An increasing number of physicians are scaling back their hours. Here's how to do it right.
Shortly after family medicine physician Suzanne Bloomhuff gave birth to her first child, she realized she needed to work part time to balance career and family. But she also knew getting her seven-physician practice to agree to such an arrangement would be challenging.
Although the Needle, Wis.-based physician became a doctor just a few years earlier, she already had an overwhelming patient load. And all other physicians she counted as colleagues worked full time at the practice, each juggling up to 10 hours of patient visits and EHR documentation per day.
Fortunately, she had a little timing and luck on her side.
A consultant had recently come to speak to the practice about productivity and overhead, and had mentioned that while part-time physicians were a financial drain, an alternative "job sharing" part-time situation - where two physicians split one full-time job - would be a win-win. So when she approached her office manager with a job-share proposal, her office manager did some research and found another female physician who wanted the same thing.
"I knew it was going to be a tough sell to my partners so the shared practice was a really good way to sell it," says Bloomhuff.
That was 10 and a half years ago.
Today, Bloomhuff is a mother of four and continues to work three days a week as a physician in the practice. Still, she is the first to tell you that making the transition wasn't as easy as having a couple of conversations with colleagues and patients.
So if you, like Bloomhuff, want to scale back your hours for a reduced schedule, know that doing it the right way takes a bit of planned effort. It's a potentially months-long process, with several considerations to take into account.
Why more docs are going part time
Cejka Search and the American Medical Group Association's (AMGA) 2012 Physician Retention Survey - which included 80 respondents representing more than 19,000 physicians - reveals a growing number of doctors want flexibility in their schedule. An increasing number - 13 percent of male physicians and 33 percent of female physicians - reported they were working part time. That's up several points from 2005, when 7 percent of male physicians and 29 percent of female physicians reported they were working part time, in a similar survey.
The two biggest demographics of physicians seeking part-time work are those approaching retirement and female physicians beginning their medical careers, who, according to the survey, also happen to be the two fastest growing populations in the physician workforce.
(For more on retraining retired physicians for primary care, see http://bit.ly/Doc-retrain.)
"It's more and more females," says Kevin Kennedy, a principal and member of the board of directors with healthcare consulting firm ECG Management Consultants. "They tend to be more interested in work-life balance, and probably more impacted by decisions to start a family. Even though gender roles are changing, they do tend to be in more of a caregiver role when a family starts."
It's important to note, however, that "part time" for a physician could mean 40 hours a week, while it might mean 20 hours to 30 hours per week in another industry. Still, for younger docs entering the workforce, even a 40-hour workweek offers what's perceived as a better work-life balance than traditional, full-time physician careers.
"Maybe one-third of new physicians will choose to go part time within five years of entering practice," says Kennedy.
Perhaps as a sign of the times, 75 percent of groups now offer a four-day, full-time workweek, according to the Cejka Search/AMGA survey.
"Nowadays, the younger generation, some of the first questions they're asking are, 'Where is it and how much?' and also 'What's the schedule? Is it just 9 to 5?' [and] 'What's my call expectation?'" says Peter Cebulka, director of recruiting, development, and training for physician recruiting and employment firm Merritt Hawkins.
Also, because there is so much more documentation involved in their jobs than in previous decades, many physicians believe dropping their hours will allow them to return to previous levels of work effort, says Kennedy.
"We have definitely seen some doctors drop to a 0.9 or 0.8 status just to get back to what they consider a normal workweek of 40 to 50 hours," says Kennedy. "These doctors were used to working 10-hour days and when EHRs came along, that increased to a 12-hour day."
Planning the transition
The first step to transitioning to part-time employment is figuring out what you want and what you can live with - in terms of hours and compensation.
You may desire a three-day schedule, but the compensation may not be enough to make working part time in your current practice worth it.
"Dropping from full time to half time, you'll probably end up making less than half of what you were making before," says Kennedy. "Overhead keeps going up. The question, if you're thinking about going part time, is, 'How are those costs going to be absorbed?'"
Once that's established, sharing your intention with your manager or clinician colleagues sets the tone for a more organized, less-hectic transition.
For Bloomhuff, this meant first offering the idea as a hypothetical suggestion to her manager well in advance of when she actually hoped to make the transition.
Experts agree transitions should be planned several months to a year in advance. This way no one at your practice is caught off-guard, and managers and colleagues will feel less stressed and more willing to accommodate your needs.
"If you can let someone know a year or so beforehand, that's great - or at least 90 days - because it is difficult," says Cebulka. "There are patients booked out several months in advance, and as more physicians are being employed by health systems, sometimes the practice manager doesn't have the authority to allow someone to go part time. It may be a decision that needs to be made from a contractual standpoint at the health-system level with whoever signed their original employment agreement."
When Lansing, Mich.-based internal medicine physician Fred Isaacs decided he wanted to devote more working hours to administrative duties, which he enjoyed, scaling down his practice hours over the course of six months was the best option.
"It got to a point where I was being invited to do more than just straight [medical practice] work, and I thought that was the appropriate time to downsize my practice," says Isaacs, who has been practicing medicine for more than 25 years.
Making the transition
Once you know what you want, it's time to hash out a detailed plan. This should include timelines, but also plans for transitioning patients.
Here are the steps you'll need to take to execute your vision:
1. Prepare your part-time request. When you approach your administrator or office manager with the news that you'd like to go part time, make sure you are ready to address the basics (such as when you would like to begin part-time hours) and potential questions from your employer. "You're going to need to plan for addressing the concerns that will come up," says Kennedy. "Those include call coverage, patients, addressing issues like, 'What is staff going to do when you're not there?' [and] 'Is there flexibility with your [physician assistant] or nurse being able to work with someone else or will they have to go part time too?' You have some potentially difficult issues to work through."
If you have ideas in mind for minimizing the negative effects of fewer hours, such as a job share, where your practice could hire another part-time physician to split one job - as Bloomhuff did - be prepared to explain. "It's a great idea," says Kennedy of job sharing. "It gives you a chance to share the painful economics and a panel of patients. But finding the right person can be like finding a needle in a haystack. You have to find someone you're compatible with clinically and schedule-wise."
2.Set clear expectations with partners. Be prepared for a potentially difficult discussion with your clinical colleagues, as they may be concerned about taking on extra work. Also check with your insurance company. "Most insurance companies and most medical staff regulations require you to arrange for 24/7 care for your patients, and so that will impact your colleagues because if you're not working, they'll have to take those calls," says Kennedy. "So that can sometimes be a very tough dialogue if your colleagues aren't expecting it or if your practice doesn't have defined policies or procedures." As soon as Bloomhuff's part-time situation was approved, she was clear to her colleagues that none of them would have to pick up the slack - her job-sharing partner would help her to handle a full-time patient load. And to make things easier for her job sharing partner, Bloomhuff says that she tries to check her EHR inbox so there isn't extra work when she's out of the office.
3.Have your contract reworked. Physicians need to make sure their contract is revised to clearly reflect both parties' expectations for compensation, as well as workload. "Working out something between you and your employer can be a potentially protracted process," says Kennedy. "That needs to be part of the discussion as well." How a contract is structured depends on the nature of a physician's practice adds Cebulka. "If they're a senior partner in a private practice, one thing they're going to want to do is make sure their compensation methodology is structured in a way so they don't have any animosity [from full-time colleagues] if they go part time."
4. Talk to your patients. After a plan is in place, it's time to talk to patients about the change and what it will mean to them. "Talk to them about things that are going to be of concern to your patients," says Kennedy. For example, prepare to answer questions such as, "If I call on the day you're not working, what do I do to get in?" or "What's the process about being seen urgently on the same day? Who's going to see me?" "You should have a script ready to answer those questions," says Kennedy. Isaacs suggests physicians help patients find a backup doctor in the practice for urgent needs. "What I've always encouraged people to do … is to try to establish a relationship with one of the other doctors in my practice," he says. "I usually tell people, 'It's a good idea … if you have a cold or sore throat or problem, to find somebody you feel comfortable with.'"
Not every job is flexible, and even if you have your transition to part-time physician life all planned out, not every employer will be able to accommodate that. Therefore, physicians should be prepared for their request to go part time to be turned down.
"Oftentimes physicians relocate when they're trying to make a change because it's hard to tell everybody around you 'no' unless you're in a specialty where you have shift work," says Cebulka. "Sometimes it's easier to move to a location with very clearly defined expectations in that role."
The good news is that it's a buyer's market for physicians in terms of opportunities.
So when it doesn't work out at your existing practice, it's time to start shopping around for the best part-time opportunities. "There are some groups and some health systems that are extremely accommodating, and there are others that are just not interested," says Kennedy. "If going part time is important to you, I would encourage you to shop around for the best arrangement."
Considering going part time? Here's the right way to do it.
• Have a plan ready before meeting with your manager.
• Plan your transition 90 days to six months in advance so everyone is prepared.
• Consider proposing a job share, where two physician colleagues split a full-time workload.
• Be ready to address concerns from your clinical colleagues.
• Tell patients far in advance and prepare to address common concerns.
• Revisit your employment contract and make sure it is reworked to set clearly defined expectations.
• Be prepared to move on from a practice that cannot accommodate part-time hours.
Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at firstname.lastname@example.org.
This article originally appeared in the January 2014 issue of Physicians Practice.