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Here, There, Everywhere

The Hospitalist. 2006 December;2006(12):

Many primary care physicians welcome the introduction of hospital medicine for its potential to help normalize their schedules, reduce interruptions to their clinic work from hospitalized patients, and moderate after-hours on-call demands. Some have found hospital medicine itself such an attractive option for balancing their schedules between work and personal commitments that they have pursued it as a career.

Internist Doyle Detweiler, MD, started closing down his medical office practice in Newton, Kan., a small town 15 miles north of Wichita, in June of this year so he could become the first full-time hospitalist at 81-bed Newton Medical Center. Pulled between his office practice and the demands of visiting his patients at the hospital, Dr. Detweiler had seen his family life suffer, with limited quality time to spend with his daughters Lilly, 4, and Hannah, 18 months.

“The worst thing was that when I’d go to work, I’d kiss my little girls goodbye and they’d still be bed. When I’d come home and kiss them good night, they’d already be in bed,” he says. “My wife would never know even approximately when I’d be heading home. So it would be difficult for us to plan anything in the evenings.” He also spent a lot of time working on the weekends.

Dr. Detweiler still faces significant time demands in his new job—at least until a second hospitalist can be brought on board later this year. But the move has already produced dividends in terms of shorter and more predictable hours. Generally, he wraps up work shortly after 6 p.m., when the last post-operative case has been admitted, and he has been called back to the hospital only three times in two months for after-hours patient crises.

“One big advantage I can see—once we ultimately get the program rolling—is that I’ll know when I’ll be working and when I’m off and checked out,” he explains. “As a hospitalist, there still will be times when I’m really busy, but it will be easier to plan something like going out for dinner at 7 p.m.”

Steps toward Balancing Work and Home Life

What can hospitalists do to find balance between work and home?

  1. Choose the job carefully. One of the most important factors in achieving a livable balance is the attitude of employers or medical practices toward the job satisfaction and sustainability of their physicians. Especially in a dynamic and growing job market like hospital medicine, it is incumbent on the physician to perform due diligence about the job and practice and to talk with those already on staff about its family values.
  2. Explore the structure of the practice. Is it sufficiently staffed for its caseload demands? Perhaps 12-hour shifts are not for you, given the evidence that they may be harder to sustain professionally in the long run. How is on-call assigned? Does the practice’s infrastructure work to minimize preventable frustrations?
  3. Know yourself. Be honest with yourself about what your real priorities are. Go in with your eyes open, be aware of what you are committing yourself to, and make good career choices. Then make sure to find and preserve balance in your life—with quality time for family, exercise, and other health-promoting activities.
  4. Explore the possibilities for greater flexibility in the job. Working hospitalists may not realize how much flexibility already exists in their jobs, notes Rachel George, MD, regional medical director with Cogent Healthcare in Illinois. When Dr. George was a working hospitalist, she would sometimes take time off in the middle of a shift for important family activities, depending on the caseload and availability of colleagues to cover for her. Although not all practices will be willing to offer this option, she believes it is a reasonable accommodation, even if it requires staying a couple of hours later at the end of the shift to wrap up the caseload.—LB