Making Part-Time Work, Work For You
Updated: Jan 5, 2019
This is not about all the reasons doctors should or shouldn't go part-time, although there are worthy arguments on both sides. I want to address how part-time physicians can make part-time doctoring work for them and for their practice. First I’m going to tell you about a job I once had:
I was a half-time employee of a small private practice I saw patients two full days per week, at 50% of an already below-average (for my specialty and region) salary. I also took full-time call.
Dividing call up evenly within a group is common practice, but in this case there was a major kicker: this was in-house call. We covered deliveries, the newborn nursery, the occasional inpatient and the Emergency Department, with no pay differential for carrying the pager or for the number of times we got called in. We also worked weekend clinics, both Saturday and Sunday, doing both acute and routine care. I was going into the hospital in the middle of the night and doing check-ups all day on weekends for exactly half of what my colleagues were getting.
The fact that I even took this job speaks volumes about my outlook at the time, but it also illustrates perfectly the problems part-time physicians can face.
Many practices insist that everyone share equally in the stuff that nobody really wants to do: nights and weekends if you are hospital-based, call if you are outpatient, committees for everyone. If you scale back your clinic you can end up doing proportionately more of what you don’t enjoy and getting paid less for the privilege.
These are the areas can make a part-time arrangement work or not:
Call: There are many ways to make call burden equitable within a group. Call can be pro-rated by FTE or assigned equally to each physician and then “bought” and “sold” by individuals. Everyone can get a base salary for clinic work and then paid on a sliding scale for the call they take. These last two can be a nice opportunity for docs who want to earn extra and can make one person’s part-time status or personal leave less onerous to everyone else. If call is busy, you can get paid a flat fee each time you get called in or you can capture the RVUs you generate on call (which can be significant if you are coming in to do admissions or procedures). Unless call is a mere formality, however, full-time call on a part-time salary is no bargain. You might as well go back to residency.
Compensation: unless you are 100% salaried, pay attention to how a change in your schedule will affect your pay and your practice (beyond just figuring out how much you need to work to qualify for benefits). If you are an established PCP, cutting back patient contact hours might mean you are seeing mostly routine visits, which are less valuable than acutes. If your practice gives bonuses based on a single cutoff point (such as “80% of revenue after meeting overhead“) you are less likely to reach this than if there is a graduated series of thresholds (such as “20% of revenue between 50th and 60th MGMA percentile, 30% of revenue between 60th and 70th etc”). Keep in mind that unless you are job-sharing, some practices hold part-time providers accountable for full-time overhead, with the rationale that the practice still has to employ an MA or nurse for them, has to pay the rent and utilities etc.
Administration and teaching: This is tricky. If you hope to stay or even advance in academics you can't avoid doing administrative work. Your practice may have admin or "citizenship" requirements. Just try to negotiate some time built into your reduced schedule for this kind of work, or be OK with it bleeding into the rest of your life. You will probably have to accept less influence when your group makes decisions that affect you. And be aware that if you take maternity leave you will be assigned to at least one committee while you are away.
These areas may not be important to you, or you may want or need to go part-time so badly that they are insignificant. They may be negotiable. You will be better able to negotiate any new situation if you avoid the powerful mix of naiveté and lack of self-advocacy that led me to take the job I described (and which so many women physicians seem to fall prey to, honestly.)
I lasted 2.5 years in that job; I completed my contract and stayed until the practice could replace me. I now have a fabulous job and a lot more savvy. You can too.