To Stay or To Go: When Cutting Back Hours Isn't the Answer

Tell me if this sounds familiar.  You’ve been working a lot lately.  Like, A LOT, a lot.  Maybe some local clinics closed, and those patients found their way to your practice: your clinic has been chockablock full, and you’re frequently getting out of the clinic after dinnertime and then charting late into the night (because it all starts again tomorrow).  Or you’ve been taking more shifts than you’re contracted to because you’re down a few faculty members: you don’t know where the patients are coming from, but your census has been hitting record highs since your previous colleagues’ departure.  You’re tired.  You’re frustrated.  You’re crispy at best and entirely burned out at worst.  You don’t see a way out, so you start daydreaming about what cutting down your clinical time would look like.  If your circumstances can’t change, maybe the way to deal with them is to be in them less often.  

You aren’t alone.  In November 2023, a study published in Mayo Clinic Proceedings found that two in five physicians, 40.3% of the 1,344 doctors surveyed, said it was “likely” or “definite” that they would cut down their clinical time in the next year.  If only some of the people currently thinking about cutting down their clinical time follow through on it, there’s going to be a big issue for patients and for those of us who stick around: the Association of American Medical Colleges is already predicting a shortage of up to 86,000 physicians by 2036.

There are many reasons physicians stay in jobs when they’re burned out.  First, we’ve been training for at least seven years to practice medicine, and by the time we have our first faculty position, some of us will have been training for much longer than that.  A sunk cost mentality makes us feel like all that time would be “a waste” if we left medicine.  Second, there can be big, bright (sometimes glaringly bright) spots to even our darkest days: a baby that gets born, an arduous surgery that goes off without a hitch, a single parent of three who gets to hear that their cancer is in remission.  Those are huge, fantastic, faith-in-humanity wins!  Third, and deeply practical, there are bills to pay, and being a physician pays well.  (I’m not up for arguing whether we’re paid what we’re worth and whatnot; I’m just looking at straight numbers here.)  If we’re going to sustain ourselves and loved ones (and oof, Sandwich Generation, thoughts and prayers to you), at least we can do it with a job that allows us some autonomy.    

If you’re daydreaming about cutting down your hours but positioned squarely in the middle of the sunk costs/medicine is still really cool/life is expensive Venn diagram, let me offer a possible solution.  In 2023, authors of a German study described, “physicians with high levels of burnout (patient-related, work-related and personal) expressed less work engagement and were more likely to plan a reduction of their working time.”  However, less than half of their cohort (about 41%) reported wanting to reduce their work hours.  What made the other 59% not want to cut back (and, by proxy, are likely not burned out)?  That quickly-looked-over word: engagement. 

Work engagement refers to a person's relationship with their work as a whole, as opposed to the granular details of the job.  “Engagement is a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption.  Rather than a momentary and specific state, engagement refers to a more persistent and pervasive affective-cognitive state that is not focused on any particular object, event, individual, or behavior.”  Authors found that “the level of (physicians’) work engagement significantly differed between physicians that want to reduce work hours and physicians that do not plan to work less.”  This underscores the importance of work engagement in our profession.

Sure, there are levels of work that are not good for us mentally or physically.  In 2019, the American Medical Association reported that among physicians working 71 or more hours a week, 57% are burnt out (compared to those working 31 - 40 hours a week, with only 36% being burnt out).  And sure, the medical system does need to change.  Nobody should be working 71 or more hours a week; that’s ludicrous, homo sapiens have not evolved to be able to do that, and it’s a person-made construct that needs to be dismantled.  But what about those of us in the 40 - 60 hours a week group?  What if we didn’t spend our time running away from what bothered us - charting perfectionism, inbox 0, insurance reimbursements, the never-ending message baskets - and spent it running towards the things we wanted to engage with?  The moment that baby is born, the spouse’s sigh of relief in the waiting room after that arduous surgery, that tearing-up gratitude in the face of the single parent whose cancer is in remission?  Doing that will get us to show up another day.  Doing that will let the annoyances fall away.  Doing that will give us the mindset and energy to change the system where we can, individually and as a group.  Talk about engagement.