Young internists: Working part-time works for them
From the October ACP Observer, copyright © 2003 by the American College of Physicians.
By Ingrid Palmer
When general internist Maria B. Wright, ACP Member, became pregnant during her third year of medical residency, her priorities immediately changed. After finishing her chief residency in 1997, she went looking for a part-time position so she could spend more time at home. Today, she works just one day a week—and has no regrets.
"My days are wonderfully full and I'm fortunate to be able to stay home to experience raising children," she explained, saying that she doesn't feel any gaping career void in her life. "I think your life goes through different stages, and down the road I'll have more time to devote to medicine."
Dr. Wright is one of a growing number of physicians who are opting to work part time. In fact, statistics show that women account for most part-time physicians.
According to data from the Physician Work Life Study published in the June 2000 Journal of General Internal Medicine, 22% of women physicians work less than 40 hours a week, compared with only 9% of their male colleagues. And while most women physicians who work part time want to spend more time with young children, older physicians are finding that part-time work can bring some much-needed balance to their lives.
Physicians who choose to work part time say they make some concessions, not the least of which is a full-time salary. In return, however, they get back a huge chunk of time to spend as they like. Many also say they look forward to eventually returning to medicine full time.
Here's a look at four physicians and the strategies they've used to make part-time careers work for them.
Time at home
Now 36 years old, Dr. Wright has worked in two different part-time jobs. First, she spent four years working three days a week at Wright State University in Dayton, Ohio. In that position, she divided her time among patient care, teaching and working with residents in clinics.
At Wright State, she spent two months out of every year doing inpatient service, including taking call. "They were very busy months," she said, "but the flip side was that during the other 10 months I worked only three days a week and had no call."
Although she was the only part-time physician in the practice, Dr. Wright said her colleagues were supportive. She received two-thirds of a full-time salary and received full benefits.
When her youngest son was born with some medical problems, however, Dr. Wright decided to scale back on work a bit more. She left the job at Wright State and eventually found a position working just one day a week for a former colleague in solo practice. While the position provides no benefits, Dr. Wright and her children receive health benefits through her husband's job.
Dr. Wright said she considers herself very lucky. She explained that her current arrangement "allows me to keep my skills up and gives me a lot of flexibility." In addition, she gets the satisfaction of treating patients in a small private practice and the benefits of being a mostly stay-at-home mom to her seven-, six- and two-year old children. (She is currently adopting a fourth child from Guatemala.)
"With part-time work, there comes some sacrifice," Dr. Wright admitted, noting that she misses the continuity of patient care and the income of full-time practice. But at this point in her life, she said, she's decided to make her family her first priority.
In trying to work fewer hours per week, Jennifer M. Marklay, ACP Member, has faced some tough decisions.
When Dr. Marklay first entered practice in 1998 in Cincinnati, she signed a contract that had productivity incentives. "I was working 45 hours a week, not including call and hospital rounds," she said. By the time her second child was born three years later, she wanted to spend less time at the office.
"I started taking two half-days off a week and leaving the office at 5 p.m. instead of 6," she said. (Her call schedule didn't change.) Instead of working 45 hours, she was putting in 32 hours per week—and earning 20% less in salary. She was able, however, to keep her benefits.
Her abbreviated new schedule gave her the time she wanted to spend with her family, but as the primary breadwinner, Dr. Marklay couldn't make the situation work financially. After about a year, she switched back to her old regimen.
Looking back, she said that money wasn't the only reason she felt compelled to return to full-time work. "I was concerned about other people's opinions that I wasn't doing my share," she explained. "The way my practice is run, the other doctors would end up having to do my work if I wasn't there."
Though she now sees the same number of patients as when she first started practicing, Dr. Marklay said that she has learned to use her time in the office more efficiently. As a result, she works only a half-day on Thursdays. Now expecting her third child, she plans to try and keep her current schedule: starting at 8:30 a.m. and leaving the office no later than 5 p.m.
The best of both worlds
After finishing training, 35-year-old Sarah K. Warren, ACP Member, first worked in full-time private practice for two years. She then worked as a hospitalist for one year and did a stint as an emergency room physician.
When she took her current job, however, she was six and a half months pregnant, and she definitely wanted a part-time position. Today, in an arrangement that she likened to job-sharing, she is one of two part-time internists in a nine-physician practice in Asheville, N.C. She works half time, splitting the hours and duties of a full-time physician with another internist.
Dr. Warren joined Carolina Internal Medicine Associates with the understanding that she would take over the clinical duties of a senior physician who wanted to spend more time on research.
"I use his office to see patients and the practice pays me a flat daily salary," she said. "If I'm not in the office, I'm not getting paid." She said the arrangement was a "no-lose situation" for the practice.
As the practice's first part-time doctor, Dr. Warren found that some of the group's partners started out being excited about the arrangement. Others were skeptical about the idea.
"It has been a pleasant surprise to the practice because it hasn't been a problem," she said. "Paying me for the days I'm there rather than a monthly salary worked out better because none of the other doctors feel they are being cheated [out of a salary]." Dr. Warren said that she is about half as productive as the full-time internists.
(For more information, see "Tips to making a smoother transition to part-time work.")
The half-time arrangement has turned out well for Dr. Warren, too. Her husband, a cardiologist, works full time while she spends her days off caring for their two-year-old.
While many physicians worry that part-time work will hurt their careers, Dr. Warren has not found this to be the case. Her practice, in fact, is now offering her a type of partnership, instead of having her continue as an employee. That means she will be able to share in the practice's profits.
Because her arrangement has been so successful, her group recently hired another part-time physician. "Offering a part-time job allowed our office to add staff at a time when there aren't a lot of internal medicine candidates," she said.
The full-time doctors have found that they rarely have to cover for the part-timers. Dr. Warren and the other part-time physician try to take vacations during their scheduled days off. They are also put into the call rotation every other cycle.
A different perspective
In June 2000, family practitioner Susan Jacob, MD, began thinking of part-time not because she wanted to care for young children, but because she wanted to get off the treadmill.
Dr. Jacob was working full time in private practice with four other physicians. The pace was hectic, and the insurance requirements and formulary changes were wearing her down. It wasn't too long before she felt that patient care was being compromised.
Office hours were officially 9-5, but paperwork and hospital rounds took up mornings, evenings and most Saturdays. "You really had no control over your schedule," she said. When it came time to renew her contract, Dr. Jacob decided to look for something less stressful.
Now a staff physician with University Health Services at the University of Cincinnati, Dr. Jacob works four eight-and-a-half-hour days and takes call every six to seven weeks. Patients who are really sick go to the emergency room, reducing the level of follow-up care she provides.
"It cuts down on a lot of extra work," said the 54-year-old, whose stress level has gone down since the switch. "I should have done this a long time ago, before my kids were in college."
Changing jobs for fewer hours and less stress does have its drawbacks, however. Dr. Jacob said she earns significantly less income, although at this stage in her life her time is more important than the money.
She also enjoys being paid a salary instead of having an income tied to how many patients she sees. "I don't have to worry: Is anyone going to show up?" she pointed out. "This is something you can depend on."
Although she wouldn't recommend her position as a career path for young physicians to follow their entire lives, she said it could be an ideal situation for those with young children at home.
"It was an easy decision for me because I already had my peak career years," said Dr. Jacob, who is now able to take four weeks of vacation a year. "This is more predictable, so I can tell people I'm off on the weekends and actually make plans."
Ingrid Palmer is a freelance writer based in Glendale, Ohio.
While many doctors find part-time work formulas that work for them, practice consultants and physicians agree on one thing: Every situation is different.
Approaching your boss or the other physicians in your practice about cutting back hours can be intimidating. Some doctors worry that their colleagues will resent their new part-time schedule—or perceive them as being less committed to the practice and their patients than full-time physicians.
That concern certainly played a role in the decision of Jennifer M. Marklay, ACP Member, to revert to her full-time status after a part-time stint. "You want to be equal," she said. "You don't want someone to say, 'She's not pulling her weight.' "
There is no one best way to broach the subject of switching to a part-time schedule. "Every scenario is going to be different because every practice is different by virtue of its culture," said Jim Bowron, a health care consultant with Gamble Givens & Moody in Charleston, S.C.
Here are some tips to make a smooth transition to part-time work:
Be willing to compromise. Experts say that it's extremely important to approach the subject of part-time with flexibility.
"It's important not to be too rigid in your expectations," said general internist Maria B. Wright, ACP Member. "You can't expect to have every benefit and compensation that someone working full time has."
While Mr. Bowron agreed that part-time work may require a "spirit of compromise," he also warned that part-time physicians should not be heavily penalized for their decision to work part time.
Beware of working half-days. Half days always last longer than you intend them to, warned Sarah K. Warren, ACP Member, who now works half time.
"It creates a problem if a day that's supposed to end at noon ends at three," she said. If possible, she advised, try working a fewer number of full days every week, rather than a greater number of half days.
Unfortunately, that's not always possible, pointed out Dr. Marklay, who worked two half-days a week when she was working part time. She didn't want the other physicians in her practice to have to cover for her when she wasn't there.
Contracts are key. Contracts often have to be rewritten or revised when a physician decides to go part time, Mr. Bowron said, because the employer never took these issues into consideration.
At the same time, he pointed out that a good physician compensation agreement should give physicians the freedom to work more or fewer hours without affecting other physicians. "A physician compensation agreement that is heavily weighted toward production and profitability helps alleviate the pressure and sensitivity of physicians cutting back to part time," he said.
Dr. Warren agreed, saying it is important for practices to work out details like call schedule and coverage before they think of getting involved with part-time work. "It becomes much more difficult," she said, "if physicians are hired without a very clear understanding of what is expected of them."
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