Who works harder on vacation?  Who takes less vacation?  Who drinks more caffeine?  Who sleeps the least?

These conversations are common in medicine, but likely also common in many other demanding fields.  The finance mavens on Wall Street work as many hours as most physicians, however their “work-life balance” doesn’t seem to be as widely discussed (as far as I can tell, not being a maven).

They entered a field that’s about money, they work extremely hard, often with hope and/or promises of a high income.

There’s little dissembling about money as a motivating factor.  That doesn’t mean people working 90 hours/week for Goldman Sachs in New York City don’t enjoy their job or find purpose in it, but they’ve entered into a different compact with their profession than doctors, or healthcare professionals in general.

This is the latest (and final, for now) post in the Life in the Ivory Tower series.  Read the first four parts here:

1. Guest post on academic vs. private practice medicine
2. Money in academia — it’s not about the $!
3. Politics in academia — aka what Kindergarten and Universities have in common
4. The quality of medical care — we’re the best!

Future entries in this series will be able to be found here.

What motivates?

As mentioned earlier, it’s not about the money.  It is of course about money to a certain degree.  Most physicians in this country would not have entered the field if it paid the salary of an elementary school teacher (I know some who would, but most would not.  It certainly does not  make financial sense to take $400,000 in loans for a job that requires a decade of extra training and only pays $50,000/year).

Money aside, most physicians view themselves as altruistic.

Regardless of specialty, geography, or patient demographics, we are ultimately a service industry that is focused on something incredibly important — the health of others (again true for other healthcare professionals, so generalize as needed).

Patients may not be customers to us, but they ultimately are the raison d’être.

Physicians whose jobs are entirely patient-focused, i.e. entirely patient-care and not administrative, educational, or research responsibilities, make up the bulk of physicians in this country and elsewhere.

While it is this group providing most of the patient care, it is the physicians in the Ivory Tower who often view themselves as the stewards of the profession.

We’re the stewards of education, training the next generation of physicians.  We’re the vanguards of research, identifying new ways to improve health.  Oh, and we’re among the lowest paid.

Why do I keep bringing up money, when it’s not about the money?  Because the money contributes to the mindset.

Doing More For Less?

When I work in the ER, my shift can be as busy as anyone working in any ER.  I can see anywhere from 20-40+ patients in 8 hours and provide care for a variety of patients/conditions, including extremely ill patients.

When I am not in the ER I am working on grants, papers, lectures, etc.  I even oversee/partially teach an undergraduate course.  Everything a good academic doctor is supposed to do.  Whether or not I do a good job of all those things is a separate discussion.

What this means is my total workload in terms # of hours is higher than an ER doctor who only sees patients.  There’s no “end” to my non-clinical work.  It can consume every moment of every day, if I let it.

While I believe I am better at setting boundaries than others, I still fall into periods where I am overwhelmed with deadlines and projects on top of regular clinical work.

The academic ethos + the doctor mindset means I’m not supposed to admit that to outsiders — we’re not supposed to show weakness.

Doctors certainly discuss it internally — I know physicians in all settings who are overwhelmed by their workload, burned out, etc.

Not taking time for themselves, not eating well, not taking real vacation, or not being able to take a real vacation because of their work obligations.

The Ivory Tower doctors are not special in this regard.  Doctors are not necessarily special in this way — this is where American culture differs from many other countries.  We work more hours and take less vacation than many others.

Europeans think we’re misguided and need an attitude adjustment.  We think they are European, and we won the Revolutionary War so we can do what we want.

I never became addicted to coffee, but I often do not sleep enough.  Because of my clinical and non-clinical obligations, I have something to work on 7 days a week.  Email alone is a full-time job.

Who Needs Vacation?

About a week ago I received an email from someone asking me to answer some questions about a project, and to respond within a week.

It was the day before I was leaving on vacation with family, with limited cell/internet access.  When I returned from the trip, I had to use part of the vacation to finish a large grant application I was submitting and finish a presentation to deliver at a national conference (the presentation to be given only a few days before the grant was due).

I explained this and told them I would work on it after I submitted my grant — a week after their deadline.

An hour later after I received a response from someone who was not on the original email.  The boss overseeing that entire group, someone who does not directly oversee me, but who wields enormous influence, somehow got involved.  It was a short, polite email that began, “I appreciate that you are busy, as we all are.”

The individual indicated the work should be easy and straightforward, that someone on my team could provide preliminary answers and I could just review/approve them and that would be all.

Regardless of my intention to do the work, I had two schools of thoughts on this:

1. Resign myself to the extra work without internal protests, because that’s the way it goes.  Once the head honcho is asking, it would take some big cojones to say no.
2. Protest!  I’m on vacation and already working!  I shouldn’t be asked to do a trivial task while on vacation while already working on other higher priority things.  It’s bad enough that I’m using vacation time to work, it’s worse that someone is trying to guilt me into doing more, especially if it’s trivial.

So what did I actually do?

I internally protested.  Then I responded we would do our best to meet their deadline.

We met the deadline.  They promptly sent a request for more information, which we have to obtain from someone else.  So the task is not yet complete.

There it is.  Life in the Ivory Tower.

We’re all important, we’re all busy, which means none of us are.