This is the final essay we are going to share from this year’s Medical Economics essay contest. It comes from locum tenens physician Steven Gordon.
“I don’t understand it,” I said to my wife during our nightly phone call. “I’m going to the gym every day, I’m doing recreational reading and recreational writing, I’m socializing down in the Commons almost every night, and I’m sleeping as much as this Arctic summer will allow. But I just turned in a timesheet for 63 hours.”
“How many hours do you think you used to work?” she asked.
“I always said 54 hours a week.”
“Maybe you should do a recount.”
I made the phone call from Barrow, Alaska. Now called Utqiavik, it is and was the northernmost point in the US. I chose it over a spot that would have paid 50% more.
Coming up to my 60th birthday, I knew that if I didn’t slow down, I would burn out. And, with 68% overhead, I couldn’t slow down at the practice I had helped build. So I found a part-time spot with another place.
But I had a non-compete clause in my contract. My lawyer assured me it would never stand up legally in the 21st century, and was pretty confident my soon-to-be ex-partners wouldn’t haul me into court over it. In the end, I decided that I had signed it 23 years ago and I knew all along what it meant, I went ahead and honored it.
Ironically, it led me to the best year of my life.
After a couple of false starts, I made arrangements to hit the locum tenens trail. With a hefty buy-out coming from the sale of my part of the practice, I didn’t worry about the money. I went for the adventure. And what bigger adventure than a whaling village on the shore of the Arctic Ocean?
So, on my wife’s advice, I added up my hours according to the same criteria I used for Samuel Simmonds Memorial hospital. I applied it to call, and to the dreaded Work After Clinic, the hours one puts in after supper finishing up documentation. With hospital rounds starting at 6:30AM, the last clinic patient done at 5:30PM, 2 hours of documentation 4 nights a week, and a 1 in 6 call schedule, I came to 84 hours a week.
I had achieved tremendous efficiency but at a terrible emotional cost; I had no flexibility in my life at all.
And, worse than that, in the evenings I would whine about my patients; I had started to lose empathy.
From May 2010 to June 2011, I worked in Barrow (Utqiavik), Alaska (8 weeks in the summer and 6 weeks in the winter), rural Nebraska, rural Iowa, and both islands of New Zealand. My wife accompanied me after the first 6 weeks.
During those 54 weeks, I cut my hours by 30%, my income by 20%, and my stress by 90%. I took 12 weeks of vacation and CME. My wife and I discovered we love to fish.
After that first year, I worked 3 years for Community Health. I signed up for a 30 hour work week, but eventually mission creep put me back into Locums land.
And now Mondays bring a special zip to my step when I go into a clinic or hospital. I look forward to taking care of patients, and my empathy has improved. I am fond of saying that perfect people don’t come to see me, and that the worst historian and the most flagrant drug seeker deserves my best work, every time. I love my work passionately again.
When I worked 84 hours a week, at the noon hour I would inhale calories without tasting them, as I frantically tried to document or to make phone calls.
I schedule work around family time instead of vice versa. I pick the assignments I want, and sometimes I get paid to go visit my children. When a close college friend had a major medical problem, I took a couple weeks to visit. I have time to go on fishing or bicycling trips with my wife. I write a blog, walkaboutdoc.wordpress.com; I’ve written a couple of novels (not yet published). I get plenty of exercise, I practice target archery, and from time to time we visit the children and our new grandson. If I go to CME, I pay more attention and acquire more new information.
I got Rosetta Stone and learned French, and now I’m learning Mandarin.
On some assignments, I take call, and still, on those nights, vigilance murders sleep. But when I don’t have call, I waken rested without an alarm.
My wife and I travel together for most of my assignments. As a teacher, she finds work easily when she wants to. She finds adventure in the travel, as well.
One of the most wonderful moments we’ve had as a couple came when we arrived in New Zealand. We ran into an immigration delay, and as we lay on the airport floor in Auckland with our feet elevated on chairs, we held hands and talked about what we would do if our plans fell through.
“Where shall we go next?” we asked each other.