The interesting movement for docs is hours worked

We do so much uncompensated work (prior authorization, multidisciplinary rounds, pressure to join committees, multiple family member updates, etc) and the work we are compensated for is so time consuming (charting) that a regular day for most physicians balloons to 12 hours a day that people get burned out. Doctors have railed for years about this and no matter what we do it just gets worse.

What I have noticed, and been a part of, is a growing movement by most doctors to simply side step this by going part time. Even though I’m a hospitalist (and do 7 12 hour days on, 7 days off) I along with most of the older members works part time. I’m a .9 which means I get 3 more weeks off a year, currently our hospital provides full benefits down to .75, and I plan to drop to that level in a few years. The issue is as more people do this scheduling becomes more onerous, and I suspect eventually there will be push back, but for now that’s the pressure release. It’s not just my field, I know clinic docs do the same. Time is increasingly becoming the most valued commodity for doctors.

Some providers leave for a new practice environment

I now work in the SNF after 12 years as a hospitalist.

The majority of our providers in the SNF group fall into 3 categories. About 33% completed geriatric fellowship. About 50% are former hospitalists. The remainder are former clinic providers.

The 12 hour days, the after hours, giving up 50% of weekends and holidays, and the overnights pushed me out of the hospital.

The years as a hospitalist still prove invaluable in providing care, in my opinion.

I’ve been spared the night shifts for nearly 5 years

Thank god there’s people who are willing to take more money to work them. It’s a huge stress off me.

Units of work per hour

You are certainly correct about the increasing volume of mandated uncompensated work. But it is also what occurs during those hours of work that has changed dramatically.

Most physicians are paid on some variation of an RVU formula, and in some cases a base fixed salary or hourly fee. There has been little change in the reimbursement for those RVUs over the past 30+ years in dollar amounts, so inflation has significantly eroded the pay docs receive for a unit of service. In organized radiology we consider it a significant win when we can hold annual Medicare decreases to estimated overall reimbursement to 1-2%, not accounting for inflation. And of course, those decreases along with inflation are compounded year after year.

But the biggest change I’ve seen since I started practice in 1983 is the sheer volume and pace of work. That increase has allowed some specialties to maintain, or even increase, their annual income. But others specialties have not been able to sufficiently increase the volume and have seen an effective decline in compensation. The idea of having a break for lunch, even 20-30 minutes, is a thing of the past. Having time to sit and chat with colleagues or discuss a case in depth with a referring physician is long gone. Every physician I know feels that they are on a fast spinning hamster wheel and are behind the moment they walk in the door in the morning.

As just a rough guess, I think the number of cases that I interpreted each year doubled from when I started until I retired. And the volume of images and complexity of interpretation increased vastly more. What was a flat and upright abdomen with a PA chest x-ray with 3 images has become a CT scan of the chest-abdomen-pelvis with 200 to 1000 images. The reimbursement is probably 3 times what I got for the plain films. There is no comparison in the degree of difficulty involved.

The intensity of the work, the pace, and the overall volume reached a point that I know I could not do anything more. Were I to work another 10 years I know my effective income would decrease as I simply could not generate any more RVUs and the effective reimbursement per RVU will continue to diminish.