Part time medicine and birth of the new normal

One of the most common stressors for physicians is the sheer toxicity of what are considered full time hours. While the rest of the world considers full time to be 40 hours a week, we all know a full time doc starts at 80 plus, if you include all the hours you must be available on call.

In physician surveys, schedule flexibility and the ability to function as a part time doctor are always sited as highly desired burnout prevention measures. However, until recently, the ability to actually be a part time doctor in a group of full-timers was frowned upon and maligned, not to mention the fact that part time slots used to be hard to find. Times are changing.

The 2011 Physician Retention Survey by the American Medical Group Association (AMGA) and Cejka Search is showing a breakthrough in the availability of part time work for doctors. The numbers are so impressive, I believe we are witnessing a change in the definition of the successful physician. Medicine appears to be accepting part time to be a legitimate practice option in critical mass. The 2011 survey covered 14,366 physicians in 80 practices, which had from three to more than 500 doctors each.

The survey shows in just the last six years,

  • Part time male doctors tripled
  • Female doctors working part time increased by 50%

I believe these statistics herald the emergence of a new normal in the definition of what it means to be a successful physician. This will have a positive effect on the health of thousands of doctors in the years ahead.

Here are the actual numbers from the survey:

  • 22% of male doctors worked part time in 2011, up from 7% in 2005
  • 44% of female doctors worked part time in 2011, up from 29% in 2005

Two demographic forces are driving this part time doctor trend – and I suspect a third is working in the background as well.

1. More women physicians in the workplace. The balancing of the genders in our profession has caused a sea change in the availability of less than full time employment. Women have a healthier perspective on the stress of full time work and they graduate residency in the prime years to start a family. These two trends lead to an instant increase in the demand for part time work. If you want women physicians on staff you simply must offer part time options.

2. An aging population of men doctors. These men are looking to scale back their practice to be a part time doctor rather than retire. The economic crash of the last several years has definitely added to this slow down in physician retirements.

3. Here is the hidden factor I think is also in play. I will call it the emergence of the “new normal.” Back in the day when women first started to show up in medicine and began to legitimately request a part time option for their participation, we all remember the grumbling from the old guard.

“Why do we even let ‘em into medical school in the first place.”

“We don’t hire women here because they go part time sooner or later.”

If the truth be told, I still see this grumbling from time to time in doctor-only websites where the MD can remain anonymous.

That was the “old normal.” Work like a dog, until you die — full time or nuthin’ — if you can’t hack it you simply weren’t tough enough and didn’t deserve it.

Now our doctor sisters are creating this new normal, where it is all of a sudden ok to be a part time doctor, to put your family first for a while, to have a life. Amazing!

So with the new normal of the part time doctor option becoming just plain normal, both women and men can go part time to raise a family, as alternative to retirement, or in any other situation where a lower work load would support a higher quality of life.

This new normal can be a part time doctor — balanced and healthy and empathetic — everything you might have imagined your life could be when you made the decision to become a doctor in the first place.

Makes total sense, and I welcome everyone to define your own new normal.

One of the keys to this whole cascade is the ability for everyone to be ok with you being a member of your medical group as a part time physician.

And it looks like the new normal is reaching critical mass.

The same survey showed 75% of groups in 2011 offered a four-day workweek, and 30% allowed job-sharing.

We have a ways to go and these percentages are a welcome change from not that many years ago. I honestly think we are witnessing the birth of a new normal.

Is a new normal with regards to a doctor’s workload emerging? If you work part time, how has that help your quality of life as a modern physician?

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

    Interesting trend and a well written article.  On ond hand, as a physician, I applaud the improvements in work/life balance that is critical to being a good family member and even a good physician (toasted docs aren’t much for empathy).  However, on the other hand, I’m really quite upset at the mere concept of a “part time [family] physician.  Other specialties may have the luxury of being “part time” to their patients, but family medicine doesn’t.  Patients may not need their surgeon/nephrologist/neurologist/rehab/pathologist 24/7, but when they bond with their family doctor, its not a part time bond.  When they are sick, ill, worried, sore, stressed, sad, injured…who do they think of?…not the on-call doctor…they want “their” doctor.  And there was a time where doctors took pride in being “the doctor” for a person/family/group.  Now, it feels more like “i’m happy to be your doctor between the hours of x and y, 3 days on even weeks and 2 days on odd weeks, excluding major/minor holidays, and if you had the good sense to schedule 2 weeks in advance.”  Not to take anything away from the part time docs b/c i’m sure they are just as caring and compassionate (if not more b/c they have a balanced life) but they are inaccessible which is unacceptable. 

    FIGHT FOR YOUR PATIENTS!

    The answer is not work less, its work smarter. The answer is in innovative business models that allow docs to be available to care for their patients 24/7 and STILL have a great work/life balance.  

    Everyday i love going to work and I love seeing my patients. I’m taken back by the trust they’ve put in me and I strive to continually earn that trust and respect.  I believe this is all due to the fact that I don’t take insurance and I keep my practice size to about 600 patients.  Yes, this is called “concierge” by some, but its just smart business and old fashion medicine to me.  I have one RN for two MDs, we run a lean ship, and provide an enormous value to our patients (unlimited home/work/office/tech visits, no copays, all procedures free, meds/labs at up to 95% discounts).  The model is sustainable/profitable, scale-able and reproducible and works for all income levels.  

    Instead of thinking about how we can work less and distance ourselves from our patients, lets fight to work smarter so we can have our cake and eat it too.

    Josh Umbehr, MD
    http://www.atlas.md

  • http://www.facebook.com/people/Ardella-Eagle/100003689610855 Ardella Eagle

    Dr. Atlas:

    Concierge care would make a whole lot of sense if it were affordable to the average middle class family.  I live it probably one of the densest teaching hospital areas of the US and concierge care is quite common.  As such, I’m not seeing competitive pricing between physicans to to render the services worth the cost of paying for it over and above insurance premiums in the event of catastrophic need.  I’m not going to suggest that the business model needs to be overhauled to make it more accessible; you have to pay your bills and you found something that works for you.  However, from the other side of the fence, the patient’s side–or to put in language I hate to use when dealing with medicine–the prospective client’s side, it’s not cost effective to have that privlege.

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      Ardella, thank  you for the response. Typically you would be correct about “concierge prices,” however http://www.atlas.md is designed to be different.  We strive to be the highest value, lowest cost model that is extremely affordable to the average american. Briefly, our prices are based on age only (not on medical history) and for $10-100/mo/pt, we offer unlimited home/work/office/technology visits (no copays), all in office procedures are free (includes ekg, holter monitor, home sleep apnea testing, laceration repair, biopsies, joint injections, dexa scans, spirometry, ultrasound, medical laser treatments, urinalysis, audiometry, strep throat tests, and much more) and discounts of up to 95% on medications and labs (via wholesale).  Not to mention, with our model, people can opt for more affordable insurance and we’ve saved business and families/individuals up to 50% on the cost of insurance. 

      If i may be so bold, if there is a better value in healthcare in the US, I have not heard of it.

      Whereas the typical family physician can have between 3-4,000 patients and see 40-50 per day.  Our clinic will cap each doctor at about 600 patients and a busy day is seeing >5 patients/day.  We take our own call for our patients and they have 24/7 access to us by phone/text/email and more.  This is a model the avg family doc can actually provide continuous high quality care to their patients AND have a balanced work/home life.

      I’m happy to answer any questions or critiques you may have.
      Thank you,
      Dr Josh

      • http://twitter.com/CLeslieSmith Clasina Leslie Smith

         I am fascinated by your model, Dr. Josh.  I’m in the process of opening a new practice and am looking for a multidisciplinary, integrative model.  Thanks for the links and the idea.

  • Elizabeth Chuang

    Thank you for your continued advocacy for physicians’ well being and health physician-patient relationships.

    • http://www.thehappymd.com/ Dike Drummond MD

       You bet Elizabeth,

      When you are sick and want a meaningful encounter with your doctor … the very LAST thing you want is for them to be too burned out or distracted to hear or empathize with your situation. We can’t continue to tolerate practice conditions that are toxic to the providers (doctors, nurses and everyone else). When part time is seen and accepted as a valued contribution and a “new normal” in the spectrum of practice options … it is a beginning in my mind.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • http://www.thehappymd.com/ Dike Drummond MD

     There are any number of practice options for physicians here in 2012 including Concierge and Part Time … my point in the article is that the old paradigm of the SuperHero physician should rightfully come to an end now for a very simple reason. It causes symptomatic burnout in 1/3 of doctors worldwide regardless of specialty.

    We can create a healthcare delivery system that is not toxic to the workers. Changing the paradigm around “success” as a doctor is part of that. Part time is an option that can make a huge difference and it starting to get some respect. And the system can also provide quality patient care and continuity while allowing those who want to work part time the option to do so.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      To be clear, i agree with you on the point of the “superhero” physician likely needs to pass.

      However, i’ll continue to respectfully diagree with the idea that a part time family physician is ideal for the patient regardless of its benefits to the doctor. 

      Thank you,
      Dr Josh

      • http://www.thehappymd.com/ Dike Drummond MD

         Hey Dr. Josh

        I believe the healthcare delivery systems can be organized so that we can have the best of both worlds. Healthy doctors and patients who are seen by doctors who are present, empathetic and at the top of their game … even if it is not their “normal” doctor. It is NOT IDEAL when you are seen by your usual doctor and they are fried.

        And I do understand the AtlasMD model.

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • MaMD

          Thanks to both of you for your comments.  I recently left primary care.  I think retainer medicine is one option, but it may not be doable for some of us.  To counter burnout of primary care doctors and attract newly minted MDs to go into this great field, there has to be more options than having everyone go into retainer medicine. 

          Job sharing done well simply means that my patient will have 2 doctors, working in partnership, who knows him well.  If one of us gets sick or disabled, the patient still has another doctor who knows him very well.  This emphasis on having “my ONE doctor who knows me perfectly” is unrealistic and ultimately, unhealthy.  No one’s health and well being should rest so entirely in ONE person’s hands. 

          • http://www.thehappymd.com/ Dike Drummond MD

             I agree MaMD … the “my doctor is always there for me” is something on the patient side that sets up the impossible situation.  Just like the doctor who thinks “I need to always be there for my patients”. BOTH of these are fantasies. The attempt to fulfill on them is a key component of the burnout epidemic among physicians. That’s my two cents ….
            Dike
            Dike Drummond MD
            http://www.thehappymd.com

          • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

            I’ll continue to respectfully disagree.  Have we fallen that far from our roots that now we try to convince ourselves that one doctor should not be in charge of their patients health? Medicine by committee will never work.  The patient wants/needs/deserves a consistent relationship.

            I’m not trying to be disrespectful of part time doctors and i continue to applaud the goal of a proper work/life balance. I just do not believe that patients will drink the koolaid that “no, really, 2 doctors who know you by 1/2 is great, and 3 docs who know you by 1/3 is better still…”

            Dr Dike and MaMD, i do not think you are giving our patients enough credit.  My patients see and know just how hard i work for them and they respect me more than any patient ever did in the old model.  Yes, I want (truly want) to be there for them as much as i can and they’d love to have me there as much as possible.  However, they also know that i have a family and want me to have my family time. They inherently know what can wait and what can’t and they trust my opinion.  

            When I signed up to be an FP, it wasn’t for dreams of working a 9-5 job.  To quote my personal statement for residency, it was to “enjoy the experience of my patients.” I’ll continue to hold that torch even while other docs are quick to punch a time card.

            Thank you for starting and continuing this important conversation.

          • MaMD

            Dr. Josh, 

            I just checked out your Atlas.md website.  Wichita , KS is lucky to have you and your partners. I’ve wanted to do primary care since  freshman year in college and for the same reasons that you call out.

            Your retainer medicine practice (I prefer that term to concierge medicine which implies that only the well-off have access) got me thinking about exploring such options in my area in Massachusetts. Kudos to you and your partners for doing it well!  I hope that you will add partners as your practice grows to keep that 1:600 ratio. I think the ratio is key.
            I can see myself being a full time doc under similar conditions. 

            However, I don’t agree that having two doctors care for one patient necessarily means that each doctor knows the patient 1/2 as well.  In my previous practices, I considered it an advantage to have colleagues whom I respected and curbsided.  I believe the key in any division of labor (or shift work) is in thorough and adequate communication between the parties.  So, if I am working Monday-Wednesday, I can talk with my practice , job-sharing, partner about the mutual patients who I am concerned about.  I agree that too many cooks ruins the soup, or however the saying goes…. but I don’t believe two is too many!   I am only human, and if something happened (if I was out a few weeks after knee surgery, for example) I would want my patients to have another doctor who could pick up seamlessly on their care.

            Having said all that, I applaud your successful efforts to break free of the tyranny of insurance companies! 

          • MaMD

            Thanks, Dr. Dike.  You point out the important other side of the coin that is contributing to physician burnout. 

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Whatever the model, smaller panels or part time work, shouldn’t we educate more doctors if each one does less now?
    If the “ideal” panel is 600 instead of 2500, should we graduate 4 times more FPs?

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      Its an interesting question, “do concierge/retainer style medical practices worsen the physician shortage?”  Of course, i’m clearly biased so my answer is “i don’t think so” for the reasons below:
      a) “each doctor does less” — not so, a quality family physician can do a full range of procedures and can often manage the majority of a pt’s needs
      b) the current high volume PCP model is inefficient and leads to more urgent care/ER visits, hospitalizations etc.
      c) happy doctors won’t retire or revert to hospital employment
      d) encourage more medical students and residents to choose FP
      e) encourage internists to leave hospitals for out patient medicine

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

         Dr. Josh,
        I did not mean does less in the sense you address. I was referring to the sum total of working hours, which would be reduced if folks work less time.
        I do agree with you that if the work is redefined per your model, better results could probably be achieved, and therefore less working hours would be required.
        I agree with everything else you write above (see my reply to Dr. D below).

    • http://www.thehappymd.com/ Dike Drummond MD

      Hello Margalit – If the Ideal Panel were 600 … your math is correct … and the equation is much more complicated than that. It is clear to me that the delivery model for healthcare is in a period of creative shift … for a number of reasons. You are seeing government attempt various “reforms”. And in the private sector, people like Dr. Josh and others working in Concierge and other systems of delivery and payment. What MUST be a component of all of these is some consideration of the health of the providers IMHO. Up until now, medicine has been a gladiator like survival game with a significant number of the doctors either walking wounded or not surviving the stress.

      What the healthcare system of the future will look like is anyone’s guess and the numbers of providers needed is a moving target. AND the acceptance of part time is a big move in the direction of provider health.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Dr. Drummond – I do agree that physician health should be a consideration, but I also agree with Dr. Josh that part time in this profession should not be defined as part care.
        Smaller panels may be a good option, as long as all patients in a reduced panel receive complete care. It should translate in less working hours for practitioners.

        We have become accustomed to FPs not practicing at the top of their license and not providing continuity of care, particularly with the advent of hospitalists. I am not sure this is a positive trend, and I suspect this “new” model, where care coordination (by computers and non-physicians) is replacing continuity of care, is adding significantly to cost of care and is adversely impacting quality.
        While the “experts” are lamenting our “fragmented” health care system and are busy offering all sorts of technologies and “team” approaches and systems integration to address this issue, I believe the fragmentation problem lies elsewhere, and the issue may be best addressed if all FPs would go back to practicing the type of comprehensive care that Dr. Josh is practicing, and this should not be limited to a “concierge” or retainer model.
        Perhaps this type of change could also help with physician health and happiness.

  • Paper Dolls

    I like full-time doctors. Full-time doctors see more patients and have more experience but part-time doctors are probably better at golf/hobbies. Colleagues, especially Residents, have a great deal of resentment toward a part-time physician/wife/mommy because of extra workload and an attitude of entitlement. The Student Doctor Network and The NY Times discuss this subject
    http://www.nytimes.com/2011/06/12/opinion/12sibert.html
    http://parenting.blogs.nytimes.com/2011/06/13/should-women-be-doctors/

  • http://www.thehappymd.com/ Dike Drummond MD

    Hey Paper Dolls … you bet there is resistance in the ranks and you are obviously in the “full time or no time” side of the question.

    Residents resent part time for a simple reason. Most Residency Call Schedules are Cruel and Unusual Punishment … it is a gladiator style program where simple survival is one of the key outcomes. If the work load is unreasonable in the first place … then anyone who does less than a “full share” will be ostracized. And the WORST EXCUSE for continuing the 120 hour weeks I had to endure is “that’s the way it has always been”.

    I have a series of questions for you.

    1) If 1/3 of docs are burned out worldwide, regardless of specialty on any given day – a statistical fact over the last 20 years
    2) If the number one complaint of patients is “the doc isn’t listening or doesn’t seem to care” which is a cardinal symptom of burnout
    3) And if burned out docs #1 complaint is inability to find any flexibility in their schedule.

    Wouldn’t a part time option make sense?
    And once this option is the norm … I predict physicians will flock to it (as these survey results show – especially for the MEN) and lower rates of burnout, better medical care, at a lower cost with less malpractice will be the result.

    Or we can just keep on doing it the way its always been done … expecting a different outcome though … that would be crazy … right?

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • Paper Dolls

      I don’t think the system will change like you predict Dr. Drummond and accommodate part-time physicians. The system is changing and in the future patients may not have the choice to see a physician if another primary care provider is closer or cheaper. There are people willing to do the “unreasonable workload” and they would like to see physicians cut back to part-time or no-time.

      Does it make sense to have primary care providers with less medical training? It’s already happening because Physician Assistants and Nurse Practitioners have less medical training then physicians and they are willing to work more and get paid less. There will be lawsuits when problems are missed and patients get injured or die because providers have less medical training. You can keep fighting for less workload and complain about burnout Dr. Drummond and in the process you will help your competition.

      Physician Assistants want expanded role-Physicians oppose bill: “…the legislation removes a patient’s right to access a primary care physician if a generic provider lives closer, it allows providers to sign documents in lieu of physicians, and substitutes physicians with providers…”
      http://www.wwlp.com/dpp/news/politics/state_politics/wwlp-physician-assistants-want-expanded-role-cl

  • http://twitter.com/KarenSibertMD Karen Sibert MD

    It will remain to be seen if physician satisfaction really increases with fewer hours.  Part-time people in any field are less likely to advance in career tracks or reach leadership positions. Part-time physicians are less likely to have interesting consults or challenging cases referred to them. Certainly it’s good for employers, who don’t need to provide any benefits for people who work 30 hours a week or less; the large HMO’s can have two physicians each working 2 1/2 days a week, sharing office space and secretarial support, and paying less than a full-time physician would cost.  No one is talking about how this affects the worsening shortage of physicians. And for women, part-time work often implies dependence on a higher-earning spouse, which is exactly what the early feminists were trying to escape. We’ll see how this plays out over time.

  • http://www.facebook.com/people/Maggie-Keavey-Kozel/1383572933 Maggie Keavey Kozel

    The biggest difference I have experienced between part time and full time colleagues in clinical practice is that the part time physicians grow less exhausted, less depressed, and less cranky over time – all of which allows them to do their job better.  It is no longer seen as a lack of commitment as much as a rational setting of limits.   My experience is that part time physicians are just as likely to earn the high regard of patients and their colleagues.  The “lunch is for wimps” approach needs to die a natural death, and I think that’s what we are seeing happen.  It is better for everyone – patients and doctors – if we dispel the myth  that tired, overworked and chronically stressed doctors are the ones who can do the best job.

  • Kerryanne8

    As I have seen it evolve over the past 25 years, the main problem with part time physician models is they are designed to be physician-centric. (All about the physician and their needs). You can design part-time models that are patient-centric. In doing so, ironically they become more sustainable and vocationally rewarding for the Docs. In our Geriatric practice here is Minnesota, we have a part-time model that includes daily access to your physician to help with triage and acute care decision making, but reduced direct patient contact time. Our financial drivers are not fee for service and it has worked well for the patients, families, and colleagues. We are fortunate to have access to managed care funding that supports this under total costs of care techniques. Good discussion. Dr Nick

  • natsera

    So glad to know you work so hard to be available 80 hours a week when I have been unable to get seen by my doctor’s office during regular work hours for extremely painful urinary infections.  And they are now closing at noon on Fridays. Don’t you see the cognitive dissonance here? I was forced to use an expensive urgent care facility because I couldn’t endure the pain (and even they are closed if it starts at night), when it would have made a lot more sense for them to simply call in a prescription for me, since I have frequent urinary infections and they know it. I just don’t see the value of so-called “80-hour” work weeks if patients are still being expected to endure pain and wait 3 or 4 days to be seen for a serious infection that COULD have gone into my kidneys.

  • HealthCareProf

    This article basically sums up what’s true about most jobs. The more time and effort you apply, the more money you get in return. Burnout happens in all jobs. You can choose to work less, but you will have the trade off less income. For some, the extra free time is worth the pay cut. All the power to you, if you can find the perfect job that meets you needs.

  • Happydaysdoc

    I have practiced “semi part time” or 3/5th time, actually for 12 years. I am nowhere even close to burnout. I also have multiple work-in slots every day so am always available to be seen urgently (except my one day per week off and my partners cover me). I work 2 full days a week, until 5-530pm, 2 days working through lunch until I leave at 3pm to pick up my kids in carpool line (these days I sometimes see more than my “full days”), and one day entirely off (well, I take calls from my nurse for what I can manage over the phone and I defer who needs to be seen to my partners) which is absolutely glorious!! I can go to lunch some weeks, go to the grocery when it’s not crowded, or just take a nap if I want!! The key is that is my CHOICE, and what I have chosen to do so I can do this job long-term. I make less money for sure, but sanity and being available mentally for my patients is worth more than that.

  • davemills555

    After nearly 30 years of private solo practice, my primary care physician has decided to sell his practice to an newly forming ACO and join them as a salaried employee. He tells me that he looks forward to regularly scheduled hours, a scheduled lunch hour every day, scheduled paid vacations, paid holidays, no on-call duty, a pension plan, a 401k plan, paid health care, vision care and dental care insurance for himself and his family and no more extreme hours and calls in the middle of the night. Best of all, he no longer will be responsible for an office and a staff. He tells me that those who say the ACO model is just a regurgitated version of the failed HMO model are simply lying and are in denial. The failed HMO model contracts with physicians to accept certain payment standards for their services. In the HMO model, the physician never becomes an employee of the HMO. With the ACO model, the doctor or health care professional becomes a salaried employee. The ACO model is nothing like the failed HMO model in any way. These two models have nothing in common. 

    • davemills555

      Oh, I forgot to mention another perk…

      My doctor says he will receive fully paid group malpractice insurance when he joins the ACO. 

      • Paul Colopy

        Sounds good doesn’t it? What about the ACOs’ major stated goal of making the “providers” totally responsible for outcomes, including the estimated 40% of healthcare costs entirely out of their control due to obesity, smoking, inactivity, and risky “client” behavior of every sort, with no responsibility or repercussions for the client aside from the bad outcome itself? When this defective logic inevitably fails, they will slash your doctor’s salary and even recoup what they paid him/her during the time he/she wasn’t slapping the lard out of the client’s hand, or dragging the client off the couch to go walking instead of eating. Of course the designers must know this unless the’re willfully blind, so think of the cynicism involved. I’ve noticed DM, that you’re basically a salesman for the ACO. Are you really Ezekiel Emanuel? His opinion pieces in JAMA, to sell the ACO to physicians, restated the above, and included vast medmal risk for providers as well as monopolizing their private time, by suggesting additional endless email and telemedicine responsibilities beyond their direct client care time, in order to nanny them into healthy behavior. Again, your doc is going to have a different view in as little as 3-5 years.

        • davemills555

          That depends on how you define “provider”. My PCP will become a salaried employee with lots of perks and with a fairly large chunk of money in the bank from the sale of his practice. Just like any salaried employee, if things change and he doesn’t like his employment situation, he looks for another job. Pretty simple? Duh! Your post shows an obvious disrespect and disdain for the patient. How soon we forget that it’s the patient and their insurance company that has made providers so wealthy for so many years in the fee-for-service model. Most will agree that fee-for-service is the main reason why our health care system is broken because providers have never been required to perform or suffer consequences. Now, all of the sudden, providers will be required to show performance based on patient satisfaction. Gee, what a novel idea, huh? Ezekiel Emanuel? Stop trying to hide your envy!

  • http://www.facebook.com/people/Donna-Rovito/100003242586757 Donna Rovito

    A significant physician shortage is forecast within the next 15 years.  Fewer hours worked by individual physicians means that more physicians will be needed to shoulder the load – esp. with the “coming of age” of the baby boomers.  While medical schools seem aware that class size needs to increase, more medical students won’t solve the problem if there aren’t residency slots to train them after graduation – and that’s under complete control of the federal government through residency funding by Medicare.  Legislators need to understand this issue and physicians need to be engaged in the policy debates surrounding impending changes in how health care is delivered.

  • http://twitter.com/krafty Michelle Kraft

    I think your “hidden factor” is being seen in more professions than just medicine.  I would venture to say it also has a lot to do with the societal norms and what is “accepted” in the younger generation that is/has entered the work force.  When I was a kid my dad (an aerospace engineer) worked greater than 40 hours as the norm (not as much as 80 but a lot) and never really would have considered taking time off to attend a midday school function, take a kid to a doctor’s appointment, etc.  My dad attended things that were after working hours or on the weekend.  Now as an adult I see more men my age taking time off to attend school or sporting events.  The doctor’s waiting room still has more mom’s but there are a few dads. 
    I think this generation of workers is more family focused as a whole.