the tacit approval of hospital administration will often assent to unpaid training sessions, because the trade-off still favors a higher level of remuneration than if the job were a corporate medicine gig and one were an employee.

      In the case of employees, I’d agree that hours spent on the job should be remunerated – it’s my understanding that certain employers (Kaiser is an example that comes to mind in my area) do remunerate physicians for training sessions. My hospital frequently does not; I attend “unpaid” because even factoring in those unremunerated training hours, my overall hourly still makes it worth the time.

      This doesn’t invalidate your point, but I’d make the case that sometimes it can be a financially rational decision to attend such training from a macro perspective.

      With appreciation for your point of view that we not get taken advantage of further,

      CD

  7. In a six doc group with an 8 hour clinic day and a call rotation, the work week comes to 66 hours (nights and weekends are the hardest hours we work; 1 hour call=1 hour work). Our “part time” is 40 hours per week, and that doesn’t take into account time spent in CME or work outside the clinic day. I took to the locums road 5 years ago, and I’m trying to make my “part time” status by increasing vacations. My goal this year is 12 weeks.

    My current (non sustainable) 4 day/26 hour/week assignment gives me a lot of time for CME, fishing, and being emotionally available to my spouse.

    Yes, I’m a better, more current, happier, better rested physician. I’m also a better husband.

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      Dear SG,

      12 weeks off a year sounds like a variant of heaven (as does fishing, or more time present with the right spouse).

      Locums seems a very viable option for a lot of physicians to take back control over careers where they’ve felt powerless over their time. Cory Fawcett and Nii Darko are a couple of surgeons who seem to have had very positive experiences making locums their full-time gig, and the venerable Physician on Fire spent several years as a locums physician as well.

      Thanks for sharing your successes in reclaiming time and peace of mind living la vida locums,

      CD

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