Part-time Schedules for Physicians

Family physician Janet Hurley was anxious to start a practice in 2003 after completing her residency at the University of Texas Health Center in Tyler, Texas, but she worried that working full time would leave little time for family or pursuing leadership activities. With one child at home and another on the way, Hurley opted to accept a part-time position at the university's primary-care clinic.

"In the past, physicians might not do leadership activities at all, or do them and have insane work hours," says Hurley, who now works part-time at Trinity Clinic in Whitehouse, Texas, a job that allows her time to take on leadership roles with the Texas Academy of Family Physicians and other groups. "This was a way to shift some of that time into an administrative role."

Whether they run their own practice or work for another employer, many younger physicians are similarly cutting back on time in the office in order to balance work with family and other personal interests. According to the 2012 American Medical Group Association/Cejka Search Retention Survey, part-time practice has emerged as a growing trend over the past several years, with 31 percent of survey respondents identifying themselves as part-time (defined as anyone working less than full-time hours) in 2011. And while women represent the majority of part-timers (44 percent of female respondents compared with 29 percent in 2005), the percentage of men working part-time jumped from 7 percent to 22 percent during the same period.

Going part-time may require some financial sacrifices or scheduling concessions, but, faced with today's workforce shortage, many employers are receptive to considering alternative work arrangements. The key to making it work, experts say, is setting realistic goals and communicating upfront with your colleagues, patients, and employer.

"Before you go part-time, you want to identify what you need out of this and what the practice needs out of this," says Kenneth Hertz, principal consultant with the Medical Group Management Association's healthcare consulting group. "Put those pieces together and work out an arrangement that works for everyone. It has to work for everybody - otherwise it works for nobody."

Setting a schedule

Fourteen years ago, family physician Sumana Reddy took a different path to work-life balance when she left a full-time position with a large practice and branched out on her own. While she still works a full week, cutting back to a part-time clinical schedule has allowed her to handle most administrative work from home and spend more time with her children.

"The way to do it is to get a group together and work cooperatively; we've come to some trade-offs around flexibility," says Reddy, who employs three other part-time physicians, who work between 20 hours and 32 hours per week, and one physician assistant at Acacia Family Medical Group in Salinas, Calif.

For Reddy and many other physicians, part-time medical practice has more to do with flexibility than reduced hours. You might cut your weekly clinical hours from 40 to 20, for example, but put in another 20 hours making calls, charting, and handling other administrative tasks outside of the office. Part-timers also typically participate in taking call.

Those additional tasks must be taken into account, experts say, in order to determine your true workload. In Reddy's view the ability to stay independent and maintain control over her group's style of practice more than makes up for the extra hours worked from home, but other physicians may choose to spend fewer hours with patients in order to lessen their overall workload.

You must also consider the needs of the practice when working out a part-time schedule, says Lori Schutte, president of St. Louis, Mo.-based recruiting firm Cejka Search. For example, seeing patients from 10 a.m. to 2 p.m. might be ideal for your family life but not very convenient for patients or helpful for your productivity.

"If the hours that need to be worked aren't conducive to when patients need to be seen, it isn't a win for the employer," says Schutte. On the other hand, a 3 p.m. to 8 p.m. shift is "a gold mine for the employer because it's a high-volume time for the office, a high-demand time for appointments, and a great time to staff an urgent care center."

Since most part-time physicians' pay is partially tied to productivity, working during high-volume times makes sense from an income perspective as well, says Keith C. Borglum, healthcare consultant with Professional Management and Marketing in Santa Rosa, Calif. If given a choice, he recommends working an afternoon shift so you can accommodate patients who call in the morning and need to be seen that day.

Job sharing, where two or more physicians share one full-time position, is another scheduling option that often meets the needs of both employer and employee, notes Schutte. Cejka Search recently filled one full-time client position with a husband and wife team who wanted to work alternate shifts in order to take turns caring for their new baby, she says.

It's important to have conversations upfront with your employer and colleagues about how your schedule changes will impact the office, adds Schutte. Will other physicians be expected to pick up the slack when you go from 40 office hours to 20 office hours or will the practice hire extenders or other part-time physicians?

Hurley, for example, realized that unless she spoke up she would be expected to take over a departing physician's full panel on a part-time schedule. The university clinic had never employed a part-time physician before and had no policies in place to accommodate part-timers or to deal with Hurley's upcoming maternity leave.

"My colleagues were caught off guard but once they realized it was a problem, they knew they needed to do something," says Hurley. "I created processes for how my patients would be managed while I was out and who would monitor labs, refills, paperwork, and other tasks."

Compensation

From a financial perspective, it's riskier to go part-time as a solo practitioner than as an employee due to fixed overhead costs, but there are ways to make it work, says Borglum. The most economical strategy is to hire one or more non-physician providers to help with routine appointments. Another option is to hire an additional part-time physician to cover night or weekend shifts, which boosts revenue without increasing overhead costs.

In a larger group, your employer bears the burden of fixed costs but you may have to make some concessions, says Hertz. For example, you may switch to a part-time nurse or share a nurse with another physician in order to compensate for your reduced productivity.

Typically, part-timers are paid a base salary or hourly rate plus a productivity bonus tied to relative value unit reimbursement, says Borglum. In today's tight employment market, he adds, employers often are willing to offer full-time benefits to part-time physicians, sometimes including malpractice insurance.

"Part-timers more and more can call their own shots and are able to command higher salaries, more benefits, and perks," he says. Larger groups and hospital employers often have the flexibility to offer higher salaries to part-timers than smaller practices due to their negotiating power with insurance plans.

Career impact

No matter how loyal your patients, going part-time is likely to have a long-term impact on your practice, says Hertz.

"Depending on how long you want to go part-time, you have to understand that some patients will leave and when you come back you'll have to rebuild your practice," he says. It's likely that you will lose referrals as well as referring physicians once they learn of your part-time schedule.

However, those potential drawbacks are unlikely to slow the trend toward more part-time physicians, considering the increasing number of women going into medicine and the high priority that younger physicians place on work-life balance.

"There are many people who would enjoy this type of opportunity - not only mothers but also fathers and physicians interested in other leadership activities," says Hurley. "I would love to see the part-time model more emphasized because I feel like we can capture those people who would otherwise choose to leave clinical medicine due to burnout."

Janet Colwell is a Miami-based freelance writer specializing in healthcare. With more than 20 years experience as a journalist, she writes frequently about clinical and practice management issues for several national health industry publications. She can be reached via editor@physicianspractice.com.

This article originally appeared in the June 2012 issue of Physicians Practice.