I haven’t worked full-time in a while, so it was difficult adjusting to the new schedule over the past couple of weeks. Today was my first day of my 3rd week at this locum tenens gig. There is no free time in medicine with this kind of a schedule. How do doctors do this?
Of course, that got me asking myself (again) why doctors need to work full-time when our work is so difficult and when the income is so high?
I am working at a Community Health Center as a Primary Care physician with a 5-day/wk work schedule. I’m to see patients from 9-6pm – a rather standard shift. But you need free time each day to “live” too, that’s the part that’s difficult for me to balance.
To get to clinic by 9am, I get up at 6am. Shower, shave, eat something, grab an espresso, and then get into work by around 8:30am. I need this free time to close charts from the previous day, review labs, and contact the pharmacy about medication authorizations.
I need my morning routine so that I can feel ready for work. It’s a way to wake up and prepare myself mentally. If I’m in a grumpy mood, then I listen to music and journal.
I can’t really eat anything in the morning, I always have that anxious feeling in my stomach before starting a clinic day. Back in the day I would get a lot anxiety the night before an Urgent Care shift but I haven’t had that this time around.
Fortunately, I don’t have a car. I just open the Uber app on my phone and Uber Pool to work which takes about 30-45 minutes. It only costs me $9 each way. Commuting in LA without a car has been way easier than I expected.
The commute isn’t always comfortable but most of the time I can listen to a few podcasts or finish a book. I’m currently listening to The Conscious Closet, a great book on sustainable fashion.
The commute has a its own stressors. You have to request the Uber and walk to the destination. When the night drops on LA all of the freaks are out. I saw a dude who had caught a pigeon – who knows what he was about to do to it.
Unwinding After the Shift
So far I’ve been getting home around 7 pm. That’s a long ass day. And because I’m doing Primary Care, half of the time I’m thinking back to whether I forgot to order something.
Sure enough, I realized on my commute yesterday that I forgot to order Children’s Tylenol for this mom and her 10 month old with a fever. It’ll be free if I had ordered it but she’ll have to pay for it OTC now because I dropped the ball.
I don’t my free time to be taken up with worrying about patients. That’s the kind of thing that leads to burnout.
I got home yesterday and just crashed. Took a 20 minute nap in my nasty ass MRSA clinic attire. Woke up to a nice drool spot and realized I better go get some food before going to bed.
Well, I guess I could cook on my day off. You know, the whole meal planning stuff – cook enough for a whole week.
I know people on social media say that in 2 hours they cook enough for the entire week. Dunno what kind of emaciated fucks can prepare enough calories for an entire week, pack it up, and store it.
I need like 3,000 calories per day. And since I’m mostly vegan, that’s like 7 lbs of roughage per day. You can’t meal plan that out.
Maybe I’m just coming up with excuses but I don’t want to and don’t have enough free time to really pack a decent meal for my workday. That sucks.
I’m already down 6 lbs ever since coming to LA. That’s a lot for me. I’m 6′ and now 170 lbs.
During the workday I might sneak off on my lunch break to the local grocery store in South Central LA in hope of finding something healthy – which rarely happens.
When I get home I will usually get pre-prepped meals from the grocery store. It’s not different from eating out. It’s expensive and it’s all in plastic containers. It’s terrible.
By the time you get home it’s hard to really plan anything social. You’re starving and so you just need to eat. Too hangry to commute to another spot to meet up with anyone.
And you feel gross in your MRSA attire, you want a hot shower and fresh clothes before socializing with anyone.
And it’s LA! Ain’t nobody gonna try to meet up until after 8 pm. Which means I’d get home from a social by 11 pm. That would get me 5 hours of sleep which isn’t enough for me.
So, as far as socializing, you’re left with sending half-assed texts to friends and family. It’s a weak stand-in for a real connection with others. I would prefer to have a real connection with someone after work. And I suppose a partner could fill that gap, but not always.
Reading, Learning, Relaxing
During my shift I look up stuff, clinical guidelines mostly. Today I had to look up an immunization schedule and a regimen for diabetes for a patient who didn’t get one of their meds approved.
But you know, you’re just rolling with the punches there. Looking up whatever you need to in order to get the work done. There is some learning there for sure, but it’s not high quality learning.
And I’m not gonna come home and pick up a journal. I don’t have any brain capacity left at the end of the day.
But it’s not just clinical knowledge which I’m falling behind on, I also don’t get to learn other things, not my Artificial Intelligence stuff and not my Spanish for living in Spain.
I definitely don’t have free time to write as much for this website, my health coaching website, record podcasts, or make my YouTube videos. And because those are the things I care about, I feel a little robbed.
I have laundry to do. I have to go get one of my pants resized down to my manorexic size. I need to take out my trash which is an involved process in the prison I’m staying in.
I have emails which are piling up. I have some job applications I need to complete. And I need to reply to friends who’ve hit me up on text. No free time.
I love exercising. Bouldering. It takes me 20 minutes to walk to the gym and that’s after I packed my climbing gear and changed clothes at home.
I spend about 2 hours at the gym. But ideally I’d like to do about 3. That’s just how climbing is. You have some downtime. And you want to some non-climbing exercises as well to prevent injuries.
After the gym I need to shower. To be honest, I haven’t even done that. I crawl into my nasty ass scabies mattress all sticky and half-sweaty and fall asleep. Fortunately my personal hygiene is offensive to the bed bugs – so far no bites.
Finally, you need some headspace. Maybe it’s gardening for you or going for a walk. You need to decorate your home or paint something. Maybe you need to take hit off your bong.
Whatever it is, we all need this in our day in order to be a little nicer at work. It’s like mental maintenance. I haven’t had much of that.
But it’s a little easier for me because I’m only in this gig for 7 weeks. If I had to do this for the next couple of years, I’d be throwing my stinky ass in front of an Uber.
Free Time on the Off-Day
Well, the off-days were designed for you to catch up on living, right?
So, finally you get your off-day. There is so much free time that you spend half of the day dreaming up of shit to do. Seriously, in the blink of an eye it’s 7 pm. Now you need to scramble to get your chores done.
It’s a sad thing to see a day pass you by having spent it doing things you had to do, not the things you wanted to do.
I won’t even talk about doing nothing – god forbid we do that in our busy, stressed culture. Just sitting around, lounging with a tea. I have a full, untouched box of organic chamomile tea bags sitting in my dungeon – I don’t have the time to get to them.
Work Culture & Free Time
I guess for this reason alone I have such a hard time committing myself to a full-time gig. I know that others have better time management skills. And others still have a partner who helps them get some of their chores done.
Toxic Work Culture
But this supposedly normal work culture is toxic. I know it’s toxic because I see it in my patients. I had a conversation the other day with an auto-body mechanic whom I was trying to get to exercise more and eat better. The dude works more than I do, gets home later than I do, and has no free time on his off days.
There is no free time in our work culture to maintain our health, to be socially active, politically active, to be involved in the community, or whatever else.
A Career in Medicine
I guess I always thought that as a doctor the longer you work in your career, the slower things would be at work. As in, you’d get a lighter schedule and watch the young guns hustle with a heavier patient load.
I thought that because I remember how much I’d run around as an intern in clinic. And I remember the attendings chilling. But obviously not every clinic has that hierarchy of interns, residents, and attending.
Maybe if you build your own practice then you can slowly develop workflows to take yourself out of the clinic full-time. You can bring in other clinicians and step out. Dunno, I haven’t gotten there yet.
I am averse to complaining. And so I try as much as possible to find a solution to any complaints I have.
And though this post reads like a giant complaint, it’s really not. I recognized that my working habits were toxic back in 2012. I realized I was having very little free time in medicine and set out to retire early, to become financially independent.
Working part-time is one solution to this hectic work schedule in medicine. Another is doing telemedicine, which allows me to work when I want, from wherever I want. Also, with telemedicine my hourly income is far higher.
Supplementing my income with some healthcare consulting has been another effective way to avoid working full-time.
Working shorter days and avoiding a long commute is also important. An 8-hour work day is ridiculous, period. Though, it could make sense to work a 14-hour shift if you’re only doing it a couple of times a week.
In the end it comes down to consuming less so that you need less income. And that means more disposable income to invest towards financial independence and more free time in medicine.
This is a bit melodramatic but I feel that as physicians we were given a false promise. That if we work our asses off then some other entity will take care of us.
That medicine is this higher calling and that we should focus the majority of our energy on doing the right thing for the patient. That we should put our heads down and work hard because medicine cannot be anything less.
But that’s no the truth. There is more to life than our careers. And there is nothing promised to you just because you’re a doctor. Free time in medicine is something you have to take, it’s not given to you.
And in order to have free time in medicine you have to sacrifice something, and that’s the number of hours you spend at work. Otherwise you’ll be a slave to your career.
Am I wrong? Probably, somewhere, yes. Still figuring it out, despite a decade+ in this career.