Burnout From Working For Free As Employee Physicians

A fellow oncologist and I were having a discussion on what her clinic day typically would look like. She told me that one of the reasons she was spending long hours to finish up her day was due to constant interruptions. Interruptions from the nurses, the staff, phone calls, and anything in between.

One of the biggest disruptions was about new patient referrals. When someone calls for an oncology new patient appointment, either referred by the primary care physician or a specialist, a staff member usually goes to find my friend in the middle of patient care to ask her what additional testing the patient needs before going to see her. My friend then stops what she is doing, reviews the available clinical data on this patient she has never met, and decides on what she wants to do.

For example, her clinic day was interrupted by a staff member while she was writing up a patient chart before seeing the next patient. She was asked to review that prospective new patient’s medical records and determine what else that patient should do before having a formal consultation with her. It took her at least 20 minutes to review the records, write orders and arrange for a biopsy.

That added at least 20 minutes to her clinical day, not to mention the seconds required to switch from one patient to another. Interrupted 2 more times, that is an hour. Although this is patient care, it is actually not reimbursable because my friend did not see the patient.

How many times have you worked for free as an employed physician? I am not talking about volunteering work.

Most physicians, myself included, do not think of earning money as the main motivation for going into the medical profession. We want to help other people with our knowledge and skills. Most of us do not get paid working overtime. The salary is set, often with RVU baseline requirements and incentives to see more patients.

These days, the medical system in the United States is such that employed physicians, especially in big institutions, are working hours beyond their last scheduled appointments because of clinical documentation, tasks, phone calls and administrative duties. All those extra hours are not paid for as extra effort to work. You can view it as working for free or your hourly rate is decreased.

While many of us believe in helping patients to the best way we can, we also do not think too much about the monetary compensation, to the point that we believe the regular practice of giving away our time, money and effort to take care of patients.

Close to 70% of the physicians in the United States report moderate to severe burnout. The long hours of work, the demand of the physical and mental capacities of physicians, the pressure of meeting RVUs, administrative work and other things all contribute to physician burnout. The hard work that is not recognized and instead, physicians are required to do even more.

I believe in serving and in exchange, receiving the token of appreciation with money. This does not mean that my primary focus is on making money; my focus and passion is still to take great care of my patients. Imagine if you are in a practice where you constantly give away your free time and effort. You are not sustaining the business of your medical practice and you have to close down your practice. Instead of serving patients, now you cannot serve them, and you are causing your staff members to be unemployed.

One of the steps we can do to decrease burnout is to examine our work situation. It starts with little steps to eventually have an impactful transformation. Until then, we do what we can do.

I invite you to look into your clinical practice. Is something similar happening in your practice, where you are creating or perpetuating the practice of working for free? Or even paying a price of your own? My friend is paying the price of working extra hours, mental burden and physical stamina.

Be curious about what can be changed in your practice so that you are serving and earning. I again emphasize that this is not a behavior of “money hungry”. It is only getting a fair compensation.

Let us go back to my friend’s example as an oncologist. As most oncology practices limit self-referral unless there is already an established cancer diagnosis, patients are usually referred by their doctors because of a suspicion of probable malignancy. Instead of having the staff interrupt the clinical day to determine pre-consultation evaluation, why not just make the consultation appointment for the patient? I believe in personal connections, especially in patients with potentially serious diagnoses. With in-person visit, physicians get to have a special bond with the patients, explain to them and their families about the findings, evaluation and management. That way, you are also going through the journey with the patient from the beginning. You are also getting compensated for your hard work and expertise. Not to mention less interruptions in the day, which translates to going home sooner.

It is okay to get compensated for your hard work. This is not a sign of greed. This is also not a compromise in patient care. And if getting credit for your hard work can decrease burnout, why not?