Physician without crazy hours

For Dr. Payal Bhandari, a balanced life counts more than mere career gains

She practices medicine without the frenzy. In a busy family medical practice in San Francisco's upscale Laurel Heights neighborhood, Dr. Payal Bhandari works four days a week yet earns more than $100,000 a year. Each work day she puts in nine hours and sees about 20 patients. Then she goes home to spend time with her two young daughters. In a medical field full of workaholics with severely limited personal lives, Bhandari has found a happy balance.

Payal Bhandari, M.D.

"It's what I've always wanted to do," Bhandari says of her career in family medicine. "It's my dream."

In 2001 after graduating medical school in her home state of West Virginia, Bhandari completed a three-year residency in family practice. Then she and her husband moved on a whim to San Francisco. She applied to work with Dr. Lawrence Shore. They talked for two hours, noting their common values. Six years later, Bhandari remains satisfied with the working relationship.

"I grew up in a small town in West Virginia—one of the poorest states in the country," Bhandari says. "By age 10 I realized that opportunities were limited in my hometown. By working hard in school I knew my life would progress and doors would open."

"Since I enjoy the sciences and helping people, I chose a field in medicine by age 14. It is a service profession where I often make a difference in peoples' lives while continuously learning and never getting bored."

"I often make a difference in peoples' lives while continuously learning and never getting bored."

To become a physician, Bhandari realized, she needed to do well in school and learn to focus. Even in choosing childhood friends she selected those who would support her aspirations by giving her positive energy. "Befriend people who support you as a human being," she says. "Be selfish in a good way. If you take care of yourself, you can easily take care of other people."

Bhandari chose family medicine because she sees it as the ideal role for a physician: to care for a variety of patients of all ages; varied types of cases and illnesses; and ongoing involvement with extended families and generations. She thrives on the human warmth of the practice.

The idea of being a medical specialist focused on one body part or one illness did not appeal to Bhandari. "That's all I'm going to do?" she says, laughing. "I can only help this group of people? I want to be able to take care of anyone who walks through my door."

Bhandari's neighborhood medical practice gives her ample opportunity to know her patients' families. "One of the best parts about what I do is meeting really cool people. I learn things about them to help put the full picture together. I get to meet their kids, spouses or significant others, parents and friends."

"The medicine part is fun. I can diagnose a cold, cancer, and see a newborn baby all within an hour on the job. I can really connect with people. They make a difference in my life. It's an interchange of people."

"To be good at this, you need to know how to connect with people."

Medical school teaches every physician how to diagnose illnesses by textbook examples and practice, but reading peoples' maladies is an art, according to Bhandari. She diagnoses intuitively. More complex maladies provide intellectual stimulation. "It's about listening to people and observing their body language," she says. "To be good at this, you need to know how to connect with people."

Bhandari recommends that other women decide what profession to pursue based first on whether they will enjoy it, not whether the job will generate a good income. "If you enjoy it, it's easy to give your best," she says. "It gets you up in the morning. You're willing to work hard because you're having a good time. People see and feel that. If you get to the point where you're bored or dissatisfied, stop and reassess. If you stop learning, you stop giving."

Even if a patient complains about a simple cold or rash, she aims to value that person's feelings of vulnerability. "I value their time," she says. "I value each person. I cater to their needs. I don't belittle them."

"I value each person. I cater to their needs."

"I love what I do," Bhandari says. "I love to learn, to constantly live life to the fullest. I picked a job that works for me."

Practicing medicine in an underserved community where patients have less appreciation for the care they receive would likely not work for her, Bhandari says. Her practice serves a largely affluent population in San Francisco. Most patients are well-educated, middle-class or upper-middle-class. Most speak English. She chose not to work in an underserved community. "This population may have limited resources and education. They may receive a lot of services from the community and possibly not value what they have been given. I would have to spend a great deal of time addressing their psychosocial issues and not just practicing medicine."

"I would be giving so much and possibly not feel rewarded," she says. "I had to be honest with myself about practicing in underserved communities. Why would I put myself in a situation where I may be a disservice to those patients? I may not relate or connect with them in my heart. Picking careers is about being honest about who you are and what makes you happy."

The majority of her patients are young to middle-aged adults, children and their families. "As I grow, my patients will age with me and I can better relate to them as individuals."

Most young people struggle to figure out their identity, Bhandari observes. Some mold themselves to fit a particular career, perhaps because a parent steered them. "Deep down, it's going to come out," she says. "If your passions lead you down a path where it's difficult to survive, you need to think about that also. There is sacrifice. But you really need to enjoy it."

The people she works with are like family, Bhandari says. Co-workers become almost like spouses, spending huge amounts of time together. "Who are you going to jive with? In this practice, there are just two doctors. If I didn't like my partner, we would be in big trouble. If I could not tolerate that person through the downs, there's a big chance I would burn out or step out. I am clear what my short-term and long-term goals are."

"Who are you going to jive with? In this practice, there are just two doctors. If I didn't like my partner, we would be in big trouble."

Most people cannot hide their angst in a job, she notes. "Panic or stress shows up," she says. "You can see it on a person's face. I see so many moms who are beaten down from trying to do it all. If you had met me just after I had my second child, I was beaten down. I was completely sleep-deprived. I did not have time to think about anything more than what I had to do in that moment."

Bhandari works as an employee in the practice. She did not seek to manage the business. "We keep figuring out where we can meet in the middle," she says. "I am at the beginning of my career. My colleague is near the end of his career. We keep honesty at the forefront and figure out the details as we go along. It is an evolving relationship."

Burnout is common for doctors. Even with her varied patient contact, Bhandari occasionally faces ennui. "It's still a job. There are mundane, boring things. There are plenty of times where you hear criticism more than the positive feedback. I knew early on that I did not want to work as a traditional family practitioner: deliver babies, see patients in the hospital and clinic all in the same day. The days would be long and I would have a high risk of burnout," Bhandari says.

Many professionals have significant separation between work and personal lives, especially if they commute. "I don't need to escape my community. I am part of it," she says. "I live just three miles from my office. My children go to school in the neighborhood. It's normal for my kids' friends to be my patients. During a workout in the park, I run into patients. My job has allowed me to have a regular schedule unlike many of today's careers working globally and 24/7. I walk into the office at 8:00 a.m. I leave by 5:00. I am not expected to be here on my day off. My time is respected."

As a young child, Bhandari observed that most doctors were consumed by their work, with pagers buzzing constantly on their "time off." She wanted flexibility to spend time with family.

"Medicine is a profession where the outside world thinks you are always on the job," she says. "But my children don't think of me as only being a doctor. I love being a mom. I want to be actively involved in my kids' lives and expand my horizons outside of work. I strive for balance. I live every day as if it were my last. If someone told me today that I had some terrible disease, I would have no regrets. I am OK with wherever I am. If I want to be alive until I am 95, I have to think about how healthy I am today."

—James Dunn
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