Doctors who work part time: I’m sorry that I’m ruining medicine

I work part-time.

Some people think that women who work part-time are ruining medicine and contributing to the physician shortage. So I want to present my very reasonable list of reasons why I work part-time in a flexible job:

1. I am sick constantly. Constantly. My kids are petri dishes. And it always lasts forever. Even as I’m writing this, I’m coughing and my left ear really hurts and keeps popping. Is it easy to work under these circumstances? Not particularly. Maybe mothers of small kids who work full time have better immunity than me. Or maybe they’re just better at working while very sick.

2. I don’t have family members who can quickly cover for me in a pinch. When the daycare calls, saying my daughter has conjunctivitis and must be picked up NOW. (Literally, I am required to show up within an hour. OR ELSE.) Ideally, I would have a babysitter who waits by their phone, constantly on call for just this situation. Do those exist?

3. If the workday “ends” at 4PM, that’s the only way to guarantee making it to the daycare by 6:30pm. I have no backup if I can’t make it.

4. I like having two days off to recover from the week. It’s called a weekend. It probably seems crazy luxurious to you, but believe it or not, it’s actually sort of normal to most people.

5. When I feel like I’m rushing around and getting pulled in too many directions and expected to do three different jobs at once, I actually get kind of stressed out. And depressed. I don’t like feeling that way.

6. There are things I enjoy doing that don’t involve medicine or my kids. And if I work part-time, I get to actually very occasionally do some of them. It’s important to me. I feel guilty saying it, but it’s true.

7. When I am really stressed out, I am not super pleasant to be around. I start screaming at the top of my lungs and then burst into tears because my daughter won’t put her sneakers on in the morning. I’m sure I have inferior stress-compensation (likely genetic) compared to full-timers, but I just hate being like that.

8. I have trouble with night call. I never liked it, but at some point, between waking up for my baby’s cries and waking up to a beeping pager, my sleep became very dysfunctional and a major source of stress. I’ve seen professions to address it, and it’s better, but I can’t deal with working at night.

9. I don’t have the physical stamina you do, apparently. After working a very busy 10-hour day, I am too tired to play with my kids. I was never a high energy person. Somehow, I didn’t realize how important this was when I went into medicine. I wish I had the energy, but I simply don’t.

10. I am not a Type A personality. I just can’t do it all at once. And if I tried, I wouldn’t do it well. Does that mean I shouldn’t be a doctor?

Trust me, I feel guilty that I can’t work the hours some physicians work. Sometimes I wonder what’s wrong with me, that I can’t seem to juggle the same number of balls as some other women. But I have found a balance of career and family life that seems to work for me.

I’m sorry that I’m ruining medicine.

“Fizzy” is a physician who blogs at A Cartoon Guide to Becoming a Doctor and Mothers in Medicine.

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  • Laura

    My favorite, beloved internist works part-time and has two small children. Good for her! I admire her ability to sort through her priorities. She is a phenomenal doctor. Did I mention I am a picky patient who readily finds another doctor if I’m not happy with my care? Yes, well that would be me. I had a doctor once who did not know how to manage family and work commitments well (he was a new parent!) and the result was very, very bad for me. And given that one of my daughters has a keen interest in medicine, I can encourage her that practicing as a doctor might require flexibility and part-time hours when and if (hopefully) she wants a family. So, I don’t know why you’re feeling guilty. I bet you’re a great doctor and a wonderful mother.

  • ColdHands

    You shouldn’t feel guilty. My GP, who is the most amazing doctor, works part time as she has a young child. It’s sometimes hard to see her. But surely it’s better to work part time than force it full time and burn out, and end up quitting.Doctors are people too.

  • Suzi Q 38

    My son’s favorite pediatrician worked part time. It didn’t matter to us at all.
    We just went in to see her the days she worked. She was so calm and patient. One of my friend’s said that she worked part rather than full time because she wanted to have more time with her 3 sons….one of which had “special needs.”
    One of my friends is a pediatrician and works part-time.
    Her daughters are teenagers, and she sain she loves the extra time she has with them.

  • super

    There is nothing wrong a person who figures out the right balance for her own life, and you shouldn’t feel like you need to apologize for that. You’re a better doctor and mother for it.

  • JD

    The author should not feel guilty, but I will say that the numbers in physician workforce is regulated. In other words, medical school admission rates are controlled with the assumption that each student they admit will eventually become a full time physician. As the percentage of doctors working part time changes, medical school admissions will also need to change to make sure that the there is not a physician shortage. So yes, part time physicians are contributing to the problem of physician shortage, but it is nothing to feel guilty about. Watching out for yourself and your family is your right.

    For those doctors out there who think that there is nothing wrong with working part time, let me ask you…would you have ever admitted it was your intention to work part time when you interviewed for medical school? Probably not. So you know just as well as I do that it is not ideal to be a part time physician. Remember that by going to medical school, part time doctors took away a spot from an applicant who could have worked full time.

    Finally – yes, patients love part time doctors. By seeing fewer patients, part time doctors get to focus and pay more attention to the ones they do have. So of course part time docs are “beloved”.

    • azmd

      Medical culture frowns upon part-time work, which as several other posters have mentioned, involves working about 40 hours a week. This has very little to do with what’s good for the patient and certainly nothing to do with what’s good for the doctor and his or her family.

      Rather, it is driven by our being socialized to need to appear super-human both to ourselves and to the outside world. This is really mostly related to our narcissism, and not to any real need that anyone has of us.

      “Watching out for yourself and your family” is most definitely not a “right.” It is absolutely a responsibility, and if more doctors took it seriously, we would have healthier lives and healthier patients.

      • JD

        There is no official definition of part time, and the author certainly did not define it, so the 40hrs a week that you use is arbitrary. I would consider it close to full time as this is the standard that is used by nearly every other industry. Since I am not of the mindset that physicians are supposed to be better than anyone else, I do not accept working 40 hours a week as the definition of a “part time” physician. I am an academic physician who works about 80 hours a week, but I would never belittle a physician who works 40 by referring to them as “part time”.

        What you casually ignore in your general argument is that there is a physician shortage in this country. Your analysis regarding “healthier lives and healthier patients” ignores that many people do not have access to a doctor. Certainly, part time doctors are not solely to blame, and plenty of blame can be distributed around our health care system. However, medical school admission rates are at least partly based on each graduate doing a certain amount of patient care. Now, if medical schools want to produce more doctors so that more people can work less, that is fine. It may even be a good idea. But until then, if we are to say that we have a duty to serve society, then, given the physician shortage, I think we are somewhat obligated to at least work 8 hour days, 5 days a week.

        Of course you know that working part time is wrong, or at least that there is something wrong with it. Seeing fewer patients, and having a reduced patient panel, compared to physicians who carry a “full time” panel of patients, is the very origin of boutique medicine. If we view doing the right thing as working just as hard as everyone else to care for our society, then by definition there is something wrong with doing less than others. That is why it is “frowned upon”.

        Ultimately, the difference between us is that I view being a physician as a duty. You view it as a job. I am not saying your view is wrong (which is why I said that the author should not feel guilty)…but my view sure as hell isn’t wrong, either.

        • azmd

          Actually I would venture to suggest that you are wrong on a number of counts, the first being your assumption that I work part time. I am a full time academic physician myself, so my comments about someone else’s working part time are based on my philosophical beliefs about medicine and how we take care of patients, not in how I have chosen to use my own medical training.

          In the second place, if you are an academic physician, I am surprised that you do not know that there is considerable debate about whether there is actually a doctor shortage in the U.S. Clearly, there is a serious shortage of primary care providers. However, it is also clear that that shortage is related to primary care docs being treated abusively by our healthcare system, not by some medical school graduates opting to work part time. The way to improve access to medical care in our country lies in a complete overhaul of how we deliver care, not in expecting all graduates to feel that it’s their “duty” to meet whatever expectations of providing medical care our private healthcare system decides works best.

          I think there is a very good argument to be made that medicine is, in fact, a job, not some sort of higher calling. There appears to be nothing whatsoever wrong with regarding medicine as a job. In many other countries such as the U.K and France, medicine is thought of as a job and doctors are civil servants. I invite you to consider the well-known fact that people in those countries in general enjoy a much higher standard of wellness than we do in the U.S. There is quite a bit of evidence that it does no one any good, including patients, for a healthcare system to be based on some misguided construct that doctors are superhuman martyrs with a “duty” to work 80 hours weeks.

          Other things wrong with that construct include the following: it is simply not realistic to expect people who have spent between $300,000-$500,000 of their own money on their training to see themselves as having a “duty” to work in a certain way. Certainly medical education is a privilege, and I personally see it that way. However, I went to school at a time when four years at an Ivy League medical school left me only $75,000 in debt. Today’s graduates are being asked to do a tremendous amount more than my generation ever was. It’s quite simply unsustainable, in my opinion.

          The other problem with the “doctor as superhero” construct, which I have personally experienced, and I would guess that you have not, is that it enables corporate, for-profit entities within our healthcare system to exploit doctors in things such as workload expectations and contract negotiations. Allowing yourself to be treated like a sweatshop worker because you think that you have a “duty” to see more patients a day than you can reasonably take care of leads to poor care. And these days, it’s frequently poor care that’s being delivered in the service of fat profits for third party payers, not in the service of improving access to medical care. We see the results in the quality of care that our system is providing, which is miserable.

          • JD

            azmd,

            1) “Actually I would venture to suggest that you are wrong on a number of counts, the first being your assumption that I work part time”

            First, I never once assumed you worked part time. In fact, I was under the impression that you were a full time physician (by your definition, 80 hours a week, although if you worked 40 I would still call you full time). I fully recognized that you were speaking on behalf of part time doctors, not as one. If you could, please indicate where in my post I “accused” you of being part time. Otherwise, it is difficult to have an intelligent discussion with someone who keeps misquoting me.

            2) “In the second place, if you are an academic physician, I am surprised that you do not know that there is considerable debate about whether there is actually a doctor shortage in the U.S. Clearly, there is a serious shortage of primary care providers. However, it is also clear that that shortage is related to primary care docs being treated abusively by our healthcare system, not by some medical school graduates opting to work part time. The way to improve access to medical care in our country lies in a complete overhaul of how we deliver care, not in expecting all graduates to feel that it’s their “duty” to meet whatever expectations of providing medical care our private healthcare system decides works best.”

            Then I am not sure what the debate is about, because there is also a shortage of sub-specialists as well, so if there is also clearly a serious shortage of primary care docs, then there is a physician shortage. Now, if the debate is regarding why this is the case, I never once suggested that it was solely due to part time docs. I also indicated, as you did, that there are many things wrong with the healthcare system. However, no one in the health care system, including doctors (part time or otherwise), is free of blame.

            2) “I think there is a very good argument to be made that medicine is, in fact, a job, not some sort of higher calling. There appears to be nothing whatsoever wrong with regarding medicine as a job.”

            Why does one have to be right, and the other wrong? As I said in my above post: “I am not saying your view is wrong (which is why I said that the author should not feel guilty)…but my view sure as hell isn’t wrong, either.”

            I never said that everyone has to view being a doctor as a duty. It is simply the way I approach medicine, and honestly I am a very happy physician, and love what I do.

            3) “The other problem with the “doctor as superhero” construct, which I have personally experienced, and I would guess that you have not, is that it enables corporate, for-profit entities within our healthcare system to exploit doctors in things such as workload expectations and contract negotiations.”

            I never said that doctors are superheroes, nor have I ever tried to defend that construct. Seriously, you seem to be debating with me over ideas that I have not proposed.

            When I say that I view being doctor as a “duty”, it means that I focus on the importance of what I do, the satisfaction of doing something to the best of my ability, and the joy of a helping my patients. I do not focus on the stresses of the job (even though they are there), the amount of money I make, or how unfairly I am being treated.

            I am not saying that everyone needs to be that way, but if you think that there is something intrinsically wrong with that view, then we have nothing to discuss.

          • azmd

            I think you probably have some ideas about medicine and what it means to be a doctor that you are not fully aware of.

            This lack of self-knowledge is one of the more serious problems with our medical culture here in the U.S.; it has contributed to our having a badly flawed health care delivery system.

            Telling people that they should “not focus on” work-related stress is just silly. Telling people that “of course you know that working part time is wrong” is, in fact, telling people that they need to be the way you are as a doctor. To pretend otherwise in this conversation is somewhat dishonest.

          • JD

            Off the top of my head, I can think of 8 people who work 20 hours a week as a physician (average). Since I do not take drugs, I am sure that they are not mythical Hence, my opinion that 40 hours a week is full time.

            By the way, when you are saying that a part time doctor works 40 hours a week, you are saying that being a part time doctor is just as hard (hours-wise) as a full time accountant, or other profession. A little condescending, don’t you think? By giving 40 hours a week as a definition of full time, I am simply trying to give proper respect to other professions, which also use 40 hours a week as a definition of full time.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Whoa… what high school teacher works 80 hours per week??? They are off on weekends, so does that mean they’re putting in 16 hour days?? My mother was a high school teacher and I can guarantee this isn’t the case.that she was arriving at work at 8AM and working till midnight.

          • JD

            This is a separate discussion, so please google “The Deceptive Income of Physicians”. In that blog, a physician tried to argue that doctors work longer hours than high school teachers, and there was an uproar from the teachers, who went on to describe their work hours. Yes…the teachers claim that with grading, extracurriculars, they work 80 hours a week.

            The major point I was trying to make- which was completely lost on you- is that calling 40 hours a week as “part time” is pretty insulting to other people in other professions who have full time jobs and work the same hours. Think about it. “My part time job is just as hard as your full time job”. Not very nice.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Full time or part time is not an arbitrary definition though. In many outpatient jobs, you may be considered part time based on working less clinics than someone who is full time. Perhaps you only do 7 half-day clinics per week. You would get paid as a part time doc, be considered part time, and get certain benefits prorated based on that. This is similar to my situation. Yet with clinics running late, phone calls, dealing with emergencies or following up on labs, this “part time” job can easily add up to 40 hours. So I would still be considered a part time physician by my practice, even working 40 hours a week. And I work less than full time physicians in my practice. So it is very appropriate to say that I work part time.

          • JD

            Then the system needs to be changed, right? Until then, stop belittling yourself by defining yourself as a part timer (no matter how much money you make), when you and I both know you are putting in full time effort.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Ah, but if the job calls for 10 half-day clinics per week, and I am only willing to work 7, then they must hire somebody to pick up my slack. Thus contributing to the physician shortage.

          • JD

            What part of “the system needs to be changed” did you not understand?

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            I suppose the vagueness of it. “The system needs to be changed.” OK! Let’s get right on that. Can’t believe we didn’t think of it before. Stupid system, messing things up for everyone.

          • JD

            OK, I thought you were following along with all of my prior comments. By “the system needs to be changed”

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Yes, obviously, but is it that easy? From everything I’ve read, training a physician is costly. So saying “let’s train more physicians” is a gross oversimplification.

          • JD

            I didn’t say it was easy. I said it is necessary. Also – azmd – I said it before that I completely agree with you that we need to look out for physicians who go into certain specialities. However, your suggestion would require a complete restructuring of the pay scale, since dermatologists and plastics tend to make more money.

            Seriously, before applying to med school, I met with doctors, pre-med counsellors, etc. who fully educated me in how “bad” being a physician is in terms of lifestyle, demands, “stress” etc. NOTHING I experienced in med school, residency, fellowship, or currently has surprised me. Actually, I thought it was going to be worse, so maybe that is why I enjoy my career so much, 80 hours or not.

            Argue with me all you want, but in our discussions all you have expressed is your dissatisfaction with the current system, and all I have done is to deal with it. I am totally happy being a doctor, and am certainly not going complain about being a doctor just because you have things to complain about.

          • JD

            I know many excellent, caring, male and female, physicians who have not only taken care of countless patients, but have advanced medicine and changed the way that we treat disease. These people work 80 hours a week, and love the work that they do. You choose to demonize them, saying that because they are not “well balanced” they are not able to “contribute to society”. Guess what? You are not more well balanced than them. They just handle stress better than you do.

          • azmd

            Ah, there it is. The ever-popular medical put-down: “She doesn’t handle stress well.” Since I don’t believe I have said too much about exactly what it is that I do, how stressful it is, how many hours a week I do it or how much I enjoy it, you again are making some big (and incorrect) assumptions about me and my work. Suffice it to say that I am satisfied that I do very well with a high-stress job. There was also no point at which I said that those who work 80 hours a week are not making a significant contribution. That would be silly and wrong-headed, and I didn’t say it.

            However, I also feel quite strongly that as a profession we need to pay more attention to our stress levels, how we handle them and how we all work together. Picking apart our colleagues is a sign of poorly coped-with stress, and it’s quite common in the medical community as I believe we have just seen.

            It is this lack of collegiality and cohesiveness in our professional community that has allowed CMS and other third-party payers to take charge of our profession. We are in danger of becoming line workers, all of us, and I think it’s partly because a lot of us are too stressed to play well with others and get organized to take control of our healthcare system as we should. I don’t include myself in that category, however, as in addition to my clinical, academic and administrative work I also manage a variety of leadership roles in organized medicine.

          • JD

            azmd – the interesting thing (and silly, since you seem to like that word) that physicians like you seem to de-emphasize in the entire “plight” of the health care system is self accountability. According to you, it is the rest of medicine that needs to change in order to to address physician stress. In your construct, stress is caused by “put downs” from everyone else, rather than something is a direct result of personal choices and personal failings.

            In your view, physicians are victims, so when any one physician is unhappy about the amount of work they do, the solution is to change what the entire system expects from physicians. To support this notion, you argue that a stressed physician is a poor physician, and while I would agree with you, you then go on to blame me and the rest of the system/society for the stress that physicians feel.

            Interestingly, whenever I feel stressed, instead of blaming society, or how others view me, or what is expected of me, I first take a deep breath and remember a few things:

            1) I chose this. No one forced me to become a physician. If I find that working as hard as other doctors is something that I makes me unhappy, then my only conclusion is that I made a poorer decision than these other doctors. I have met many, many, doctors who are delighted with their careers, and would never want to do anything else. They made a great decision for themselves. Perhaps Fizzy did not have an accurate expectation of what working full time is like. No one else other than herself is accountable for that. Perhaps she is not a good multitasker (actually, neither was I, but I got better in residency). If so, at some point she thought that this was not particularly important in medical practice, because she chose to become a doctor anyway.

            2) It is a privilege to take care of patients. That does not mean, nor have I ever said, that I put the patient ahead of myself. What I did say was that the patient’s stress makes me forget about my own stress. When I think about my patients, things like paperwork, taking call etc really do not seem to be a big deal.

            3) There is very little that I can do about being a “victim” of the rest of the system, but there is much that I can do about how I perceive stress and deal with it. I might see a counsellor. I might use it to drive me to become better. I might (and I have) see that stress is a challenge, and try to overcome it. If I keep insisting that the only way my stress can change is by changing what everyone else expects of me, then guest what? I end up feeling guilty and inadequate, just like the author of this article.

            In your comments, you have suggested that the solution to physician stress is

            1) for me to shut up

            2) for allowances to me made for women with children (I have NO problem with that, I completely agree)

            3) For everyone to stop seeing doctors as superheroes, and for doctors to stop having a sense of duty, and that having a sense of duty makes doctors less happy and patients less well.

            4) To improve collegiality and cohesiveness

            5) Not over working, i.e. working as much as you can, even if it is not “full time” (whatever that means).

            Completely ignored in your argument is the fact that stress is an internal, personal, response. No one has more control of how stressed they feel than the person who is feeling it. My comments have only served to suggest that, if someone is stressed out by the practice of medicine, the solution begins and ends with them. It certainly does not begin with me having to agree that it is OK for her to feel stressed. It certainly does not begin with changing the entire health care system. It certainly does not begin with me accepting that it is OK for one physician to work 40hrs while I work 80 (although I do accept that, because I don’t have time to worry about what others do).

            Do you really think that the author would feel better if physicians such as myself were more “tolerant” of her inability of deal with stressful issues? Talk about silly and wrong headed. Why in the world should she care about what I, or anyone else, thinks about her? That would be like me saying that I am stressed by my discussions with you (thank you for partaking, by the way, very interesting), someone who I do not know or care about (no offense). If I were to be stressed by your opinion of me, would that not say something more about me, than it does you?

            I might agree with your solutions if the majority of physicians were miserable, and that physician stress was going to be the downfall of medicine. But that is not the case. I simply know too many “full time” doctors who love what they do, working insane hours, balancing work and life, and spending very little time/focus complaining about the flaws of our health care system. As far as I am concerned, the author should find one of these people, and use them as a role model. I know I have.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            JD: Wow, are you being patronizing on purpose or is that just how you are? You said, “I simply know too many “full time” doctors who love what they do, working insane hours, balancing work and life, and spending very little time/focus complaining about the flaws of our health care system. They deal with stress not by changing their environment, but by changing their view of it. As far as I am concerned, the author should find one of these people, and use them as a role model. I know I have.” So I say I am happy with my part time job and the way it reduces my stress, and your response is that I “should” find someone who does something I don’t want to do and use them as a role model just because that’s your personal idea of what’s right?

            How about this? We have a primary care shortage in this country and you’re not a PCP. I think you should find a PCP and use them as a role model to work as a PCP so you can do a better job fulfilling your duty as a physician.

          • JD

            No….I am saying that if you find a role model who ignores what other people think of them, then you can do whatever you want and stop saying things like “I’m sorry I am ruining medicine”.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            It really wasn’t clear that’s what you meant if you read that paragraph I quoted.

            This post was taken somewhat out of context for KevinMD, but it was originally on my personal blog as sort of a belated response to Karen Sibert’s NYT article about how women who work part time are ruining medicine. So that is the reason for the last line, not my need for a role model. I know lots of female physicians who work part time and are happy to do so. Not sure why I’d need a role model who does something entirely different from what I do or want to do. Those women most likely deal with stress of working full time by having lots of ancillary support in the form of nannies and relatives, because caring for small children and working full time as a physician is more than just mind over matter.

          • JD

            That’s because you are quoting some of my paragraphs, and not all of them. On reading your article, I got the sense that you were stressed out by the practice of medicine, which is why you work “part time”. If it turns out that your article was in fact an attempt to mock Karen Sibert (and I think you should), then I can hardly be blamed for not knowing that.

            I have repeatedly said that I do not consider you as part time, and I have also said that I have no doubts about your ability, and I have repeatedly said that you have nothing to feel guilty about. Amazingly, not a single one of those comments was acknowledged by you or azmd. Most importantly, my main point is that the physicians that I admire the most are those who: i) own their stress ii) view it as a positive, and iii) have the ability to ignore people like Karen Sibert (fine to write an article, as long as she does not bother you internally).

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Even if I personally can ignore Dr. Sibert, I think it’s important for people like me to write rebuttals to her article for the sake of others reading it. I’m glad for every woman out there who wrote they felt Dr. Sibert was wrong (and there were many).

            Maybe “owning” stress is one way to approach things, but I guarantee the women you know who work full time also deal with their stress by hiring ancillary childcare. They must. Maybe you don’t mean it to come off this way, but you don’t seem to be acknowledging that being a mother and a full time physician adds a whole new set of challenges, ones that you can’t deal with by just “owning” your stress. A 2-year-old can’t find his own way home from daycare, after all. The options are to find extra help or cut back your own hours. I chose the latter. The women you know chose the former. Two different choices, same result: the ability to balance work and home life without going crazy.

          • JD

            I did not say that you should not be a role model. You should be. In fact, we all should be for each other. Each physician has strengths, each has weaknesses. I am sure that I could learn a lot from you about balancing work and family.

            In your article, it appeared that your stress, at least partly, came from feeling guilty about not being able to work full time. So, I was wondering if you were really effectively dealing with stress, since it appeared that you replaced one stress (full time work) with another (feelings of guilt). Now, I am a pretty stress free physician. By this, I tend not to get too angry at the system, or how society places unfair expectations on me. I literally can ignore this, and from your article it sounded like you can not. Perhaps I was wrong, but that is what your article sounded like. From the sounds of some of the other comments on this page, it seems that in general you gave an impression of self pity.

            In the female physicians that I know (not all of them, but many) who have been able to raise a family and still have remarkably productive careers, self pity simply does not exist. This is what I meant when I said that they handle stress better. They simply refuse to view themselves as victims of a broken system.

            This is in stark contrast with the other posters on this page, who constantly blame everyone else for the stress in their careers. I was getting a little tired of it, hence my irritation. I was not trying to be condescending (I was actually trying to be a little helpful), but I find that when physicians complain about the the heatlh care system they look at everyone but themselves for a solution.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            You say that “In the female physicians that I know (not all of them, but many) who have been able to raise a family and still have remarkably productive careers, self pity simply does not exist.” Do you think that I walk around, reading this article to my coworkers? Do you think that all the women you work with wear their stress on their sleeves for all the world to see? That is one thing that is great about the internet and sites like these–people can be honest about their thoughts and feelings in ways they might not be in real life.

            In one of the blogs I write for, Mothers in Medicine, multiple female bloggers in every discipline talk about the stress of balancing home and work life. In one post that really struck me, a female neurosurgeon talked very seriously about her desire to quit her field. And she’s not the only one who’s written about this. And I’d guess their colleagues don’t have the slightest idea. It’s naive to think you know everything going on in your coworkers’ heads.

          • JD

            Actually, I think it’s naive for you to make assumptions about how well I know my co-workers.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            “Naive” probably isn’t the word you want. Presumptuous, maybe.

            And yes, unless you are their therapist or spouse, I doubt you would know. I am quite close with many of my coworkers and none of them would have any idea I’d write the above post.

          • JD

            I would think both naive and presumptuous are appropriate, since the colleagues I am referring to are pretty much well past retirement age, and are still working. Hard to argue that someone is on the verge of quitting when they have been doing it for more than 30 years.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            The comment you just made shows that we’re somehow not understanding each other. When I talk about stress, I am NOT referring to the stress of being a physician, even though I know that’s what you keep referring to. I am talking about the stress of working full time physician hours and raising small kids. OF COURSE your colleagues who are working 30+ years aren’t stressed about that… their kids are obviously grown by now. In 30 years, I am not going to be complaining about shuttling my kids to two different schools and running out of work for conjunctivitis. Maybe at that point, I’ll change my hours. But the women who work part time are generally the ones with small kids and little ancillary support, not weak-willed women who can’t deal with the stress of being a physician. That’s what I feel like you’re not hearing.

            I think the reason you’re having trouble seeing what I’m saying is that I’m guessing your wife is the primary caregiver for your kids, so you’ve never had to deal with these issues (like many men). And in this day and age, some women have a similar arrangement with their husbands, so maybe that’s the case with some of the women you work with… or maybe they have very supportive families. But I bet there’s some number of them who if you sat down with them with a few drinks and asked if they ever felt overwhelmed or contemplated quitting or cutting back when their kids were small, you might be surprised at the answer.

          • JD

            Do you really think that my colleagues would have made it to where they are if they were unable to handle stress during their younger, child raising, years? Back in those days, work hours for residency were insane, mom docs were not tolerated, and maternity leave was discouraged. Whatever complaints you have about the plight of being a mom doc today, they were far worse during the time when my colleagues were raising their children.

            Were they stressed about it then? Of course. I am not saying that stress is impermissible. I am saying that there are ways to control it, which my colleagues clearly did, because they have risen to positions of leadership despite working full time in a system that, quite frankly, hated them. Do you really think that you have nothing to learn from these women?

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            There are things I could learn from them, but is it necessary to learn those things is the question? I mean, if I met a woman from the 19th century, I could learn how to churn butter from her, but I could also go to the grocery store and buy some butter. If I have a job that allows me to work part time and I’m happy with that situation (and have zero desire to rise to a position of leadership at this time in my life or maybe ever), then what exactly is the point of learning from these women? Shouldn’t I learn from somebody who’s doing what I would *like* to be doing, not what you think I should be doing?

            Despite your protests, you seem to have very definite ideas of what a woman in medicine ought to be doing, much like Dr. Sibert. I, on the other hand, love the idea that I can work part time and see my kids more and have less stress. I think these women you mention are admirable, but I definitely do NOT strive to be like them so I think it would dumb to use them as a role model.

          • JD

            In your article, you gave every indication of someone who is stressed, regardless of how much you work. You might not be that way, but your article indicated this. I am certainly not alone in that opinion, since you have received dozens of comments from others saying telling you not to feel guilty and trying to defend you. Therefore, I think it is safe to say that most readers think that you are a stressed physician, despite the fact that you work part time.

            The colleagues that I have described are masters of handling the stresses of being a mom doc. That is NOT to say that you need to do what they did/are doing. They just know how to deal with the issues of family and career. As a man, even I have learned a tremendous deal from them, even though I have never had to “churn butter” like them. Just because they started their careers in a different era, does not mean that they have nothing to teach us. Even if you worked 10 hours a week and spent most of your time at home, you would STILL have something to learn from these remarkable women. They have the strongest self images that I know, and their confidence is an inspiration.

            Perhaps you are a confident person…but you don’t get to write the article that you wrote, and then get upset when people think that you have a poor self image.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            JD: My article is meant to be taken tongue-in-cheek, especially the last line. Maybe you should read it again with that in mind, and the fact that it’s addressed to the fair number of people (yourself included, I believe) who think it’s wrong that mothers work part time, and that really, they ought to just learn to deal with their stress and work full time.

            It also should be said that there are some people that THRIVE on high-stress environments. Women who entered the field when it was not female-friendly are probably more likely to be these types of go-getters. I have a very laid back personality and I like my world to reflect that. The last sentence of the second to last paragraph is “I have found a balance of career and family life that seems to work for me.” I just said my life works for me! Yet somehow you take issue with this and want me to be more like the women you personally admire, and insist that I’m miserable.

            And that’s why this article is addressed to people like you, who think that people like me just aren’t good enough.

          • JD

            OK, you’re right. I don’t think you are good enough. By the way, your article only reinforced my opinion.

            Seriously, when people only want to pick and choose on what you say, there is no point in arguing.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            “OK, you’re right. I don’t think you are good enough”

            Thank you for finally admitting what you truly think about women like me who work part time.

          • JD

            No problem. Thanks for giving women who work part time a bad name.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Why so angry, JD?

          • JD

            You mistake anger for pity. That is what you are looking for, isn’t it? It must be difficult to practice medicine when every time someone says you are ruining medicine, you actually believe it to the point that you having to ask for “support” from random strangers (being a super mom, I would have thought that the support of your family would be enough). It must be horrible to be the victim all the time.

            Luckily for me, I get to happily practice medicine without caring what you (or Karen Sibert) thinks about me.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Why would you pity me when I said in my post that I was happy I’d struck a balance? I find it sad that you feel that there’s only one way to be happy and that’s to work as hard as you possibly can. If you think that, OF COURSE you don’t think I’m happy. I wrote the article BECAUSE of people like you but not FOR you because I will never ever convince you, no matter how hard I try. I wrote it for all the women who work part time and feel attacked by people like you, for no good reason.

            It’s actually very sad that you can’t see how patronizing you’ve been in your responses here even though several people pointed it out to you. You could not be satisfied in this argument unless I conceded your patronizing point that I “could learn something” from women who work full time. Even by your snarky comment about “giving women who work part time a bad name” you managed to insultingly group all these diverse women into a single lumped category. It would be equally ridiculous if I said you “give male physicians a bad name.” I wonder if you’re like this in real life and just haven’t the slightest clue. You have so little insight into your own thoughts. I’m sorry.

          • JD

            What I find interesting is that you (and the other commenters) could be so easily offended, insulted or patronized by someone you don’t even know. I could be writing this from jail. I might not even be a physician. For all you know, I could be a professional troll, who doesn’t believe a word I say but wants to cause trouble.

            And if were a troll, I would have achieved my goals 110%. Why? Because you and the other commenters, despite saying how happy you are to find “work and life balance” are so insecure that a random stranger like myself was able to evoke a response.

            This is the psyche of the stressed out physician. You feel guilty, disrespected, insulted, criticized, and patronized. Yet you don’t have a clue who is guilting, disrespecting, insulting, criticizing or patronizing you. You are so desperate to find a target, that you decide to blame “people like me”, and yet you do not know who I am.

            So yes, if the comments of a random stranger are able to evoke negative feelings in you, then I do pity you.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Oh, don’t worry, I’m not angry at all! I love writing somewhat controversial posts on my blogs to evoke the exact emotional response that this post had in you… it’s one of the hobbies I have time for thanks to my work schedule. I’m always disappointed when nobody gets riled up by something I write. I was very pleased that KevinMD picked this post to feature on his site, and thanks to your many many comments, you kept the post on the front page as “trending” and got lots of people to read what I had to say. So thanks for that!

          • JD

            No problem. Thanks for helping Karen Sibert.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Yay, I’ve still got you writing!

            If you support women working fewer hours, as you claimed in several other comments you wrote and feel “the system should change” to support this, why would you thank me for helping Karen Sibert? Are you saying everything you’ve written so far is a lie?

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            The number of posts with your name on them seems to belie that statement.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            Thanks for giving female physicians a bad name. I’ve been reading your comments. When Dr. Fizzy said she was offended when you said that part-time physicians were somehow being duplicitous by not saying that they wanted to be part time when they applied to medical school, or, better yet, ceded their spots to a person that would work full-time, you decided to reframe the argument by saying that you didn’t mean Dr. Fizzy.
            In medicine, 40 hours is part time. It even says it on my paycheck.
            Next, when Dr. Fizzy referred to her decision to go part time because when she worked full time she felt she was so stressed she was unhappy, you told her that she should find a mentor to give her a better role model for stress management. Pretty invalidating– but I’m sure that an adult professional isn’t capable of determining what is and what is not too stressful.
            Finally, you fell back to just “blaming the system”. Yes, the system is dysfunctional, but the solution is not for medical school applicants to feel guilty “taking up a spot” if they don’t want to work full-time (or decide that later).
            And, for the record, I decided to go part-time before I got married and had kids, so I do not regard this as a “women’s issue”.

          • JD

            Miriam you wrote to me above: “Thanks for giving female physicians a bad name.”

            Well that just proves that you have not been reading my comments very carefully, because I am not female. You pick and choose to process what I write, and then let your rather dull imagination conjure up some image of a driven female physician that you can attack. The fact that you did this only discredits your points, as they were clearly made to target a Karen Sibert – like figure (who, by the way, I can’t stand). Next time, read all of my comments before you make assumptions about where I stand.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            Since that is your only rebuttal on my comments, I will respond. You’re right, I stand corrected. I became distracted when I concentrated on your arguments, and responded to them without being sure of your sex. Now that you have corrected my assumption that you were female, I can see how incredibly arrogant they were. I am thankful that none of my colleagues (male and female) have mentored me in the way you say you have mentored your colleagues. In fact, if I mentored any of my trainees in this way (if only you would think as I do, you would have no problems) I would be called to speak with my program director in a nanosecond. I can only hope that your interactions with your patients are more empathetic.

          • JD

            Miriam wrote: “You’re right, I stand corrected.”

            Thanks for agreeing with me. I am glad that you are on my side with all of this.

            See what happens when someone takes select quotes and puts them out of context?

            Miriam wrote: “I am thankful that none of my colleagues (male and female) have mentored me in the way you say you have mentored your colleagues.”

            I never once said that I mentored my colleagues. I said that I have benefited from being mentored. Again, you are just making up what you think my stance is, and fabricating statements to fit your image of me.

            Miriam wrote: “Since that is your only rebuttal on my comments, I will respond.”

            Of course that is my only rebuttal on your comments – why would I want to debate this issue with someone who clearly has a biased, totally inaccurate image of who I am and what I stand for?

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Miriam, thank you for so fantastically summarizing what was so frustrating about arguing with JD.

            You just need to change your first sentence to “Thanks for giving male physicians a bad name” :)

          • Suzi Q 38

            JD,

            I think that you are full of poop.

            You think you can speak for all physicians that are parents that WANT to spend more time with their families and STILL work at a career that they went to college for.
            You can’t.

            You can try, but how would you know what anyone truly wants in life?

            Are you saying that if you go to med school to be a doctor, that you can not work part time, be a parent and care for your children?
            As if you have to “choose,” a la “Sophie’s Choice??”

            Conversely, because you have chosen to spend most waking hours at your profession, that you are not a good parent? Remember…either /or according to you….

            There are doctors that actually chose NOT to get married , or have a significant other, AND not have children because they are devoted to medicine.

            Are they necessarily better doctors?
            Maybe, maybe not.

            Can you consider the thought that some people want a 50%-50% way of life?

            That it is O.K. not to be the director or the head of the medical staff at the teaching hospital.
            It is O.K. for them to work at the busy medical group down the street from their home so that they can be home at 6:00 or 7:00PM for family dinner.

            When the children are older, they may have more choices of how they want and need to spend their time.

            You don’t know if your colleagues are masters of handling the stresses of a mom doc unless you have interviewed their spouse and their children.

          • JD

            I was referring to a role model for how one handles stress, not a role model for what a physician should be

          • azmd

            I think it’s great that you have effective coping mechanisms for handling stress, and that they enable you to do difficult work for long hours and feel good about it. There would be no reason at all for anyone, including myself, to object to that. I would have no personal reason for being perturbed by your being satisfied with your work, since I am also satisfied with mine.

            But the fact is that although you appear to know many physicians who enjoy their work, that is anecdotal information and actual studies looking at job satisfaction among physicians have found concerningly high levels of burnout and emotional disability. I believe that there is a connection between this phenomenon and the fact that our general health levels here in the U.S. are poor compared to other developed countries. A physician who is not emotionally healthy is not going to be able to take good care of his or her patients, and certainly is not going to participate in efforts to improve our healthcare delivery model.. Obviously the results of measurements of health in the U.S. are multifactorial and physician burnout/stress is clearly only one factor among many.

            But for physicians like us, who are fortunate enough to be in specialities where we are relatively less stressed by our work, to ignore the distress of our colleagues or worse, to blame them for it, and to deny that changes should be made to our healthcare delivery system seems to me to be bad for our healthcare system and our patients. However, I am aware that criticism and blame of our colleagues is a deeply entrenched part of our medical culture.

          • JD

            Stress does not require blame, it requires ownership. I have no reason to blame anyone for being stressed, since it hurts no one but themselves (and their patients). Any physician being stressed certainly is not hurting me, so why should I blame them?

            The issue that I was getting at is that very often we blame our stress on everyone else and everything. I am sure that many physicians have issues with burnout, but in my work I honestly seldom see it, and I think I know why, and I was trying to share it with the author.

            We all want to feel that what we do is important. I believe that this is the single most important factor in determining whether a doctor is happy doing their job. The problem is, we have a health care system and society that, at times, makes us feel that our work is utterly unimportant. Perhaps it is because some insurance agent sitting behind a desk is challenging my right to prescribe a drug, or to get reimbursed. There are numerous examples, I agree, including the poor treatment of moms who are docs.

            I learned early on in my career that it is ridiculous for me to allow the system to make me feel this way. What we do IS important, regardless of how the system treats us. I believe that having medicine as a “calling” and a “duty” helps us to understand that. I think that physicians burn out because they view being a doctor as a “job”, and someone has convinced them that they are not a valued part of an “industry”.

            While I would like to change the system so that I get automatic respect for being an MD, this is not going to happen. I can not possibly control my stress by looking and directing anger externally. What I can control is how I view myself. That being a doctor is an important part of me, not something that I can separate myself from whenever I want. You might argue that this is unhealthy, but it serves as a constant reminder that there are patients who need me, that I should keep doing what I do the best I can, and that it is important to put those who need me ahead of my stress that the healthcare system unloads on me. To me, it is not paperwork or long hours, or even limited family time that is stressful. It is feeling unneeded, and I will not allow myself to feel that way, no matter what the health care system tries to tell me. I am as much a doctor as I am a husband or father. That doesn’t mean that I don’t love my family – it just means I would not let society define me as a physician any more that I would let them define me as a husband.

            Now, not to be arrogant, but if everyone thought the way I did, do you think that there would be such a problem with burnout?

          • azmd

            Well, that’s a fascinating question. My answer is: both yes and no. Here’s why. Your style of coping works very well for situations related to a patient’s clinical needs. If a patient has an emergency and you miss your child’s piano recital, that’s completely unavoidable, your patient’s needs must come first and it’s best for everyone if you don’t concentrate on being stressed about not being there for your child’s event. That’s how we are all socialized and that’s how it should be.

            However, that coping style works very poorly in a situation where there’s a problem with effective healthcare delivery and the system needs a physician to take some leadership role in being a change agent. If we are all busy putting our heads down, concentrating on our patients and not worrying about whether the system works or not, then guess what, it won’t work. No one knows more than doctors about what a system needs in order to be able to deliver care effectively. A lot of the stress that our system unloads on us has nothing to do with the clinical needs of the patient, it has to do with bad management. When you have people working in a badly managed system, burnout is inevitable once stress gets to a certain level.

            I would suggest that the reason that you still feel that your coping style works well is not that it’s uniquely effective, but because as a specialist, you have not yet been exposed to the kind of stress that our primary care colleagues have. But you will be. If we let it happen to the primary care docs, it will inevitably happen to us. I think we owe to them, and to ourselves, to consider the possibility that the reason they are stressed and burned out is not because they are not coping as well as we are, but because they are getting the first taste of changes that are going to affect us all if we don’t recognize what’s going on and do a better job of taking ownership of how healthcare is delivered.

          • JD

            First, I would argue that the differences in stress between specialists and primary care physicians is with quality, not quantity.

            You seem to infer that because I do not stress out over issues with our health care system, that it means that I deny that these issues exist. Not letting them give me anxiety is not the same as saying that I do not think that they are problems, or that they need to be addressed. They certainly do.

            However, physician stress is not going to make me better equipped to lead the charge for change. Whether it is seeing a patient in clinic, or taking leadership roles in medicine, the ability to introspect, self affirm, keep things in perspective, and own stress is equally important for my ability to be effective.

            My coping style has absolutely nothing to do with ignoring the plight of primary care physicians, or the problems with health care delivery. There is a huge difference between not stressing about something, and ignoring something.

            I would therefore argue that my coping style would be universally effective, no matter whether one is talking about patient care, or health care reform.

            Frankly, I am very surprised by your point of view. You say that you are an academic physician with leadership roles. Can you honestly tell me that the degree of anxiety exhibited by the author of this article would make you a more effective leader? I would guess not. My guess is that your ability to institute change is very much dependent on your ability to use the very coping style that I employ.

          • azmd

            Of course that level of anxiety would not make one an effective leader, so I am not advocating that one should be so anxious. What I am saying is that someone with that level of anxiety should not be criticized, they should be supported. Part of that support has to come in the form of acknowledging that our healthcare system could be constructed differently.To the extent that we tell our colleagues who are stressed that they should be handling stress differently so they don’t have to work part time, we miss out on opportunities to think about how things could be changed.

          • JD

            Just because I say that stressed physicians should take ownership of their anxiety and develop better coping styles does not mean that I am criticizing them or blaming them.

            You say that “we miss out out on opportunities to think about how things could be changed”. Actually, we think about how to change things all the time. We seldom think about how to change ourselves and our perception of ourselves.

            Yes, I agree that our health care system could be constructed differently. In fact, I would say that this website is composed 95% of articles and comments complaining about the woes of being a doctor in the current system. I do not see how me adding to this is helpful, since I hardly think that ANYONE is missing out on opportunities to think about how things could be changed. In fact, that is ALL anyone is thinking about.

            I am going to suggest the polar opposite of your comment above. Based on what I have seen on this website, it is the minority opinion.

            Physicians with anxiety should absolutely be supported. Part of that support has to come in the form of acknowledging that stress is internal, and that they do have control over it. To the extent that we tell our colleagues that they have no control over it, and that their stress is 100% a product of external forces, we miss out on opportunities for improving self perception, valuing ourselves, and empowering ourselves to implement change both for us and our patients.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            Again, what makes you happy in your career is not what makes everyone happy. And your insistence that what makes you happy should make everyone happy is not what I would expect from a leader.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            I am thinking that your long hours are preventing you from using that most important of physician qualities– empathy. It would be nice if everyone thought like we did, but that is not realistic. People think and feel differently than we do, and part of being a good adult is realizing that and even learning to understand someone else’s point of view, even if we ourselves do not share it. For my part, I figured out quite early that there were many things that made me unhappy in my work– people, I worked with, patient populations, and practice environments. But the one thing that remained constant was that when I worked more than 50 hours, I was miserable. When I worked around 40, I was happy. Obviously that is not your experience, but this does not make me any less of a physician or my contribution to patient care any less important.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            I get it, JD. You are awesome, you love your job, and you are great at dealing with stress. That’s so great for you that you have all that.

            I enjoy my job and I also enjoy spending time with my family and having hobbies and minimizing my stress level. Working part time allows me to do all that. I have no complaints, other than about the people out there who vilify the choices I have made.

          • Marianne Evans

            IGNORE those people. It’s none of their damned business what you do.

          • azmd

            Not only do we need to consider increasing the number of medical school matriculants, it looks like we need to start working on a better way to sort out who goes into which specialty. Having our top graduates go into plastic surgery and derm and our bottom graduates go into family practice, internal medicine and ER medicine is backwards from the way it should be.

          • azmd

            There is an absolutely fascinating table in that article; one that show that the very top graduates of medical school are overwhelmingly going into two specialties: Dermatology and plastic surgery. Where’s the outrage about that?

            If our top graduates are going into fields where clearly the vast majority of the work they do is somewhat elective, then the selection process for medical school is badly flawed in terms of whether or not it selects young people who truly want to devote themselves to serving others.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Actually, I looked at that article and I didn’t see one teacher claiming to work those hours. 50 at most. And I just spent the afternoon with a teacher friend of mine who thought that estimate was laughable.

          • azmd

            As I have commented elsewhere, there are some interesting similarities these days between the teaching profession and the medical profession, both of which are increasingly troubled, and showing increasingly poor outcomes,

            If you do know 8 docs who are working 20 hours, then I am impressed, and concede that point to you. I would tend to agree that working 20 hours a week is potentially problematic. But I think that criticizing docs who have those schedules is also potentially problematic because it carries a strong whiff of sexism.

            Most docs who are working part-time are, let’s face, it women with children (like me). We are quite critical of their choice to work as part-time primary care providers, possibly temporarily, but not at all critical of a medical school graduate who chooses to match into dermatology because he wants a high income and no night call in a low-stress specialty. I think if we are going to criticize doctors who make lifestyle choices in their professions, we should criticize all of them, not just the ones whose choices are based on having children at home.

          • JD

            I agree that we should be fair, but I really was not trying to be critical. I was simply saying that their are healthier ways of viewing our profession, so that we aren’t stressed and angry all the time.

            The 8 docs I mentioned are represented by both men and women (actually, 4 men and women), so it is not only moms who do this.

            When we interviewed for medical school, I am sure that each and every one of us told the admissions committee that we should be doctors because we would work endlessly to help our patients, that it was our calling, that we would put our patient’s well being ahead of our own. We probably told them that we were fully aware of the stresses of being a doctor, that we recognized that it would become a part of our life, and might even consume our life, but that we were prepared to handle this.

            Maybe we said these things to please an over demanding and unreasonable medical education system. That does not make us right. I am simply trying to keep my word, and re-assessing my “stresses” in a way to keep me happy enough to do so. What is condescending about that?

          • azmd

            Interestingly, the admissions committee for the medical school where I ended up did not appear to be too interested in medicine “consuming my life.” There was, rather, quite an emphasis on the doctor as a whole person, one who had spent time, and would continue to spend time, developing him or herself to be a humanistic physician. There was a general sense that the doctor who led a well-balanced life was the kind of doctor who would contribute the most to society.

            I think (or at least hope) that we can all agree that a patient’s medical needs must come before our own. However, I think the popular phrase “put the patient’s well-being ahead of our own,” is a dangerous one, and one that predisposes us to overwork, to guilt, to resentment, and to burnout. How does one define “well-being?” That’s a somewhat nebulous concept, and open to quite a bit of interpretation. Does it extend to providing supportive psychotherapy (free and unscheduled) to a patient’s family members at the end of the day while your children wait in the dark to be picked up for an activity? I have frequently found myself in the position of being expected to do that, because arguably if I can provide support to a patient’s family, it’s good for their well being. But does it really make sense to expect ourselves to provide that level of support to our patients and their families? And to prioritize that over our own family’s needs?

            I think once we start promoting ourselves as being willing to put our patients’ “well-being” ahead of our own always, we set ourselves up to disappoint, both our patients and ourselves.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            I totally do not remember this pledge in my admissions packet.

          • http://www.facebook.com/miriam.anixter Miriam Anixter

            I know no physicians that work 20 hours a week– in fact, I know no medical professionals — male or female, kids or no kids– that do so. If there is anyone reading this that does, please direct your comments to them.

          • buzzkillerjsmith

            “primary care docs being treated abusively…”

            Insightful and well put. I will use that line when the need arises. Without attribution of course. Sorry, azmd, but that’s the risk you take when you share wisdom on blogs.

          • azmd

            No worries, you are very welcome!

        • Marianne Evans

          Wrong to work part time? Wow, super judgmental there. Let me tell you something, life throws you curve balls I graduated from med school at 24, worked right through three pregnancies and worked about 40 hours a week. I started to ramp up my hours when my kids started high school and middle school and guess what? My oldest son had a psychotic episode. His dad or I had to be home when school let out every single day, not to mention the endless psychiatry visits, the appointments with the school psychologist, etc. My elderly parents became ill and needed care. And guess what? Other doctors could take over some of my patients, but no one else could make sure my son recovered or that my parents got the care they needed. Every full time mother even the smug Sheryl Sandberg is one disabled child or one sick spouse or parent away from becoming a part time worker. And no, when I was 21 and applying to med schol; I had no clue that any of these things would happen. I am now almost 60, in excellent health, my kids are grown, my parents have peacefully passed away, and I am working harder than ever as a Hospice doctor, work that I really love. Life is long and by not burning out, you get to work for more of it.

  • NorthwestResident

    I am a resident considering going into “part-time” work, with the understanding that being a “part-time” physician is actually working 40 hours a week. If you did clinic in the morning and charting/follow up work in the afternoon, you would probably end up working 8 hours/day. To work full time would always mean working more than 40 hours/week. I think I am okay with working 40 hours and being a mom, but anymore would be too much. I think the problem is that physicians are expected to work super-human hours.

    • YoungMD

      full time is more like 75 hours…. You have the right idea…. It is still fun now that the whipping has stopped.. :-)

    • sungazer4

      Your gut feeling is correct. My 2 cents of advice…

      1) Build some locums relationships or moonlighting relationships that are flexible and fit your needs, perhaps even before you decide on a “real” part time position. Keep them active because they can be a fall back and give you some flexibility. There is no misery like finding yourself in an awful position with no financial fallback plan. One of the happiest docs I have ever known used to work the ER urgent care clinic and had a small little practice of his own. He put the two together and what he didn’t have from the “prestige” of having a practice at a notable institution he more than made up for in flexibility, autonomy and happiness.

      2) Really access your desires in life (in life, not in work).

      3) Next, get some business acumen (including internet, social media, etc.) under your belt. Take some business classes or find a mentor or mentoring groups or physician entrepreneurship groups. Even if you ultimately opt for employment, this is the one piece of advice I wish someone had told me and that I tell to every person I mentor. You never know when you might decide to use this.

      4) Then proceed. You will have given yourself the gift of control and choice over your destiny.

  • YoungMD

    I concur …. going into medicine does not mean selling your soul…. at the end of the day it IS A JOB!

    • http://www.facebook.com/miriam.anixter Miriam Anixter

      I don’t know it I would call it merely a job. However, I will say that the hospital will always be there tomorrow, and that caring for patients is a TEAM effort. Sometimes it requires long hours and sacrifice, but it is important to know when to go home and deliver your patients to the care of other members of your team. In the words of the sage, you’ve got to know when to hold them, you’ve got to know when to fold them. You’ve got to know when to walk away, and when to run.

  • JD

    On reading your article again, I think it is less obvious that you are “ruining” medicine, and more obvious that you don’t seem to enjoy being a doctor very much.

    • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

      What are you basing that on? Wanting to also have a life outside of medicine?

      • JD

        No. I am basing it on the following (just some examples):

        “When I feel like I’m rushing around and getting pulled in too many directions and expected to do three different jobs at once, I actually get kind of stressed out. And depressed. I don’t like feeling that way.”

        “I have trouble with night call. I never liked it, but at some point, between waking up for my baby’s cries and waking up to a beeping pager, my sleep became very dysfunctional and a major source of stress.”

        “When I am really stressed out, I am not super pleasant to be around. I start screaming at the top of my lungs and then burst into tears because my daughter won’t put her sneakers on in the morning. I’m sure I have inferior stress-compensation (likely genetic) compared to full-timers, but I just hate being like that.”

        It’s one thing to want a life outside of medicine. It’s another to have your job make you unhappy.

        • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

          Right. And that’s why I took a part-time position that doesn’t require night call or crazy hours that stress me out. So that I can actually enjoy being a doctor. I think it’s interesting that you equate being a doctor with having tons of stress, and my simply saying I hate stress means I must hate being a doctor. There’s more to my career than simply the hours I work.

          • JD

            When you enjoy something, you tend to do it more, not less.

            It sounds like what you are saying is that you enjoy being a doctor…but only in moderation. I feel the same way about spinach.

            Stress is not something you have to hate. What one sees as stress, I see as intellectual stimulation and challenge. The high “stress” level of being a doctor is one of the things I love the most about it.

            I have no doubt that you are wonderful physician. My comments are in no way meant to suggest otherwise. There are things that are intrinsic to the practice of medicine that are good and bad. Instead of giving up both the good and the bad, perhaps it is possible to enjoy the bad as well?

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Huh? I love ice cream, but do I want to eat it every meal? No. I love to read, but I get sick of it if I do it more than a couple of hours at a time. I love my kids, but I like having a job that gives me some time away from them. It makes no sense that liking something means I have to want to do it as much as humanly possible.

            I don’t know if you’re a working mom (I think not), but my idea of stress may differ from yours. For me, stress is having a clinic that’s running late and realizing I might not make it to daycare by closing time. Or having to completely rearrange my workday due to a sick kid. Are you suggesting there’s something wrong with me because I don’t enjoy that feeling?

          • JD

            No…I am not suggesting that there is anything wrong with you. I am suggesting that should not be considered as “part time”. I am saying that if you do feel stressed, there are ways of changing your perspective to make the stress more tolerable.

            “It makes no sense that liking something means I have to want to do it as much as humanly possible.”

            You are not doing something as much as humanly possible. By your own words, you are doing it less than you could.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Right, I am doing it less than I could, less than is possible for me if I were to stretch myself. That’s my point.

            How would you “change my perspective” to reduce the stress of clinics frequently running late, causing me to have to race to daycare in time? If I’m zen enough, will time simply stand still? Because if it doesn’t, my kids will get ejected from the daycare permanently.

          • azmd

            I think the bottom line is that you’re having this conversation with someone who has probably never had primary responsibility for the care of children, so he can’t relate to the kind of stress we are talking about. As a single mother of three teenagers, I recognize what you’re talking about though, and I think there needs to be room in medicine for meaningful ways to address that stress. Or, we could just go back to not allowing women to be docs. That could work, too, I suppose. Maybe.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Agree, azmd. Balancing medicine and small children is a challenge and can be stressful, and it’s not just a matter of “changing your perspective”. I’ve said many times that if there are going to be women in the field, we have to make allowances for them to be mothers as well as physicians. And part of that is allowing part time schedules if they need it.

          • JD

            Hmmmm….so all of my female colleagues who have raised multiple children while working full time their entire careers (other than maternity leave) must be people I have imagined?

          • JD

            The way that I would “change your perspective” is to consider yourself a full time physician, and not let the medical system define what that means for you. That way, you don’t need to stress yourself out about being part time. Are you contributing to the breakdown of our medical system? We ALL are, in one way or another. We could ALL do better. So, as I said from day 1, nothing to feel guilty about.

          • Suzi Q 38

            Do you have a friend or family member that can pick up your children if that happens?

            I used to do that for a friend of mine that was an NP.
            Her son hated the daycare, so I picked him up early two afternoons a week, whatever days I wanted. If she was running late, she would call me and I would go get her son.
            I remember having fun leaving the day care center with him. I would creepily sneak up to him and say: “Bradley, let’s bust out of this place!” We are going to go where ever you kids want to go.”

            He would be so surprised and happy.

          • Suzi Q 38

            You are not unlike millions of parents, finding a way to live a life that involves having a good part of both: family and work. In the 1950′s, this would have been highly unusual.
            Good for you. Then, when your children are grown and moved on to college and adult life, you still have a viable career. Even then, you may still enjoy or prefer part-time.
            Maybe you like to paint or visit family members; care for aging parents. Travel on longer weekends with your spouse or children. Help out with the darling grandchildren.

            Whatever. Life is not totally cut and dried. Doctor=full time??? Not necessarily. It just can be a bit risky career wise, depending on where you work, and what the manager’s or owners attitudes about part-time or flex time work is.
            You can get creative about how you want it. It is just very lucky to find employers that agree to it.

          • Suzi Q 38

            Michelle Obahma once said: “My job doesn’t define ME.”
            She went on to talk about how she is a lawyer, but recognizes that she wanted to stay home more hours than that job permitted. she made a drastic choice to do what was best for her and her family.
            She wanted to do what she wanted to do, instead of what people were expecting her to do.
            I admire all of you.
            Life is full of choices. It is so nice that we have so many ways to work and live.
            If my doctor works part time, it is my choice to have him or her as my doctor. Luckily, the pediatrician that we had that worked part-time belonged to a group of about 5 or 6 pediatricians.
            It worked out just fine.
            My dermatologist isn’t at her office everyday. Two days a week, she works in a different city entirely. She relies on PA’s to “pick up the slack.” She can go on vacation.
            The derms have it good.

            My PCP had two offices for a couple of years. It was inconvenient at times, but doable. I would just try to see him at office “A,” which was 10 minutes from my home.
            He could have been working part time due to stress for all I know. I am a loyal patient, and I appreciate his services, so I just came on the day he was in.

            If you arrange your work as part-time and you can pay your bills, fantastic.
            Let’s face it, some people probably owe a lot in student loans, while others don’t have to pay as much back.

            Also, some people know how to live on less money and save that way.

            Some people love working. they are happiest when they are helping others. To those doctors, I thank you.

            To the part-timers, I thank you.

            There are so many ways to live a life.

            Make it the way you want it.

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Medicine is actually a fantastic career in that you *can* work part time and still pay the bills. A lot of women choose it for that reason. It’s just sad that a guilt trip goes with it.

          • Suzi Q 38

            Guilt is inherent in most humans.
            If I do this with the family, something else does not get done, there is career or work guilt. If I do that and less time is spent with family, there is family guilt.

            Recognize it for what it is, make your decisions based on what is best for you, and move on.

            I was a SAHM part time and I still have guilt about work and family.
            My friend worked 40+ hours a week and has a lot of guilt about missing her family, who I helped care for…Sometimes “it takes a village.”

            Whatever you choose to do, there is guilt attached that is there, but should not take too much of anyone’s thoughts.

            If it does, maybe some adjustments need to be made.

        • azmd

          It’s an interesting perception that a job as a doctor “has to” involve high levels of stress. I would argue that there is no real reason that every doctor has to have a job that involves multi-tasking and staying up all night, two activities that this doctor has wisely identified as unhealthy for her particular personality makeup and has chosen to avoid.

          The idea that a profession where you take care of people “has to” be a high-stress profession is, again, a misguided construct. Think about what happens physiologically when a person is stressed. It’s just a fact that that person is going to be biologically less able to care for someone else.

          The fact that someone sensibly chooses to pursue a medical career that does not leave her too stressed to function effectively does not in any way mean that she does not enjoy being a doctor. She just does not enjoy being a doctor as defined by a narrow and outdated notion of what doctoring has to involve.

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

            High-stress is just one effect people may experience in response to complex chains of events. It is not a requirement of any job or career that that one actually becomes stressed, but some careers, more so than jobs, are more likely to cause people to feel stressed out, and medicine is one of those careers, but by no means the only one.
            Since as JD mentioned above, the production of doctors is highly regulated in this country, one has to wonder about the consequences of having a significant number of these doctors choose to avoid activities that may cause stress. Is the expectation that others, less prone to experiencing stress will be picking up the slack, and thus increase the likelihood that they will become even more stressed than originally estimated?
            I find it strange that one would choose to go to medical school expecting not to have to take night calls, or not to have instances where one is pulled in multiple directions at once. It would be like joining the army and expecting to never be in harm’s way.
            Perhaps the time has come to deregulate the admissions process to medical schools, so graduates can have the choice of a “desk job” vs. a career.

          • azmd

            I think there is (or should be) room in our healthcare system for many different types of doctoring jobs, and many different types of doctors. I doubt that too many doctors go to medical school expecting not to have to take night call. That would be extremely silly, as you say. However, there are probably doctors who learn through their training that they tolerate sleep deprivation poorly, since all humans are individuals with their own unique physiology.

            A lot of those doctors decide to go into ophthalmology or dermatology, in order to avoid night call, for example, and we don’t criticize them. Why should we criticize those doctors who decide to go into an underserved area such as primary care, but criticize them for trying to construct a work life that works well for them?

          • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

            Very true. You don’t necessarily realize when you start med school that you’re going to be sleep deprived from two kids and not want to deal with night responsibilities on top of that.

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

            Far be it from me to criticize anybody for putting their children first, or for making a less than perfect decision a long time ago. Been there, done both.

            The question in my mind is how do you define part time in primary care. Does part time mean providing complete care to only a part of what is considered a full panel, or does it mean providing partial care to the usual number of people?. The former is a type of concierge medicine, which may be bad for the perceived shortages, but is not detrimental to patient care. The latter, and most likely possibility, however is a bit problematic in my mind because it alters the definition of primary care, and I am perfectly aware that this definition is already under attack by various “new models” of care, which have nothing to do with the subject discussed here.

          • azmd

            I am not even sure what kind of model would involve delivering “partial care to the usual number of people.” I suppose much depends on how one defines “partial care” and “complete care.” I would have to know more about how you are defining those terms to have an opinion.

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

            The kind where a patient receives services from a number of providers that come and go and continuity of care is replaced with continuity of access to the medical record, and the kind that stops at say, 5 pm and/or at the hospital door.

          • azmd

            So, in other words, your definition of “complete” primary care would be that which is provided by a doctor who is available 7 days a week, 24 hours a day, and follows his or her patients while they are hospitalized?

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

            Pretty much. If you think this is just a pipe dream, Dr. Steven Reznick who posts here frequently, is one example of this type of primary care.

            If insurers would dare step out of the box and pay primary care docs a couple thousand dollars a year per patient, and leave them be, I bet we wouldn’t have any “shortages” and expenditures would be significantly reduced, and so would the stress levels in this field.

          • azmd

            As usual, I couldn’t agree with you more. Obviously the model of care we’re talking about is best for the patient, even though our healthcare system doesn’t want to pay for it. But the chances of reform are diminished by doctors who like to insist that a “real” doctor is one who selflessly works 80 hours a week and doesn’t worry too much about getting paid or being stressed. That’s just not a realistic expectation to have of the vast majority of our medical graduates, most of whom have significant educational debt and who are voting with their feet, matching into dermatology and plastics whenever they can and avoiding primary care like the plague.

          • JD

            It’s an equally interesting perception that the “stress” of being a doctor comes from “multi-tasking” and “staying up all night”.

            For me, 99.9% of the stress of being a physician comes from the fact that I could hurt someone, or that someone could die, if I make a poor decision. And when one of my patients is sick, the 99.9% becomes 100%.

            I remember taking night calls in the hospital and being exhausted. I also remember how none of that mattered when a new leukemia diagnosis hit the floor. When one focuses on the patient, and not themselves, it is amazing how tolerable, and even rewarding, “stress” can be.

          • azmd

            The writer says that multi-tasking and sleep deprivation are stressful to her. For you, the stress points are elsewhere. Everyone is different, and stressed by different thing.

            Implying that someone’s physiological reactions to stress could be altered by becoming less self-centered is both critical and condescending. It is just this type of attitude in medical education that produces medical graduates who go on to treat their patients in a critical and condescending way. As medical educators, we have an obligation to model empathy and helpfulness to our trainees.

          • JD

            No….implying that someone’s physiological reaction to stress can be altered by becoming directing it to something else (I never said self centered), such as a patient’s condition, makes the stress more tolerable.

            As an oncologist, I never get to have the worst day of anyone I meet. I never implied that I am a better person by doing this. I simply implied that keeping things in perspective makes being a physician more enjoyable.

        • http://www.facebook.com/miriam.anixter Miriam Anixter

          Again, too much of anything is a bad thing. I also hate night call, but it is part of my job. Part of being part-time gave me the luxury of recovering on my post call days. Some of my colleagues do much better on night call, and choose to take them all in a row. Why does it mean “I don’t like medicine” to say that “when I work too many hours I become tired and unhappy”?

  • http://www.facebook.com/profile.php?id=1448172743 Tapati McDaniels

    I see absolutely no reason anyone should feel guilty for working part time to balance their life responsibilities. No one is under any obligation to work more hours than they would like to. No one else has any right to guilt trip them about it, either. Aren’t we all free to pursue happiness? Doctors aren’t slaves or indentured servants. We need more of them, to be sure, but a shortage doesn’t mean doctors should martyr themselves or spend even less time with their children. Kids only get one childhood and they deserve quality time with parents who aren’t exhausted or cranky.

    Also, while we are talking about a high-end profession, next time you hear people disparage the working poor as some kind of losers or deadbeats, keep in mind that they don’t have the option of working part time and often work more than one job to make ends meet. Next time you hear about the need to increase minimum wage I hope you’ll all support it.

  • NormRx

    If part time means working a 40 hour week instead of 80 you certainly should not feel guilty.

    Now, if more lawyers would work part time, maybe a five hour week, America would be a much better place.

    • Suzi Q 38

      Haha.
      Except if you are sued without merit, or unjustly fired, then a good lawyer would be O.K. to work his or her 60 hours for you and others like you.

      • NormRx

        Suzi Q, I would never sue if I was unjustly fired. I believe an employer can hire and fire at will. I, my G.F and my sister have all hired lawyers for various things and all of us got screwed by our own lawyers incompetence. Even though lawyers, doctors and police are necessary in our complex society, I thank God for every day I go through life without the involvement of any of them. You mention a lawyer working 60 hours for me. I am sure you are talking about billable hours, not actual hours worked. Lawyers are the only profession that work a 36 hour day.

        • Suzi Q 38

          I have only had to use lawyers once, and they were worth the $30K i paid them.
          After that experience, it is far better to avoid such nasty situations.

  • buzzkillerjsmith

    As dyspareunia is sometimes better than no pareurinia at all, so part time is sometimes better than no time. For at lot of docs, those are the two options ( the time part, not the dyspareunia part).

  • tiredmd

    Wow, I see the comments on this article are not very supportive, so doubt I’ll revisit the comments section. But I did want to post and thank Fizzy MD for the article, it made me feel less “alone.” Also I think you are modeling some very healthy behavior being willing to say things to the effect of “when I’m tired I get crankey, so it’s best for me to not allow myself to get that tired.” Thank you for reminding me that is it “ok” to be *human.* I’m in the final year of my residency, about to graduate, and am so burnt out I don’t know which way to turn. I’m not even thinking clearly about career options. What I have historically always wanted to do (and have been passionate about) I am just too burnt out to pursue right now – which is very upsetting because I know when I’m feeling a bit less burnt out I’ll be horribly upset with myself for having allowed these opportunities to slip by. I’ve also looked at some “path of least resistance” options but they just are not things I am passionate about – sound like committing myself to a life of drudgery & dullness. Anyway, I appreciate your willingness to publicly state that it’s ok to not like being tired, cranky, sleep deprived. Thank you.

  • http://www.cosmetique.com.pk/ Dr.Azim.j Khan

    Then the system needs to be changed, right? Until then, stop belittling
    yourself by defining yourself as a part timer (no matter how much money
    you make), when you and I both know you are putting in full time
    effort.

  • Haleh

    I’m a mom. I’m glad part-time exists. I hear everything you are saying. I also think that after years of practice, a full time doctor would see more than you will. And given two equally talented and able doctors, the full time one will over time simply have more skill, expertise, and sixth sense.

  • Anthony D

    18-40 million new patients coming into a health care system and many of today’s medical physicians what to be PT mommies & daddies?

    I’m sorry, I don’t tolerate that!

    Doctors knew that this is NOT an easy job when they were in college. So I guess you knew that if you have children, its only going to slow you down. In today’s economy and how health care is changing so quickly, your career has to come FIRST! Especially in this profession.

    So yes, you should think that your ruining medicine! Because when your children are sick and stay home, you stay home as well. BUT if we want our doctors and us patients are sick……..WELL?!….I WANT YOU!!! THE DOCTOR!!!

    Now of course others will disagree. But this is my opinion. That’s all I have to say!

    • N N

      Sorry but you don’t OWN any doctor and his/her decision on how he/she chooses to distribute their services, and you don’t own their lives. Don’t worry though, based on Obamacare, primary care physicians can easily be replaced by NPs, so go to them for your care.

  • SBornfeld

    Aww, somebody needs a hug!

  • http://twitter.com/TheUnorthodoc Dr. Cory Annis

    Fizzy….Encouraging “part-time” doctors (both men and women) is one of the best ways to avoid the carnage of physician burnout. To give highly trained and committed MDs no other choice than to quit medicine all together is an obscene waste of talent and passion. Our private Med/Peds practice in North Carolina hires part-time physicians only. We insist on vacation. Flaming out is not an option here. We are suspicious of docs who are happy working 70-80 hours a week…what are they running from?

    • Turis

      Amen!!!!

  • MeredithKendall

    One of the most problematic things I’ve found about helping professions is the complete lack of taking care of oneself. If you can work 80 hours per week or more for thirty years and be effective as a physician, be my guest (bonus points if you can swing it without a prescription stimulant). There is no such thing as super human, and I try not to think about the number of medical mistakes that are made out of stress, burn out, and lack of sleep. I will love doctors just as much without the dark circles under the eyes, I promise.

  • beebee pomegranate

    Part time is plenty for your patients. Our country likes to run people, like your patients, and some doctors to burnout for the Almighty Dollar. If the patient care you provide starts to suffer, then do something about it. But that probably will have nothing to do with you keeping your own life manageable–which will make you a better provider overall.

  • http://warmsocks.wordpress.com/ WarmSocks

    Do those exist?
    Yes. You’d be amazed at the number of moms who are willing to help other moms out (especially if it generates a little income). I’d be happy to watch someone else’s kids with the understanding that I’d treat them just like my own, take them along on our errands, teach them how to behave in a store, go to swimming lessons with us, eat dinner if the parents couldn’t get away from work on time, etc. First, we’d have your entire family over to play and see how the kids interact. If that went well, we’d have the whole family spend a whole day together – maybe meet at our house, let the kids help with feeding horses & picking eggs, then we’d all go to the zoo. If that went well, we’d try things for a month (while you worked) before making a long-term commitment.

    • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

      I’m not talking about daily afterschool care. I’m talking about needing someone to be able to drop everything at a moment’s notice to pick up a sick kid at any time. So you *wouldn’t* be able to do your errands with a febrile child or drag them to swimming lessons… you’d be stuck at home.

      • http://warmsocks.wordpress.com/ WarmSocks

        When you said “daycare” and “young kids” I assumed she’s younger than school age. There are people who would be happy to add one or two pre-schoolers into their family’s activities, and find swimming lessons at a time that accomodate everyone (nto sit and watch while others have the fun). I can’t speak for anybody else, but when my kids are sick, we cancel everything and stay home so that they can recover; I’d expect to do the same for anyone else in my care. I was not suggesting someone to drop everything if a child gets sick in daycare, but rather proposing family-care as an alternative to daycare. Sorry if I misunderstood your kids’ age.

        I think it’s fantastic that you don’t put a job ahead of your kids’ needs. Kudos to you. Working part time doesn’t ruin the practice of medicine. It shows that you’re able to prioritize.

        • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

          Thanks :) FYI, I did use a “home” setting for daycare in the past and it was a bit of a disaster, which is part of why we use large daycare centers now. If it’s an individual person or even two people taking care of the kids, you’re subject to that person getting sick herself and wanting to take extended vacations, all of which are just as difficult to deal with as my own sick kid.

      • Suzi Q 38

        Kids do get sick, sometimes at the worse times for the working parent.
        Also, kids deserve to be able to do activities that they enjoy and learn from.
        Some of my children’s friends could not do activities because there was no one to take them and pick them up.
        These kids were sad about that. They could have been talented musicians, or volleyball players. They could have forged new friendships or maintained familiar ones. They could have learned from other children or adults in charge.

        One of my daughter’s friends from college could not believe I worked part-time. She was incredulous that I made it to 80% of the practices and activities and 99% or their games or tournaments. She said that while she is very proud of her mother and the work she does, their housekeeper “Marina” did all of that. She said that she also learned how to speak Spanish and make ethnic food from Marina, so it wasn’t all bad. She said it would have been nice to see her mom or dad in the bleachers watching her instead of Marina all of the time.

        I was probably on 6-10 parent’s emergency cards, LOL.
        The school would call me with one child or another at least once every two weeks.

        Also, we need to remember that many times, if you are lucky, there is a spouse to help out when you can’t make it.

    • Suzi Q 38

      Yes, that is a good idea.
      A couple of friends did that. I picked them up and she helped me out when I could not find childcare. It was more of a I helped her 50% of the time, and she helped me 10% of the time. The rest of the time, I did it all for my kids as I worked a part-time and flex time schedule.
      She worked full time, so I was there for her kids a lot of the time.
      The rest of the time, they were in day care. Unfortunately, some days, they HATED day care. This is why she had me as a “back up” for those special days.

      I grew to love her kids. To this day, they stop by my house (they are now in their 20′s) and eat a meal. If they are lucky, I make them their favorite meal.

      I didn’t realize that I had formed an attachment to them, and vice versa….. Similar to an aunt.

  • LastoftheZucchiniFlowers

    Fizzy – you owe no apologies and are ruining NOTHING save the old guard’s crumbling paragon of ‘when I was a student/intern/resident’ diatribe. The tall and erudite, waspy-looking, elder-statesman(male) visage of old medicine is long, long gone. Most recall that in his prime, he had: two secretaries (one was his often his wife), a nurse with an assistant (if the wife wasn’t his secretary, she was his nurse), an office schedule of M,T,Th,F (NO Wednesdays because tee off was chipped in stone at 9am) and an unbelievable array of perks which included but was not limited to: big pharma junkets (like trips to Bali for two weeks in January, bring the whole family-thanks Eli Lilly!), tickets to the game, concert, ballet, circus (for the kids) etc. (GOOD seats, no crap) along with endless professional ‘courtesies’ which he afforded to others of his esteemed echelon and vice versa. His office used to be the entire downstaris of his seashore colonial mansion before the mid 70s, but then Abe (his accountant and poker buddy of 20 plus years) informed him that it made more sense to buy the office building downtown (only four miles out) move the practice there and lease office space to ancillary guys who supported his efforts. The hospital administrators kissed his feet and practically threw rose petals on the tiles when he arrived to do rounds (with his kid(s) on Saturday mornings all in Tennis Whites) and his charting looked like Parkinsonian Sanskrit which was translated by long term, steadfastly loyal floor nurses in white shoes, white dresses and varying configurations of caps) to say, “patient doing so-so, will d/c next week”. Yes – this was SOP back in the ‘golden days of medicine’. Minimal notes so rounds could be made on all patients on a quick Saturday AM (of course he billed for those visits!) The aforementioned floor nurses (who idolized him) fluttered about with all charts he might need and accompanied him on rounds bringing him WHATEVER he needed even if it was on another floor. They also cleared the dictation area of debris when he arrived and after ALL THIS, when he left the floor these same nurses discovered that his snotty kid raided the patient fridge and ate the last chocolate pudding which was really GOOD back in the day forcing the charge nurse to call dietary for replenishments.
    How do I know these things? I was that pudding-stealing, snotty kid of the elder statesman/surgeon dad!
    You are not supported like he was. No one is. Don’t worry about it. Work part time and enjoy your family – there is no second chance to do it later.

    • Suzi Q 38

      “Don’t worry about it. Work part time and enjoy your family – there is no second chance to do it later.”

      Now, THAT is reality.
      At some point in time, it “hits” you.
      It might be watching your kid get dressed up for Senior Prom;
      high scholl graduation, or moving them into their college dorm.

      Wow, THAT went fast.
      I would rather be a part timer, enjoying the fun rather than watching it as I walked out the door everyday.

      If you want to work part-time and spend more time with your family, your choice should be admired.
      You still get to do the type of work you always wanted to do, just part-time.
      I don’t know why there are those that do not understand the different choices.

  • http://www.facebook.com/josh.hornstein.1 Josh Hornstein

    I is great that you know who you are and what makes u tick. However, it is true that your med school spot could have been utilized by a “full time” md. Primary care does lend itself to part time work. As a surgeon, that is not feasible. My surgical partners count on me pulling my fair share of call, sports coverage, lecturing etc. maybe u should have considered your constitution before entering med school. Physician assistant or nurse practioner lifestyle may have suited u better. I’m an ortho surgeon, a man, and work about 60 hrs per week. I have been at it for 10 years, I make time for my kids, see all their games, and am home for dinner 95% of the time. It’s all about time management and setting up a good support network.

    • Something From Nothing

      What a load of crap, and, on top of that, spoken like a man. Give me a break. I am an ob/gyn, mother of two girls and I work 3/4 time. Are you suggesting that women who work less than full time were a waste of a medical school spot? I find your post extremely insulting. All of the women in medicine I know who work part time are highly valued members of their groups. None of the men in my group work full time either, by the way and we all enjoy excellent work -life balance. You will have to forgive my skepticism at your insistence that you are home for dinner 95% of the time. Your priority seems to lie with work.

      • Suzi Q 38

        While I agree with you, maybe his home is located next door to the hospital…or maybe he does the “eat and run.”
        More like a “break.”

        • http://www.facebook.com/miriam.anixter Miriam Anixter

          Actually, if he really works 60 hours (don’t forget weekend coverage), he is likely able to do these things. But of course, maybe he should be working more…

    • Suzi Q 38

      That is really good that you make time for your children’s games and eat dinner with them every night. My friend is married to a physician and he makes it to dinner each night too.

      What does your wife do for work? Does she also work 60 hours a week, or does she have a more flexible schedule?

      In other words, who takes them to and picks them up from school?
      If not, who transports them to and from daycare? If you have an older child, who transports them to all of their activities ( after school group study, soccer, volleyball, basketball, dance, band, hula, glee club, computer programming club, SAT prep classes, speech and debate club, community volunteering, Associated Student Body (ASB), etc.).

      If your wife is a full time surgeon like you, who does all of that and picks up or makes the dinner that you get home to eat?

      Do you have “Alice” like the character on the “Brady Bunch” reruns come and help out? It appeared as if she came in the Brady home and basically cooked and cleaned. She, in essence, was Mrs. Brady’s “wife.” Only Mrs. Brady did not work outside the home. She just had 6 children she needed assistance with every day.

      Maybe you have a “wife” that is not a physician but has a more flexible schedule when she works.

      If so, that is good.
      The author is the wife, so she does not have the same situation that you may have. I am guessing that she has a husband that works full time. If is wants to be a full time + (50 or 60 hours) physician, she may have to get herself a “wife” to help out, as her husband is working full time and unable to do so (just guessing).

      Instead, she chooses to spend more time at home for those crucial young years that her children are home and work a little less.

      I may be of the minority here, but I think, that given her situation, that is a really good plan.

      When they drive themselves to college and don’t want her anymore, (my personal empty nest bitterness, sorry, LOL) she can go back to working more or looking for more career advancement opportunities. This is only if she wants to.

    • azmd

      No offense, but it is important to remember that being an orthopedic surgeon gives you the financial resources to have that “good support network.”
      Someone in primary care is not going to be compensated at the same hourly rate as you are and so will not be able to afford to have a stay at home spouse or significant household help.
      I am a specialist and it allows me to pay for a full-charge nanny; that goes a long way to alleviating the stress of having children at home who might get sick in the middle of the day, have days off from school that I can’t cover, etc.
      But I am capable of using my imagination and imagining how it would be to make less money and not be able to afford those resources. It would be really stressful and I also would want to work part time. I am not sitting around patting myself on the back about what a great parent and time manager I am.

    • http://www.facebook.com/miriam.anixter Miriam Anixter

      60 hours would put you part time with the orthopedic group I work with. Part of good time management means figuring out how many hours you want to work. I wanted to work 40, so I went 60% FTE with 80% clinical and 20% academic. I chose a group that has a practice model that supports that. I take my share of call, and– guess what! Since my work days are flexible, it means that I can support my other partners that need to go to meetings or need to take leave because I can work more or less on a given week.

  • MayFran

    Fizzy, I think it’s fine that you’ve found a way to balance your personal and professional lives.

    Now quit whining.

  • http://www.facebook.com/SabbaJoe Joseph More

    We have regulations that limit the working hours of airline pilots, bus drivers and truck drivers, because doing otherwise might endanger the lives of others. Why is it OK to routinely have physicians who are impaired by overwork and lack of sleep make life and death decisions?

  • shiriegale

    Bravo Fizzy! Balance in work and life – what a concept!

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

    Good grief. So much emotion. I really don’t recall saying that anyone who works part time is “ruining” medicine. What I said is that no one’s medical degree is entirely his or her personal possession; society contributed a lot to that degree in terms of dollars and resources. Accepting the degree confers some obligation–how much, obviously, is a matter of debate.

    When my children were small, I did indeed always work full time. I found the time to “blog” once the last one left for college.

  • Barry Nuechterlein

    There’s nothing wrong with part-time practise or job sharing, as long as it’s done transparently, and incomes are proportionate to hours worked. When people enter their fifties and sixties, or are looking after children at home, they should have the option of a less-demanding work schedule. No shame in that, and they aren’t ruining medicine.

  • chachacha222

    I spent my 20s working 3 full-time jobs (known as medical school and residency). I don’t care what others think, I’m working part-time b/c full-time of whiners, non-compliants, druggies, and morons will lead to my brain exploding.

  • CatLover MB

    I am an European physician, and while reading some comments below I found myself baffled by the idea that working 80 hours per week is in any way healthy for body and mind, no matter how much you love your job. A hospital is not some Chinese factory, we treat people, for God’s sake. We’re not supposed to be robots.

    With all due respect, American medicine is quite extreme in this, I must say. I love my work and it means the world to me – in spite of tough moments, I have never had a moment of doubt. I enjoy my work – every day. It’s a challenge, it’s fascinating, it’s both science and art. I do my best to help people.

    However, when I think that I could work twice as much (I work 4 8-hour work days plus one 24 hr shift), it seems quite crazy. I can’t imagine having no personal life, no time for my kid, no time for studying, no time for my interests outside of medicine, hell, no time for proper sleep! – it is not healthy to me.

    Of course, there are stimulants, and some people use it… I have no comment on that.

    I am well aware that people differ, and that some get off on stress, have some wild energy level, and simply do not need to have a life outside of work, I respect that. But the system that prefers workaholics (that’s who they are, sorry) to people who want a balanced lifestyle – that system is a pathology. The idea that med school admissions are based on that work scheme is insane.

    Who would I be to advise people on healthy living if I were spending my whole life at work?
    I have colleagues who work some mad hours and while some of them enjoy all of it, some are far from being satisfied with their private lives, even when highly proud of their work. Some of them started to suffer burnout, which can wreck even the best doctors. No amount of coping strategies can help if you are simply unhappy with the situation and being deprived in the field of basic human needs. I’m happy that my work environment puts no pressure when it comes to lifestyle choices – your contract, your life, nobody else’s business.

    Kudos to all US doctors working part time, be proud of it :-)

    For MD trolls, just in case – yes, I know that US medicine is much, much superior and us Europeans are lazy, undedicated physicians (who supposedly don’t like their work because they don’t accept slave labor), I’ve heard that opinion. Really, get a life ;-)

  • http://www.facebook.com/leah.c.rey Leah C. Rey

    I am laughing at this post because I hope your are joking. I am an ED Physician, and I work “part time” It really means full time when you consider all the e-mails chart review CME etc we do to keep our license etc. Not to mention the time away from normality we all take in order to adjust our brains to the ever changing day-night schedule.

    I truly feel this is the only way to do it and not get burnt out. I never feel bad because I am really there and am happy to be there for every patient I care for. I am able to be the best physician I can be under this circumstance. When I was working “full time” 12X12 shifts/mo I was constantly exhausted and frequently frustrated, and it came out in how I cared for patients, as although they probably had the same “outcome” their experience and/or mine was not as pleasant.

    We as physicians need to take back our right to practice medicine the way we see fit, and take care for our patients the way we think is right. We need to cease to relinquish control to hosptials/insurance co/and gov’t and be aware that only we know whats best for the health of the nation. Working part time is the smartest way to take good care of patients while also working to regain control of the market and keep control of our income/salary.

    Side note: Please contribute to your specialty PAC to ensure our interests are in mind during legislative session…. $500/year from each physician will keep our voices heard and is worth more than you realize…..

  • Gayatri Khanna

    Thank you for validating what I go thru everyday.

  • lord one

    great text!

    Two years ago I’ve worked in emergency medicine as a
    physician, and worked 8 months only nights 12-hours shifts, every second night.

    Most nights without sleeping at all, sometimes working 24 hour after night
    shift +day shift without sleeping. I had a bad relationship at a time, and my
    private life was a mess. I was uninterested for people who bread heavily, or
    maybe have a heart attack, or are just anxious…it was all the same to me, I
    just wanted to say to all the patients go to hell! Sometimes I wasn’t thinking
    logic, in all that sleep deprivation in like 20.hour of working, I‘ve made
    mistakes, ordering all unnecessary labs.. complicating everything, I felt
    half-delirious. At home I was irritated, everything was annoying to me.

    I was taking diazepam or alprazolam in nights, an once I woke up and managed a
    patient, and get back to bed, and half hour later woke up and didn’t remember
    the patient at all! I was so tired, and thank god I did id well. Then I stopped
    taking benzodiazepines. I felt burned out, and quit my job.

    I was unemployed for 3 months, sick of medicine. Driving a bike, shopping(spending
    that saved money), turning channels on TV when there was something about
    medicine because I felt ashamed for my quitting job).

    Then…my love for medicine came again, and again I began working in ER, this
    tine shifts 12-24-12-48(day 12-hours, tomorrow night 12-hours, than 2 days at
    home). That is 7-8nights a month, altogether 15 shifts. I coped well with
    stress, but after a year of working shifts, not having weekends, I applied for
    oncology. The reasons: no acute medicine. If there is an egzitus in nights,
    that is not a surprise. I never thought I would be an oncologist, but
    now…after ER, that seems less depressing!

    In choosing a specialty I’ve considered dermatology, ophthalmology, oncology…
    all the fields that do not involve fast decision making, and acute stress.

    When I “burned out”…I lost confidence as I physician. I made
    mistakes, heard my colleagues comment on my messy work with laugh. It took me
    long time to gain back the confidence. When I came back in ER, it was easier,
    cause i had more colleagues my age, and we would take coffees once a week, and
    talk about the stress, and patients, and what we overlooked…I could say
    everything on my mind with confidence, and I saw that others have same worries,
    and that I am not the only one feeling stupid.

    I can’t cope with sleep deprivation, I am extremely neurotic and irritated behavior.
    I was young, inexperienced physician, and with huge responsibility.

    But I think that is not only specific to medicine, I’ve read that police
    workers also show the same neurotic behavior, anxiety, even dissociation.

    No one who is out of medicine can understand what is responsibility + night
    shifts + sleep deprivation for a longer time.

    My colleague sad once on her managing night shifts: “I was working nights
    in ER, it was 3AM and nurse knocked on my door saying:

    -Dr, get up, epistaxis is here!

    I was in my first REM sleep, deeply sleeping, woke up, bread in heavily
    thinking in a second…Oh my god! What is epistaxis?!” :)

    Now…after two years ER, I am coping better, I have greater experience, but
    now I have other worries.. One night nurse wake me up “Dr, a young women
    came, unconscious” I sad “OK, I am coming” and rolled over on my
    other side in bed, and continued sleeping. Nurse came again in 5 minutes sad
    “Are you coming?” I sad “What? Why?” I didn’t remember her
    waking me the first time. I am now worried of sleeping too tight, and moon
    walking again.

    I don’t think I am a bad doctor. Just not coping well with
    emergency medicine and working at nights. I am happy to finally have an easier job.

  • verkMD

    Apart from this article and another here defending part time work I am unaware of the overall animus toward part timers. I work part time and don’t have kids, am not a woman, and have never received any hassle about it, other than envy. I choose to do shift work. I fill a defined need at the hospital where I am employed. Most ED docs I know work between 9 and 14 shifts per months. Part-time, full-time, 40 hours, 80 hours… we all have stressful jobs and try to balance them with the other non-working parts of life.

  • lolao4

    the last reason why i work parttime…is BECAUSE I CAN..

  • Marianne Evans

    You ARE working full time, based on your description I am getting 8-6 5 days a week, and that is 50 hours. Since when is 50 hours a week part time? I work full time now but never could when my three kids were little. However I did have live in child care when they were babies an absolute must for a professional mother, or at least a full time nanny who will be capable of caring for a child with a cold. Daycare is useless especially if you have more than one kid, becasue one of them is always sick.

  • Mike Miller

    The physician shortage is because resident physicians a overpaid, student loans are based on “INCOME BASED REPAYMENT”. They do not need 50,000 a year while they are still training. Hello, they aren’t yet full-fledged physicians. They shouldn’t be making more than 35,000 per year. The ACGME, AMA, AAMC, and each specialty board work together to limit the number of physicians this country produces. Why, because they are greedy and want the elitist lifestyle. They don’t want to have to compete with other healthcare providers. Unless legislation is enacted to change the way physicians are trained, there will continue to be a physician shortage. Physicians have something no one else in society has. The ability to find a job somewhere in the country. perhaps they can’t find a job in Miami, but they can find one somewhere. Working part time isn’t limiting the healthcare providers, it is the overpayment of residents and the fact that speciality boards have too much authority over the number of trainees. The government should step in and limit the authority that The American College of Surgeons has. They should open more residencies at more hospitals. Physicians are incredibly deceptive when they argue that the number of residency positions should be kept constant. Whats more, they then argue that they should be exempt from lawsuits, that it is easy for others to make them pay when they do wrong. Physicians are quick to lie to defend themselves,

    • http://www.facebook.com/fizzy.mcfizz Fizzy McFizz

      I made about $10/hour as a resident. You really think that’s “overpaid” for a person in their late 20s/30s with over 8 years of higher education under their belt? I saw a study once that showed a large percentage of residents live in poverty.

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