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Work-life balance? Not for these super-driven docs. They keep a hundred balls in the air, and they wouldn't have it any other way.
Dana Ray Fouchi, a family medicine physician in Metairie, La., near New Orleans, has become adept at juggling cell phones, pagers, and beepers while he travels to and from his many jobs. As the owner of a family practice, half-owner of two hospices, and medical director of three other facilities - a nursing home, a home for mentally retarded adults, and an addiction-and-depression treatment center - Fouchi works about 84 hours a week.
And he loves it.
“There’s a lot of things you can do to goof off in the world,” says Fouchi, who also makes regular trips to 10 area nursing homes, “but they’re not productive; they’re just fun. If I can work and have fun at the same time, I think it’s more productive. … There’s so much work to be done, and so many people who need help. There’s no end of things to do, whether it’s going to the nursing home, going to the hospital, going to the hospice, or even making house calls.”
As more physicians aspire to attain a “work-life” balance, doctors like Fouchi are rare. But they’re not extinct.
We set out to locate physicians for whom a 40-hour workweek would be, in a word, boring. We found five who love their craft so much that they largely eschew personal lives in order to spend almost all of their time with patients.
They work up to 100 hours a week, maintaining jam-packed schedules that would leave most of us burned out in no time. Yet far from burning out, these physicians are energized by fulfilling what they consider to be a calling rather than a job. To those who stress the importance of maintaining work-life balance, they respond: Life is work.
It’s an attitude that puts them in the minority among modern physicians, but for which they make no apologies.
These are their stories.
A hurricane of a physician
Fouchi’s abundance of energy for his work is shared by Ed Gaber, an internal medicine physician who, at 62, says he “hopes never to retire.” Gaber, who also practices in Louisiana, moved his practice from Metairie, on the south shore of Lake Pontchartrain, to a location closer to his Covington home following Hurricane Katrina. The hurricane also brought home to Gaber just how much patient care means to him. “During the storm, there were five weeks in which I couldn’t find my patients, and they couldn’t find me,” he says. “I nearly went nuts. I had nothing to do. I lost my identity.”
Gaber had been commuting more than an hour each way to work when Katrina hit; he could have moved his practice sooner, but he felt “a moral obligation” to his patients in New Orleans, 23 of whom were over age 90.
Gaber says he works from roughly 8:30 a.m. until 8 p.m. each weekday, and he takes call every Saturday and Sunday. Rather than cringing when those after-hours calls come in, Gaber says he wants to be available when his patients need him. “I tell my patients - I beg them - to call me when they’re sick at night or on weekends,” says Gaber. “Many say they don’t want to bother me, and meanwhile they have a 104-degree temperature for four days. That upsets me tremendously; I get very upset with them. I tell them, ‘You have to call me.’”
What keeps Gaber going? He says he can’t think of anything else in the world he’d want to do. “It’s very enjoyable,” says Gaber of his lifestyle. “Even though it’s very physically and mentally taxing and difficult and challenging, it’s also very personally rewarding.”
For Gaber, that reward has a spiritual element as well.
“I have former partners who burnt out,” he says. “They were excellent doctors when they began practice, and then toward the end they didn’t seem to care. I think it’s a spiritual thing. You have to really be into the goodness of it, the good that you’re doing. … You can’t be depressed if you’re selfless, basically. … If you’re living for yourself and wrapped up in yourself, you’re going to be depressed. … So this is my goal: to keep people healthy and happy, and it’s good work. Physicians have to love people; they have to realize they’re not here for themselves. … To enjoy your practice, you have to understand that you are there for your patients.”
When family physician Ted Epperly was 15 years old, his 4-year-old sister died of a congenital heart defect. Moved by her death, Epperly says it came upon him “like a laser beacon” that he would grow up to be a doctor. He promised his father he would pursue a medical career, and, now 52, Epperly says, “I’ve been happy with that choice ever since.”
Epperly, an Idaho native who works in Boise, estimates that his professional responsibilities keep him busy between 70 and 75 hours a week. The eldest of five children and the son of a grocer, Epperly got through medical school on a military scholarship that required him to spend four years in the service after graduating. He says that “one thing led to another,” and he stayed in the military for 21 years.
By the time Epperly retired from the Army as a colonel in 2001, he had held all elected positions in the Uniformed Services Academy of Family Physicians, including president.
Today, Epperly is the chairman and program director of the Family Medicine Residency of Idaho, a residency training program based in Boise that also operates as a medical practice. In addition to overseeing the 30 residents and 17 faculty members and physician assistants who work at the practice - which generates roughly 46,000 patient visits a year - Epperly maintains his own small panel of 50 to 75 patients. He says he particularly enjoys making house calls to his elderly patients: “It’s a great way to see them in their home environment.”
Within the practice, Epperly also takes call once or twice a month. The morning we spoke to him, he had already delivered a baby and admitted a patient with diabetic complications to the hospital. He takes a great deal of satisfaction from the patient care he provides, but the administrative, teaching, and leadership responsibilities that come with overseeing a 138-employee operation now dominate Epperly’s workdays, leaving only a quarter of his time for direct patient contact. He is also on the board of directors for the American Academy of Family Physicians and a member of the Residency Review Committee for Family Practice, which accredits all family practice residency programs in the United States.
For Epperly, a typical day starts around 5 a.m. for his morning workout, after which he goes to his practice. He usually holds a 7 a.m. meeting, and his schedule is packed with patient care activities, lectures for the residents, and many administrative, educational, and leadership tasks. He says his day usually wraps up at 7 p.m. on weekdays.
On weekends, Epperly works for five to seven hours a day on both Saturday and Sunday. “Part of the reason I do that is it gives me large chunks of time in which I’m not interrupted and can get some of the bigger projects done,” he explains. During the few hours he manages to reserve for personal activities, Epperly spends time with his wife and his two grown sons, and he occasionally gets in a ski run or golf outing.
He says he generally enjoys the pace he keeps: “My time is pretty well spent. But I’ll be honest; it’s not as balanced as I would like it to be. However, I have a very understanding wife who also has her passion,” which involves tending to their five-acre farm and training the Australian shepherds they keep.
Epperly credits his positive outlook for his ability to both maintain his hectic schedule and live a satisfying life. “Medicine is all about passion and a sense of service,” he says. “You need to look at life as unbelievably fun and rewarding. What you give should be freely given. Because of that outlook, I have been prevented from becoming burned out and cynical. I practice medicine because I enjoy it.
“A lot of people are working hard, but they see it as a means to an end. For me, I’ve always seen it more as an enjoyment in the act itself. It makes it easy for me to do. What drives a lot of people - people you would call workaholics, I presume - is true enjoyment of what they do. For me, it’s not about money at all. It’s about being happy with what you do. I stopped counting the hours I work because I truly enjoy what I do.”
Becoming a superhero
Gil Holland agrees.
“I think it’s all about your outlook,” says the 34-year-old family physician who recently opened a solo practice in a suburb of Phoenix. “If you love what you’re doing, you’re going to do great.” When he was a toddler, Holland informed his parents that he was going to be a doctor. He says he thinks this idea was related to his childhood fascination with wanting to be a superhero. “I always equated that with being able to help people,” Holland explains.
After attending the Medical College of Wisconsin and completing a three-year family practice residency in Phoenix, Holland experimented with several professional paths before opening his solo practice in November 2004. He has made his practice unique by offering the services of a full-time naturopath to his patients as well as aesthetic procedures, including Botox, laser therapy, facelifts, and scar therapy. He says that patients who come in for his aesthetic services also often choose him as their family physician, and vice versa.
Even though he retains an eight-person staff, Holland invests anywhere from 60 to 100 hours a week in his practice. After rising most mornings around 6 a.m. and working out, he sees patients from 8:30 a.m. to 5 p.m. each day, sometimes longer. He estimates that 30 to 35 patients come into his office each weekday. When the last patient has left and his staff goes home, Holland, like most solo physicians, wades through his e-mail, finishes patient notes, does prescription refills, and calls his hospitalist. He also takes all of his own call, which, he says, “essentially means I am on call all of the time.”
And Holland does nearly all of his practice’s administrative work.
Although he retains an office manager, Holland says he “feels like it’s my responsibility” to ensure his practice’s CPT codes are correct, that the PA billing is conducted properly, and that he is maximizing billing for his patient services.
“I think a lot of physicians have decided to let other people do this, and it’s been happening so long, that’s where our voices have come short,” says Holland. “We’re just funneling all of our responsibility away, and later we don’t have much of a voice as to where things are going in medicine, and that’s why reimbursement ends up going down. … I want to stay on top of it.”
So on evenings and weekends, you can usually find Holland at his practice, taking care of his administrative duties as well as working on any technical problems that have arisen, such as glitches with his computer system or phone. Holland recently purchased an EMR for his practice to lighten some of his administrative burden, and although he calls his first vendor choice “a huge mistake,” he is now very happy with his second one, Amazing Charts.
Like the other physicians we spoke to, Holland tries to turn his trips to medical conventions into vacations by tacking on a few days at the end. Earlier this year, he took his wife, 4-year-old son, and 2-year-old daughter to Disneyland after attending a conference there.
Holland says he’s happy with his life, and he can’t imagine doing anything else. Like Epperly, Holland believes satisfaction with one’s life and career is all about personal perception. The most fulfilling part of his life is his ability to “be there when a person is really asking for help.”
“I may not have the answer,” Holland says, “but being able to be there for them, to be that person who can listen and lend a hand and help them get through some of the most trying parts of their lives, is so rewarding. Not just the sore throats and ear infections that come in but also end-stage heart failure patients, or newly diagnosed cancer patients, or people going through some major grief periods in their lives. I think that’s the most incredible thing that one person can do for another fellow human being, and I have the privilege of doing that every single day.”
Born in Bangalore, India, Aparna Chacko was in fifth grade when her best friend fell ill and died. It made a huge impression on little Aparna, who decided she wanted to be able to cure sick people when she grew up.
Chacko attended medical school in Bangalore, where she graduated first in her class. She then worked in poor villages in her native India before applying to and being accepted into an internship and residency program at Texas Tech University Health Sciences Center. While still a resident, she applied for a fellowship in hematology/oncology at the University of Texas Southwestern Medical Center in Dallas. Her work there in a large hospital gave her the opportunity she wanted to treat people from a wide range of cultural backgrounds. Today she works at Tyler Cancer Center in Texas. “I’ve been in practice now for almost five years, and again it’s a whole different world,” says Chacko. “But there’s not one day of it that I don’t enjoy.”
Chacko’s seven-physician practice employees 115 people and has been recognized as one of the nation’s top cancer centers for research. She treats roughly 300 to 400 cancer patients at any one time. She is also active in the research in which her practice participates, and she conducts clinical trials of new therapies.
The mother of a 3-year-old daughter, Chacko, 36, struggles to balance her life among the 60 hours she spends at her practice per week, her community outreach activities, and her time with her daughter. Chacko’s workday typically begins at 6:30 a.m., when the practice holds its meetings and conferences. She then arrives at the hospital to do rounds. By 9 a.m., she is at the clinic, “and once I’m there, it’s a whirlwind,” she says. It settles down around 6 p.m., after which Chacko returns to the hospital, participates in professional activities, or tries to spend a few hours with her daughter before bedtime.
Chacko’s desire to care for people in her community extends beyond her work in the practice. She runs a support group for patients and their families who are dealing with cancer, she gives talks at churches and other gathering places to increase cancer awareness, and she’s active in promoting and conducting cancer screenings in her community.
Chacko says she is often asked what she would want to do if she were not a doctor. “I think I would be a full-time mother,” she replies. “That’s just my personality. I enjoy being of service, whether that be on a personal level or at a job. … I have no second thoughts about what I am doing. I’ve always thought that there’s a reason why I’ve been given the opportunity to be part of my patients’ lives during the toughest parts of their lives. I take it as a privilege more than anything else, and I think my patients understand that.”
The key to happiness
For these five physicians, the rewards they reap from their busy careers far outweigh the drawbacks of modern medical practice. At different ages and from different places, they have chosen a lifestyle that few of us can imagine sustaining for very long. Yet, by their own testimony, it is the very nature of medical practice itself that energizes them and fuels their passion for their profession.
When asked how he sustains his busy schedule without burning out, Holland replies, “The [physicians who] are dissatisfied with everything that’s involved in medicine these days … I think they should rethink why they’re in medicine and the goals they hope to achieve. I think the key to happiness lies within you, and if you’re unhappy with what you’re doing, there’s something else out there that you can do.
“Now, are there things in medicine that are not as great as they could be? Yes, definitely. The bureaucracy is awful, the legislation is not that great, and I live in Arizona, which is in a crisis regarding medical malpractice. But it’s up to us to make things change, and we can do it. We need to put forth the effort.”
Barbara A. Gabriel, MA, is the managing editor of Physicians Practice. She can be reached at firstname.lastname@example.org.
This article originally appeared in the September 2006 issue of Physicians Practice.