Michael E. DeBakey, MD, the late legendary heart surgeon, was known for making his residents and fellows sleep in the cardiac ICU at Houston Methodist Hospital when they had patients on the unit.
Sometimes they would work and sleep there for two months at a time. Dr. DeBakey's residents expected those long hours away from home and accepted it as part of the learning process and a well-established rite of passage.
Now generations have passed, and younger physicians are expecting something different — work/life balance.
As The Wall Street Journal recently reported, this generation of young physicians insists on balance, which means less call and less time working after hours in general. According to the article, young doctors' desire to spend more time with family and on personal activities may be creating a generational divide in the physician workforce.
Being on-call at all times of day and night during the pandemic may have exacerbated physician burnout, which is considered the reason for the increased number of doctors retiring now. In the story, young physicians talk about the "outdated expectations of overwork."
The American Medical Association says half of all doctors are experiencing some burnout. A 2020 systematic review published by JAMA looked at the reasons why. From a total of 48 studies, researchers found that the main cause of burnout among trainee physicians is the stress of work demands. Reducing the workload is one way around that, even if older generations of doctors are steadfast that putting the patient first means long hours.
The Accreditation Council for Graduate Medical Education has long recognized that the long hours aren't good for doctors or patients and made guidelines that limited residents to 80 hours a week. Did the limits work? This publication reports on the initial outcomes of the hour limits put on residents.
What does it mean to be on call?
On-call work means different things depending on a physician's status. For example, residents who are on call typically spend the night in a hospital. For others it might mean being close to the phone, wherever they are.
On-call typically involves working nights and holidays, responding to calls from other hospital/medical staff to help direct patient care, supporting more senior physicians, staying near the hospital or clinic, and maintaining availability during designated periods.
This traditional system faces challenges from younger physicians seeking better work-life balance.
"With a very peculiar way of life and a paradigm-shifting attitude that challenges the 'pecking order' and the existing medical hierarchy, the digital natives, as they are called, are going to disrupt the medical world," an older physician who published an opinion piece in Frontiers in Public Health last year wrote. "This evolution is forcing managers and healthcare systems to adapt. With the arrival of these young people whose ambitions are different from those of their elders, the medical world will undergo profound changes."
This physician, and others who have opined on this issue, say Generation Z doctors and the older physicians who often practice together, need to learn to live and work together despite different perspectives.
What are the basic characteristics of Gen Z?
Gen Z, born 1997-2010, represents the first truly digital generation. Beyond basic tech fluency, they integrate technology seamlessly into daily life, work, and relationships. This shapes their core characteristics:
- Tech savvy (often called the digital natives)
- Collaborative
- Diverse
- Values flexibility
- Values self-care
In a Medical News Today podcast, two physicians of different generations compared their experiences as junior physicians. In the beginning, the more experienced doctor said she often worked 135 hours a week. Her friend, a new doctor, said he averages 48 hours a week, and that includes 8 hours of being on call. The retired doctor admitted that she once fell asleep on a patient while listening to his heart.
Are young physicians on to something?
The COVID-19 pandemic intensified scrutiny of physician burnout and its cascading effects on healthcare quality. Research published in the Clinical Case Reports Journal reveals how excessive work hours and disrupted sleep patterns impair physicians' cognitive function, performance, and emotional stability — directly compromising patient safety.
The path to better work-life balance in medicine requires structural changes, according to the research. Medical practices must maintain sufficient staffing levels to distribute on-call responsibilities across more physicians, preventing excessive burden on individuals. Support systems like flexible scheduling and childcare facilities can significantly reduce work-family conflicts, enhancing physicians' psychological well-being. Additionally, giving physicians input into their call schedules creates a more collaborative environment and ensures fair distribution of responsibilities.
Are there alternatives to the on-call model?
There will always be a need for doctors to be on call for emergencies, but there are ways to lessen the burden — mainly through technology and the rise in popularity of hospitalists. Hospital medicine is one of the fastest growing medical specialties in the U.S. This is good news for the primary care doctors who are on-call less because hospitalists can round on their patients.
Technology is reshaping on-call demands as well. Telemedicine platforms enable remote consultations, while artificial intelligence streamlines administrative tasks. Though these advances don't eliminate the need for on-call coverage, they help create more sustainable work patterns for physicians.
This evolution comes at a crucial time: with 38% of Generation Z expressing interest in healthcare careers, adapting to their expectations for work-life balance may be essential for addressing physician shortages. As multiple generations of doctors collaborate in today's healthcare environment, finding ways to honor both traditional dedication to patient care and modern approaches to physician well-being becomes increasingly important.