Flexplans for MDs

I have become convinced that when it comes to work-life balance in medicine, you can structure the hours however you like shift work/call, but ultimately it comes down to how many patients you can comfortably manage as a provider which should be up to each physician to determine for themselves. Interestingly this goes to a huge area of cost on the hospital financial side namely the tension between every increasing demands of hospitals to churn more volume and “decrease” costs and efficiency by working the docs harder which leads to hospital turnover and decreased continuity of care. What if we had a system where physicians could adjust how many patients they see? I suppose this happens already in primary care. And from at least one of the studies looking at physician job satisfaction, it certainly seems like office based practices where it may be easier to titrate ones cases rather than high paying high volume practices (hard to turn down emergency room volume, trauma surgery cases) lead to less job satisfaction

http://www.medfriends.org/job_satisfaction.htm

Maybe pain medicine is starting to look a bit better!

On Self-motivation

You know that feeling you get in the morning when you just don’t wanna get out of bed. Maybe you had a late night, maybe you’ve been deprived of sleep all week. But you know you have to because 1) you gotta get your day started 2) you are getting out of shape 3) its fun (once you get going).

This sense of universal inertia is a fundamentally human part of all of us. It struck me today (as I finally got myself on the treadmill this morning) that overcoming this “mental inertia” is the fundamental challenge underlying much of leadership, marketing, medicine, economics. I mean, if you can’t motivate yourself how can you claim to be able to motivate others? If you can’t get yourself to take the pills four times a day, how are you going to market this pill to docs/patients?

It strikes me that this inertia is fundamentally a neurochemical problem. It is no coincidence that Apathy is a characteristic symptom of depression, schizophrenia and many other extreme psychiatric disorders. Overcoming this in a non exogenous way really then lies in altering both our long term neurochemical balance (days and week) as well as our short term balance. I think the best polypharmaceutical here are things like exercise, meditation, a positive state-of-mind and things that give one positive bolus of endorphins. I wonder if things like 10 jumping jacks or relaxation breathing in lieu of long term maintenance stuff may be efficacious as well? I also believe that negative modifiers such as self threats “if I don’t do this now”, poor mood, bargaining are helpful to a point but do not work by themselves to steel the will to act.

The moral of this story is not new nor mindblowing, we need to be happy and balanced in our lives and in our neurochemistry and that will do wonders for us in the short term. In the meantime, beating oneself up has its limits, perhaps a little jolt of energy from short term versions of neurochemically modifying activities can be helpful?