In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn’t relax, and I was always irritated. Even a few days off didn’t help because of the mountain of phone calls and paperwork waiting for me upon return to work. I asked myself, is this burnout?
Coincidentally, I happened to meet a neurosurgeon practicing locum tenens who was happy with his work-life balance. I signed up for a weekend trial as a locum neurosurgeon, then a week trial, and then I looked at my wife who was also my office manager, and asked, “Why are we doing this?” A month later we closed the office.
Stress and burnout are often lumped together, but they are distinct processes. Unlike stress which is associated with over engagement, burnout is characterized by disengagement, blunted emotions, depression, exhaustion which affects motivation and drive, and demoralization. Stress produces a sense of urgency and hyperactivity, while burnout produces a sense of helplessness and hopelessness.
This country is losing the experience, skill and wisdom of senior physicians because of burnout, yet the problem is not discussed openly among physician peers, and there’s a paucity of relevant psychological services for physicians. My personal solution: locum tenens.
I made the adjustment from working full-time to locum tenens through support and access to other locum doctors, and now I honestly look forward to my monthly 10-day assignments. Many productive people don’t do well when jerked into full retirement, and I have the best of both worlds: steady, satisfying work, on my terms of time and intensity, predictable income, and freedom from government/insurance company machinations and hospital political intrigues. The agreement (contract) with the hospital is clear, and short term, and the supply-demand balance for locum tenens doctors in my specialty is currently in my favor. When at home, I have the freedom to not answer the phone, the certainty that the concert or nice restaurant meal or the weekend away won’t be interrupted, and the security that my income checks will be as expected and on time. The conflict between family and profession is now moot.
Another issue is a sense of financial fairness. My income doesn’t depend on “production units,” euphemism for “you get more income if you see more patients, do more complicated procedures …” My value to the hospital depends on my professional ability, and availability. What used to be uncompensated time talking with patients and their families both in hospital and in the office is now mutually rewarding. Getting up at night to see an emergency room patient often used to be uncompensated time, while taking away from needed rest for the following day’s frenetic activities.
Now, I’m paid for the time spent taking care of folks, rather than for how much I can bill for this or that procedure. It’s a four-way win – families benefit from improved relationships with their doctor; I benefit professionally from the satisfaction of providing excellent care no matter how long it takes; the hospital benefits by providing continuity of care and consistent coverage, and I benefit financially by the time I spend in direct patient contact, whether in the operating room, emergency room, intensive care unit, etc.
In private practice, I had the pervading sense that because of all the distractions and competing agendas I wasn’t able to deliver the best care I was capable of. There was an underlying layer of guilt, and of missed professional opportunity. In speaking with many physicians in many physician lounges, I believe many still have this pessimistic view.
By moving my career into the locum tenens venue, these are issues of the past.
Duane Gainsburg works as a locum tenens physician with Weatherby Healthcare.
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