By the time you read this, I will have completed a transition to working half-time. Now, I know a lot of docs out there think emergency docs are already only working half-time, so perhaps I ought to start with explaining why that isn't the case, even if emergency physicians work fewer hours than many other physicians.
Emergency Doctors Work Full-Time
Let's start with the fact that most Americans consider 35-40 hours a week to be a full-time job. A typical emergency physician works 12 twelve-hour shifts a month or 16 eight-hour shifts per month. Add an hour on to the end of each of those shifts “to clean up” and perhaps another half day at some other point in the month for administrative duties and you get to something around 150 hours per month, or about 1800 hours per year. Let's compare that to a typical office worker with a 40 hour work week.
52 weeks a year x 40 hours per week = 2080 hours
That's 280 hours more than our hypothetical emergency physician. But we've forgotten a few things. We haven't considered the paid holidays. Emergency docs get paid holidays because they work on holidays! EDs are open 24/7/365, remember? If you're working half the days in a month, you work half of the holidays in the year, and the other half were unpaid. According to the Bureau of Labor Statistics (BLS) the average professional worker gets 8.5 paid holidays a year. 8.5 days x 8 hours = 68 hours.
What about vacation? When emergency docs go on vacation, they cram their shifts into the rest of the month to free up time to go. There's no “paid vacation.” They worked the exact same number of shifts in a month when they went on vacation as they did in a month when they did not. The BLS says the average professional worker gets about 17 days a year of paid vacation. So 17 x 8 = 136 hours.
What about sick days? Emergency physicians don't get sick. Okay, we know that's not true. But they rarely miss work for illness, and when they do, it usually becomes a shift trade, not a day off. The BLS says that not only do most professional workers get to have the day off, but they get paid for it too! About 10 days a year. 10 days x 8 hours/day = 80 hours. Let's see where we're at here:
2,080 hours – 68 hours – 136 hours – 80 hours = 1,796 hours, amazingly similar to what the average emergency physician works.
But wait, there's more. We haven't adjusted for the rotating shifts factor. If you go to work at 9 pm and work until 9 am, which day did you have off? That second day is referred to by emergency physicians as a DOMA (Day Off My Arse) because you're so jet-lagged that you're useless. In fact, it might be several days before you get back to normal, and that's before you hit your 50s. Those night shifts typically make up somewhere between 20% and 50% of your shifts, so you've probably got a couple of DOMAs each month. One emergency physician I know feels that every hour worked between midnight and 6 am is the equivalent of 1.5 hours at any other time. I think that's about right, and in fact, that's about how my group reimburses the shift. Add in a factor for most EM shifts being in the evenings (because that's when most patients come to the ED) and you can quickly see why EM has the highest burnout rate in medicine. We thought we chose a lifestyle specialty but in reality, we work more non-banker's hours than anyone else (although there are some other hospital-based specialties that get awfully close.)
At any rate, emergency docs work full-time, even though they work significantly fewer hours than many specialists. Just because you're working 1.5 Full-Time Equivalents doesn't mean someone else isn't working full-time. Now let's get back to talking about half-time. Here are
7 Reasons I Practice Medicine Part Time
# 1) I Can Afford To
This is perhaps the major factor, and I'm hardly alone. The informal surveys that I do when I speak to groups of physicians suggest that nearly every physician would like to work less than they are working now. So why do they work more? Sometimes it is out of a sense of duty- they're the only doc around and patients need them. Sometimes it is due to contractual obligations. But most often, the reason is financial. They've got big student loan, mortgage, car, and boat payments they need to make, and that doesn't even count paying for the kids' private school and activities, the Paris vacation the partner wants, saving for college, or saving for retirement.
However, I was lucky enough to become financially literate as a resident, hit the ground running as an attending, and build wealth rapidly. My wife and I became millionaires seven years out of residency, multi-millionaires shortly afterward, and financially independent not long after that. That process was sped up a few years by the financial success The White Coat Investor, LLC has seen, but from early in my career I knew I was going to be financially independent at least by my early 50s and work part-time after that. At any rate, between our savings and that second income, I don't HAVE to practice medicine at all. So I get to choose how and how much I practice. I choose to practice between 6 am and 10 pm and to only do it eight days a month (plus a little administrative time.)
# 2) Other Interests
If you pay attention in medical school, and actually attend a medical school where the students take real call, you get to learn a lot about yourself and what you want out of your career relatively early. I learned that I didn't like being in the hospital 120 hours a week. I learned that I didn't like being attached to a pager. I learned that if I was going to be in a hospital at 3 am, I might as well be awake and working. And most importantly, I learned that there were a lot of other things I wanted to do with my life other than practice medicine. That's not the case for every doctor. By MS4, I could see a pretty clear divide in my med school class between those for whom medicine was a calling and those for whom medicine was a job. That's not to denigrate the “medicine is a job” crowd. They're generally excellent, dedicated doctors. But they didn't live for medicine. They had other interests. Well, I had other interests too. In fact, I have yet to find anything in my life that I enjoy doing for more than 20 hours a week (except sleeping.) That includes medicine. It includes blogging. It includes exercising or even adventuring. It even includes spending time with my kids! Maybe it's a little bit of ADHD, but I'm a big fan of variety in my life. It's not necessarily laziness; I'm perfectly happy to have three different 20 hour a week jobs, it's just me. You may very well be different in this matter and that's fine. But knowing yourself and what makes you happy certainly makes it easier for you to find happiness in your life!
# 3) I'm a Better Doctor
When I was working full-time, I had very limited time to go to conferences or read journals. Now I can do those things. In addition, my compassion-o-meter tends to run dry by the end of the third shift in a row. If I'm working seven in a row, my annoyance, cynicism, and eventually hatred start skyrocketing. I remember early one morning on a trauma rotation as a resident when I'd already been awake in the hospital for over 24 hours straight and probably hadn't had a day off for a week. I was rounding on a patient with two chest tubes, a PCA pump, two limbs in splints, and a catheter and thinking “I need that bed more than you do.” Compassion fatigue is very real. Our jobs are demanding and patients deserve a doctor that actually cares about them. Maybe I'm just a jerk, but I care a lot more working 8 shifts a month than I do 22. Now I don't actually recommend anyone go part-time for at least 5 years out of residency. In my case, I didn't go to 3/4 time until I'd been out 10 years and to 1/2 time until I'd been out 12. I think those first few years are critical to solidifying clinical skills. But eventually, part-time work can make you a better doctor, not a worse one. Certainly, it can help you become a happier, more well-rounded person.
# 4) Promotes Longevity
Here's another interesting point. I enjoy my job a lot more when I do it less. I look forward to going into the hospital. I miss the work and my co-workers. I'm more willing to stay late instead of signing a patient out. I sit longer with the patients. I find it is almost impossible to feel burnt out when you have 22 days off in a month. 65% of my EM colleagues have symptoms of burnout. But I don't. Why not? Well, a big part of it is part-time work. (Another big part is owning my job which helps minimize its toxic aspects.) I feel like I can do this until I'm 70.
# 5) I Hate Missing Out
You know what the problem with Q2 call is? You miss half the good cases. Well, after a decade practicing, the “good cases” were becoming exceedingly rare. While there's always something to learn and see, I began to regret missing out on stuff outside of the hospital more than missing out on the good cases. I got sick of flying home early from a vacation to work some shifts. I got sick of missing kids' soccer games, recitals, and performances. Missing out on trips with friends. Missing church and opportunities to volunteer. Bedtime with the kids. Sure, I had lots of time off, but it was time when the kids were in school and my friends were at work. By reducing shifts and especially evening and night shifts, I'm able to catch a lot higher percentage of those things I had been missing out on. In addition, when your spouse knows you don't need the money from work, that career starts looking more like your choice than something that has to be done for the benefit of the family. “If you want to spend your free time practicing medicine that's fine, but when you're home, you're going to have to make up the chores you missed instead of running off to go rock climbing.” I mean, I like practicing medicine but I don't quite like it enough that I'm willing to give up all my recreational pursuits to do it!
# 6) Marginal Utility of Wealth Changes
As you get older, and hopefully wealthier, your marginal utility of wealth changes. With no student loans, mortgage, or car payments hanging over my head, motivation to work more, at least for money, falls. If there were something else I could buy that would make me happier, I would have bought it already. It gets even worse when you apply a progressive tax code to those earnings. A larger and larger percentage of your income goes to the tax man and at a certain point, Atlas shrugs. How much more do you want to work just to pay more taxes, give more to charity, and leave more to your heirs? At a certain point, it becomes “What do you want to do with the rest of your life?”
# 7) I'm Lazy
Just kidding. I'm actually more of a workaholic. I mean, I'm certainly lazier than lots of people in medicine, but compared to the general population, I'm a pretty hard worker. However, I feel called to do something else with a big chunk of my time. I feel about as passionately about bringing financial peace to the lives of doctors, other high-income earners, and their families and creating jobs as I do about healing the sick and injured. And I simply ran out of time to do it all. One of my attorneys asked me the other day, “When are you going to quit practicing medicine? Isn't your time worth too much to do that anymore?” While flattering, the truth is being a doctor is a big part of who I am, and paid clinical work is likely going to make up a meaningful part of my life for years to come. I want to do it all, but I've got to find a balance in order to keep all the balls in the air. For now, that balance means practicing medicine half-time.
What do you think? How do you feel about part-time work? Would you like to do it? Do you look down on those who go part-time for family reasons, health reasons, or simply because they can? Can a part-time doc still be a good physician? Do you work part-time? Why or why not? At what point would you consider it? Comment below!