Rural's Schedule: How to Have a Life

I received an email from a prospective medical student last week, asking about how I manage work/life balance and see my family and friends. This is one of those excellent questions that has no easy answers. Ask five doctors, you'll get five different answers. So here's my $.02.

Let's start with my schedule for June 2008 (click here for a full-screen image):

Overall, not a bad month. I get six days off. In fact, I'm in the middle of the first group of three days off right now. Of course, I've been sucked into covering a little bit of call because one of the midwives injured herself, but that was not anticipated on this schedule.

A few notes of explanation:

• Night Hosp: available at 3pm, pick up admissions after this time and up until 11pm, cross-cover until 7am the next morning
• Day Hosp: available at 7am, round on hospitalist service, do all admissions that come in after midnight and up until 3pm, usually leave hospital at 6 or 7pm
• OB Call: phone calls, triage, care of laboring patients and newborns, C-section assists from 8am until 8am the next morning
• PM Clinic: Usually 1:30-4:30, sometimes 12-2 if I have Night Hosp
• AM Clinic: Usually 8:30-11:30
• Outreach clinic: one Saturday a month, usually 9-3pm
• Obviously, double-dipping (scheduling more than one obligation per day) is acceptable and practically the only way to make being on call pay off.

When I consider my schedule, I look at a number of factors that makes my work bearable:

• How much do I get to sleep? I tend not to sleep well on Night Hosp or OB Call days, just because I'm one of those people who worries she's missing her pager going off. Some doctors can fall asleep mid-sentence, wake up and do some highly technical procedure, then immediately nod off again. Not me.
• How many days in a row do I have to work? Ideally not more than 7 in a row, but I have worked 14 or more days in a row many, many times since moving to Rural, CA. Once, I scheduled myself to work all but 2 days out of 30. Mistake. There needs to be some breathing time in your schedule, otherwise you run out of laundry and self-respect.
• How many places to I have to go to? I always prefer not to create a schedule in which I can potentially be expected to be in two places at one time. An example is running late in clinic when I'm supposed to be on Night Hosp. I try not to do this too often, otherwise it stresses me out.

It is also critically important to look at your quarterly schedule to see how much you are working. I find that going more than 10 weeks without a substantial (i.e. long weekend) break makes me crazy. Once, on week 11, I announced to the hospital staff, "I need to get out of Rural for a few days." That afternoon, I drove to San Francisco (6 hours). I spent two days there taking photos of Thai restaurants and the shopping aisles at Trader Joes. I felt much better when I went back to work the next week.

But, I hear you saying, but, but...what about having fun?

I have fun. I enjoy my life. Some days more than others, perhaps, but I do enjoy it. I might approach having fun a bit differently than some people. For example, I never get to go out at night to the bars, or even to see a movie. I don't go clubbing. If my idea of having fun was being Andy Warhol at Studio 54 every night, I'd be miserable. But that isn't my idea of fun. Sounds like purgatory to me.

Over the years, my idea of fun has evolved into creating "boluses" of creative time. I learned this in residency, where you must be extremely strategic about scheduling time off. Rotation schedules were established at the beginning of the year, and call schedules quarterly, so obviously I was never going to be able to drop everything and go to Bali for a week. What I learned to do instead was identify events and opportunities that would recharge my batteries--attending a craft retreat, visiting my best friend on the East coast--and schedule everything else around it. I still do this. How?

1. Identify everything you'd like to do in the upcoming 12 months. If you can find out when things are going on even earlier than this, more power to you. Go to event websites and find out when things are scheduled for 2009 and 2010, call up your relatives and find out who's getting married or having their Golden Anniversary Party. Make it known you need to know ASAP.
2. Sit down with a pencil and a year planner (I used the fold-out organizer from Levenger) and write down all the dates collected in Step #1.
3. Immediately put in for time off during the dates you have identified. Make notes to yourself of when you made requests and whom you spoke to. Keep copies of time off forms.
4. If you have call obligations that will be interrupted by your plans, look at least three weeks before and after each event and determine whether you can take call during those times. You need to offer flexibility to your call group when you inform them of your time away.
5. Try to schedule only one major holiday away per year. If you are always asking for Thanksgiving, Christmas AND New Year off every year, you will be justly hated by all.
6. Conversely, if you are like me and are not attached to working on major holidays, you can volunteer to work on these days and use that as leverage to get time off when you really want to be away. 
7. If you have several events clustered close to each other, resign yourself to a dense working schedule when you are home. This is the price you pay for your precious time off.
8. If you do not earn time off at your job, make sure you budget for your time away. Start a separate bank account for time off. Even if all you want to do is sit at home, you need to have some money banked for non-earning days.
9. Make sure you tell everyone you're leaving a day earlier and returning a day later than you actually are. Otherwise you'll find yourself on call five minutes after you pull up into your driveway. 

This is my preferred way of taking time off. Other people require at least a few evenings and weekend days off every week, to spend time with children. In that case you are better off with a scheduled call day and a regular shift/clinic schedule rather than the mishmash I have.

I know I haven't presented a very rosy portrait of a doctor's work/life balance, but then again this life isn't all roses, is it? If you want regular hours, ten holidays and four weeks of vacation per year, and don't like the idea of a 12-hour shift unexpectedly turning into a 16-hour shift (and this happens all the time), then medicine probably isn't the life for you.

It should also be said that, if you're willing to limit your income potential, you can elect for part-time work and have more free time. That is not a bad strategy and should not be dismissed. I do believe, however, that newly-minted doctors should expect to work full-time for a few years before falling back to a part-time position. Why? Because--trust me--you didn't learn everything during your residency. You barely touched the tip of the iceberg. I had a very wise preceptor say to me once, "Your first job will be your second residency." He was right.

Comments

[Christian Sinclair]

I totally agree with point #9. This has taken a long time for my doctor/wife and I to realize but it is well worth the time.

Great post!

[Liana]

Good list. Very useful for a rural family med resident who's going to be entering practice in 2 weeks (aka moi).

[flo]

*"nice of you"it has to be of course

[flo]

Really nice for you to give us an example of good organization. :)