Thursday, July 17, 2008


One of the attractions, theoretically, of going into private practice was that I could take time off whenever I pleased. In my latter years at Green Acres, on short-term contracts, I had succeeded in carving out as much as 8 weeks of vacation each year (I am a big believer in the "Euro-style" vacation allowance). That was super. But still, mundane little errands would come up between weeks off (getting a sick cat to the vet, getting the car to the mechanic, getting a cracked filling replaced) which were nearly impossible to accomplish-- partly because I was an hour's drive from home, and partly because there was very little leeway for disappearing in the middle of the day. (In fact, that's generally true of doctoring-- it just isn't the ethic. I remember in residency one of my colleagues, a senior resident, had gone home for an hour mid-day to check on a new puppy. When this was discovered it became a HUGE deal, with much discussion, analysis, disciplinary talk from the higher-ups, and snickering among the lower-downs. It just was NOT done. Looking back on it now, the reaction seems absurd.)

Anyway, working for myself-- and moving my office within a mile of home-- has definitely solved the problem of scheduling errands. And I've even played hooky for a day at a time, here and there, for one reason or another. But I recently realized that I've only had one actual week off since last August. How did that happen?? I've given it some thought, with these observations:

1) My income has been about cut in half, with this career move/mistake, and if I'm not in the office I'm definitely not getting paid. So it has felt fiscally irresponsible to go away.
2) Objectively, I'm not actually working all that hard. Trying to figure out how to run all the aspects of my practice has consumed a lot of energy and time and worry, but in terms of actual hours seeing clients, it's not very impressive yet (this leads to (1), above.) So I have this sense that I don't really deserve time off.
3) Weeks off may not really be weeks off. During my one vacation this year, I had a brand-new patient who was in a crisis. I was at the beach, but he kept calling, I kept trying to help, we kept revising medications. It didn't take much time, per se, but it was stressful. "Don't you arrange someone to cover for you?", you're asking. Well, yes, I did. But when you're reachable by by cell phone, it's hard not to allow it. If I told people they absolutely couldn't call me, I would worry almost as much that something bad was going on and I didn't know about it. But, I have learned this lesson: don't take on any new patients in the week or two before a vacation.

In short, my new boss, as I keep telling people, seems to be a real a-hole. But I've decided that one week off a year is not enough, regardless. So week after next I'm not coming to the office. I might take Sandra Lee up the coast, along with Brushfire, who will be on Dasein. And maybe I'll even take a vacation in the fall, too.

[Postscript: Shortly after my vacation, the patient who had been in crisis disappeared, leaving me with a bounced check for $250, which I never managed to recoup. Lesson #2: Don't take any wooden nickels.]


Anonymous sara said...

Ahh, thanks for the perspective when we all envy the private practice guys...

7/17/08, 3:05 PM  
Anonymous Anonymous said...

This may be presumptuous, but I think you need two cell phones. One for yourself and business elements of your practice (ie landlord, utilities) and another that you use for client communication. This way, you can pass the client phone off when you go on vacation.

I'm not a doctor or therapist so I don't know if this acceptable practice.

I have had someone follow me when they went on vacation, and they did have to do med adjustments. this was 3 months after starting treatment, so I don't know that it really matters when a patient starts - I was less likely to call the first week of treatment. And, I don't know- it may have been better if she had just passed me on to the covering doc because while on the one hand I appreciated the diligence on the other I felt intensely guilty at disturbing her vacation.

anyway- I enjoy your blog. good luck working out the whole work/ life/income balance.

7/17/08, 7:23 PM  

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