At least one commentator has opined that “physicians aren’t burned out. They’re abused.” That is an extremely accurate diagnosis. No matter how many mandatory meditation sessions physicians are required to attend during their lunch hours, they remain overworked, overstressed, and unhappy with their careers.
Although there is no easy fix, there are issues that can be addressed in the physician employment agreement that can ameliorate the horrible working conditions foisted upon most physicians.
One issue that can provide physicians some relief concerns patient contact hour requirements in physician employment agreements. Too many agreements simply provide that the physician is a “1.0 FTE.” (“FTE” is corporate speak for a “full-time equivalent”). Frequently, the agreement provides no clarification as to what this means.
In my negotiations with health systems, I have frequently been told that an FTE means the physician should work 40 hours per week (exclusive of call, of course, because physicians should be expected to provide call, up to 24/7, as a normal part of their lives). Few physicians would argue that 40 hours per week is reasonable. In fact, I suspect most physicians dream of a position where they work 40 hours.
Any physician knows that seeing patients is only one aspect of their job. In addition, they are required to maintain charting, convince nurses employed by the managed-care companies that the prescription or procedure they ordered should be covered, etc. However, many health systems attempt to press the position in negotiations that a physician is only “working” when the physician is in direct contact with a patient.
The massive time commitment entailed in a workweek with 40 patient contact hours can be modestly reduced by designating patient contact hours as part of a definition of “1.0 FTE.” When I am negotiating with hospitals, I attempt to insert a definition that 32 patient contact hours per week represents an FTE for a physician with no nonclinical duties (i.e., no duties as chief of the department, medical director, committee chair, etc.). Incredibly, I have frequently been informed that “working less than 40 hours per week is a part-time position.” Hospital administrator seem to believe that giving a physician eight hours a week to accomplish administrative duties is the equivalent of a four-day workweek.
Nevertheless, when pressed, most administrators will admit that physicians have responsibilities over and above the time spent with patient contact. I have found that administrators are becoming more accepting of the concept that physicians are “full-time” even if they are scheduled for something less than 40 patient contact hours per week. Although I don’t always obtain 32 patient contact hours per week as a definition of full-time, I don’t believe it is an exaggeration to say that 36 patient contact hours per week is approaching the norm.
Will reducing patient contact hours to allow more time for administrative duties end physician burnout? Hardly. But anything we can do to slow down the hamster wheel that has become physician employment has to help, if only a little.
Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be reached on Facebook and LinkedIn.
