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Here, There, Everywhere


 

Many primary care physicians welcome the introduction of hospital medicine for its potential to help normalize their schedules, reduce interruptions to their clinic work from hospitalized patients, and moderate after-hours on-call demands. Some have found hospital medicine itself such an attractive option for balancing their schedules between work and personal commitments that they have pursued it as a career.

Internist Doyle Detweiler, MD, started closing down his medical office practice in Newton, Kan., a small town 15 miles north of Wichita, in June of this year so he could become the first full-time hospitalist at 81-bed Newton Medical Center. Pulled between his office practice and the demands of visiting his patients at the hospital, Dr. Detweiler had seen his family life suffer, with limited quality time to spend with his daughters Lilly, 4, and Hannah, 18 months.

“The worst thing was that when I’d go to work, I’d kiss my little girls goodbye and they’d still be bed. When I’d come home and kiss them good night, they’d already be in bed,” he says. “My wife would never know even approximately when I’d be heading home. So it would be difficult for us to plan anything in the evenings.” He also spent a lot of time working on the weekends.

Dr. Detweiler still faces significant time demands in his new job—at least until a second hospitalist can be brought on board later this year. But the move has already produced dividends in terms of shorter and more predictable hours. Generally, he wraps up work shortly after 6 p.m., when the last post-operative case has been admitted, and he has been called back to the hospital only three times in two months for after-hours patient crises.

“One big advantage I can see—once we ultimately get the program rolling—is that I’ll know when I’ll be working and when I’m off and checked out,” he explains. “As a hospitalist, there still will be times when I’m really busy, but it will be easier to plan something like going out for dinner at 7 p.m.”

Steps toward Balancing Work and Home Life

What can hospitalists do to find balance between work and home?

  1. Choose the job carefully. One of the most important factors in achieving a livable balance is the attitude of employers or medical practices toward the job satisfaction and sustainability of their physicians. Especially in a dynamic and growing job market like hospital medicine, it is incumbent on the physician to perform due diligence about the job and practice and to talk with those already on staff about its family values.
  2. Explore the structure of the practice. Is it sufficiently staffed for its caseload demands? Perhaps 12-hour shifts are not for you, given the evidence that they may be harder to sustain professionally in the long run. How is on-call assigned? Does the practice’s infrastructure work to minimize preventable frustrations?
  3. Know yourself. Be honest with yourself about what your real priorities are. Go in with your eyes open, be aware of what you are committing yourself to, and make good career choices. Then make sure to find and preserve balance in your life—with quality time for family, exercise, and other health-promoting activities.
  4. Explore the possibilities for greater flexibility in the job. Working hospitalists may not realize how much flexibility already exists in their jobs, notes Rachel George, MD, regional medical director with Cogent Healthcare in Illinois. When Dr. George was a working hospitalist, she would sometimes take time off in the middle of a shift for important family activities, depending on the caseload and availability of colleagues to cover for her. Although not all practices will be willing to offer this option, she believes it is a reasonable accommodation, even if it requires staying a couple of hours later at the end of the shift to wrap up the caseload.—LB

The Needs of Children—and Parents

The classic juggle of work and home life involves the care of young children, although that is only one of the competing personal demands on doctors’ time. As the proportion of women in medicine has grown, employers have been challenged to find ways to accommodate their staffs’ maternity leaves and child-care responsibilities, while working parents seek to accommodate their children’s swimming lessons, ball games, and ballet classes.

The generation that now dominates hospitalist ranks (average age 37, according to SHM’s “Biannual Survey of the Hospital Medicine Movement”) has little taste for the traditional image of the old-fashioned, male family doctor, essentially available to his patients 24/7. Lifestyle issues are important factors in their career choices.

Other working hospitalists want time to travel or to pursue outside interests. Their hours of work may be shorter and more predictable than for other physicians, but the pace can be intense, with life-and-death situations involving critically ill patients occurring every day. Many of today’s hospitalists also belong to the “sandwich generation,” juggling simultaneous caregiving responsibilities for children and aging parents.

Stacy Walton Goldsholl, MD, of Wilmington, N.C., president of the hospital medicine division of TeamHealth, and member of the SHM Board of Directors, faced an extreme version of these competing demands when starting her new managerial position on January 1, 2006. Pregnant with her second child, Richard, who was born in April, she was also caring for her 65-year-old father, who died of cancer in February.

“It was tough watching my dad, formerly a very robust person, truly the motivating force for my professional success, my moral compass, confidant, and advisor, as he got sicker,” says Dr. Goldsholl. “Some days I’d leave my two-year-old, Aiden, with my husband and go care for my dad, giving him his injection of Lovenox [enoxaparin] or replacing his PCA pump. My mom and I were his primary caregivers at home until we physically couldn’t handle it.”

At that point her father was admitted to a hospice inpatient facility, where she would sit by his bedside with a computer in her lap.

Dr. Goldsholl probably would have needed to take a leave of absence if she had been working as a hospitalist, but her new employers at TeamHealth gave her a lot of flexibility, limiting the number of strategic meetings she had to attend. In general, however, she believes hospitalist shift work is more accommodating to family demands than an administrative position. She returned from maternity leave full time on June 1 and now travels every week for her job; her mother, who lives nearby, fills in as her grandchildren’s nanny. But Dr. Goldsholl’s experience has sparked her interest in exploring sustainability issues for other hospitalists.

“TeamHealth’s leaders told me their turnover rate is about 5 percent for hospitalists, versus an industry average of 19 percent,” says Dr. Goldsholl. “I found that hard to believe, but when I interviewed some of our local medical directors, it turned out to be true. They were all extremely positive about their relationship with our operational infrastructure.

“There’s so much to do and so many opportunities out there, but it must be sustainable,” she continues. “In order to sustain a career, you must be fulfilled personally, which is directly related to your work/life balance.”

When she drilled down into the company’s data, trying to find out why TeamHealth is able to retain its doctors, she found that the hours they work average 7.3% less than the industry as a whole, while their compensation is comparable to others.1

For Daniel Dressler, MD, medical director of the Hospital Medicine Group at Emory Healthcare in Atlanta, Ga., hospital medicine can be a juggling act—as can his committee work for SHM—although he is able to conduct some business from home. “When we do the conference calls for SHM, half of the time I’m home taking care of our kids”—one-year-old twins—often with one of them in his lap.

Dr. Dressler and his wife had been building a new home and working closely with contractors and subcontractors when she discovered she was pregnant last year. The construction project experienced multiple delays. When interviewed in September, the Dresslers were living temporarily with his in-laws and hoping the house would be completed within another month. His wife, a physical therapist, was not working but was looking forward to returning to work.

Dr. Dressler estimates that he puts in a 60-hour workweek, including 30 hours of hospitalist shifts and the rest administrative, teaching, and education. “I don’t recommend building a new house and having kids at the same time,” he says. “Taking care of one-year-old twins is more difficult than anything I do at work. But we have a good time.”

He also tries to squeeze in a basketball game with the medical residents every weekend.

Dr. Dressler’s schedule demands reflect an additional wrinkle in terms of juggling work and family—especially in a relatively new field with huge growth opportunities and an emphasis on changing the healthcare system. Doctors must balance what is truly required to perform the job and satisfy their employers with what they do to satisfy their own standards and expectations, as well as take advantage of opportunities to advance their careers.

“There’s the balance of what’s reasonable for you at this point in your career. It’s a personal decision for everyone—[deciding] what is an adequate amount of time for each of the priorities in your life … what drives you, and what makes you happy in your life,” says Dr. Dressler. “The things that drive me include teaching and advancing the field, which means seizing opportunities to grow with this new and growing field, but hopefully not to the detriment of the rest of my life.”

I believe I am an optimist, but my advice to young doctors is this: Don’t believe you can do it all. You need to make careful, considered decisions along the way, understanding you do have control over your choices. But there’s no question that you’ll have to give up many things if you choose medicine as a career.

—Lisa Kettering, MD, medical director, Exempla-St. Joseph Hospital, Denver

A Family-Friendly Practice

Arpana Vidyarthi, MD, an academic hospitalist at the University of California-San Francisco (UCSF), has responsibilities for teaching residents and medical students and additional roles in hospital quality and safety. “It’s a somewhat different role than a shift hospitalist, with different stressors,” she says. “But there are many options out there, and one of the things that makes being a hospitalist attractive to me is the flexibility it offers.”

Dr. Vidyarthi’s husband also has a demanding job. She is able to do some of her own work at home with her two-year-old daughter, Anaiya, but estimates that her nanny puts in a 50-hour week. “I came to UCSF to do a hospitalist fellowship, and this is exactly what I want to do, with tremendous job satisfaction and a varied schedule. Yet I feel stretched all the time,” she says.

Dr. Vidyarthi credits her group practice at UCSF and its head, Robert Wachter, MD, for a supportive and family-friendly working environment. Colleague Adrienne Green, MD, agrees, adding that three of the group’s 24 physician members are pregnant at this time.

Dr. Green’s children are very interested in her work and have visited her at the hospital, which makes the work more real to them. “I’ll tell them about some of my patients who are really sick, and I’ll explain that the reason I’m going to work on the weekend is that I’m helping people get better and get out of the hospital,” says Dr. Green. “When I’m working on a Saturday and my son has a baseball game, I’ll tell him I’ll try to get to the game, but I can’t promise. But when we do have family time, we make it quality time.”

Dr. Wachter explains how he promotes a family-friendly work environment for hospitalists at UCSF: “My overarching management philosophy is that the quality of our program is equal to the quality of the people we’re able to recruit and retain. Thus, an environment that is professionally satisfying, collegiate, fun, and supportive of everyone’s personal and family goals is fundamental.”

Balancing life and work requires some give and take among the members of the group, who cover for each other when needed. It also takes a commitment to staffing in anticipation of predictable future needs for maternity leaves, sabbaticals and the like, rather than waiting for the actual need to arrive.

If my children three sons age 21, 19, and 16 were not almost grown, I could not have accepted this position. she says. But this job is my passion. For me, the key to family balance has been a supportive spouse and lots of child care and other supports.

—Lisa Kettering, MD, medical director, Exempla-St. Joseph Hospital, Denver

Making Good Career Choices

Lisa Kettering, MD, a member of SHM’s Board of Directors, has been a working hospitalist since 1998. Before that she worked in a traditional internal medicine practice. She also believes that hospital medicine offers more flexibility and opportunities for balance, with a full-time hospitalist position roughly comparable to the “part-time” private practice position she once held.

“In private practice, you’re always coming back to phone calls and piles of charts,” says Dr. Kettering. “As a hospitalist, you take care of your business in real time, instead of always playing catch up.”

A year ago, Dr. Kettering assumed medical direction of a practice of nine hospitalists and three intensivists at Exempla-St. Joseph Hospital in Denver, Colo., a position that includes significant clinical duties and requires about 80 hours of her time per week.

“If my children [three sons age 21, 19, and 16] were not almost grown, I could not have accepted this position,” she says. “But this job is my passion. For me, the key to family balance has been a supportive spouse and lots of child care and other supports.”

Dr. Kettering’s sons were born just before or during her medical school and residency, so her long hours have always been part of the equation. “What I gave up [for this career] were aspects of a social life, such as dinners out with our friends and an opportunity to work on my tennis game” and similar hobbies, she says. She has continued to run, a time-efficient form of exercise and stress management. Now that her children are leaving home, there is more time to indulge a love of yoga and Pilates and to resume a more normal social life—although she doesn’t do much cooking.

Don’t be shy about getting help, Dr. Kettering advises. She engages a personal assistant eight hours a week to help with errands such as making travel arrangements, picking up groceries, taking the car in for servicing, or wrapping the birthday presents she buys. “Not that I couldn’t squeeze in a few errands on the way home from work, but it would just be more demands on my time,” she explains.

“I believe I am an optimist, but my advice to young doctors is this: Don’t believe you can do it all,” says Dr. Kettering. “You need to make careful, considered decisions along the way, understanding you do have control over your choices. But there’s no question that you’ll have to give up many things if you choose medicine as a career.”

The biggest recommendation Dr. Kettering offers for future hospitalists is to make career choices based on a passion for the work—not on the flexible hours. Then consider how to make the job work in terms of schedules and the other nuts and bolts of practice, being aware of the varied opportunities that exist.

Although hospital medicine is sometimes described as a young person’s game, Dr. Kettering believes that if it is practiced correctly, with a sustainable work schedule, it doesn’t have to lead to burnout or exhaustion. “My practice is [composed] exclusively of doctors who have chosen hospital medicine as a life’s work—not a stopgap between residency and fellowship,” she says. “We also have a wonderful group of physicians, and there has not been a time when somebody had a family emergency that somebody else didn’t step up to cover.” TH

Larry Beresford is a frequent contributor to The Hospitalist.

Reference

  1. Compensation by Employment Model, Society of Hospital Medicine Benchmark Survey, 2003.

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