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Cartoon: A Typical Friday Night In The Emergency Department

Physicians, You CAN Have It All: How To Run A Business And Also Practice Medicine

It’s no secret that physicians are experiencing burnout at an exponentially increasing rate in our progressively bureaucratic healthcare system. Many are looking for “alternative careers” as their salvation. I receive emails from physicians all the time, asking for advice about getting out of clinical medicine, since I have spent a few years outside it myself. As my own career pendulum has swung from full time clinical work to full time editorial and/or consulting work, I’ve found that the best mix is somewhere in between.

If you’re like me, you’re happiest using both halves of your brain. You have a creative side (I’m a cartoonist and blogger) and an analytic side (hospital-based physician). It’s not easy to make a living as a cartoonist or writer, and it’s soul-sucking to work 80 hour weeks in the hospital without rest. So how do you make a living, but participate in all the things you love? You work as a traveling physician (aka locum tenens) one third of your time, and spend the other two-thirds doing the creative things you also enjoy.

“But I couldn’t survive on 1/3 of my salary,” you say. Actually, I make the equivalent of a full-time academic physiatrist salary while working ~14 weeks a year as a traveling physician. Really? Yes, really. Because when I’m filling in at a hospital with an acute need, the work hours are long, and I’m paid by the hour. It can be grueling, but it is short, and the pay is fair so morale remains high. Drawing a flat employee salary (and then often discovering that the work load requires double the time estimated by the employer) can cause a lot of unconscious resentment. But when you are paid for your time, long hours aren’t as dread-worthy. This is what attorneys have been doing from day one, so why not physicians?

“But if all physicians suddenly dropped to half or 1/3 time, wouldn’t that do irreparable damage to patient access?” you cry.  Yes, it could be catastrophic. However, if physicians stay the course and do nothing about our burnout, then the powers that be will continue tightening the vice – targeting physician reimbursement, increasing the burden of bureaucratic monitoring, pay for performance measures, and meeting “meaningless abuse” requirements for our electronic medical records systems. If there are no consequences to their actions, why would they ever stop?

I don’t think that most physicians will read this blog post and quit their jobs. I’m not worried about a sudden reduction in the physician work force. What I am offering is a suggestion for those of you who have a secret passion outside of clinical practice – a pathway that allows you to continue practicing medicine, and also enjoy cultivating your other talents. I’m hoping my advice will actually reduce the full drop out rate (if you believe the polls, up to 60% of PCPs would retire today if they had the means) to partial drop out rate (keeping those wanting to quit completely working part time).

So if there’s something you’ve always wanted to do (A non-profit endeavor? A low-paying, but rewarding job? Running a small business that can’t pay all the bills but is fun to do?) I say do it! Life is too short to get caught on the clinical treadmill, driving your spirits into the ground. You love your patients but can’t tolerate the work pace? Don’t quit altogether… you can still be a fantastic, caring, clinician in fewer hours/week and make the salary you need to maintain a reasonable lifestyle.

Please see my previous blog post to gain more insight into whether or not locum tenens might work for you.

And here’s a video of my recent thoughts about locum tenens work:

The Benefits Of Locum Tenens Work

Cartoon: Health Privacy Concerns – Real or Imagined?

Physicians: It Doesn’t Matter Where You Work, It’s All About The Team You’re With

Moose, A Therapy Pet In Idaho

As a traveling physician, I’m often asked if I have a favorite place to work. Since I have licenses in 14 states, I have an usual vantage point from which to compare hospitals. I know that people who ask this question presume that my answer will be heavily influenced by the town where the job is located, and all the associated extra-curriculars, environmental peculiarities (ocean, mountains, desert), and potential amenities. The truth is that very little of that is important. Over the years I’ve found that it doesn’t matter so much where you are, as whom you’re with.

As I’ve argued previously, true quality health care is not always predicted by reputation or academic prowess. It has a lot more to do with local hospital culture, and how invested the staff are in giving patients their all. In my experience, some of the very best institutions (in terms of reduced medical error rates, evidence-based practices, and an avoidance of over-testing/treating) are in rural areas. They are not on the America’s Best Hospitals list, but are hidden gems scattered throughout the country. Of course, I’ve also seen some abysmal care in out-of-the way places. My point is that hospital location and reputation is not directly correlated with career satisfaction or excellent patient care.

My favorite hospital is populated by perpetually cheerful staff. Their energy, enthusiasm, and constant supportiveness is remarkable. I once commented that I felt like a therapy pet when I arrived on the unit – everyone was so happy to see me, it was as if I were a golden retriever who had shown up for play time. That feeling can carry me through the most difficult work hours or complicated patient problems. It is so emotionally sunny in that hospital that the surrounding environment could be an Alaskan winter and I’d be ok with it.

Alternatively, there are hospitals where I’m regularly greeted with all the affection that Jerry shows Newman in the Seinfeld sitcom. You know, the eye-rolling, sarcasm-dripping “Helloooo Newman…” Yeah. In those hospitals where I’m made to feel like an unwanted nuisance, time goes by so slowly I can barely stand it. I fight to keep my spirits up for my patients’ sakes, but in the end, the negativity takes its toll. I could be located in the middle of northern California wine country at harvest season and want to get the first flight out. Seriously, your micro-environment is so critical to your happiness. Do not underestimate the importance of liking your peers when you choose your job.

Which leads me to my final point – if you’re thinking about relocating, but aren’t sure if you’ll be happy, why not “try before you buy?” Become a traveling physician (aka locum tenens) for a while to gain some exposure to different places and work environments. Your pre-conceived notions may be off-base. You may fall in love with a place you wouldn’t have thought twice about based on a state map…  Because a map won’t tell you where you’ll be welcomed with open arms, versus ostracized by hostile peers. Find out if you’ll be a Newman or a therapy pet at your next hospital. It makes all the difference in the world.

Cartoon: America’s Problem With Pain Meds

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