Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Labor Day

This past weekend’s Labor Day holiday has me thinking about the workweek and the current schedule followed by many healthcare practitioners. In the medical profession, we have such a varied set of schedules, that it seems almost impossible to talk about a “workweek.” For example, if you’re a ward nurse working in a hospital, you may work four 12 hour shifts a week. Or you might be an emergency room physician working three 24 hour shifts a week. If you’re an office-based physician, you’re likely to work whatever hours are necessary – usually far beyond any “standard” time period. This holiday had me wondering, is a typical Monday to Friday workweek reasonable or even realistic for us anymore?

History

The older I get, the more often I find myself looking to the past for perspective. Where did the 40 hour, 5 day workweek come from? A quick Internet search found that during the Industrial Revolution, the typical work day for adults and children was around 14 hours. In 1919, the International Labor Organization created the 8 hour work day with a 6 day per week schedule. Then, in 1938, President Roosevelt signed the Fair Labor Standards Act, establishing the United States’ modern 5 day 40 hour per week standard workweek. In the United States, certain cultural and religious influences, such as the Jewish Friday night to Saturday Sabbath as well as the Christian importance of Sunday, made these two days our current end of the week.

The “Modern” Workweek

For many workers in the United States, the 8 hour, 5 day workweek remains the rule. However, for many (most?) of us in the medical profession, these hours seem more like wishful thinking rather than reality. Think first about the training we undergo. During medical school of any sort (pick a specialty, any specialty) we spend ungodly numbers of hours in and out of class for variable years learning all that medical science has to offer. I can recall my own schooling, with an average “day” lasting around 16 hours (class and study time) every day without a weekend (those were golden study times). Today, many of my students currently study similar hours, with the expectation that they will not be successful without contributing this kind of effort. Similarly, residency training requires an incredible number of hours. Most of us have heard about the mandated work limitations for medical residents which occurred as a result of terrible costly mistakes due to exhaustion. Residents are now limited to no more than 30 continuous in-house hours with a total of 80 hours per week averaged over a 4 week period ⁽¹⁾.

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What about those of us in active practice? Of course, there are no such mandated limitations on our workweek. Those who are sole practitioners will attest that every hour spent actively seeing patients brings income to the practice, while taking a day off – for any reason – loses money for the practice. Close the doors, close the income stream. An innate pressure exists that drives many sole physicians to work ever increasing hours. During my training in Michigan, many of my attendings had spent years of their practice lives working not only Monday through Friday but also holding office hours on Saturdays and late evenings (after 5 PM). Bankers hours? Ha!

When I started in practice as an associate for another physician, I didn’t have to hold office hours on weekends. But with taking call at 3 different hospitals, and often doing surgery during the late evenings, (“Pus doesn’t take holidays” or weekends, according to one of my attendings during training) I went far beyond the typical 40 hour, 5 day per week schedule.

Currently, as an actively practicing academic podiatric physician, I average about 12 hours per day during the week, with at least a part of my weekends and evenings taken for work-related activities. My work week in total probably averages somewhere between 60 and 70 hours per week.

Now I want to be clear. I’m not complaining about the number of hours those of us in medicine work. On the contrary, I have voluntarily chosen both my profession as well as the number of hours I work per week. No one has asked me to put in more than 40 hours per week. I simply love what I do and enjoy spending time doing it. I also find that I would be far less effective if I worked less hours. This is simply how it is.

With that said, I believe certain professions should have more leeway with their formal work hours. For example, on rare occasions, I’ll have a day that is, simply by chance, light on responsibilities. On a day like that, I’ll either leave work early or come in late and spend some extra quality time with my family. I have no qualms about this, because I more than make up for the time lost.

It’s this type of occurrence that makes me wonder about the utility of a formalized workweek such as we have today. Perhaps some physicians would be better off with office hours that differ from the 9 to 5 day currently seen so often. For example, perhaps changing hours to include early or late appointments during one or two days per week would improve physician availability for patients who themselves work long or irregular hours. Or maybe a physician would add a Saturday office day while taking one of the standard business days off.

There are so many creative ways the work week schedule can be manipulated to our benefit, but we’re currently locked into the standard Monday to Friday work week with its limitations. For the majority of us, we manage to fill the standard week plus add on yet more hours as a necessity of our jobs. I say, this Labor Day, we begin considering how we may put the schedule to work for us instead of the other way around.