No matter what your profession, it is increasingly challenging to find and maintain the perfect work/life balance. Physicians are no exception to this conundrum.
On the one hand, home/life pressure may come from a loving spouse, a naïve child or a doting parent who wants to make sure you’re happy and healthy.
On the other, every individual expects to be seen and treated by a physician for their malady in the most timely and comprehensive manner. A portion of the Hippocratic Oath states, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.” Physicians work with a sense of urgency and purpose and intense professional pressures.
We’re going to look at the key employment contract terms that can help physicians achieve the needed (but perhaps not perfect) work/life balance with the help of Snow White’s Seven Dwarfs: Grumpy, Happy, Sleepy, Bashful, Sneezy, Dopey and Doc.
The days of extremely long training hours in residency and fellowship have been moderated (a bit) by the change in ACGME Resident Duty Hour Guidelines. According to the ACGME standards, “Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.” Working 80 hours in one week is a lot, let alone averaging that amount over a four-week period.
Once a physician’s training is complete, most physicians realize they need a break or they will be grumpy to everyone they encounter, including patients, their family and colleagues. If taken to extremes, this may have professional consequences, as the vast majority of hospitals have rules allowing them to discipline a physician for displaying disruptive behavior. Moreover, this could violate standards in a private practice’s employee handbook relating to boorish behavior.
A physician’s contract may state the minimum number of hours a physician is expected to work on a weekly basis. The contract may not, however, state the maximum number of hours or shifts that a physician will work in a given time period. It is important that physicians confirm the expected schedule prior to signing an employment contract, or they may find that the “break” they were anticipating after training did not come to fruition. Striking the balance between minimum and maximum is very important.
There are lots of different things that can make a person happy or content. One of the most obvious elements that must be addressed or negotiated in an employment contract is salary. Be wary of a salary that seems too good to be true.
Though many physicians carry significant debt upon completion of training, taking the job that pays the highest salary or that provides the largest bonus may not be the best job fit for a physician in either the short or the long term.
There may be reasons why a prospective employer has to “over pay” to recruit a physician. Bonuses built into a contract may be illusory because the suggested thresholds can’t be realistically attained. Or it might take an excessive number of hours worked or improper billing techniques to achieve these goals. For instance, a contract that offers a physician-employee 25 percent of all revenue generated by the physician-employee in excess of three times the physician’s base salary may not be realistic if no other physicians in the employment setting generate more than two times their income.
In addition, other employers may offer non-salary terms that will ultimately amount to more value to the physician than a contract that simply includes a higher salary. Such items may include comprehensive family health insurance, CME reimbursements, board expenses reimbursed, technology stipends or reimbursement, and other business expenses.
Though a physician may decide that he would not be happy if poor (or in debt), if you’re measuring happiness by your monthly bank statement or investment portfolio, you’re sure to be disappointed. There will always be someone who makes more money and seemingly works less to reach that status. An unhappy physician should give careful thought to changing employment as soon as possible.
No one works well when they are tired. A tired physician can have life-or-death consequences for a patient. In addition to including language in the employment contract that describes a “typical” workweek, a physician is well-served to include language that specifies call frequency.
There is a substantive difference in quality of life for someone who has call every seventh day versus someone who has call every other day. Seasoned physicians may suggest that when they started in practice, they took call every night or every other night, and this is the way they built their practice. The expectation is that every physician needs to fulfill this legacy to achieve success and “earn their stripes.”
Instead, make sure that your employment contract specifies call frequency and call distribution. Confirm whether call is a week off or a week on. Confirm how weekends are handled and how weekends are measured. Does call go from Friday night to Monday morning or something else? Confirm distribution of holiday call. If “extra” call is taken by a physician, is additional remuneration provided? Though all professionals are expected to work hard and be proficient, a disproportionate call responsibility can have terrible consequences for the physician and the physician’s patients.
Physicians are trained to learn and diagnose a lot of different things. No physician can know everything. In an employment setting, it is just as important to recognize what is not known as it is to understand core competencies of sound medical practice. If a physician is not comfortable treating children or adolescents, the physician should not be bashful about stating what is in the patient’s best interest. If a physician is not comfortable performing a certain surgical procedure, a physician should not be bashful in asking for assistance.
No professional enjoys telling others about a potential weakness in a practice setting or procedure. However, to be the best physician, constant learning and innovation is required. A physician should make sure the employment contract provides adequate CME reimbursement and a CME time allowance to ensure maintenance and enhancement of skills. Many specialty boards require physicians to undergo maintenance of certification processes to ensure clinical competence and public confidence in skill sets. A physician should not be bashful or afraid to want to be the best at his or her craft. To reach that standard and maintain that excellence requires time and effort and the ability to know that improvement is possible.
The lessons that may be derived from Sneezy extend beyond the allergy practice setting. You can’t afford to sneeze at the progress being made in online communication tools.
The electronic era is upon us. Connectivity is key. Smart phones and tablets are common in medical practices. EHR and e-prescribing incentives are available, and the cost of technology makes going paperless a viable and affordable option for health care providers.
A physician should ensure that the practice setting he or she joins is focused on technological improvements and e-communications. Paper is quickly becoming a relic of the past. Sleek office space is replacing cluttered, dusty desks stacked with reference books and journals. Smart phone and tablet apps are prevalent and useful. Patients are also getting smarter as they have instantaneous online access to medical journals and diagnostic tools.
Many practices are considering outsourcing basic functions to maintain economies of scale, ensure the best patient experience and protect decreasing profit margins. A physician should stay ahead of the proverbial curve or at least not fall so far behind that it is virtually impossible to maintain relevancy and the confidence of colleagues and patients.
The temptation can be overwhelming to simply say “yes” when offered an employment contract, especially if it’s your first. But don’t be foolish about it—make sure you understand what may and may not be negotiable in your employment contract.
Be sure to understand every term in the contract. If drafted properly, every paragraph, sentence and word is meaningful. If something should be changed, make every effort to have the change made before signing.
After years of training in medical school, residency and fellowship, you should be an advocate for yourself or seek professional assistance to accomplish needed contract objectives. This philosophy applies to your first job, the next job and every job thereafter. A properly drafted contract protects the employer and the employee. The contract sets expectations for daily responsibilities and opportunities for advancement and maps an exit strategy when things do not go as anticipated.
And finally, Doc. Of any work title for an individual, “doctor” probably has the most honor and prestige. In the television and the movies, a doctor is often the hero and the savior. The doctor is intelligent, driven, compassionate and confident.
However, maintaining a medical license is a privilege, not a right. A state medical board has the authority to punish a physician for an inappropriate action. A hospital, ambulatory surgery center and third party payor can each restrict or revoke a physician’s privileges.
A successful physician is one who finds and maintains the appropriate work/life balance. The balance is different for each individual.
It is important for a physician to: not be grumpy; not think that happiness can be bought; be too sleepy and have lapses in judgment; be bashful to recognize boundaries of knowledge; sneeze at the chance to embrace technological change and advancement; or act dopey and not look to protect his or her interests in each employment contract executed.
The Hippocratic Oath states, “If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” Working as a physician is not a fairy tale. It takes years of discipline and skill. Though it is unrealistic to think every physician will sing “Hi Ho! Hi Ho! It’s off to work I go!” in a blissful state each day, achieving and maintaining the “right” work/life balance will be music to a physician’s ears and bring added joy to a stressful professional life.
Bruce D. Armon (email@example.com) is managing partner of Saul Ewing’s Philadelphia office.
Karilynn Bayus (firstname.lastname@example.org) is an associate in Saul Ewing LLP’s Health Practice.