Recently, KevinMD reposted my post about the reasons why I have chosen to work part time as a physician, even though some people think doctors who work part time are doing damage to the health care system in that we contribute to the physician shortage. Mostly, there were a lot of really supportive comments. This was not one of them:
18-40 million new patients coming into a health care system and many of today's medical physicians what to be PT mommies & daddies?
I'm sorry, I don't tolerate that!
Doctors knew that this is NOT an easy job when they were in college. So I guess you knew that if you have children, its only going to slow you down. In today's economy and how health care is changing so quickly, your career has to come FIRST! Especially in this profession.
So yes, you should think that your ruining medicine! Because when your children are sick and stay home, you stay home as well. BUT if we want our doctors and us patients are sick........WELL?!....I WANT YOU!!! THE DOCTOR!!!
Now of course others will disagree. But this is my opinion. That's all I have to say!
I think it's sad that there are patients who actually think this way.
So you don't have to go through all the 100+ comments, I'll copy and paste a few other choice nuggets:
It is great that you know who you are and what makes u tick. However, it is true that your med school spot could have been utilized by a "full time" md. Primary care does lend itself to part time work. As a surgeon, that is not feasible. My surgical partners count on me pulling my fair share of call, sports coverage, lecturing etc. maybe u should have considered your constitution before entering med school. Physician assistant or nurse practioner lifestyle may have suited u better. I'm an ortho surgeon, a man, and work about 60 hrs per week. I have been at it for 10 years, I make time for my kids, see all their games, and am home for dinner 95% of the time. It's all about time management and setting up a good support network.
And:
I know many excellent, caring, male and female, physicians who have not only taken care of countless patients, but have advanced medicine and changed the way that we treat disease. These people work 80 hours a week, and love the work that they do. You choose to demonize them, saying that because they are not "well balanced" they are not able to "contribute to society". Guess what? You are not more well balanced than them. They just handle stress better than you do.
Dear Dr Mc Fizzy Fizz,
ReplyDeleteRespectfully, I read through almost all that interesting dialogue on Kevin MD. I hail from Australia, as a med student. I just wanted to say, despite those three particularly objecting comments, a lot of other commentators supported your point of view. It is a little self-debasing just to fester on those three points of view, when many others supported your stance!
You're right, and I did say the comments were mostly supportive. However, I think it's educational (and entertaining) to hear the other perspective.
DeleteI think I'd rather see a pt doctor who wants to be there (at work when scheduled) than a ft doctor who hates working or is tired and grouchy from too many hours.
ReplyDeleteDissent from an ortho surgeon, one of the ROAD specialties? The guy must have busted his butt in medical school to get there, but he thinks his current lifestyle is about time management and doesn't have a thing to do with the specialty he made it into? Although he might be onto something, writing "u" instead of "you" - cutting out two letters is a big time savings :)
ReplyDeleteSnarky jesting aside, those three comments all make valid points. The patient wants you in their time of need, the physician needs to have good time management to meet the demands from all aspects of their life, and some people are in balance even when they seem out of balance to others. The major issue I have with all three comments is that they're incredibly judgmental.
We're facing many problems with our healthcare system, and newer physicians seeing fewer patients than older physicians - whether because they work part-time or not - is a partial contribution to that. Part of the focus now is shifting to our lack of primary care options. Why is nobody demonizing physicians who choose to specialize and sub-specialize? Why is nobody speaking out against government officials who want to cut Medicare and Medicaid left and right? Where is the outcry against budget cuts to GME funding, particularly from those who are well aware that one medical school slot does not equal one doctor? And why isn't anyone livid with the average American, who doesn't exercise or eat healthy and then becomes a complicated medical case that takes up a lot of medical resources? If one aspect of the problem will be criticized, all aspects should receive the criticism fairly.
I thought the O in ROAD was ophthalmology? :)
DeleteYou're right though. It's easy to criticize physicians who make the choice not to work as hard as they theoretically could, but there are so many other, more effective ways to address the problem.
The o is for ophtho.
DeleteMore seriously though, if working an extra 20 hours a week meant that I would make an additional 100-200K per year, I might be inclined to do it too. Esp if I had a SAH-spouse.
Maybe we newer physicians are seeing fewer patients because the documentation each visit requires takes more time than the visit itself. Most of it does not improve patient care. If I could just scribble a few salient points in a chart for each visit (as my childhood doctor always did -- and he knew my medical history impeccably well) I could see at least 3 times the number of patients I see now.
DeleteThe practice of medicine today involves more documentation than patient care, and I wonder when/if physicians will collectively decide to stop letting the insurance companies, lawyers, and politicians decide how they must practice medicine.
Food for thought: http://boards.medscape.com/forums/?14@251.kDODaSGWctP@.2a33efbf!comment=1
I'm kind of refusing to believe these stories about people who work 60-100hours a week and then do hours of homework with their kids and take the kids to three different sports practices and probably even practice yoga for an hour every day with their spouse and eat all their vegetables and get 8 hours of sleep. Unless you can be in two places at once you can't stay home with a sick child and be in the hospital 20 hours at a stretch. Nope. A "good support network" and "handling stress well" I'll bet you means "has a really hard working stay-at-home wife" and unless they're going to start handing those out at the end of med school, the solution has to be somewhere other than berating physicians (particularly women) choosing regular full-time or even part-time practice.
ReplyDeleteAs I said to commenter #3, balancing small kids and being a physician is not "mind over matter." You can't just will your children to get picked up on time from daycare by being zen about it. These things MUST get done.
DeleteI'm fairly sure all these commenters are men.
Oh come on, Fizzy. You know that only children of bad mothers ever get sick.
DeleteFor some reason, people tend to put doctors on a pedestal and it shows up in situations like this.
ReplyDeleteI bet for every one person that says "I work my @$$ off 80 hours a week; I'm a REAL doctor" , there are 10 who used to have that attitude, then burned out and quit, cut back on their hours, or got a divorce, or got another degree, etc. etc. I also bet that the doctors who don't get it are the doctors who are men and in part, don't recognize the sacrifices that their significant others are putting into childcare.
Fizzy, I've been reading your blog for a few years now and I decided to come out of the woodwork in support of you.
The same people whining about "needing you" are the types who demand a same-day appointment and then no-show because they feel that they need a doc to respond to their every whim.
Thanks! So true about putting doctors on a pedestal. Nobody would expect that level of commitment from other fields. Doctors are just human.
DeleteSome of these people remind me of my pathology professor, who told my friend and I that we were going to be bad doctors for missing ONE class because we wanted to do community service work. She also told my other friend that he was going to KILL patients because he missed ONE class to go see his mother on her birthday. It's people like her that give doctors who want to also have lives a bad name.
ReplyDeleteAs long as no one is getting substandard care, who cares if you work part or full time! After residency I'd like to think most people have paid their dues and can do whatever they want with their career. And if they're so worried about the doctor shortage and healthcare going to crap, then why don't they go to medical school?
Why do you need people's approval so badly? This seems to be the theme with your posts lately. Why do you care what other people think? Someone out there will always disagree with a decision you've made.
ReplyDeleteTrue. I post things that I think are interesting to others. I found it interesting that people would make the above comments, so I shared it on my blog. If you read the comments on yesterday's post, people say they look forward to my rants. I hate to deprive them :)
DeleteAs a med student who wants a family and a life as well as an enjoyable career, thank you for sticking up for those of us that believe that medicine doesn't have to be everything.
ReplyDeleteI'll be honest Fizzy: At this point in time, I don't want kids. I don't want to deal with the things that you struggle with to give your work and your kids the time they deserve. I don't want to deal with the crap people give to doctor-mothers either. It's a sad consequence to the medical culture, but I have also met medical school mothers/residency-mothers and I'm always so amazed that they're able to pull it off.
ReplyDeleteI'm glad that you and other doctor-women have the lady-balls to do it though :)
I get that residency is subsidized but the hospital is getting a bargain starting at PGY-2. I'm guessing you paid for med school and college so I'm confused as to why patients think you owe it to them to work 60 hours a week (I recall that you once said that your part time was 40 h/week so its not like you mosey into the hospital one afternoon a week and sit on your *ss the rest of the time). People don't feel equally entitled to make nurses, PAs, cops, firemen, civil engineers work over time even though they are at a shortage in many places and we need nursing, public safety, and safe bridges. If there's a Dr. shortage, we need to increase the number of med school spots not coerce physicians into working into burnout.
ReplyDeleteRe the ortho surgeon: I wonder what his wife does for a living. It seems like all the men in medicine who I've heard talk about work-life balance work 60-70 hours a weeks and cite better time management as to how they balance it all. They all seem to also have a stay at home wife but that has nothing to do with it obviously...
Sophia
Theoretically, even though we pay a ton for med school and we work at minimum wage through residency, it still costs even MORE than that to train us. Although I have to be honest, as many times as I hear that, I just don't understand how it's possible.
DeleteThis may be a bit random, but I think one possible reason why firefighters/EMTs (maybe even other civil servants) are not pushed to work more overtime to make up for shortages is because they have groups that lobby to protect their time. Unions can make if very hard for them to work massive amounts of overtime and get away with it (unless its private but thats another story). Additionally, as much as firefighters/EMTs love running into calls, their first rule is always "you come first, not the patient" (its a scene safety thing since if the provider dies, not going to do much for the patient).
DeleteMedicine typically does not have this. If anything, it advocates to do MORE work because thats how it has always been; long hours, take care of the patient first, what you need falls somewhere towards the bottom of the list.
Whether any of this is what we should be doing is up for debate. Thats just what I have seen from being on both sides of the debate (fire/ems/medicine).
I guess it depends on the state or department you work for. In my experience as a FF/paramedic, we had mandatory OT if no one voluntarily took the open shift. The spot HAD to be filled regardless.
DeleteI guess it does depend on where you work then. Here, they get really grumpy if you work too much OT. Interesting, I may have to look into this more! Thank for the perspective!
DeleteWhen I think about the physicians who I see and the physicians who have really made an impact on my family, they are all physicians who do not have the mentality discussed here. Medicine would be a sad place (and probably grossly underrepresented by females) if you could not have a life outside of medicine. There is a cost to the public to train a doctor, but there is also great cost to the physician. You are still entitled to have a full life and make choices that work for you. I am thankful that medicine is becoming more family friendly, and grateful for the physicians who have made that happen.
ReplyDeleteAt 68 I want doctors who are complete people ~ who have people they love and spend time with away from the office. We need more med schools not more hours from the overly limited number of doctors we have. People, including doctors, who are overworked and who do not have time to be human and enjoy their own lives are not well equipped to deal with other people that they meet while working. This is not good for quality medical care or other careers.
ReplyDeleteOrtho has a terrible lifestyle... just what is this guy trying to prove? The point about his likely having a stay-at-home (or, worse, part-time worker!) wife is probably valid. I know at least one classmate going into anesthesia who would have considered surgery if she felt she could have some semblance of a family life in that career. She'll still work a lot but more flexibly.
ReplyDeleteI don't get why anyone would complain about this at all. It's one thing to try to be part-time when you're a resident (not possible), but if your practice wants to hire, say, 2 part-time physicians instead of 1 full-time, what's the big? Unless the complaint is that patients want their own personal doctor available to them at every moment of the day or night, in which case, too bad. No doctor is going to be available to all their patients 24/7, 365 days a year.
ReplyDeleteDr. Alice
I agree with those that believe doctors should be able to have an outside life from work. We need more physicians in this country, not the same number working more hours. The common belief is that in order to be a doctor, one must sacrifice family, children and a personal life. How is this going to attract young people to the field?
ReplyDeleteI know a doctor who decided that it wasn't worth missing events in his children's lives - he cut back his practice so he could attend soccer games, school functions, etc. His patients respect him immensely for that.
I don't think it is even about being a mom. Again, I decided to be part-time before I even had kids-- I figured out very early that if I worked more than a certain number of hours I was a very unhappy camper. If I was part-time, I was happy and could not only keep myself healthy (read, socialize, exercise etc) but also be more productive in my work (keep up with journals and other academic requirements). Now that I have two kids, my "me" time is even more important to make sure I am a good parent AND a good doctor.
ReplyDeleteI have a feeling that keeping up with my specialty and making sure I am healthy will make sure I have a long and productive medical career, not to mention have a family I am happy to come home to. One of our most annoying orthopedic surgeons has a son with ODD-- I wonder if he ever doubts the wisdom of his 80 hour weeks... or the other orthopod who is working on his second marriage. There are risks of putting career before family because some things cannot wait.
The idea that the number of spots for medical students is the limiting factor in the physician shortage is false. Residency is the limiting factor because you need at least one year of residency to even practice at an urgent care here in the US. Medical schools across the country have increased their class sizes. Four brand new medical schools graduated their first class this year. The result was not thousands more newly minted physicians, the result was, for the first time EVER, 1,100 Allopathic students went unmatched this last friday. With all spots, including all preliminary or transitional spots, filled, there are still 1,100 medical students with nowhere to go next year, an average of $200,00 in government loans a piece, and the inability to practice medicine because they cannot finish their training.
ReplyDeleteThis does not even count the unmatched DO and American IMGs this year. Putting pressure on current physicians is not the answer. WE have the students. What we need is GME funding and ACGME approval for new residency positions.