Medical practices, just like other work environments, face significant challenges when it comes to navigating increasing demand for flexible scheduling.
On Monday, President Obama hosted a summit on working families. On the top of his agenda is looking at more flexible scheduling for work hours, starting with federal employees. Additionally, he is hoping to encourage more friendly policies for pregnant workers, citing the U.S.’s failure to mandate paid maternity leave.
I’ve been fortunate to have had paid maternity leave for all four of my own pregnancies, which was especially important for our family as I am the sole wage-earner. The flexible scheduling has been a little more challenging, but part of that deals with the nature of being a physician. While I was in the Army, there was no flexibility to the 24/7 expectation of availability but since joining the private sector, I’ve seen increased attention and acknowledgment of the desire among particularly younger physicians to flex their schedules. It doesn’t mean it’s easy and it is not always welcomed with open arms by colleagues who may be responsible for covering phone messages and patient care issues in your absence.
President Obama argues that a more flexible work environment is necessary to keep workers in the workforce. As we face the seemingly always present physician shortage, it is also important to allow and perhaps even encourage more flexibility in work schedules. In addition to physicians who wish to work part time in order to have time at home with young families, physicians toward the ends of their careers may welcome the opportunity to gradually reduce hours and maybe even prolong retirement in favor of a part-time status. Despite the myriad benefits, flexible hours can bring about challenges.
As mentioned above, patients have needs 24/7, and while call will cover after hours and weekend requests, partners may not be as keen to provide coverage during the workday for a colleague who only works two or three days each week. In addition to the patient coverage issue, there is potential concern about the cost of overhead for a part-time physician. While some operating costs are also flexible and can be adjusted up or down based on the workload, many more are fixed - think the building, computers, EHR - and are present whether a physician is seeing 30 patients a week or 100.
Patients also may be off-put by a physician, particularly a primary-care physician, who is only available three days per week. Patients like to feel that their physician will be available if they get sick or have an urgent need, but a part-time primary-care physician may not be able to provide the availability that patients expect.
Finally, what is the minimum number of patient contact hours required to keep clinical skills sharp? Is it sufficient to limit one’s practice in terms of scope or clinical hours and still retain the clinical competence required?
Just like the rest of the country, medicine struggles with flexible scheduling for physicians because it is desired by many physicians and because it has the potential to be a win-win for the practice and the physician. However, medicine is not unique in the challenges faced by flexible scheduling either and will need to address issues such as overhead costs for part-time physicians, maintenance of clinical competence, and equity in call coverage and patient-care needs.