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  • burnout

    serious question about burnout.

    how much are you willing to give up to decrease risk of burnout???

    for example, hospital says we have noticed that you have been working long hours.  we are concerned that you may burn out.we think another physician should be added.let's say you are on RVU based reimbursement formula, and offer to guarantee salary for new doctor.  let's say you are at 70% percentile RVU for your specialty and growing.

    are you honestly more worried about loss of income for short term or more worried about long term burnout risk?

    wild ****************** guess off the top of my head, are two scenarios:

    let's say you are a specialist making 400k and because your are a wci guy, you spend 100k.  your new pay would drop from 400k to 300 in the new model, but hopefully in 3 years you would be back... assuming reimbursements don't change, market doesn't change, etc.  you are 40 years old so been working enough to have some coin in the bank, but not yet truly fi.  i feel like these people want to power through a few years and lock in there FI and then retire.  they vote not to expand group.    (side note-if we can't offer high salary out of the gate, we won't attract a new resident/fellow anyways).

    another scenario is you are making 400k and decidedly not wci guy, so you spend 200k and save a reasonable amount, but definitely there will be lifestyle pinch if the new guy/gal is hired.  also instead of q3 call, you will be q4 call so more chances to spend money.  they also vote not to expand group.

    as i ponder the question, the only ones i realistically think that are not worried about short term income loss are the older docs and FI docs.  and i estimate these at 30% of the physician population i see (at most).  iow, despite the concerns over burnout, really we are more concerned with loan payoff, FI achievement, and high incomes to allow this.  burnout while popular to talk about, is a lower concern for most.  certainly there are some other considerations, like geography/family.  however, my wild ****************** guess is that most would not favor group expansion.  there is rather a general hope that there is some solution for burnout that doesn't involve making less money or somehow less coverage for the hospital can be arranged.

    Discuss.  throw in your own examples.  bonus points for suggestions on how to stave off burnout and keep high income earners happy.

    locums too expensive and not widely available.  no bonus points for locums suggestions.

  • #2
    It’s a great question.

    For me it was a 20% drop in production and pay.

    Went to a 4 day work week (still have heavy call burden) and it made a world of difference

    But I think it’s something we need to constantly ask ourselves

    Comment


    • #3
      I am always, always overbooked in the office. We are short staffed and actively looking for another doc. Sure, my RVU-based pay may go down because I would deliver 1/7th of the babies instead of 1/6th, but I think it's worth it to have my office days be calmer.

      Comment


      • #4
        @Q-school, our regular group meeting is a version of that discussion, 12 months per year. It’s the tension between making more money and having a better lifestyle. It’s the old, rich and comfortable vs. the young and hungry.

        My take on it is that you are more miserable when you are understaffed than when you are over staffed...BUT I did not realize it until I transitioned from young and hungry to old, rich, and comfortable, and therein lies the problem.

        Comment


        • #5
          The goal is not to have two tiers, but one steady that wins the war on all fronts.

          This does take a hard sell on all stakeholders to do this.

          Comment


          • #6
            I think you have it.  You make more money unless you burnout or you have a better lifestyle and worry about money.

            Comment


            • #7
              I've been in a group situation similar to Vagabond's and yes, the struggle is real. For groups that are large enough, allowing variable FTEs is an attempt to remedy this problem. Whenever the discussion of adding another doc was on the agenda it was always a battle of valuing time vs. money.

              For the record, while I was pursuing FI, I would always side with the add-a-doc. I valued time >> money. I was always willing to trade less call and lighter regular work days in exchange for taking a little while longer to achieve FI.

              Comment


              • #8




                I’ve been in a group situation similar to Vagabond’s and yes, the struggle is real. For groups that are large enough, allowing variable FTEs is an attempt to remedy this problem. Whenever the discussion of adding another doc was on the agenda it was always a battle of valuing time vs. money.

                For the record, while I was pursuing FI, I would always side with the add-a-doc. I valued time >> money. I was always willing to trade less call and lighter regular work days in exchange for taking a little while longer to achieve FI.
                Click to expand...


                me too (time >> money).  but at different times, i was accused of having a doctor wife (true), being old (true), being rich (subject to discussion-  but i made a lot less when i started than the new guys starting, i make less than younger partners now to maintain their professional satisfaction,  i trained for nine years, and i had a butt load of educational debt//not i was born on third base), and not being able to relate to the younger partners (possibly true but how can anyone know this)?  i was advised that my opinion was really disruptive, etc etc.  some people are not looking for illumination, they are 100% interested in their own opinion.  

                these topics are sensitive ones.    trying to convince larger groups can be a difficult issue.  we've never allowed variable FTE in our current group, but that is an issue i'd like to explore.  not allowing variable FTE i think makes some of the discussion harder.  whenever we discuss FTE, the people who want to go part time want to keep doing all the parts they like and none of the parts that everyone hates.

                i'm superinterested in the collective wisdom and experiences because i'd actually like to convince group to allow part time work over the next five years.  that's my proposal to reduce burnout risk.

                Comment


                • #9
                  Spouse and I are both primary care. We both dropped our hours due to burnout and administrators turning up the treadmill only a few years out of residency. Honestly, it was that or leave medicine. We found that our happiness shot up profoundly, and we both produce an amazing amount because we can work hard the days we are there, knowing we can rest on our days off. What did we give up? I don't think much. Initially there was a pay drop until we figured out how to maximize our scheduling. We now make more than when both of us were working full time. We really love our situation and it kept us in medicine. Others benefit too as keeps us refreshed for our patients, and, most importantly,  around for our children

                  Comment


                  • #10
                    I'm not in a group private practice setting so there may be things I don't understand, coming from an academic setting. But allowing variable FTE makes the most sense to me. Those who want to make more or have a better lifestyle can work more and those who don't mind making less can work less, essentially leaving their work for those that want more money. You could require they still take a pro-rated to FTE portion of call or whatever undesirable work there is. I think the biggest barrier is just changing the culture in your group. If everyone loves working a lot or making a lot of money, it's hard to change that mindset and it might be hard to recruit people that think differently or have different values.

                    For me though, it was an easy choice, to leave money on the table and work less in return.

                    Comment


                    • #11







                      I’ve been in a group situation similar to Vagabond’s and yes, the struggle is real. For groups that are large enough, allowing variable FTEs is an attempt to remedy this problem. Whenever the discussion of adding another doc was on the agenda it was always a battle of valuing time vs. money.

                      For the record, while I was pursuing FI, I would always side with the add-a-doc. I valued time >> money. I was always willing to trade less call and lighter regular work days in exchange for taking a little while longer to achieve FI.
                      Click to expand…


                      me too (time >> money).  but at different times, i was accused of having a doctor wife (true), being old (true), being rich (subject to discussion-  but i made a lot less when i started than the new guys starting, i make less than younger partners now to maintain their professional satisfaction,  i trained for nine years, and i had a butt load of educational debt//not i was born on third base), and not being able to relate to the younger partners (possibly true but how can anyone know this)?  i was advised that my opinion was really disruptive, etc etc.  some people are not looking for illumination, they are 100% interested in their own opinion.  ????

                      these topics are sensitive ones.    trying to convince larger groups can be a difficult issue.  we’ve never allowed variable FTE in our current group, but that is an issue i’d like to explore.  not allowing variable FTE i think makes some of the discussion harder.  whenever we discuss FTE, the people who want to go part time want to keep doing all the parts they like and none of the parts that everyone hates.

                      i’m superinterested in the collective wisdom and experiences because i’d actually like to convince group to allow part time work over the next five years.  that’s my proposal to reduce burnout risk.
                      Click to expand...


                      Unfortunately, trying to get a group of doctors to agree on anything is like herding cats. Nevertheless, it is possible to craft a workable plan if there is more than one interested in working less/earning less in some capacity. Since the baseline is to do nothing, everybody stays the same, the key is to make sure those who want to do nothing remain whole, i.e. minimal to no change in their earnings, work/call schedule. That usually means those wanting less have to make some compromises to make it work. It also helps if there are any who might even want to work more earn more, whether that be more call, more of "the parts everyone hates", etc. Proper incentives, whatever that may be, make the system work. Good luck in your quest to reduce your workload. It is definitely worth the effort.

                      Comment


                      • #12




                        Spouse and I are both primary care. We both dropped our hours due to burnout and administrators turning up the treadmill only a few years out of residency. Honestly, it was that or leave medicine. We found that our happiness shot up profoundly, and we both produce an amazing amount because we can work hard the days we are there, knowing we can rest on our days off. What did we give up? I don’t think much. Initially there was a pay drop until we figured out how to maximize our scheduling. We now make more than when both of us were working full time. We really love our situation and it kept us in medicine. Others benefit too as keeps us refreshed for our patients, and, most importantly,  around for our children
                        Click to expand...


                        You guys must have an awesome system because if I were seeing more patients in less time and then had to spend my time off charting (unclear if you do or not), then I would go insane. Can you elaborate on the adjustments you both made? Do you both work for the same employer/at the same clinic, etc?

                         


                        I am always, always overbooked in the office. We are short staffed and actively looking for another doc. Sure, my RVU-based pay may go down because I would deliver 1/7th of the babies instead of 1/6th, but I think it’s worth it to have my office days be calmer.
                        Click to expand...


                        Having non-chaotic office days can make all the difference in the world even if you're busy as snot. It always amazes me how my half day can feel more draining because of needing to squeeze everything in compared to my "busier" full days. I still can't quite always pinpoint that fine line between busy non-chaotic and busy chaotic.

                        Comment


                        • #13
                          “Pro rating” call doesn’t work because that increases the call of others.

                          As alluded to above when one wants to cut back they love to cherry-pick what they want to do and what they want to give up.

                          The way I view it. You take the same call burden otherwise you need to be replaced - or you find/pay someone to do it.

                          If you want to drop off on the other work that doesn’t impact others than have at it and work as little as you want

                          In medicine it nearly always comes down to call (at least in my specialty). No easy answers. One of the biggest issues with our profession.

                          Comment


                          • #14




                            I’m not in a group private practice setting so there may be things I don’t understand, coming from an academic setting. But allowing variable FTE makes the most sense to me. Those who want to make more or have a better lifestyle can work more and those who don’t mind making less can work less, essentially leaving their work for those that want more money. You could require they still take a pro-rated to FTE portion of call or whatever undesirable work there is. I think the biggest barrier is just changing the culture in your group. If everyone loves working a lot or making a lot of money, it’s hard to change that mindset and it might be hard to recruit people that think differently or have different values.

                            For me though, it was an easy choice, to leave money on the table and work less in return.
                            Click to expand...


                            culture is always the biggest barrier.  people want easy money and easy rvu.  if i offered them $100 for a procedure, they would do it.  if i offered them $100 for clinic, they would happily decline.   allowing part time is a difficult decision-it depends on what impact any one person cutting back has on the rest of the physicians.

                            it's easiest if you don't have to convince 12 other people to take up more work they don't like so you personally can go part time.  (this is the royal you, not you personally) 

                            Comment


                            • #15










                              I’ve been in a group situation similar to Vagabond’s and yes, the struggle is real. For groups that are large enough, allowing variable FTEs is an attempt to remedy this problem. Whenever the discussion of adding another doc was on the agenda it was always a battle of valuing time vs. money.

                              For the record, while I was pursuing FI, I would always side with the add-a-doc. I valued time >> money. I was always willing to trade less call and lighter regular work days in exchange for taking a little while longer to achieve FI.
                              Click to expand…


                              me too (time >> money).  but at different times, i was accused of having a doctor wife (true), being old (true), being rich (subject to discussion-  but i made a lot less when i started than the new guys starting, i make less than younger partners now to maintain their professional satisfaction,  i trained for nine years, and i had a butt load of educational debt//not i was born on third base), and not being able to relate to the younger partners (possibly true but how can anyone know this)?  i was advised that my opinion was really disruptive, etc etc.  some people are not looking for illumination, they are 100% interested in their own opinion.  ????

                              these topics are sensitive ones.    trying to convince larger groups can be a difficult issue.  we’ve never allowed variable FTE in our current group, but that is an issue i’d like to explore.  not allowing variable FTE i think makes some of the discussion harder.  whenever we discuss FTE, the people who want to go part time want to keep doing all the parts they like and none of the parts that everyone hates.

                              i’m superinterested in the collective wisdom and experiences because i’d actually like to convince group to allow part time work over the next five years.  that’s my proposal to reduce burnout risk.
                              Click to expand…


                              Unfortunately, trying to get a group of doctors to agree on anything is like herding cats. Nevertheless, it is possible to craft a workable plan if there is more than one interested in working less/earning less in some capacity. Since the baseline is to do nothing, everybody stays the same, the key is to make sure those who want to do nothing remain whole, i.e. minimal to no change in their earnings, work/call schedule. That usually means those wanting less have to make some compromises to make it work. It also helps if there are any who might even want to work more earn more, whether that be more call, more of “the parts everyone hates”, etc. Proper incentives, whatever that may be, make the system work. Good luck in your quest to reduce your workload. It is definitely worth the effort.
                              Click to expand...


                              thanks!  i'm not really trying to reduce my workload.  I'm actually quite happy.  I'm trying to be proactive to prevent the situation Vagabond described.  but it's hard swimming upstream.  it's easy to say no one tried to do anything.  i'm just looking for other easier to implement options in the meantime.

                               

                              Comment

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