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Can You Work 40 Hours a Week In Medicine?

I’m a part-time family medicine doctor and my girlfriend is a part-time rheumatolgist. When we work just 2 days a week we look at each other wonder how any physician can work 40 hours a week. So, 2024, the age of AI and GLP1s and homelessness, can a doctor work 40 hours a week?

The Average Doctor

The average doctor is brown, male, married, straight, in their early 40s, lives in NY or CA, has 2.5 kids, 1.5 pets, student loans, mortgage, car payments, takes call, sees 163 patients a week, is not in the best of shapes, eats healthy, works out, takes 2.1 vacations a year, reads journal articles, takes CMEs, recertifies every few months for their boards, pays taxes, supports extended family, volunteers, answers medical questions for family, friends, and baristas, and schlepps their kids to their next dream Olympic sport.

That’s a lot of shit to be doing and being, so let’s see how someone has time to do all of it and still work 40 hours in the clinic or OR or in a dungeon looking at path slides.

Medicine in the New Millenium – Working 40 Hours a Week in Medicine

In 2024, we have lots of promises and very few solutions. We can cure everything, and yet the population as a whole is sicker than ever before. GLP1s are about to completely change the game and have everyone looking like a model, even though these drugs have been around since 2005.

Bloated Admin

We have more and more diagnostic codes, reporting requirements, screening requirements, administrative burdens, and a ton more research that comes out every single day.

I need to update my DEA address, do 12 hours of popping opioids … no, I think that’s supposed to be 12 hours of opioids CMEs, report anything and everything to the state medical board, review my NPDB, check CURES, update my data on PAVE, figure out the most fucked up website on the planet called CAQH, and get more state licenses.

Vetting Clinical Knowledge

Let’s zoom in on the last part. Because back in residency I thought that you learn medicine from your attendings. But, really, they learned it from their attendings. And you really need to stay up to date on all that is being reported.

So, let’s say I decide to read JAMA, NEJM, Lancet, Nature, Annals, JBJS, CORR, ASA, BJA, Circ, JACC, EHJ, etc. Well, I can’t just read that shit, I have to vet each journal article. Why? Because I can no longer rely on editors or peer review to publish something trustworthy.

I know, I’m jaded, bitter, and bald. But that doesn’t change the fact that most articles are rather useless. Still, I need to know whether a post-op beta blocker or a cath for angina is necessary or not – I owe at least that much to my patient.

Documenting Visits

As far as EMRs, I input a lot and it outputs very little. I know nothing about my patients between their visits. Their health data disappears into the dark, hairy gluteal cleft of the US healthcare. I will only find out that my patient never got the MRI I ordered after I am sued for missing their cancer. Lovely.

Navigating Access

Patients have less access to healthcare than ever before. Many are left without health insurance despite of or because of the ACA. Once they come in, I have to put on my social worker hat like I never did before.

Patients are also a lot more sensitive to certain matters such as the idea that statins kill and that all surgeons just want to cut you so that they collect their $146 per case. I also failed to call him they and so she now complained to them about me, who, by the way, is a him/her.

Self-Care When Working Full-Time

The government doesn’t seem to care much about homeless people so I have to pick up human manure off the side walk, remove left over food the church gives out to the homeless to minimize the roches and rats, and pick up the skin popping needles while avoiding the dude blowing meth right there in the open. At least he has clothes on this time.

I need to go to the gym because my work is more sedentary than ever before. The only exercise I used to get was manipulating someone’s rotund leg while doing a knee exam, but now I need a chaperone because … because I might glance a beaver shot? Or maybe place my right hand a touch too high on the thigh? Or maybe get aroused as I feel those sexy bristles against my delicate fingers.

I need to go spend $175 on groceries at Whole Foods while finding parking and then coming home to cook that shit. Why? Because my taxes aren’t going towards any kind of legislation that might ensure a healthy food supply system.

While I have to document someone’s pain score even if they came in for a blood pressure refill the grocery stores can purchase their cucumbers from Mumbasa where the farmers decided to just go ahead and grow their veggies in pesticide and do away with the whole messy soil thing.

Mental Health Care

On a serious note, burnt out physicians cannot deliver good care. That should be intuitive. All the knowledge in the world in your head can’t fill in the void that’ll exist in that exam room when you feel totally disconnected from the patient.

I have to do stuff for my mental health. Drinking didn’t work – who would have thought? Complaining about patients didn’t do it. Yoga and meditation shockingly didn’t help.

What has helped is what I referenced in the last article I wrote; it’s figuring out my new motivation to keep working. The motivation that got me from young attending to seasoned attending just won’t cut it. I need to journal, sit with my emotions, cry, talk to others, listen a lot, and explore.

My Attention, My Focus

My 12 hour shifts begin at 8 am and end at 8 pm. I get up at 5 am to have a coffee, read a little, take a shit in the toilet and not the sidewalk, and go for a morning walk. Is there any chance that my first 4 hours of focus at work will be anything like the 2nd or 3rd quarters? No way.

I’ll be energized, attentive, and engaged from 8 until 12. From noon until 4 pm I’ll be mostly farting in my office, trying to digest the vegan food which was a little more al dente than I liked. And from 4 pm until 8 pm I’m picking my ear with the left and digging for treasures in my nostril with my right.

After just one of these shifts I need 1.5 days to recover. Now, imagine doing this 4 times a week or even 3. When do you cook? When do you talk to your partner? When do you connect with your kids? When do you process the emotions and thoughts you had during your work day? When do you exercise? When do you analytically read the new journal articles?

4 x 4 x 4 vs. Full-Time Work

After your 4th decade, I suspect that most doctors can realistically see patients 4 hours a week, 4 times per week. Your stamina might vary and it will depend on your motivation, focus, energy, and drive.

But I would gander a guess that most of us work because we need the money. That, too, is a motivator but it’s one of those motivators that breeds resentment.

For the surgeons your 16 hours of clinical time might need to be mostly surgical with peripheral involvement in the pre-op and post-op cases – in total, you’ll still be doing full-time medicine. For the rheumatologist and endocrinologist you’ll need a lot of time to read up on your very complicated cases.

Look, no way you’re going to be able to do a good surgical job on the 4th knee revision in a patient with hypermobility and autoimmune disease.

If you’re a rheumatolgist and you have a mixed connective tissue disease patient with a recent Hep C diagnosis, latent TB, and heart failure – first of all, WTF! Second, that’s a week of studying up on that case and reaching out to that patient’s specialists to do just a half-decent job.

Not Convinced?

I didn’t even talk about adding to the knowledge of medicine or advocating for legislature. I didn’t mention time needed to volunteer or getting involved in your local community.

We didn’t talk about family time when raising young kids who will without a doubt shape the future of this country.

Many of you will say this isn’t feasible or that you’re totally fine doing 40 hours a week. To those who say it’s not feasible, you’re right, the sacrifice will have to be great. You cannot keep doing what you’re doing, living where you are, thinking the way you’ve been.

For those who are cruising by at 50 hours a week I want to question the impact you’re having on your patients and whether you happen to have a care extender not at work but at home. If you are working 50 and your SO is doing all the child rearing, house stuff, and bills then you are working 25 hours a week as far as the economy is concerned. The problem is that the 50 hours a week will eventually catch up and that Philipinna who will take care of you and your stroke at 62 isn’t gonna care as much as your SO.

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