The notion of the “self-sacrificing physician” is so common it’s almost a cliche. We all heard about it in medical school, and the general public talked admiringly about it. Unfortunately, working long hours is the rule for most doctors rather than the exception.
In June of 2021, Medical Economics presented the 92nd Physician Report. This in-depth survey presents data collected from their physician audience on, among other things, how many hours physicians work.
According to the report, physicians currently work an average of 49 hours every week, much longer than the average US employee, who worked about 35 hours per week in 2020.
Not many studies have looked at the comparative working hours of physicians across specialties. One older study published in JAMA Network included 6,381 physicians across 41 specialties.
Researchers found that surgery, internal medicine, and pediatric subspecialties tended to have the most prolonged working hours. Specifically, physicians working in vascular surgery, critical care internal medicine, and neonatal and perinatal medicine had the longest workweeks.
Medscape’s National Physician Burnout & Suicide Report reported that while many factors can cause burnout, physicians’ top two reasons are spending too many hours at work (34%) and too many bureaucratic tasks like charting and paperwork (59%). The Endocrinologist quoted one doctor saying, “There’s so much redundant work due to incompetent third parties’ data collection.”
The report, with over 15,000 responses, also looked at which physicians work more than 51 hours per week:
●General Surgery 77%
●Urology 76%
●Cardiology 72%
●Pulmonary Care 68%
●Nephrology 68%
●Critical Care 65%
●Oncology 64%
●Gastroenterology 63%
●Orthopedics 62%
●Infectious Diseases 62%
●Ob/Gyn 60%
●Neurology 56%
●Anesthesiology 54%
●Rheumatology 50%
●Plastic Surgery 49%
●Radiology 45%
●Internal Medicine 44%
●Otolaryngology 42%
●Physical Medicine and Rehabilitation 40%
●Family Medicine 36%
●Diabetes and Endocrinology 35%
●Pathology 35%
●Ophthalmology 33%
●Psychiatry 29%
●Pediatrics 28%
●Public Health and Preventative Medicine 25%
●Allergy and Immunology 25%
●Dermatology 24%
●Emergency Medicine 13%
These findings are, in part, because each specialty in medicine has found its way to cover the 24/7 nature of medicine. Medicine is simply an always-on kind of job.
Even though primary care doctors work “easy” hours, their patients still need medical care, especially in emergencies. Therefore, most primary care doctors still have an after-hours doctor on call or a nursing line to refer patients to the ER.
While it is possible for a primary care doctor to work 9-5 four days a week and only see patients by appointment, it’s a lot more difficult for an ob/GYN who’s responsible for delivering babies to stick to office hours. Or an ER doctor who needs to treat a patient having a heart attack in the middle of the night.
Because of this, recurring practice patterns differ by specialty:
●Emergency physicians work shifts, covering a mix of days and nights and averaging around 120 hours per month (or 30 hours per week).
●Hospitalists work seven on, seven off to maintain continuity with their patients and split weekends.
●Nocturnists (doctors who only work night shifts) are hired to cover nights and typically get paid more or work less than day staff.
●Primary care works 4-5 days per week but sets up a call system for after-hours emergencies.
●Ob/Gyn doctors typically work in a clinic group plus call or can work in a system with specialized nocturnists.
Physician comments gathered in this report include:
“I need to take a lot of time away from the office to find balance and re-energize. [This] was never an issue 15 years ago.” — Pulmonologist
“It’s getting worse every year. Data collection is more important than patient care to everyone except the physicians actually practicing.” — Nephrologist
More information on this topic was gathered in Medscape’s recent Physician Compensation Report 2021. It found that doctors specializing in infectious diseases and nephrology tend to spend the most hours on paperwork and administration tasks:
●Infectious diseases: 24.2 hours
●Public health and preventive medicine: 20.7 hours
●Nephrology: 19.8 hours
Worst Lifestyle Specialties
In an article published in July of 2021 by Med School Insiders, Kevin Jubbal, MD, lists the worst lifestyle specialties as general surgery, primary care, ob/GYN, and surgical specialties. He says:
“If you want a challenging lifestyle, you should check out general surgery. The running joke among medical students is that you go into general surgery if you’re either a masochist or couldn’t get into any more desirable surgical specialty. This is obviously not the case, and general surgery is a fantastic field with lots to love, but the reason medical students joke about this is four-fold.”
General surgeons often:
1.Work very challenging, unpredictable, and long hours
2.Deal with the least appealing pathologies and body parts
3.Make less money than other surgical specialists
4.Find it to be the least competitive surgical specialty to match into for residency
Primary care, ob/GYN, surgical specialties, and general surgery have challenging lifestyles, but for slightly different reasons than the number of work hours.
These long working hours majorly affect physicians. Long work hours throw off any work-life balance and can lead toburnout. According to one study, burnout affects half of practicing physicians and results in more medical errors, lower quality of care, higher costs, and worse health outcomes. Unfortunately, COVID-19 has only exacerbated physician burnout and compassion fatigue.
Of course, the COVID-19 pandemic causedchanges in physician work hours and activities, with data showing a decrease in physicians’ work hours throughout 2020. However, the study acknowledged its limitations, and no further data were yet released for work hours in 2021.
Not every doctor wants to be a superhero doctor performing procedures at midnight, delivering babies at the crack of dawn, or spending 14+ hours transplanting organs. Some doctors want to give their patients the best care but still have dinner with their families. And have the luxury of sleeping through the night.
The most common 9-5 specialties include:
●Internal Medicine/Primary Care
●Family Medicine
●Pediatrics
●Dermatology
●Ophthalmology
●Psychiatry
●Pathology
●Pain Medicine
●Wound Care
●Obesity Medicine
●Rheumatology
●Allergy and Immunology
Physician Burnout
Medscape’s 2021 Physician Burnout & Suicide Report also looked into the links between hours worked and burnout. Along with 58% of doctors listing “too many bureaucratic tasks” and 37% reporting they were working too many hours, 42% wanted “a more manageable work schedule” when they were asked what would help reduce their risk of burnout.
Solving the very real problem of physician burnout will take more than just a modest reduction in average hours worked per week. Burnout seems to contribute to doctors leaving their jobs altogether, if not choosing to reduce their work hours.
Psychologist and researcher Christina Maslach writes about the three key signs of burnout:
1.Overwhelming exhaustion
2.Feelings of cynicism and detachment from the job
3.A sense of ineffectiveness and lack of accomplishment
She goes on to state that within healthcare, the prevailing norms are to:
●Be selfless and put others’ needs first
●Work long hours and do whatever it takes to help a patient
●Go the extra mile and give one’s all
As well, the organizational environments for healthcare jobs are shaped by social, political, and economic factors (such as funding cutbacks or policy restrictions) that result in work settings that are “high in demands and low in resources.”
The Physician Lifestyle & Happiness Report 2021
Another survey from Medscape, the Physician Lifestyle & Happiness Report 2021, looked at responses from 12,339 physicians. This survey revealed that 47% of doctors would take a salary cut for a better work-life balance, while 31% would accept $20,000-50,000 less annual pay for more free time.
One-third of all doctors reported feeling at least “somewhat conflicted” over how their work demands impact their roles as parents. About 15% of male doctors and 21% of female doctors feel conflicted, and 1 in 5 female doctors feel “very conflicted” about the situation.
If we can all agree that working an average of 49 hours each week isn’t a good model for creating happiness and wellbeing, what’s a way forward?
Work-Life Balance
A recent buzz term, “work-life balance,” came on the scene due to employers putting in a tremendous effort trying to determine the best way to appeal to millennial workers. With the millennial generation of workers projected to take up 75% of the workforce by 2025, many leaders think it’s time to redefine work-life balance.
An American Medical Association survey showed that 92% of physicians aged 35 or younger felt that creating a work-life balance was important. One respondent noted:
“We are focused on maintaining our identities and relationships outside of work, and many older physicians sacrificed having a life to be good doctors.”
Female physicians, in particular, report work-life balance as a significant concern; achieving this balance often affects their career choices. Recent statistics showed many female physicians in the United States in 2018-2019. Females represent 52% of medical students and 46% of residents.
What does a work-life balance look like? Unfortunately, there doesn’t seem to be an agreed-upon description, with the concept meaning different things to different generations.
Baby Boomers and Work-Life Balance
Born at the end of World War II, this generation (born between 1945 and 1960) faced a lot of hardships. They craved stability in the workplace and were thankful for employment opportunities.
The idea of a work-life balance wasn’t a concern or even a main priority for this group. At this point in their lives, many Baby Boomers are currently in senior or director-level positions, and 80% report only moderate to high stress levels.
Gen X and Work-Life Balance
The children of Baby Boomers, Gen Xers (born between 1961 and 1980), grew up watching their parents work long hours without regard for any work-life balance. They saw the effect on their family life first-hand and made choices to do things differently.
Gen Xers tend to think of a work-life balance as a necessary prerequisite of employment and look for opportunities to telecommute, take extended maternity/paternity time, and use their annual vacation time.
Millennials and Work-Life Balance
Millennials (born between 1981 and 2000) are generally stereotyped with a poor work ethic, viewing work as secondary to a work-life balance. This assumption seems less accurate, with many millennials reporting they are most interested in finding a career path that supports their life outside of work.
What’s become clear is that the same factors that mattered to previous generations also matter to Millennials. Payscale, career trajectory, job location, etc., still matter more than an overcompensating industry built around adding game rooms and beanbags to interest this group.
Finding Balance: Make Work Meaningful
Some strategies can be used to stay working in your chosen specialty and achieve a work-life balance. By making work meaningful, setting priorities and managing time, and assessing and resetting, it’s possible to manage your career towards a better balance.
Making work meaningful can feel at odds with current health care institutes focusing on productivity, sustainability, and cost control. It’s important to remember why we became doctors and protect these motivations.
InThe Nine Things That Motivate Doctors, James Allen, MD, Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital, states:
“Doctors are unique animals in that the things that motivate them don’t necessarily motivate other people and they aren’t always motivated by the same things that motivate everyone else.”
He lists that the number one motivator for doctors is the drive to improve patients’ lives. It’s this drive that gives meaning and purpose to our work.
Finding Balance: Setting Priorities and Managing Time
Setting priorities, such as putting family first, greatly informs your work-life balance. When you prioritize the truly important things in your life, some career decisions become obvious, despite the healthcare profession’s expectations.
There is good evidence that working fewer hours is associated with a reduced risk of burnout. The 2019 Medscape report referred to at the beginning of this post showed that 36% of doctors working 31–40 hours a week had symptoms of burnout compared with 50% working 61–70 hours and 57% working more than 71 hours.
Balancing work and life roles also require good time management skills. Effective time management involves setting long- and short-term goals, planning and organizing, and refraining from engaging in time-wasting activities.
Finding Balance: Reassessing and Resetting
During life transitions, such as after completing your medical training, marriage, childbirth, and the death of family members, take time to reassess and reset both work and life goals. This can help create the balance we’re all looking for.
Each of these life transitions poses different challenges, and it is our responsibility to plan for them. Identifying and acquiring the essential skills you need to make each of these transitions smoother can make the difference between success and failure in your career and your life.
Send me a note if you think it’s time to stop being a “self-sacrificing physician” and invest in the behaviors that create a balance between your work and the rest of your life. I’d be happy to hear your thoughts on how to achieve this, and I have some thoughts of my own I’d love to share!
