May 2008 | Welcome to Finding Balance eNews.

The New Generation of Docs; Slackers or Realists?
The resident that walks into your practice as a new employee this year is very likely to have a different attitude towards work than you have. They are likely to want time off for family, evenings free and plenty of vacation time. Your response may simply be; “I never had it that good, why should you?” You may see them as a problem and part of the ‘slacker’ generation.

Who is right, a doc that wants down time with family or one who dedicates themselves to medicine regardless of the costs? Statistics have shown that for the latter:

• There is a 67% burnout rate (1)
• A 38% rate of dissatisfaction with their work (2)
• Higher than average cardiovascular death rates and suicide rates (3)
• High rates of depression (4)

Other publications have shown that physicians who make time for family, spiritual growth, and volunteer work are happier and healthier (2, 5).

"Physicians who manage their own stress and feel happy with their own daily circumstances are probably better physicians,"
— American Medical Association President Ronald Davis.

My belief is that, as medicine changes, we must change as well. The style of practice that worked for physicians 20 years ago no longer works for most physicians. This style includes being the sole decision maker who fails to delegate, and who insists on being available 24 – 7. With increasing demands on physician’s time, the growth and aging of the population, and the relative decrease in the number of physicians per capita, (especially in primary care,) it becomes impossible to maintain the ‘old’ style of practice (6).

The new style of practice includes:

1. An integrated team approach using other physicians and clinical team members
2. Flexible schedules
3. Accepting less continuity and using hospitalists
4. Electronic medical records for ease of access to information
5. Equal pay for equal hours worked

Between 1996 and 2003, the proportion of women graduating from U.S. medical schools who chose more "controllable" lifestyles — specialties allowing them to dictate hours spent on the job — doubled. Those opting for more flexible fields rose to 36% from 18%, according to a 2005 study published in the journal Academic Medicine. For men, it rose to 45% from 28%, the study showed (6).

In the business literature the number one contributor to work satisfaction is enjoying the work you do day to day. My concern with choosing your specialty based on lifestyle is that it will quickly lead to work dissatisfaction, as you are less likely to enjoy day to day working.  I believe this too is a mistake that many young physicians are making.

The short term solutions are to create more flexibility in practice options, greater pay for primary care docs for the patient management work that they do, such as the medical home concept, and to accept that the world of medicine has changed. The long term solution, besides the ones stated in the bullets above, is to educate more doctors and clinicians who will share their work as integrated teams.

From my stand point, there is no right or wrong. The young generation of physicians has as much to teach us as we do them.

1. The American College of Physician Executives, The Physician Executive, December 2006
2. E. Frank, McMurray J. E.; Linzer M.; Elon L ., “Career Satisfaction of U.S. Women Physicians: Results from the Women Physicians’ Health Study,” Archives of Internal Medicine 159 (July 12, 1999): 13.
3. Erica Frank, Holly Biola and Carol A. Burnett, Mortality rates and causes among U.S. physicians, American Journal of Preventive Medicine, Volume 19, Issue 3, October 2000, Pages 155-15
4. C. Center et al., “Confronting Depression and Suicide in Physicians: A Consensus Statement,” Journal of the American Medical Association 289 (2003): 3161–166.
5. Factors Explaining Career Satisfaction Among Psychiatrists and Surgeons in Canada, Rein Lepnurm, DrPH, Roy Dobson, PhD, Allen Backman, PhD, David Keegan, MD, Canadian Journal of Psychiatry, March 2006
6. J. Goldstein, As Doctors Get a Life, Strains Show Quest for Free Time Reshapes Medicine; A Team Approach, The Wall Street Journal, April 29, 2008

Just for fun
Eat, Pray, Love by Elizabeth Gilbert
OK, it’s tough as a guy to recommend a ‘chick’ book, but I read it en-route from Asia and loved every minute. If you have a fondness for India, Bali or Italy, it’s a must read. If you don’t, this book is a personal travelogue through these countries that will make you want to buy a ticket! Enjoy the journey.