Part-Time Hours, Job-Sharing
Options to Help You Maintain Balance

by Laurie Hyland Robertson
Laurie Hyland Robertson is a writer for Physicians Practice

“There are never enough hours in the day.”

This has never been truer than in today’s world, where people continue to strive for the perfect work-life balance. Physicians are no strangers to this demand for more personal time. Although, the reasons they cite for practicing part time vary widely, as do the arrangements they devise to make it possible; the trend toward part time is clear and growing. A need for flexibility and an appreciation for work-life balance cuts across generational, gender and geographic boundaries.

A reason for all seasons
There are almost as many reasons to go part time as there are part-time physicians.

In addition to a need for more family time, a desire to take on other responsibilities within an organization — research, teaching, management — may contribute to the part-time decision.

Per diem and locum tenens positions may appeal to doctors nearing retirement looking to decrease their clinical responsibilities. In the past, such doctors went directly from full-time practice to full retirement. The newer model — in health care and elsewhere — is one of semi-retirement that allows for easing out of clinical practice. This increased flexibility can help soften the blow of leaving patient care when one’s identity is strongly rooted in a medical career.

Midcareer physicians who have built sufficient cash reserves may be attracted to part-time practice, too. Sometimes, they go part time for a while as a sort of semi-sabbatical — using the time to reconnect with their families, travel while they’re still fairly young, and cope with burnout — then go back to full-time practice.

And younger physicians are perhaps most likely to see the value of balance of work and personal time.

Some, like Joseph and Theresa Newton, of Quincy Medical Group in Illinois, have never practiced full-time. These married DOs love their patients and their practice — Osteopathic Specialty Care for Musculoskeletal Medicine — but they have a strong commitment to family life and their four young children. “We wanted to be able to have dinner together on a regular basis. And we home-school — we had made a commitment to that even before we had children. … In order to do that, it really does mean that one of us needs to be there … so we made the decision to share a practice,” explains Theresa Newton.

Between them, the Newtons are one full-time doctor. He practices Tuesdays, Thursdays and Fridays, while she picks up the other two weekdays. The specialty nature of their practice allows them to have weekends free and means that none of the group’s other doctors, who all practice in other disciplines, would be expected to take call for them.

Full-time equivalent (FTE) arrangements like this one tidily address many of the hurdles that go with a simple reduction of clinical hours. The Newtons’ clinic simply treats them as a single full-timer in terms of salary and benefits (one spouse is covered under the other’s health insurance), and they bought into the practice as one doctor.

Malpractice insurance is covered by the clinic group, which is a common arrangement. It’s become less of an issue now for part-timers than a few years ago as more insurers offer customized, prorated solutions. (As with other types of benefits, some groups stipulate that the doctor work a certain minimum number of hours to qualify.)

Theresa Newton says there will likely come a time — when their kids are older and more self-sufficient — when they’ll both go into full-time practice. For now, however, she takes issue with the term part time, “because you’re a doctor all the time.”

Practices have their reasons, too, for valuing part-timers. Large groups with urgent care and 24-hour centers like them because they can parcel out shifts easily. Take HealthCare Partners Medical Group as an example. The Torrance, Calif.-based group, with more than 35 clinics, employs 500 physicians — 400 FTEs — across a range of specialties. Bill Chin, M.D., executive medical director, says per diem physicians in the group may choose to pick up, say, five of the 10 shifts for which a given site needs coverage during a month. Some of these exclusively “on-call” doctors cover vacations or after-hours care.

Share and share alike
The Newtons have shared their professional responsibilities in one way or another for all of the eight years since they finished school. After bringing their request to the American Osteopathic Association, they were the first osteopaths to complete their internships and residencies on a shared basis, even dividing teaching duties at Kirksville College of Osteopathic Medicine in Missouri.

“We split the clinic — I did a little more clinic and [Theresa] did a little more classroom, but we both did some of each,” says Joseph Newton. As in their home-schooling efforts, the couple was able to make the most of each one’s strengths. Sharing doubled the time for residency from three to six years, but the trade-off was worthwhile for the couple, who say the extra time they’re able to spend with their kids is invaluable.

M.D.s can seek permission to complete their postgraduate training part time, too; requirements vary by specialty and residency location. Like employers, residency sites may find unexpected value in part-time arrangements. Joseph Newton points out that the site — and its patients — will experience the benefit of a longer relationship with the doctor, making for better continuity all around.

Some believe that fostering access to part-time educational and clinical opportunities will be crucial to addressing the looming shortages and gender imbalance in certain specialties and between general practitioners and specialists. The changing face of medical practice will make these arrangements ever more crucial — and feasible, with the aid of technologies like PDAs, laptops, and EMRs.

Bend, don’t break
A little flexibility can go a long way in job sharing and in regular part-time work. Chin says clinic administrators have told him, “‘Well, I can’t have a meeting at 8 [a.m.] because two of my doctors have to take kids to school.’ … I say, ‘Look, you’re having this meeting twice a year. You mean they can’t find somebody to take the kids twice a year?’ ” He adds that handling these difficulties often depends on the skill of the intermediate manager.

Achieving an FTE staffing model has so far been a struggle for Chin, “because the part-time docs say, ‘I want to work Monday, Wednesday, and Friday, in the mornings, no evenings, and I want to be done by 1 [p.m.] And they expect us to fix it. And I’m trying to throw it back at them: ‘You want permanent part-time work? I can do it, but you have to work with your colleague in meeting the organizational needs.’ And that has been a tremendous hurdle that I’ve not yet been able to overcome.”

A situation like the Newtons’ and the one Chin envisions clearly require meticulous planning and communication. As doctors engaged in any form of partnership well know, compatibility is key. Chin returns to the patient-centered approach, stressing that, “[O]ur job is to care for our patients, to provide good care for our patients and to maintain good morale at the [clinic] site. And I think when you speak with the part-time doctors, they understand this. But sometimes when they’re talking about their own personal needs, they forget about that.”

Clarity of vision and expectations, along with established procedures, are a must on all sides. When talking with both colleagues and employers, part-timers need to be upfront about the motivations behind their decision. Attitude is of paramount importance — appearing to have zero flexibility, even though a doctor may view his free time as sacred, will be viewed negatively by full-timers and administrators.

The part-time bottom line
A 2003 article in the Journal of General Internal Medicine indicates that physicians who work part time may actually have better patient outcomes than their full-time peers. The part-timers had small but significantly higher rates for cancer screening and diabetes management. The authors suggest that part-timers may, in an effort to dispel their peers’ negative perceptions or questions about their commitment to medicine, be especially attentive during their time in the office.

But didn’t patients resent their doctors not being available full-time? Nope. Most patients respect the motivations behind doctors’ reduced schedules and are willing to trade a little inconvenience for seeing their chosen provider.

Theresa Newton advises keeping your eye on the part-time prize: “[K]nowing your reasons for what you’re doing is very important. Because [they will] sustain you through those challenging times, and also help you when there’s a question possibly about perception from other physicians about why you’re [working part-time].”

Chin says it’s vital to maintain a patient-centered perspective, noting that the approach for managing a part-time physician’s patient panel and workload should be tied directly to the reasons that physician wants to work less than full time. “Whenever a physician hands off care on a patient to another physician, there’s always a communication gap,” he says. “As detailed as you are, as conscientious as you are, it is not always easy to communicate with precision what … needs to be done.”

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