Rocky’s rules of the road

Each year Medical Economics holds a physician writing contest where it asks physicians to write a short essay on a particular topic. This year’s topic was “How I achieve work-life balance as a physician” and we at were pleased to sponsor this year’s contest.

We previously posted links to the winning essays but felt that there were others in the contest that shared good messages on work-life balance so we will be sharing some of them here.

The following essay comes from Dr. Rocky Khosla.

When I got out of my Family Medicine residency in 1987, I took a year to do locum tenens work, and it gave me the opportunity to look at different styles and types of practice, which in turn helped me develop rules that have allowed me to maintain a relatively healthy work-life balance, and to have some fun along the way! I would like to share these “Ten Rules of Rocky’s Road” that may help my physician colleagues develop their own work-life balance.

My first assignment was in a small town on the southern part of the big island of Hawaii. The town was supported historically by fishing and a C & H sugar plant that was no longer active. The assignment involved working in a small clinic that was attached to a 4-bed hospital, and I worked alongside another family physician. We would alternate call on weekends, and take alternate day calls. It was idyllic, and I spent three months working and loving it! However, I got island fever, and when the regional medical group made me a great offer to stay, I told them that I had really enjoyed my assignment, but had to get back to the mountains of Colorado.

This brings me to Rule #1 of Rocky’s Road: No matter how good a location sounds on paper, if it doesn’t feel right, move on.

In addition, being on call every other night can be challenging, even in paradise, because you often don’t sleep the same way when you are on call than when you are not on call!

This leads to Rule #2 of Rocky’s Road: Try to minimize the amount of call that you have to take!

My second assignment was in small town in Minnesota. This was a last minute call, and I was offered a bonus if I would take the assignment. I found myself in a town of three thousand people, where I was the only doctor, and would essentially be on call the whole time for the entire month. The clinic was busy and there weren’t many specialists around, unless you wanted to send patients to Sioux Falls, which was the closest big city and was a four hour drive away!

Rule #3 of Rocky’s Road: Don’t let the lure of a lot of money make you take on something that you will hate. You can always make more money, but you can never make more time!

My third assignment was in the state of Washington, and involved working in an urgent care center. The work was interesting, but the place really didn’t offer much in the way of activities or entertainment.

This is where I learned Rule #4 of Rocky’s Road: Pick a place where you can pursue your hobbies and passions.

My fourth and final assignment was once again in Washington, and it involved working as a civilian contractor at a local naval outpatient clinic. It was interesting work, but we civilian physicians felt resented by the military docs. I suspect that this was because we were making more money and didn’t have to salute and stand at attention when the top brass came around! The weather was pretty dismal, and it rained 27 out of the 30 days that I was there. Towards the end on my assignment, I started to mark the days on the calendar with a giant black marker.

With this assignment, I learned Rule #5 of Rocky’s Road: Pick a place where you don’t think that the weather sucks all the time! If you are a warm weather person all year round, Colorado may not be the place for you!

After my year of doing locum tenens work, I decided that Pueblo, Colorado, where I had completed my residency was really the place for me. Another buddy from residency and I started a private practice, which went really well for the next 24 years, until the Affordable Care Act made its presence known. I read through the 2000+ pages of the proposed act before it was passed by Congress, and decided that private practice would be facing significantly greater difficulties in the future. I sold my share of the practice, put my profits into the kid’s college fund, and became a salaried physician.

Through this, I learned Rule #6 of Rocky’s Road: Look around, and if you see trouble on the horizon, get out of the way!

Around the time that I became a salaried physician, the topic of concussions was becoming a hot issue in Sports Medicine, and I decided to get more involved. I traveled to Pittsburgh and got credentialed in administering and interpreting ImPACT testing. I also studied up, took and passed the Certificate of Added Qualification test in Brain Injury Medicine. I approached the hospital where I am employed and talked them into starting a concussion management program, and it has just gone gang-busters!

From this, I learned Rule #7 of Rocky’s Road: If you rest, you rust! Don’t be afraid to learn something new, as it could save you from getting burned out doing the same old thing over and over.

Now, I work four days a week in the office seeing patients, teaching residents, giving talks and coordinating our concussion management program. On my days off, I go skiing and snowboarding in the winters, and kayaking and camping in summers.

Through this, I learned Rule #8 of Rocky’s Road: There is nothing better than only working four days a week!

You may be able to make more money by working five days a week, but some things are just priceless, like having first tracks on powder covered slopes! I usually take Wednesdays off, and can’t tell you how much I love having Wednesdays off. I can work hard on Monday and Tuesday, and know that I have a day off coming, and then work hard again on Thursday and Friday, knowing that I have the weekend to recover!

Rule #9 of Rocky’s Road: If at all possible, take Wednesdays off!

On occasion, I have swapped days off to be able to attend my kids’ track meets or other special events.

This brings me to my final rule, Rule #10 of Rocky’s Road: Do what you have to do so you don’t miss much in your family’s life.

Remember, the practice of medicine can become all consuming, and it will if you let it. Its fine to be a dedicated physician, but my credo is and will always be: Family First!

I hope that my rules for the road may help make for a smoother ride for you, particularly if you are just starting out on your journey as a physician.

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