Should Doctors Work From Home?

Work from home -- does that work for doctors? And should it?

Just the other day, for the second time ever, I worked from home. It happened on a Friday -- not a patient care day, but an administrative day, full of meetings from dawn to dusk. I woke up at the usual time on Friday morning, and as I was getting ready to head to the office, I got a series of messages that essentially ended up canceling or rescheduling every single meeting on my schedule that day.

Because of a combination of factors, including a lot of people being away for the Society of General Internal Medicine annual meeting in Colorado and administrative preparations that were underway for a mock Joint Commission survey scheduled for next week, everybody was bailing on meetings that usually occur at this time. So suddenly, I was faced with an empty schedule.

A lot of the partners in my practice, and a lot of colleagues I know throughout healthcare, have figured out ways to do different iterations of work from home, including administrative meetings, video visits, and other non-patient facing clinical activities. But somehow, I've never really taken to it. I was worried that I would just find the lure of having my living room couch nearby too strong, and I'd end up napping all day on it.

In fact, on this day I ended up getting a lot done: closing all my notes from the prior week, doing a couple of hours of lab follow-up and letter writing, and actually finally tackling my in-basket, which had become painfully bloated over the past few months.

With dedicated effort which left me pretty bleary-eyed by the end of the day, I cleared out all but two of my in-basket folders. As each of these folders dwindled in size and number, and finally disappeared with a click of the "refresh" button, a weird sense of satisfaction welled up inside me. I was actually very proud of myself.

But is working from home the best thing for healthcare? Is this the best thing for our patients? And is this the best thing for doctors?

Many of my colleagues have built up and are highly efficient at their video vision sessions, doing jam-packed days full of telehealth visits with their patients. The number of video visits we've done at our practice, through the pandemic and even now as we've come out of it, is sort of mind-boggling, something we never would've predicted before COVID-19.

The convenience of patients being able to stay at work, or stay at home for a sick visit when they're not feeling well, is probably a far more attractive option than getting in a car, bus, or subway and coming all the way in to our office. And for those providers doing clinical sessions at home for telehealth, they get to avoid their own commutes, and this probably leads to some increase in satisfaction and efficiencies.

I will tell you that at times, when many of my partners and colleagues are working from home, sometimes the halls of our practice can feel pretty empty. Many of our conferences, from morning report to faculty meetings to departmental grand rounds, often seem vastly under-attended, and I find myself missing the warmth and camaraderie of the 3D versions of ourselves.

But as we move forward to build a better healthcare system, the model of working from home certainly makes sense, and will have a place in whatever paradigms we create as things change. It's good for patients, it's good for providers, and in fact it might even be a more efficient model for ways to use less real estate for healthcare.

A really efficient system of telehealth, including additional members of the patient care team doing video visits with patients, such as nursing follow-up, pharmacy check-ins, post-op wound checks after surgery, mental health visits, and so many other opportunities and options, could be part of the answer of building a better system to take care of our patients wherever they are.

As the public health emergency has been canceled and we've emerged from the pandemic, at least for now, we need to readdress some of the bureaucratic hurdles that are likely going to re-emerge -- hurdles that may prevent us from taking care of our patients in these settings.

I can imagine a lot of the insurance companies will not want to keep paying for this stuff, insisting that we revert back to a more traditional model of in-office care, saying this new type of visit is really no longer necessary. But I think we've proved it is necessary -- a really great way to deliver care that can have a powerfully beneficial place in the acute and long-term care of our patients, in the management of many diseases, in hospital discharge follow-ups, and in care coordination and care management.

For me, I still like going to the office, I still like seeing my patients, and as the mask mandates have lifted, I've enjoyed seeing everybody's face again. But from now on, I may just figure out a way to do some sessions at home, to have some quiet time where no one is coming through my door with questions and concerns and little emergencies, a little peace and quiet to get things done.

On the whole, I think that for me, working from home will still be the exception rather than the rule, but who knows? For now, I think I'll just take a nap on the couch and think about it for a while.

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