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Job-sharing can boost work-life balance, cut practice expenses

A column about keeping your practice in good health

By Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Feb. 8, 2010.

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Jennifer Stahl, MD, and Suzy McNulty, MD, two pediatricians in Mission Viejo, Calif., have discovered that sharing is not just a good way for children to play. It also can be a good way for adults to work and a means for physicians and their employees to have both ownership of a practice and a life outside of it.

After several years working for larger group practices, they established Mia Bella Pediatrics in 2007. No one works full time, but they're not exactly part-time employees, either. Rather, they and their staff share each full-time job. Much like other part-time arrangements, this allows everyone involved to balance the demands of child care and other responsibilities with a career.

"What we wanted was more control over what we were doing, " Dr. McNulty said. "The benefits of having our employees and ourselves share jobs is that you are not always at work. You can be well-rounded. We're working with kids, and we have kids in our lives. It gives us a lot more empathy."

The practice saves money on benefits, although this is offset slightly by base wages that are higher than most other physician offices in the area. The higher-than-average wages help the practice retain skilled staff. The physicians say that all involved are more engaged and committed to the success of the practice because they don't just clock in and clock out as part-timers. They are sharing job responsibilities with another person, which makes each staff member more accountable.

"In medicine, basically a part-timer comes in as an employee, sees the patients and goes. Most practices are not wiling to let part-time employees be partners," Dr. McNulty said. "What we wanted was more control over what we were doing. It works for us to split the job down the middle."

Dr. Stahl and Dr. McNulty each provide clinical care for 2½ days a week in the office and carry beepers to handle emergencies. Paperwork and various nonclinical duties are carried out elsewhere after their own children are put to bed or during other opportunities, such as a child's gymnastics class. Some tasks are divided based on skills and interests. Dr. Stahl carries out most of the accounting and marketing; Dr. McNulty handles human resources as well as establishing and maintaining the information technology systems. This means that both physicians work between 30 and 50 hours a week, but they also are there for their families.

Four medical assistants and two billers have their own job-sharing arrangements, and all but one are parents.

"It's working really nicely, and all our employees are able to have flexible schedules," Dr. Stahl said.

Done well, this is an example of how allowing employees to share jobs can provide a medical practice with the financial advantages of part-time workers and the working qualities of those who are full-time.

Done badly, such an arrangement can lead patients to feel like they are always seeing someone different who doesn't really have the information to care for them, experts say.

In addition, cost-savings in one area may be offset by increased expenses in others. For instance, liability insurance may be lower for part-time physicians, but insuring two part-timers most likely will be more expensive than insuring one full-timer.

"The goals and what exactly the one or two or three people need to be doing need to be very clear," said David Javitch, PhD, an organizational psychologist and president of Javitch Associates in Newton, Mass. "And it has to be really clear what the rules are, what the reporting relationships are and who comes in when. What exactly was done by whom, and how does it impact the other person with whom that person is sharing the job?"

Job-sharing tends to function best when two people are well-matched in skills as well as lifestyle. For example, Dr. McNulty and Dr. Stahl are at similar points in their lives and have comparable practice styles and philosophies. Their children are even close in age.

"You need to choose well," Dr. Stahl said. "It's kind of like a marriage in a way."

Constant communication is vital. This is particularly crucial in the medical setting. Time also needs to be provided for people to share information as the job transitions from one person to another.

"The more practitioners, the greater the risk of error," said Alan Lambert, MD, a lawyer and chair of the health care practice group at Butzel Long in New York. "Accuracy and communication are very important."

Dr. McNulty and Dr. Stahl handle this by each having their own panel of patients for well-child visits. In the case of illness, patients have the choice to see either, and most patients are familiar with both of the physicians. An electronic medical record allows the doctors to easily access each other's notes.

"All of our patients know both of us," Dr. Stahl said. "They are all comfortable with it."

These arrangements can pay off for medical practices beyond helping employees achieve work-life balance. In addition to possibly saving money on benefits, depending on state and federal law, job-sharing can lower expense associated with overtime. The Fair Labor Standards Act requires nonexempt employees to be paid time-and-a-half for any hours worked over 40 per week, although state laws can vary.

"Overtime is expensive and a real drain on your staff," said Judy Bee, president of the Practice Performance Group in La Jolla, Calif.

These arrangements can reduce employee turnover, absenteeism and burnout, but they also can mean that, if one of those involved is not available for work for a while or does leave, another person who knows the job is already there. "In the event of illness or scheduled time off like a vacation, you have coverage," Bee said.

The Labor Dept. has no official policy on job-sharing, although experts advise consulting an attorney to determine if any local laws apply. How benefits will be split, if they are offered, needs to be spelled out in advance.

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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