Typically atypical?

I was recently asked if I would consider sharing what a “typical” week for me, as an academic burn surgeon, looks like, something I am happy to do.

It’s important to understand first that I tend to do my clinical work in an “episodic” fashion- while I will do a bit of clinical work in the form of telemedicine visits and take some call, I am either “on” clinical service or “off.”  Clinically I work for 18 weeks a year, give or take.  Those 18 weeks I plan to do little else besides take care of our patients, mostly because I’ve learned that if I try to make other plans I’ll end up canceling them.  My senior partner who retired a few years ago used to refer to the Burn Unit as a “jealous mistress;”  for me, it’s felt more like a bad boyfriend, but the intent of the analogy remains the same.  The clinical work is intense and challenging and wonderful and horrible and heartbreaking and satisfying- and that can be in a single day.  Our unit practice is that we take care of patients during their acute injury and burn resuscitation, and we still take care of them years later if they need fairly routine reconstruction of their burn scars for functional issues (this primarily relates to our pediatric patients since they do grow after initial injury).  We also take care of other soft tissue stuff- nec fasc, toxic epidermal necrolysis, sequelae of purpura fulminans, and frostbite are also common to us, as rare as they may be in the rest of the universe.

So, that’s about a third of my year, and it’s a great third.  The clinical part of my work also provides me with a great teaching foundation about burns and critical care for our residents and students, is the foundation for my clinical/ outcomes/ QI research that I do, and feeds my soul in a unique way that the other parts of my professional life can’t.    My students in particular know how dedicated I am to them, but there’s a certain incomparable value to a bear hug from a 5 year old who you’ve been their surgeon for as long as they can remember.

So…the students and the other stuff.  I have non-clinical Departmental responsibilities that take up about 50% of a normal job (as opposed to a surgeon job, which requires different math in terms of the hours) in my roles as our clerkship director for surgery and as the Vice Chair for Education and Professionalism.  In any given week, the clerkship can take as few as 4 or as many as 10 hours, just depending upon where we are in the cycle and what the student needs are.  The Vice Chair job is new in the last few months and we’re still defining the parameters I’m working within.  The one thing that has been very clear to me early on is that there is definitely a need for someone to systematically look at education in our department as well as at perioperative professionalism, and both of those things are resulting in some great collaborations and efforts.

But wait! There’s more!  I also have some extramurally funded burn-related research, we have some of our own projects we’ve developed (how long do patients who present with an NSTI and who undergo appropriate surgical management need antibiotics post-op?), and at any given time I typically have a couple of my own research “passion projects” I’m working on in the education arena.  And, of course, there’s my social media stuff, both here on the blog and in the Twittersphere, personally and with JAMASurgery.  Organizational leadership is another piece of the puzzle, and one that potentially merits its own blog post.

Those are the things that fill up my days from a professional standpoint, and this completely leaves out mention of my anti-burnout regimen that includes yoga, running, good food, attending arts events, and pet therapy with my menagerie.  These things are absolute cornerstones of maintaining my sanity and my productivity, and while some of them wax and wane while I’m in the clinical trenches (arts events, yoga tend to suffer first), some are not negotiable (short runs, quality cat and dog time).  I do try to take one day per week completely off when I’m non-clinical, including email, and when I am clinical I’ll try to have one of the weekend days “just” be a rounds/ patient care/ call day, ignoring the other things that are out there nipping at my heels. I’ve also become more possessive about my sleep, something that’s a consequence of improved judgment and wearing long nights less well than I used to in my 30s.

I wish I could put a schedule up to give you a visual, but that doesn’t work terribly well for me- both because of the ebb and flow of my life and because I rebel against structure when it’s not absolutely necessary.  Patient care and rounds?  Necessary, no question.  Administrative tasks?  Necessary, though it pains me.  Writing and editing, project development, innovation and positive disruption?  Little structure around making these things happen, though I’ll admit that these are the things I often work most intensely on at home rather than my office desk.  I value the flexibility (and honestly, the lack of interruptions) when I’m able to spend a half-day at home focused on a project or two.

And with that, and the above comment about my jealousy of my need for sleep, it’s late here in the Mountain West.  Questions? Just ask!

4 thoughts on “Typically atypical?

  1. Wow. I’m tired just reading your schedule. At first glance, the “I work 18 weeks a year” really stands out when compared to the typical workforce that works probably 50 weeks a year. Clearly, however, that is not the case, as you have clinical duties 18 weeks a year but you have so many other responsibilities that take up more weeks. I’m wondering, for the benefit of future trainees like myself, if you could just add a comment (maybe in the article?) about how many total weeks you work per year (ie 52 – time off) to help put it in perspective, AND, if you were a resident on today’s world, how many hours would you work per week (clinical + research + educational duties but not including free time and passion projects that you take on yourself). Great article!

    1. Hmmm…Steve…if you include my professional travel time, which amounts to right around 4 weeks per year, I do still try to take 2-3 weeks off from work responsibilities. Those weeks aren’t always contiguous, and I honestly tend to favor taking one decent vacation and otherwise doing long weekends that are sprinkled throughout the year. I have evolved to a plan of alternating “big vacation” and “small vacation” years- last year’s river trip was obviously a big vacation since I was out of pocket for almost two weeks. This year will be small vacations, with a long weekend in Santa Barbara, a long weekend in Oregon, and Cowgirl Yoga camp in Montana already planned, and likely one more long weekend in the Fall as well as my annual Texas pilgrimage in early December. I’m also trying to get some ski time on the 15-16 winter calendar since I flunked skiing this year (snow situation didn’t help).

      I have a hard time saying how much I would work if I were a resident under today’s system since I trained almost entirely under dinosaur rules and still somehow managed to generate some research productivity in my haze. Realistically, I think a modern resident week for me with reading and trying to do other scholarly/ academic activities would probably total out at 100/ week, with 20 for the other stuff on top of the 80ish clinical.

  2. Hi Amalia,

    Thanks for this great post!! My question is about your 18 weeks of clinical duty. How do you spread those throughout the year since I imagine you cannot “ignore” the other things for 18 weeks straight (or maybe work in a burn unit for that long without a break)? Are they like 9×2 weeks? And when you are on service, I would guess there always needs to be an attending physician in house. Do you cover the days, your partner covers the nights, and you switch after a week? (Basically, how does call work for a burn unit or ICU?)

    Thanks again for the wonderful post!

    1. Tyler, great questions!
      We stay in-house if patient conditions mandate it, but otherwise our call is from home. We do rotate night call when we’re on service, and have recently moved from 6X3 to 9X2 as our model; 3 weeks is grueling, even 2 can be tough under some conditions.

      Many ICUs are in-house coverage and we may eventually find ourselves there. For now, we rely on each of our best judgment (and I appreciate my home that is 1 mile from the hospital, as does our staff).