Medical Practice Creative Work Schedules

November 2, 2011

Here's how to rethink the work day to find the balance you need with the rest of your life as a physician.

As an author, consultant, and specialist in female sexual health disorders, Lara Burrows has made a name for herself as one of the leading OB/GYN practitioners in the country. But it's her talent with time management that may be more impressive still. With two school-aged kids, Burrows, 40, has devised a schedule that allows her to remain focused on her career and still be there for homework and hockey practice.

"My schedule is like a quilt," she says. "I block out specific time slots during the week to do specific things." Indeed, Burrows spends two to three days a week seeing patients at Summa Health Systems hospital in Akron, Ohio. She also shares a private practice in Washington, D.C., with an internationally renowned specialist, where she flies out to treat patients twice a month. When Burrows is out of town, her husband, a plastic surgeon, gets the kids off to school. On most days, though, her doctor duties end promptly at 4 p.m., when homework and extracurricular activities (hockey, figure skating, cello, piano, and chess) begin. "Between the hours of 4 and 8 [p.m.] is sacred family time," she says. "Then it's lights out and that's when my work starts up again. I'll research and write from home."

Burrows may be ambitious. But she's not alone, says Nick Fabrizio, a consultant with the MGMA Health Care Consulting Group, noting flexibility has fast become the marketing tool of choice for practices looking to recruit the new generation of family-focused physicians. "Workforce planning today means practices are going to have to accommodate physicians who have different expectations about their job and are looking to contribute in different ways," he says. "They see the older, male-dominated groups logging 60 or 70 hours a week and that's just not consistent with their priorities. They want a better balance."

And it's not just working mothers, he says, noting male and female physicians in their 20s and 30s are equally attracted to flexible schedules that allow them to pursue personal interests and continued education. The same is true of older physicians entering the pre-retirement phase of their careers.

A 2010 study in the Journal of the American Medical Association indicates that due in part to lifestyle choices and declining fees, physician hours per week are down among various specialties and across genders, ages, and employment settings. The largest decrease in the survey period (1996-1998 and 2006-2008), indicated that nonresidents younger than 45 years old, saw a 7.4 percent drop in work hours, which researchers said might suggest a more balanced work-life scenario.

But not everyone seems to have reduced their work hours.

According to our 2011 Great American Physician Survey, 53 percent of physician respondents indicated they would like to work fewer hours per week, with nearly 17 percent indicating they would take a 10 percent pay cut to reduce their work hours by the same percentage.

There are a number of scheduling arrangements that can help you score the "me time" that you seek. The following provides a snapshot of the most common scenarios, and more importantly, tips on how to pitch it to your practice.

Part-time

For those wanting less stress in their daily lives, part-time schedules are one option. According to the 2010 Physician Retention Survey by Cejka Search and the American Medical Group Association, the number of part-time physicians nationwide has grown by 62 percent since 2005 - not surprising given the changing profile of today's medical workforce, in which the two fastest growing physician segments are young women and older male doctors approaching retirement. As a result, the survey notes, "medical groups are adapting to demographic changes in the workforce by providing practice models that permit flexibility to support lifestyle choices physicians make throughout their careers."

If your practice already offers part-time positions, or you plan to propose it, keep in mind that not all such arrangements are created equal, says Patrick Alguire, director of education and career development for the American College of Physicians. "It's been my experience that half days just never work," he says. "They tend to extend out because if there's one extra patient or you need to talk to a family or make a few telephone calls you're going to do those things and that begins to eat into the part of the day you didn't promise to your employer." It'll be better for you if you commit instead to two or three full days and anticipate long hours when you're there, he says.

Depending on how your practice is structured, however, working less than 36 clinical hours per week may be a tough sell - especially in offices where overhead and call duty are shared equally. "Private practices often find it very difficult to accommodate physicians who work part-time because it means they contribute less to call and overhead so it's both a philosophical and financial issue," says Fabrizio, noting older physicians often resent that they put in long days and feel the next generation should have to as well. Both issues are less of a sticking point at larger groups and hospitals, which benefit from economies of scale and as a result can more easily accommodate part-time requests, says Fabrizio.

In terms of patient care, the impact of working part-time seems to have no detrimental effect. A 2003 study in Medscape Today (Medscape.com) indicated the shift to part-time clinical practice by primary-care physicians "may occur without harm to patient outcomes," and that part-time doctors ranked higher in quality performance than their peers working longer hours.

Job sharing

You can try to negotiate a more equitable distribution of overhead expenses in smaller practices, of course, one that does not hit part-timers disproportionately hard. But you may have better luck proposing a job-sharing arrangement instead, in which two physicians perform the duties of one full time equivalent (FTE), says David Knocke, president of BJC Medical Group in St. Louis, Mo., a multidisciplinary group with 13 locations and more than 250 physicians. "It's inefficient to staff for part-time roles because of overhead and because it can be hard to recruit part-time physicians," he says. "It works better if two physicians pair up to take care of one full-time practice and work together with complimentary schedules to essentially practice as one." Patients who visit such practices are made aware that they may see either doctor, depending on the day of their visit, and it's rarely an issue, says Knocke. More importantly, he says, there's no loss of revenue or contribution toward call duty and overhead.

Be forewarned, though, that most practices only offer benefits - retirement plans, health and life insurance - to those who work at least 36 clinical hours. If you're planning to work less, be sure to consider the fallout it will have on your family. That's not an issue if your spouse can get coverage through his or her employer, in which case you might even be able to push for a bump in part-time pay, says Alguire. After all, the practice is saving money by not having to provide you benefits. Conversely, though, if your spouse does not have coverage, you should make every effort to renegotiate your employment contract to include prorated benefits based on hours worked, says Alguire. The same is true of malpractice insurance. Many employers, he says, will allow part-time doctors to purchase coverage through the practice on a prorated basis.

Lastly, if you're looking to work part-time for now, but expect to return to full-time status down the road, Alguire says you should consider your opportunities for partnership. You won't likely be offered partnership during your part-time tenure, but you should ask to receive credit for the years you serve, making you eligible for partnership sooner once your full-time status resumes, he says.

Alternative solutions

You may not need to reduce your hours, though, to achieve a better work-life balance. You might, for example, get permission to work a condensed schedule, in which you put in 10-hour days, four days a week, in exchange for Friday or Monday off. Likewise, you could come in Saturday mornings in exchange for more time off during the week, or negotiate to work several mornings a week remotely from your home office.

Patients at your practice may appreciate the weekend hours to fit their own busy schedules during the workweek in return.

No-call contracts and the use of hospitalists, who eliminate the need to round on patients at the hospital, are also an option that can make your job less consuming. You'll have the best luck negotiating a no-call contract if you agree to play nice, says Alguire. Make yourself available for telephone calls from home at night and on the weekends, but leave the hospital admissions and in-patient calls to the full-time physicians. Just don't expect to get paid the same as your call-taking colleagues who spend their days running between the hospital and the office. "If you're working three days a week and not taking call, you can't expect to make the same salary," says Burrows. For Burrows, the loss of income is a small price to pay. "You have to be willing to compromise and set limits on your time," she says. "There's always going to be another patient, but at some point you have to draw the line in the sand."{C}

It's all in the delivery

When you sit down at the negotiating table, be sure to focus on how your schedule will benefit the group, says Cheryl Devita, a senior consultant for physician recruiting firm Cejka Search in St. Louis, Mo. If going part-time renders you ineligible for benefits, for example, highlight the savings to the practice. If you're willing to work Saturdays in exchange for time off during the week, note how that will benefit your patients - and potentially help build the practice base. And explain to the shareholders that by establishing a successful flexible work program, the practice will be better positioned to recruit and retain top talent going forward. "With the economy being what it is, we're finding fewer physicians willing to relocate unless they have to," Devita says, noting depressed housing prices have tethered many doctors to their local markets. "We're seeing practices prorate benefits and back off on call coverage just to get someone signed. They know they need to look outside the box and be more open-minded." Likewise, she says, the best and brightest coming out of training today are saddled with so much debt that they need to work full-time, but they want the freedom to work those hours on their terms. Practices that are willing to accommodate have a distinct advantage in getting those doctors through the door. Fabrizio agrees: "When I look into my crystal ball, it says the groups who are going to be strongest are those willing to accommodate a diverse workforce in work hours, gender, and culture."

Even so, you must be prepared to defend your case. Start by drafting a written proposal that preempts the shareholder's questions and include such details as how you'll get paid (a percentage of either revenue, profit, or hours worked), when you will work, and how you'll be accountable for performance. If you sense hesitation, suggest a trial period, says Fabrizio, which allows both sides to test the waters before making a commitment. Above all else, though, be honest about who you are and what you're willing to give, says Burrows. "I think women, in particular, are afraid in this day and age to say, 'I really care about being a mother.' If your children and family are your priority, say that," she says. "When you're upfront about who you are, people will respect that."

As the 70-hour work week goes the way of the cassette tape, physicians who seek a better balance between personal time and their careers need only ask. Be aware, however, that some flexible options may mean a smaller salary, loss of benefits, or temporary derailment of a partnership track. It's up to you to decide how far you're willing to go to win back control over the clock. Depending on the culture in your practice, adds Burrows, that may mean finding a new employer. "I came to Summa Health because they're family friendly and they don't pressure me about my schedule," she says. "They're very understanding about what it means to be a working woman with young kids and my partner in D.C. is the same way. It's all about who you work with."{C}

In Summary

•Half days don't work well for practices; try working two or three full days per week
•Some practices will prorate benefits for part-time doctors
•Flexible schedules can also offer flexibility to patients
• Pitch flexible hours by focusing on the benefits to the practice

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the November 2011 issue of Physicians Practice.