"I felt utterly betrayed," recalls the now-retired St Catharines FP who had previously practised in a four physician group. "I just didn't have the energy to keep up my usual workload in my last few years of practice, and my younger partners hated me for it."

This doctor thought it was reasonable to cease his on-call duty since he was in his 60s and he'd been pouring his heart and soul into building this practice since the early 70s. What's more, the two physicians who founded the practice had already set a pre-cedent for taking on an easier call schedule in one's last few years before their retirement about 10 years ago. He remembers thinking at the time: "Sure I have to work a bit longer to cover them, but this is all just part of paying my dues — one day it'll be my turn to relax." He wondered why the younger doctors he worked with couldn't see things his way.

CULTURE CLASH
It's truly a shame when physician partners see their relationships break down over workload disputes. It places a pall over the practice's spirit of collegiality. In the case above, the doctor was more than a decade older than the next most senior group member. But it's also common for physicians with young children or passionate interests outside of medicine to want to reduce their workloads.

Striking a work-life balance is a relatively new concept for younger MDs in Canadian medicine, born of the realization that physician shortages aren't going away and burning yourself out isn't going to make matters any better. The only problem here is that these newer values clash with those of the generation of doctors nearing retirement age. One is reluctant to sacrifice their present for the promise of an easier future, while the other expects to wind down a little just as their predecessors had done. Something has to give.

1IU OF PREVENTION
Most conflicts over workload are solvable. Very few physicians are actually, in the true sense of the word, lazy. They don't give out medical licences in Cracker Jack boxes — you had a hard slog to get to where you are now.

But everyone sees their energy level and priorities change over time. Sometimes financial comfort causes us to approach work with less vigour, other times it's a desire to spend time with family, and then there's the inevitable forces of nature as we get older. One of the blessings — and curses — of healthcare in Canada is that physicians don't have to expend energy wooing patients to their practices. The few bucks you save by not having to put your name in the yellow pages gets paid back in grey hairs worrying about the overstuffed waiting room and the stress of constantly turning away new patients. That's partly why a partner's decision to slow down can cause a maelstrom of resentment.

In an ideal world a group practice could have its practitioners split call duty equally, but that often just isn't realistic. The best we can usually hope for in the real world is a fair agreement on call handling, accepted by all parties.

GET IT IN WRITING
The aforementioned senior doctor eventually worked out a compromise with his younger colleagues — but only after much rancour. First off, they decided to axe the practice's long-standing (but ill-advised) tradition of handshake agreements among partners. They wrote up a formal partnership agreement that they decided could only be amended by unanimous decision.

Here are some of the things addressed in their agreement:

• Beginning at age 50, call duty will gradually be reduced.
• A doctor may choose to stop taking call altogether if they continue to practise past 65.
• Any retirement-age doctors who opt to not take call must recruit a locum tenens to cover for them.
• If all the other doctors in the group unanimously decide a partner isn't pulling their weight, the group reserves the right to buy out their share in the practice (part of the building plus equipment) and replace them.

LUCKY DISCOVERY
Sometimes workload conflicts can carry silver linings in their dark clouds. It can alert the partners to hitherto unnoticed inefficiencies in their practice. In one of the heated meetings of the troubled St Catharines practice, someone voiced a concern over the senior doctor having a significantly larger office than anyone else. It turns out he — and another of the partners — didn't care one bit if they had a private office at all. So they unanimously decided to abolish personal offices and started using the newly-liberated space for examination rooms. Having the extra exam space proved to be a boon for practice efficiency and the now-retired FP thinks this helped everyone's bottom line. And the extra income went a long way in healing the hurt feelings in the run-up to the practice's new written partnership agreement.

MORE FROM YOUR STAFF