When Your Paycheck Affects Physician Work-Life Balance

I have a new challenge to my work-life balance. It’s my paycheck. I recently made the decision to come off my salary guarantee. Truthfully, I’d be happy to work forever for a set salary as it’s much less stressful. But, that’s not an option and I’m at the point now where it makes sense to move to productivity-based pay. In the “eat what you kill” mentality of productivity based pay, everything from my decision to leave work early on Monday nights so my husband can go to his game night to taking off a day of work on my birthday comes under increased scrutiny.

Whether I work very hard or just medium-hard, I’ll take home a very generous salary by anyone’s accounting simply because I’m a physician and we earn a lot of money compared to the rest of the population. In fact, having recently discussed the issue of money and happiness, I looked up the set point - what you need to make in order to be “happy” - and it’s around $75,000. So, logically, I can’t quite figure out why I feel the need to push my productivity numbers; I don’t need the extra salary and I certainly value my time above a salary increase. However, I’m also a goal-driven perfectionist. Put a number in front of me - whether that’s the percentage of my patients with an A1C at goal or the number of RVUs I generated in March - and I’m going to try to make it better.

I’ve been reading a lot of John Grisham novels recently. One of the recurring themes is the insatiable greed of corporations and mass tort lawyers. Having a jet, a yacht, a beach home, etc., is never enough. While I don’t have to worry about yacht maintenance or the cost of jet fuel personally, I can all too easily understand the draw of just a little bit more that in itself becomes a goal. When I started working and making real money, my goals were to buy a house or a car or save for college and retirement. The actual process of making money was secondary to a larger goal. Now that I have a car and a house and money saved for college and retirement, I have to strongly consider what my motivation is to earn “just a little bit more." I fear that I will embark on a slippery slope where it becomes too easy and too attractive to stretch my work hours a little bit further since the pay-off is so directly seen.

We often see the negatives that push us into unfavorable work-life balance - too much to do, crises at work, understaffed clinics, insurance paperwork to be completed - but don’t often acknowledge the positives that push us into unfavorable work-life balance - a larger salary, another publication for your resume, one more set of letters to add to your signature line. I think these positives can be much more dangerous because they are not bad in themselves and are actually good things. But, it’s important to remember that no number of accolades or zeros on a paycheck can take the place of enjoying all life has to offer.

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