Doctor ‘Wage Theft’ Is Not Without Consequences

By N. Adam Brown, MD, MBA, Contributing Writer
November 30, 2023
If you worked retail or behind a fast-food counter in the pre-digital age, you may remember the time clock and cha-chunk sound it made when you signed in and out of your job. (Okay, it was not really a cha-chunk sound, but everyone noticed when you came and went because the sound was…forceful.) If you remember that sound, you will also remember that once you clocked out, you were free. No more obligations!
For many emergency department doctors, hospitalists, intensivists, and other clinicians today, there is no such freedom. When the shift ends, they keep working, documenting, or “signing out” (briefing the clinician who is there to relieve them). Because many staffing companies and hospitals do not schedule any overlap in shifts, this work is “off the clock.” In other words, the time is uncompensated when doctors are paid hourly (as many of us are).
When this happens, staffing firms and hospitals are, wittingly or unwittingly, making clinicians choose between their own financial well-being and caring for patients. Businesses would face significant pushback and legal ramifications if they tried to take advantage of hourly workers in this manner. But due to physicians’ ethical and cultural sense of duty, they stay and rarely complain.
Uncompensated Time Inside and Outside the Hospital
While most staffing firms create approval mechanisms for requesting compensation for hours worked over a shift-end time, requesting extra time is often looked upon negatively unless there is a direct patient need; it also requires extraordinary circumstances for approval.
But “sign-out” is a direct patient need, documentation is a direct patient need, and both are a required part of many healthcare jobs. Sometimes, sign-out takes just a few minutes to brief colleagues about patients in their care, but more often, it takes much longer to give a comprehensive report. Every practitioner knows that “sign-out” is a part of their job to provide safe continuity of care. Every practitioner also knows that “sign-out” is prone to errors and liabilityopens in a new tab or window.
What’s worse, this uncompensated work does not end with the shift change. Often, clinicians sit in the corner after their shift, go to a back office, or go home to finish documentation and answer clinical and administrative emails. Again, when doctors are hourly workers, the time is not compensated. A dollar here and a few dollars there, and suddenly you are talking about real money. The practice of “pajama timeopens in a new tab or window” or working outside of a shift also overestimates the operational efficiencies of the practice. Why? Because clinicians are completing their required, uncompensated tasks off the clock.
But there’s more to the story. Scheduling clinicians without adequate overlap for sign-out, or building staffing matrices without considering uncompensated administrative hours, places clinicians in dissonant, binary space. Clinicians either provide the best patient care, clear the waiting room, and do documentation, or they forego wages. This creates a slow, steady chipping away of one’s values, leading to a moral injuryopens in a new tab or window.