Table 8 Participant perspectives on influences on practice schedule and work volume

Professional influences on practice schedule and work volume

 Offer better access to care

“And how we set it up is because there’s enough of us to do this, one person each week will take after 10:30 in the morning so that all of their appointments would be open. So they’d be available to any patient that’s part of our practice for a same-day visit. So it’s not walk-in style. If patients call and need to be seen urgently, like for something that was infectious or if there was a last minute refill or that sort of thing then we take turns each day to see them.” P42 NS

“I have a lot of patients who work. So I just decided to kind of change my hours to accommodate a lot of my patients who prefer to see me in the evening.” P51 ON

 Remuneration

“Like ideally for me I would do like … 75% hospitalist work, 25% in an office, doing family medicine in an office. Hospitalist work I find a little more interesting. It’s convenient that it also pays quite a bit better. If it didn’t pay as well, would I … Like there's a combination of things. Why do you pick up work? Part of it’s how much you enjoy the work, part of it’s how well compensated you are for the work. … You can’t always parse it out precisely as to how much each of those factor in. But they both play a role.” P37 NS

“If I have 30 people scheduled in a day, and say 10 people decide not to show up, that’s 10 patients who could have been in my office. That’s also a significant loss of income [in a FFS model]. So if I’m not guaranteed patients to show up on evenings or weekends, there's no incentive for me to open my office because I will actually lose money by doing that.” P41 NS

 Acquisition and maintenance of skills

“Because it’s very hard in a newer practice for a physician … Everything is new and everything is challenging. … And just my baseline stress level of seeing those patients is going to be a ton higher because I’m just less confident about everything. And so it's just really hard to work at full-time levels with that underlying increased stress. … I think the idea of introducing yourself into that more slowly with lots of time off is a very important thing.” P15 BC

“Yeah, I mean I don’t think it’s sustainable forever [working a 6-day week]. You know, I think right now as like a brand new grad, I want to solidify my skills. And I’m still trying to figure out exactly sort of what my ideal practice looks like. So try and keep my skills up and trying to do all these different things so I don’t limit myself in what I sort of feel comfortable to do.” P17 BC

Personal influences on practice schedule and work volume

 Work-life balance

“[I] have a lot of interests outside of work. So I want to be able to have the time off to engage in those interests. Like for example, you know, I snowboard a lot. And so I try not to take too many rural locums like during the snowboarding season. But then … when I’m not doing much snowboarding or hiking then I work lots. So that allows me to make a bit more money.” P18 BC

“So that was a positive thing—to realize that I didn’t have to work 5 days a week, you know, 50 weeks a year to earn a living. But that I could work part-time and still maintain a lifestyle that allows me to focus my leisure activities or personal activities a bit more than just, you know, grinding away at a job just to pay the bills.” P24 NS

“The reason I’ve had to cut back on hours is I was finding I … would put my kids to bed and … I’d eat supper and then spend the whole rest of my evening doing paperwork. So it just wasn’t feasible to continue doing that for the long term.” P36 NS

“I kind of got tired of the hospital inpatient setting. I think maybe in the future, like much later down in my career, I might want to come back to that. But right now I don’t really want to be on call and spend long hours in the hospital—overnight hours, things like that. So I did want more of a bit of 9 to 5 structure.” P38 NS

 Financial considerations and pressures

“Like I have worked 6 days for several months. Really bad weeks are 7 days. But some weeks can be down to like 3 days a week. So it varies. … Now that I’m approaching the next stage of my life, I hope to be less busy. But with some of the financial pressures with debt and housing, especially in BC, sometimes you just need to work more … in BC … I think the realization that, you know, even though physicians are well paid, you know, it still can’t buy you a house or even like a condo that’s big enough for a family.” P21 BC

“So I am the primary breadwinner in my house. I’m married. My husband would make like just kind of like an average income, I guess. So I’m basically … There's a decent amount of pressure on me to work as well.” P34 NS

 Family and relationships

“I have two kids, another one on the way. And I’ve tried to make sure that I don’t work too much. That I have that balance and that I have enough time at home … But I think if I didn’t have a family I probably would work a lot harder and do different things, and getting more involved.” P51 ON

“I guess now definitely having a new … like a young child, that’s definitely changed things a lot. Like I’m much more restricted in hours that I can work or that I want to work. I want to work less.” P62 BC