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Job-share works as internists try to balance work and home

It's not for everyone, but limited hours and patient load pays off for one unique practice and its patients

From the April ACP Observer, copyright 2006 by the American College of Physicians.

By Gina Shaw

Michele K. Herring, ACP Member, rarely missed a school play, a class party or a turn chaperoning a field trip for any of her four children, even though she has been a partner in a thriving internal medicine practice since her children were very young.

By the time her now high school-age children get home from school, Dr. Herring is always home. And one of her partners, Carol A. Sharpe, MD, has for many years taken month-long trips to places like Turkey, China and Australia.


Michele K. Herring, ACP Member (left), and Carol A. Sharpe, MD, say they and their partners run a 'bare-bones office' to keep overhead down.



How do they do it? The answer lies in the unusual nature of their practice. Now a partnership of six female physicians, Sharpe, Dillon, Cockson & Associates PA, in Edina, Minn., "job-shares" the entire practice, with each doctor working the days and hours she chooses. Three of the partners currently work seven half-days a week, while one works six half-days, another works four half-days and one works only two half-days. Their combined time equals the coverage of three full-time physicians.

"It's a unique group," Dr. Herring admitted. "Everybody in our group puts her life ahead of financial gain, and there's no pressure here to see more patients. There's never a practice decision that comes down to infringing on our personal lives."

Such an approach is far from commonplace: A recent survey by MomMD, a support organization for women in medicine, found that only 18% currently have a job-sharing arrangement. However, the survey also showed that more than 60% would job-share if they could. ACP is responding to that level of interest by publishing the "Part-Time Employment for Physicians" guide, written by Sarah K. Warren, ACP Member, who also has a "job-sharing" arrangement. (More information about the guide is online.)

Picking the right people

Those who job-share or work part-time report high satisfaction levels, according to the MomMD survey. The trick is not only focusing on work-life balance, but finding the right type of physician to work with.

It's not surprising, then, that the partners liken their practice more to a marriage than a business. "We've been approached more than once when we thought it might be a bad fit," Dr. Sharpe said. Red flags, she said, include people who might be "too controlling" or those who can't manage their time well.

A "hard-driving person" who's focused on maximizing patient volume and revenue, would probably not work out, Dr. Herring agreed. "We strive to keep a viable practice and be financially responsible, but we respect each other's decisions as to how much time to be at work and what to bring to the practice."

That's how it's been since a female internist, who has since retired, left the grueling hours at one group practice to set up shop on her own in 1980. Dr. Sharpe joined her a year later. "I worked four days a week when we first started," Dr. Sharpe said. "We felt that if you don't do it right off the bat, it's very difficult to cut back when the practice is busy."

In the early days, both partners would each take one weekday off while the other covered, sharing weekend call with another group so each could avoid taking call every other weekend. Another physician soon joined the group, with each partner working four days a week.

It took several years for the number of partners to top out at six, making it possible for them to take turns on call. "We each take call roughly every sixth weekend, and then one weeknight," Dr. Sharpe explained. "Monday night is my night, but because there are six of us and four non-weekend nights, we can rotate a little bit."

The practice has been all-female since its inception, and the partners see no reason to change that, even though they've been approached by male colleagues. "We've never contemplated adding a male partner, because I think it would change the dynamic," Dr. Sharpe said.

Juggling everyone's needs

The part-time model seems to work well for both patients and physicians. The group is in such high demand that five of the six partners no longer accept new patients except those referred by a colleague—an indication that patients are well satisfied with the group's services, even if they don't always see "their" physician.

"We brief each other on our patients if needed," said Dr. Sharpe. "And we all have very good handwriting and keep very complete notes." The practice's two registered nurses also help doctors keep up-to-date on their partners' patients when they fill in.

Do they ever feel they're missing out on knowing their patients better? Not really, Dr. Sharpe said. "We each have our band of patients that we've really gotten to know over the years, and they'll schedule appointments when their doctor is available. The fact that the two doctors in the practice who have the lightest schedules still continue to carry a full patient load is proof that it works."

Meanwhile, the partnership has successfully juggled the changing needs of its members, who now range in age from 46 to 59. One partner, for example, had a chronic illness that kept her out of work for a full year.

Dr. Herring held off on joining the practice for a year, to take a sought-after chief resident position.

"Not only was it an honor, but it was appealing because I had a newborn and it was a day job with no call," she said. "The practice held the position for me because they said they wanted the right person, and I was the right fit." She came on board in 1992, working four days a week when her children were small. She's cut back her hours as her children have taken on more activities and when her mother became ill.

"When someone goes away for a long period or cuts back on hours, we do have to kick it up a notch to get patients seen," Dr. Sharpe said, "but not to the point of having a lot of extra hours."

Making it pay

Despite the shortened hours, the practice estimates that most of the partners earn about 80% of the usual full-time salary for a physician in their area. After overhead and expenses, all partners share in the profits; 85% is split directly on the basis of production, while 15% is "share and share alike." (Each new physician usually spends a year on salary and then has the option to buy into the practice.)

Business decisions—such as the current discussion over which new computer hard drive to buy—are based on consensus. It seems to work. Neither Dr. Sharpe nor Dr. Herring can recall a time when the partners couldn't agree on a staffing or business issue. "As a corporation, we have certain mandated official meetings, but other than that, it's not like we meet every other Thursday or anything regimented," Dr. Sharpe said. "We're small enough that often we can just grab each other in the hallway to talk about whether to buy a new fax machine or just replace the part that's broken."

If the practice sounds ideal to physicians who rarely see their children before bedtime, the partners warn that job-sharing isn't for everyone. The practice does not, for instance, offer any guaranteed salary and physicians would likely make more money elsewhere. As with any position where you're your own boss, Dr. Herring pointed out, if you're not working, you're not making money.

"If I were to offer a position like this to one of my friends who's the sole provider for a family, I'm not sure it would be appealing, because the money's not there," said Dr. Herring, whose husband is an attorney. (Five of the six partners have two-income households.) All the benefits physicians expect from a group practice, such as paid vacations and money toward continuing medical education, "we pay for ourselves," she added. "We run a very bare-bones office and we don't have a very large space or a lot of staff, to keep overhead as low as possible."

The physicians don't, for instance, dictate their charts; instead, they transcribe their own notes into their charts. They don't have an electronic health record system and have no current plans to buy one. Limited staffing means the doctors often make their own follow-up calls to patients on such issues as normal cholesterol levels or follow-up exams.

"That's the downside," Dr. Sharpe said. "We're not part of a large organization that can absorb overhead and expenses. But we're quite efficient, and if you control things yourself, you can control costs."

Gina Shaw is a freelance health care writer based in Montclair, N.J.

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