Brigid Schulte recently had a piece about Stanford Department of Emergency Medicine’s “groundbreaking new “time banking” program aimed to ease work-life conflicts for the emergency medicine faculty.” It’s aimed at dealing with two interlocking issues: the insanity of ER doctor hours, and the fact that there’s a lot of additional work that faculty do that generally goes unrecognized, but which certainly takes time away from things like sleep, kids, cooking reasonable food, etc.

Doctors can “bank” the time they spend doing the often-unappreciated work of mentoring, serving on committees, covering colleagues’ shifts on short notice or deploying in emergencies, and earn credits to use for work or home-related services.

The simple idea is aimed at addressing a complex challenge: Doctors, on average, work 10 hours more a week than other professionals, with nearly 40 percent working 60 hours or more, according to a 2012 study published in the Archives of Internal Medicine.

It found that “an alarming” 1 in 2 physicians report at least one symptom of burnout and that they’re twice as dissatisfied with their work-life balance than those in other professions. Within 10 years of joining an academic medical faculty, 5 of every 10 doctors leave, and four leave academic medicine entirely.

It’s an interesting program, at a place I quite admire (both my kids were born at Stanford), though part of me thinks that the program also illustrates that any effort to construct something that we imagine is “balance” between work and life is going to fail for people like ER doctors.

If by “balance” we mean conformity to a normative vision of work and child-raising, for people with really involved, challenging jobs, “balance” is always going to be very hard to accomplish. There’s just too much uncertainty in the life of someone like an ER doctor (a situation that’s made worse by zero-hours contracts etc.), not to mention too much to learn. But that’s not the same thing as saying that a good life is impossible to achieve; I think there are lots of people who are the children of doctors who remember them missing dinner because they were called away to deliver a baby, and don’t feel the need to tell the story to a therapist. (And many kids, I suspect, need less attention from parents than we like to think.)

Still, it’s not a program that should be dismissed: it addresses some real needs in people’s day-to-day lives, and seems to have had a material impact on the department’s ability to win grants.  So looked at strictly in terms of return on investment, it looks like a win.

On the other hand, the comments are kind of depressing. A few are sympathetic, or extend Schulte’s observations; but most are along the lines of “these spoiled rich doctors knew what they were getting into when they went to medical school.” One ex-physician declared, “I have little sympathy for the overworked physician (and many are overworked to an extreme that few ever experience). They chose this profession and then perpetuate the abuse within it that leads to burn out.” Another said, “This is just an additional cost Stanford will pass along to patients, insurance companies and students.” A third wondered, “They can’t pay it out of their own overblown salaries?…. This is a ridiculous pandering to the 1%.”

Comments like these feel like explanations for why We Can’t Have Nice Things. But it seems to me that there are a couple pieces of context worth adding:

  • Stanford is in Silicon Valley. Compared to the kinds of favors that are showered on the region’s “unicorn” programmers– i.e., people who figure out things like how to marginally improve the cooling systems in server farms, how to subtly change the design of a button to get more people to click on it, how to extract another half-turn out of Moore’s Law– this is peanuts. The company bus? The luxe cafeteria? That’s for the mere developer. The stars can now command sleep pods, chauffeurs, and personal assistants. A box of food and house-cleaning for someone who figures out how to reduce the mortality rate for victims of multiple gunshot wounds, or improves the protocol for people with strokes? That doesn’t seem like much.
  • Given the very high price of fatigue-related mistakes in the ER, and the reality that these are mistakes that can’t be effectively reduced except through finding ways for medical staff to get more rest, the program seems pretty cheap. (And yes, it would be great if there were a similar trial, and a full-blown program, for nurses.)
  • Incredible as it may seem, physicians are no longer as high in the 1% as you’d think. MDs have high occupational status, but have witnessed a decline in professional power over the last generation. Of course there are still some who live quite comfortable lives; others who have to work enormously hard to make a good living; and many others who’ve found that the life is too hard to sustain, or– especially once you factor in malpractice insurance, the odds of divorce, etc.– just isn’t worth it.