Making part time work
■ More physicians are seeking to cut back from full-time schedules. How can physicians make sure that move benefits themselves -- and their practices?
When Deborah Gilboa, MD, and Noam Gilboa, MD, fell in love during medical school, a few things quickly became clear. They wanted several children and would work part time.
"You have to consider quality-of-life issues," he said. "Let's face it, when you are 70, you don't sit on the porch swing with your patients."
They set out to arrange their working lives so that their jobs never overlapped. They have four sons, ages 2, 5, 7 and 9, Dr. Deborah Gilboa works three days a week as a family physician at a federally qualified health center in Pittsburgh training residents, making house calls and doing inpatient rounds with two other physicians. Her husband works seven 12-hour shifts a month as an emergency department physician at an area hospital.
The Drs. Gilboa are examples of an increasingly common phenomenon -- physicians seeking part-time work.
More physicians are figuring out ways to practice part time to raise children, achieve a work-life balance, pursue other interests or extend working years beyond expected retirement age.
Thirteen percent of physicians worked part time in 2005, according to the 2010 Physician Retention Survey by Cejka Search and the American Medical Group Assn. This grew to 21% in 2010. When broken down by gender, 7% of male physicians worked part time in 2005, a rate that nearly doubled to 13% by 2010. With female doctors, 29% worked part time in 2005, and 36% did so in 2010.
Physicians with part-time positions say the key to making it work is knowing what you want and having firm boundaries but being willing to be flexible. Experts say it's critical for part-timers to have hours, duties and expectations clearly defined in their contracts to make the arrangement work for everyone, including the practice or hospital granting the status.
Some medical practices are finding that accommodating part-time requests can be to their advantage, particularly with a physician shortage that is only expected to get worse.
"In a lot of instances, half is better than none," said Tommy Bohannon, vice president of hospital-based recruiting at Merritt Hawkins & Associates, a physician placement firm in Irving, Texas. "People are coming around and realizing this is necessary. We don't have enough doctors, and we're not going to have enough any time soon."
According to a paper in the Feb. 17 Human Resources for Health analyzing a survey of physicians under age 65 listed as inactive in the American Medical Association's Physician Masterfile, 42.5% of the 436 who were fully retired were considering returning to medicine because of the availability of part-time work or flexible scheduling. Also, 47.8% of the 226 who already had re-entered did so because they could work part time.
"We have to be working on strategies for keeping physicians in the work force for a number of years, which means you have to be flexible with the lifestyle needs and requests of physicians," said J. Gregory Stovall, MD, senior vice president of medical affairs for Trinity Mother Frances Hospitals and Clinics based in Tyler, Texas. "It's in every health system's interest to improve their flexibility so that these well-trained physicians do not abandon the work force."
Experts say part-time practice is possible in just about any setting and specialty, although some are more challenging than others.
For instance, part-time hours tend to be harder for surgical than nonsurgical specialties. Shift-oriented settings such as emergency departments or urgent care centers tend to be more amenable to part time. Part-time work may be more financially viable at larger groups. Specialties subject to high liability premiums may have a harder time making part-time status work financially.
However, "anything can be worked out if the determination is there," Dr. Stovall said.
Moving to a part-time world
The first step to part-time work, experts said, is thinking about goals. How many hours is a physician willing or able to work? When does a doctor want to work? Does a physician want to be employed or be a shareholder in a practice?
Arrangements vary widely. The Cejka/AMGA survey found that some practices considered any physician working less than 45 hours a week as part time. Others defined part time as working more than 16 hours but less than 32 hours a week.
"Physicians need to define what part time means in their practice," said Jon-David Deeson, a health care consultant and part owner of Pershing Yoakley & Associates in Knoxville, Tenn. "At a minimum, groups need to think through the economic implications, call schedules and compensation. There are high fixed costs in a physician practice, so it's not an automatic decision without careful planning. In practices where this is not well defined, physicians should prepare a plan for part-time status and present this."
The next step is to identify a setting most likely to be amenable to part-time work. Experts say a practice that already has part-time physicians would be a strong candidate, for example.
It may be possible to adjust a current situation. For instance, Claire Wolfe, MD, a physiatrist in Columbus, Ohio, worked full time with the Ohio Orthopedic Center of Excellence, a group of 22 physicians, until about two years ago, when she wanted more free time but didn't want to leave medicine completely.
Dr. Wolfe, also Chair-Elect of the American Medical Association Senior Physicians Group Governing Council, decided to cut back to 20 hours a week. The group was amenable, because all members pay their own expenses, taking home what is left.
"I pay my share of the overhead. I pay for my malpractice. If I work less, I make less," she said.
Physicians need to articulate what part-time duty includes. Will the doctor take the same amount of call as a full-time physician, or will that be reduced? Will a physician work the same hours each week or will the schedule change? What meetings will he or she need to attend? What other duties will be expected? What happens if a doctor needs to stay past the time he or she usually leaves because of patient care needs?
The next step is to consider compensation. Physician staffing agencies and medical societies can be sources of benchmarking data for salary levels. But doctors need to figure out details beyond the actual dollar amount. Will pay be hourly or a portion of collections? Will compensation be set based on relative value units? Will there be a productivity bonus? If overhead is shared, what portion will be paid if a doctor has limited hours?
Can a part-time physician become a partner in the practice? In some cases the answer is yes.
For instance, Shannon Cole, MD, works three days a week at Gwinnett Pediatrics in Duluth, Ga., and takes call. She also is a partner. The practice of 15 physicians is structured so that both full-time and part-time physicians can buy in.
Benefits such as health insurance and retirement funding need to be considered when negotiating total compensation. In some settings, part-time physicians are able to access similar benefits as full-time physicians. Other settings might prorate various benefits based on average amount worked or give part-time physicians some benefits but not others. Some part-time positions don't have any benefits at all.
After the terms are negotiated and the job has been started, physicians who work part time say good boundaries are important to prevent what's often referred to as schedule creep -- being asked to work more hours little by little until the job is practically full time.
But flexibility is key. For instance, Dr. Cole and the other part-time physicians with Gwinnett Pediatrics work an extra half-day in the winter, when lots of children come in with respiratory illnesses. She helps market the practice and carries out administrative duties. Other part-timers expand their hours when others working full time take vacations. "I don't mind doing it on an as-needed basis," she said.
At Gwinnett Pediatrics, some part-timers rotate days. Doctors who need a set schedule are required to make at least one of their days a Monday or a Friday. This allows full-time doctors to take long weekends more frequently.
This willingness to be flexible when needed may reduce possible negative feelings from fellow physicians and others at the practice. The dedication of the part-time physician is a debate that periodically flares up, experts said.
Part-time physicians can cut resentment from co-workers by doing less popular tasks or shifts or contributing special skills. For instance, Dr. Deborah Gilboa is fluent in sign language, so her health center does not need an interpreter for deaf patients. Her husband often takes the less-popular Friday and Saturday night shifts.
"You have to be sensitive to the fact that being part time is an extra burden on your partners," she said. "Be appreciative, and find ways to make yourself valuable to your practice."
Part-time physicians say this setup doesn't work only for them, it can benefit the practices.
"When I am at work, my head is completely in the game," she said. "I'm not worrying about my children. When I'm at work, my kids are with their dad. There's not going to be an emergency at school or day care that I have to respond to."
And because physicians are in such demand, switching back to full time should be possible, experts said. Dr. Deborah Gilboa will stay part time, but her husband probably will go full time when their children are older. "There are other facilities in my group that occasionally need coverage," he said. "I think I would just pick up shifts."