Physician Burnout and The Locum Tenens Sabbatical
Physician burnout is a very serious problem. According to a 2015 Medscape Physician Lifestyle Study, over 45% of practicing doctors admitted to feeling burnout, and what is even more scary, that stat was up 7% since the study done in 2013. If we extrapolate the data, that means we are somewhere close to 50% burnout as I write this article in 2018. Think about what that means for practicing doctors, it’s downright scary! For us as physicians it equates to decreased quality of life, increased risk of physician depression, higher rates of substance abuse, higher medical errors with associated malpractice cases and even increasing risks of physician suicide. For our patients, it leads to declining quality of care and for health systems it means a loss of productivity and physician attrition. Despite clear data to support this massive issue, it’s not looking like health systems are doing anything to make it better. Let’s all just put our heads in the sand and hope this issue goes away, right? Wrong. The situation isn’t getting any better with increasing physician shortages, workloads, and non-clinical demands. So how do physicians manage this level of stress and burnout?
In a recent article by The American Academy of Family Practice (AAFP), the five main causes of burnout were defined. To start, the clinical practice of medicine as a whole is stressful. We all have personal experience with sick and dying patients and their families, some specialties deal with this every hour of every day. In some scenarios the outcomes may even be out of our control, a situation that drives in more frustration and stress for the practicing doctor. Medical schools and residency programs have worked to increase education on stress, but as a whole, the “tough it out” mentality persists, despite its clear lack of effectiveness. The second cause of burnout relates to the management of your personal job. Such things as keeping track of wRVUs, compensation formulas, politics, and personal call rotations within your health system can sometimes feel like a second job. Managing your own practice? The situation gets even worse with declining reimbursements and increasing demands, leading to feelings of stress and depression that have nothing to do with patient care.
The third reason doctors are feeling run down relates to our lives outside of the patient rooms and our offices and focuses on our personal lives. In an ideal world, we would balance our time and energy equally between work and family, but as physicians we continue to say yes to more and more, our families suffering as a result. We all know the quote, “the worst thing about being on call q2 is missing half the cases”, but this false reality has led to abnormally high divorce rates and piles even more pressure on to doctors who value their lives outside of medicine. On a similar note, the fourth reason doctor’s burnout relates to the individual personalities that initially attracted us to medicine. “Perfectionist, workaholic, early to arrive, last to leave” were how I was decribed on my residency application, and these traits were considered necessary to get into that top tier training program. The idea that we can never show weakness or not know the correct answer is not only unreasonable but its detrimental to your health.
The last item driving burnout relates to our superiors and how their leadership skills develop an environment of stress. This one is outside of your control, but think closely about the milieu of your training program or first job, did it mold you to be similar to your ancestors? I’d be hard pressed to tell you that 6 years of surgical training in a high powered academic center made me a softer, more compassionate person to my junior residents. I wish I could tell you I was more gentle to them than others were to me, but it isn’t 100% true. Or perhaps you are out of training, 10 years into a career with quotas and metrics to meet in your practice or health system, do you take the time to advance the environment of your junior partners?
When we look critically at this problem, we find the issue is somewhat too large to fix easily, especially if you are immersed in the “don’t show weakness” environment every day. What’s the solution? Well, there are several things you can do in your own practice to combat stress, depression and burnout. We recommend all practicing physicians attempt some, if not all, of these items. Such things as automation of your EMR and order sets. Yes, there is upfront work in this, but studies have shown that doctors who take the time to efficiently build their templates will be rewarded in the long run. In addition, team building exercises with your physician and non-clinical colleagues can improve morale and comradery. Making your work a more enjoyable place can lessen the harsh blow of the medical work. Physicians can also start to say “No” more frequently and create more space for themselves. There has to be a better life balance and we have to start protecting ourselves and our families. What is more important, your daughters dance recital or that 5 o’clock meeting about the JAHCO visit in 9 months? With all this said and done, many doctors just can’t seem to disconnect from the stress and constant pull of their work. We all have heard the new trend in digital vacations, where you disconnect from your computer, ipad, and iphone for a week. It does miracles for many and made us wonder if a disconnect from your work for a short period may also have the same refreshing results. In that, the Locum Sabbatical was born.
The term sabbatical typical refers to a teacher or professor taking time away from their profession after they have put in a certain amount of years to study or travel. Typically, a teacher would receive one year of sabbatical for every seven years of work! Now we aren’t advocating that everyone needs a full year off to combat their stress and prevent burnout, but when we think critically about the idea it makes a lot of sense. Physicians are teachers in the purest sense, to both their patients, colleagues, and families. We recognize the need for continued medical education and most of our specialties have requirements for licensing that mandate certain credits or hours every year. So why do many doctors take the easy way out and sign up for quick last-minute CME courses and tests, or even worse, fake their CMEs to avoid penalty? Shouldn’t we be dedicating more time to educating ourselves and protecting our health? The clear answer is yes.
A locum tenens sabbatical may be the sweet spot for many doctors looking for a life rebalance, allowing for maintenance of clinical experience while increasing dedication to family and self. In addition, it eliminates some of the major barriers to entry into the locum tenens world by preserving the benefits that are still associated with your permanent job. Most physicians choosing a 3, 6 or 12-month locums sabbatical will find that although they may sacrifice their prior salary, the locums contracted rates will most likely be higher than the 50% MGMA averages. We aren’t saying that we can guarantee that everyone will break even or even be allowed to do a sabbatical but choosing a location and practice structure can bring the return for your time higher while allowing you the needed time to focus on your well-being. The real benefit to a sabbatical relates to maintenance of benefits. Short term locums sabbaticals are often well received by health systems and large groups, as the cost and headache of replacing a doctor who leaves because of burnout is much greater than allowing an establish physician to take a needed break. The chief medical officer you work with knows all too well that to find, hire, train and market a new doctor will cost much more than allowing you to take a locum tenens sabbatical and maintain your existing benefits and return to the position as a stronger person. Most will allow you to keep your health, malpractice and group disability insurance through your existing company for the time you are away. Full transparency here, some of your health systems or practices will not be on board with the idea of a locums sabbatical, especially those in highly competitive areas or specialties. In addition, if you are feeling burnout, chances are your partners or colleagues are as well. We understand they may feel upset or even anger about the idea of you taking a position away for several months and perceive you as dumping more work on them. In some situations, your prior practice may consider a locum tenens swap. You may be able to negotiate a locums replacement for yourself at a similar rate, making the work impact and finances minimal to your colleagues. However, with this said, we need to remember who comes first, it’s you and your health, and this replacement work may be best left to your employer to handle. Lastly, your current position may allow you to take a locums sabbatical but require you to find your own benefits for the time you are away. Most commonly, the prior employer will not allow you to utilize their malpractice as technically you are not representing them in this work, and you will need to secure malpractice for the locum tenens assignment.
The last benefit to a locum tenens sabbatical, one designed to give you the mental health break you need from your current situation, relates to the major issue at hand. Perhaps you didn’t realize that the position you have is not suited for your personality but were unaware while in the thick of things. A locums assignment in a location or practice you are (or should be!) considering may allow you the opportunity to see what else is out there before making a permanent move from your current stressful position. Always wanted to live closer to family? Maybe you take a locums sabbatical near them and see if this improves your happiness. Living in Michigan and dreaming of the Florida sun? We know those cold winters can add to your stress and perhaps a few months in nice weather will give you the perspective to know what is right for you.
Physician burnout is a problem for our country and industry, but more importantly, it’s a serious issue for our health. Utilizing the concept of a locum tenens sabbatical may allow more physicians the much needed break from the stressful position and provide the opportunity for a little self-care. On a short term basis, it may be easier and more beneficial then you expect, but the details need to be worked out to maximize your individual situation.
~The Locums Life~