Current Perspectives on Regular Irregular Work Schedules in Radiology

I started seeing a new primary care doc. It was partially because I was way overdue for routine stuff, but mainly because I had a syncopal episode. I subsequently learned a couple of things about syncopal episodes.

• Passing out can be brought on by motionlessly standing upright after exercise. The activity doesn’t even need to be that intense. I had not cranked up my regimen at all when this happened. Evidently, one should continue moving around after a session or sit a spell.

• Syncope can include seizure-like elements. My brief collapse was witnessed by someone whose brother has had seizures all his life, and she considered some involuntary movements from me to be evidence of the same. It took a bit of research (and of course my subsequent evaluation) to reassure me that I did not, in fact, need to panic about new-onset seizures.

I have always believed it valuable to get a primary care doc who specializes in whatever issues you have or are prone to develop. For example, I have no expectation that I will ever need to see a rheumatologist. However, I do have some family with cholesterol issues, and this episode raised the possibility of exercise-induced syncope/seizure. I thus aimed for a cardiologist.

That subspecialty always appealed to me. Before I zeroed in on radiology for my own career, cardiology was one of my major considerations. I absorbed and understood its concepts easily, even during early med school. Decades later, these concepts still come to my mind at the slightest provocation.

Cardiac rhythm, for instance, struck me as an elegantly simple yet complex affair. A med student learns early on that a beating heart can have a (normal) regular rhythm, or an irregular one. Irregular rhythm is further subdivided into “regularly” or “irregularly” irregular. It’s easy to look up the difference if you’re so inclined but the more you know, the more you discover there is to learn.

A lot of other biological things, under ideal/healthy circumstances, have rhythms. Generally, they favor regularity as well. I think evolution favors it. I took a course on “biological timekeeping” in college, focusing on how life, plants as well as animals, maintains rhythms approximating a daily cycle (“circadian”) as well as monthly and yearly cycles. To me, this is another elegantly simple yet complex affair.

It shouldn’t be a surprise then if we have a psychological as well as biological preference for regularity, and disfavor things that are not as regular as we might hope. I have thought about this stuff more than a few times when it comes to work schedules (including, of course, radiology, since that is where I dwell). Most of us, especially those organized and planning-oriented enough to make it in a demanding field like medicine, prefer structure and predictability.

Regular rhythms might be our best fit, but that’s not what society has chosen. We don’t have a regular calendar for instance. Traditionally, folks work and most businesses are open for five days at a stretch, bookended by two-day breaks. At best, that’s “regularly irregular,” let alone the irregularity of months with differing lengths, occasional holidays, daylight saving time, vacations, etc. If you tried superimposing a regular work schedule, like a few hours every single day, or maybe working every other day, you would rarely sync up to have the same days off that everyone else did.

Most of us health-care types have the added challenge of covering nights, weekends, and whatever else so that there is 24-7-365 (366 in a leap year; even that’s a little irregular) coverage. Unless a group is fortunate or clever enough to have dedicated people for those off-hour shifts, making everyone share the burden introduces further irregularity.

Your mileage may vary, but after working in a few different settings, I have come to believe that certain types of (ir)regularity are better for morale, and others are a formula for burnout. Folks (myself included) seem to do best when the irregularity of their schedules best matches the irregularity of society.

Part of that, of course, is work not getting in the way of interacting with family and friends. However, the rhythm of a schedule has its own impact. The more irregular it is, the more frequently one has to think about whether one is working on any particular day. Whenever that question is in mind, there is potential for unhappiness depending on the answer.

For instance, my most irregular job didn’t want to contract for as many hours per year as I sought. We negotiated a higher number than they originally proposed (with a proportionally higher salary), but I still wound up with a bunch of random days off each month. It became a routine thing for me to check my schedule and see a non-workday when I would rather be working/earning, or that I was on the schedule when I thought for sure I was free.

By contrast, if it’s a given that during any non-vacay week, I will be working Monday thru Friday, I expend less mental energy keeping track of it, and I have no unwelcome surprises. Unfortunately, every job I have ever had has included a weekend call schedule, and that’s an unwelcome irregularity all its own. Part of the reason I chose my next gig is that it’s actually weekend-free, something I haven’t experienced yet in my rad career.

There are, of course, exceptions to the rules of regularity. My first teleradiology job was a classic schedule of one week on, one week off. Strictly speaking, that’s the most regular rhythm I have ever had with a work schedule. As I mentioned above, however, it did not match the regularly irregular rhythm established by society. I didn’t like having half of my weekends spoken for and I also had no use for 26 weeks off per year.

Meanwhile, irregularly irregular work could be a dream come true. Imagine, for instance, a rad being able to log in whenever he or she feels like it, read as many cases as he or she likes (per click, of course), and log out just as freely. The only regularity the rad would have experience would be that which the rad imposed upon him- or herself. Such jobs do exist, by the way. I have considered one or two.