Andrew Wilner, MD, FACP, FAAN, shares his thoughts on how to balance a career in medicine with personal life.
When I entered the world of medicine, there was no such thing as physician burnout or work/life balance. It was a privilege to become a physician. The chosen few admitted to the hallowed halls of medicine expected to devote 100% of their lives to this sacred calling. Doctors relied on their talents and skills, took full responsibility for their patients, and were modest about their achievements.
Missed children’s recitals, sports events, and vacations, even divorce, were often unavoidable consequences. If one could manage a family on the side, so much the better. If not, that was the price one paid for the privilege of healing the sick, attaining community respect, the opportunity to work as one’s own boss, and earning a better than average living. As a product of that generation, the drive to excel as a physician significantly postponed my family plans, almost permanently.
Keen competition for training programs
When I applied to medical school in 1977, only one student in three was accepted. A thick medical school admission letter came with a heavy burden of responsibility to the two students denied admission because of you.
To accommodate the growing demand for physicians, U.S. medical school enrollment has surged by 31% since 2002. Despite this impressive increase, recent figures from the Association of American Medical Colleges reveal that competition remains keen. In 2019, 21,869 students matriculated out of 53,371 applicants, an acceptance rate of only 41%.
To enroll students intent on becoming physicians, dozens of medical schools have cropped up in the Caribbean. Unfortunately, a shortage of residency training program spots constitutes another bottleneck that limits the number of medical school graduates who enter the workforce.
An inadequate response to burnout
Since I graduated from Brown medical school in 1981, the landscape of physician practice opportunities has altered dramatically. The number of solo practitioners has dropped below 20% and will likely continue to fall. Since 2016, fewer than half of physicians own their practices. Currently, approximately 90% of newly graduated residents begin their careers as employees.
The prospect of obtaining rewards such as community respect, clinical decision-making authority, and financial independence has plummeted. For as many as 50% of physicians, burnout symptoms of cynicism, exhaustion, and reduced effectiveness overshadow their personal and professional lives. Like the coronavirus, burnout has reached global epidemic levels. Responses by academic institutions, government, and private industry to systemically address the burnout epidemic are woefully inadequate.
Is it a surprise that physician suicide rates top those of the general public and any other profession?
A means to achieve work/life balance
Locum tenens offers physicians the opportunity to control their work schedules, income, and vacation time. Locums physicians choose when and where they want to work. Assignments are typically well-compensated. They are also time-limited, which always offers a light at the end of the tunnel.
Financial advantages of self-employment as a locum tenens physician include the ability to deduct business expenses from federal taxes as well as retirement options such as a solo 401k. Staffing agencies pay travel, housing, and credentialing and licensing fees, limiting your overhead. In addition to the financial benefits, locum tenens physicians often work in underserved communities, resulting in appreciation from patients and staff that is often sorely lacking in permanent positions.
As a result of physician burnout and other factors, the number of locums physicians has grown from 26,000 in 2002 to 48,000 in 2016. Educational resources like Locumstory.com and The Locum Life are likely to attract even more physicians in the future.
The medical landscape of 2020 differs dramatically from the one I entered more than 40 years ago. Job satisfaction was a foregone conclusion in the “old days” but now escapes many physicians. While not a perfect solution, locum tenens is one avenue of relief for physicians struggling with burnout, which restores control over schedules and income and can help you achieve that elusive work/life balance.
For an in-depth discussion of the advantages and disadvantages of locum tenens, consider reading my book, The Locum Life: A Physician’s Guide to Locum Tenens.