Tag Archives: doctoring

The Shift in Physician Attitudes Toward Work Hours

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Te-Ping Chen, Wall Street Journal, 11/3/24: Young Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job. (Behind Paywall)

An excerpt:

For decades, …doctors accepted long hours and punishing schedules, believing it was their duty to sacrifice in the name of patient care. They did it knowing their colleagues prided themselves on doing the same. A newer generation of physicians is questioning that culture…

Nearly half of doctors report feeling some burnout, according to the American Medical Association. Work-life balance and predictable hours shouldn’t be at odds with being an M.D., say doctors who are pushing against what they view as outdated expectations of overwork…

Changes in healthcare mean a growing number of physicians now work as employees at health systems and hospitals, rather than in private practice. Electronic paperwork and other bureaucratic demands add to the stress and make the profession feel less satisfying, they say. More physicians are pursuing temporary work…

Physicians work an average of 59 hours a week, according to the American Medical Association, and while the profession is well-compensated—the average physician makes $350,000, a recent National Bureau of Economic Research analysis found—it comes with high pressure and emotional strain…

More young doctors are choosing to join healthcare systems or hospitals—or larger physician groups. Among physicians under age 45, only 32% own practices, down from 44% in 2012. By comparison, 51% of those ages 45 to 55 are owners…

“Now, everything’s changed. Doctors are like any other employee, and that’s how the new generation is behaving.” They also spend far more time doing administrative tasks. One 2022 study found residents spent just 13% of their time in patient rooms, a factor many correlate with burnout.

My take: Over the past few years, I have heard many physicians bemoan the change in work ethic among younger physicians. In response, many younger physicians would be justified in saying “OK Boomer.”

Medicine has changed a lot and it’s not surprising that young physicians’ attitudes have changed. Health care is increasingly more business-oriented and less personal. Private equity, insurance companies, hospitals, and pharmaceutical companies are each trying to monopolize/consolidate. At their whim, small practices and independent pharmacies can quickly be crushed. There is increased demand for documentation/audits, increased requirements for authorization for needed care, increased educational costs, and social media misinformation. None of these trends prioritize patient care.

While some older physicians are worried about work ethic, many are glad that they are not starting their medical career/calling in this environment.

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Is Medicine a “Calling?”

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A recent thought-provoking commentary on medical training delved into the issue of “workism” and sacrifice in medicine. 

L Rosenbaum. NEJM 2024; 390: 471-475.On Calling — From Privileged Professionals to Cogs of Capitalism?

Dr. Rosenbaum notes that some believe using the concept of medicine as a “calling” is “weaponized against trainees as a means of subjugation — a way to force them to accept poor working conditions.”

Some excerpts:

  • The sacrifices that once brought physicians spiritual fulfillment have increasingly been replaced by a sense that we’re simply cogs in a wheel.
  • Historically the missions of trainees and hospitals were better aligned…there was a shared commitment to serve vulnerable people. Today,… most hospital boards and leaders — even at so-called not-for-profit hospitals — increasingly prioritize financial success. Some hospitals view trainees more as an inexpensive labor force… As educational missions are increasingly subordinated to corporate priorities (such as early discharges and billing documentation), sacrifice becomes far less appealing.
  • [Some younger doctors are] disheartened by what she saw as medicine’s dismissal of people’s pain, poor treatment of marginalized populations, and tendency to assume the worst about patients.
  • My interviews with trainees, educational leaders, and clinicians suggested that efforts to keep work from consuming life have unintentionally increased resistance to medical education’s demands… Some trainees insist that expectations to read up on patients or prepare for conferences violate duty hours.
  • Educators recognize changing norms… And many worried that they were guilty of the generational fallacy — a tendency sociologists call “kids these days” — of thinking their own training was superior to the next generation’s.2 

My take: Whether medicine is a job or a “calling,” like the author, I view doctoring as sacred work. There are many parts of this work that cannot conform to a 9-to-5 schedule. Some work cannot be delayed to the next day and some work can be difficult to delegate. Yet, I definitely understand how a focus on documentation/billing rather than patient care could result in physicians (young and old) not wanting to ‘go the extra mile.’

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