By Dr. Margaret Curtis, WCI Columnist

[Editor's Note: Readers of The White Coat Investor might know our columnist Dr. Margaret Curtis as a pediatrician, half of a dual-physician household, and the proud owner of a sidewalk sofa. She has been around long enough to have seen and experienced all kinds of professional challenges that physicians face. As her alter-ego, Auntie Marge, she shares opinions and gives advice. If you have questions about your work or financial life, Auntie Marge is here for you. The following is a real question posed to a Facebook group, with identifying details changed. This question was not directed at Auntie Marge, but she's going to answer it anyway.]

“I am a hospitalist on the East Coast. I am a W-2 employee, and I've been at this position since I finished residency. Like every other hospital, we are understaffed, and my group in particular has been short at least 1.5 FTE (really, we could use at least another 2.0 FTE). Between understaffing, the usual sick days, vacations, etc., we are stretched way too thin.

Years ago, our group agreed to 24-hour shifts. When I started, we would alternate two shifts in one week, then one shift the next. This felt like enough time to recover between shifts and have some semblance of work-life balance. Now, we are regularly working 24 on/24 off/24 on. In other words, after working all night, I drive home, nap, try to function for a few hours, sleep poorly, and wake up early the next morning to do it all again. This has been my work life for over a year with no end in sight. I don’t know how much more I can do this.

I met with the admin to discuss this situation. I told them that I am worried I am going to fall asleep on my drive home after being awake for 24 hours straight. They did not seem concerned, and they have done nothing to change our schedule.

Please don’t tell me to leave my job. I love my colleagues, and I am fairly compensated. My wife wants to stay in this area, because we are near her family. How can I convince the administration that this schedule is unreasonable?”

You won’t be able to convince your employers to change anything about this situation, because right now, it is working just fine for them. Patients are cared for, and quarterly productivity targets are met. If you get in a car accident on the way home, the liability will be entirely yours. Stop believing that the hospital administration shares your priorities (and before you say that I am being unfair to people who run hospitals: trust me, I know what I’m talking about).

None of this is to say that you have no leverage in this situation, because you do. Physicians are difficult and expensive to replace, especially for a work schedule like yours. If you leave and your hospital can't find a permanent new hire, it will have to use locums, which might cost 50% more. If you leave and the other hospitalists decide to head for the exits as well (and given what you have described, this sounds likely), the hospital will have to replace an entire department. The specialists who rely on your group to admit their patients to your service won’t be happy with any of this. Your hospital needs you as much as—or more than—you need the hospital.

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Leaving a Difficult Work Situation

A great deal of the advice for physicians in difficult or toxic work situations is “leave, right away,” but we all know that changing jobs is not that easy. You may have a non-compete clause or other restrictions on where you can practice, and you will have to find a new position in your field. There's also credentialing, licensing, etc. You will probably have to give 4-6 months notice at your current job, so even if you decide to leave, you will have to make it work in the short term.

Even though “leave, right away” might be the best solution, I won’t say that. Not yet. Instead, this is what you should do next:


Figure Out How to Make This Job Work for You

This should include protecting your medical license. Your license is your single most important asset. You didn’t mention unsafe working conditions, but it is common in understaffed practices that physicians and other clinicians are asked to practice outside their scope or without proper support staff. If you are asked to do anything that you feel does not meet standard of care, refuse and be loud about it. Send emails up the chain of command (following whatever grievance procedure is in place, which will be in your employee handbook). Send these emails to your own personal email as well as your work email. This will create a paper trail and hopefully will give you some legal protection in the event of a bad outcome.


Review Your Contract and Your Personnel File

It will be worth the few hundred dollars it costs to have an employment lawyer review your contract and tell you what options you have. A lawyer or internet search can tell you the laws governing the release of personnel files in your state (here, I did it for you). Check to make sure there is nothing in your file that shouldn’t be, and check again after you have raised your concerns. Yours would not be the first hospital to put negative or incriminating language in your file as retaliation for speaking up about your employment or operational issues.


Talk to Your Colleagues

They are probably as miserable as you are, and if so, you have more power as a group than as individuals. If they aren’t willing to make waves, you will have to do it alone. When I was working in a hostile and totally bonkers job, I told all my colleagues what I planned to do and that I would support them in doing whatever they felt was in their own best interest—and then I did just that. I stayed friends with everyone in that group, even those whose interests didn’t align with mine. At the time I wrote this, I am still at the job, and it has gotten better because many of us pushed for change.

Leaving terrible job


Ask for What You Want

Ask for the schedule you want and the salary you want. You say you are fairly compensated, but I doubt it. Unless you are paid for your actual FTE and at the high end of MGMA (to compensate you for the added difficulty of 24-hour shifts), then you are being taken advantage of. And don’t fall into thinking, “I won’t ask for a raise because they are being really nice and giving me a halfway decent schedule.” You are not being unreasonable by asking for a salary that accounts for your skills and training AND a schedule that is not trying to kill you.

More information here:

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If you do all this and nothing budges, you will have to leave this job. In fact, you should start a job search at the same time you are taking the steps above. Which brings me to my last point: your wife should support you in this, up to and including moving for a better situation. Partners (unlike hospital administrators) prioritize each other’s well-being. Her happiness and time with her family are important, but not if they come at the expense of your sanity.

You deserve a better job.

Have you been in a similar situation during your career? What did you do? How else could this person improve their work life? Comment below!