Part-time practice: Slackers need not apply

Fifteen years ago, when Laura Boehlke-Bray, MD, a Wisconsin family physician, decided she wanted to work part time so that she and her husband, also a physician, could start a family, just one group out four she interviewed with was receptive to her request, according to a recent article from the New England Journal of Medicine's Career Center.

But today, as physician demand surges and doctors across all demographics (though primarily men approaching retirement age and women in early to mid-career) desire greater work-life balance, more and more practices are considering offering alternative, flexible work arrangements to candidates like Dr. Bray.

"In our recruiting, we advertise for full-time physicians, but about half of the candidates want to do something different," Christine McGee, vice president of physician practices for Licking Memorial Health Professionals in Newark, Ohio, told NEJM. "Five years ago we wouldn't even consider that, but we can't turn a blind eye to the market."

And it's a market that's undeniably changing. According to the recent Cejka Search/American Medical Group Management Retention Survey, part-time physicians now make up 21 percent of the workforce, compared to 13 percent in 2005. A 2008 survey by The Physicians Foundation in Boston echoes the trend: 30 percent of the 12,000 physician respondents who indicated they would modify their practice within three years planned to either cut back on patient panels or switch to part time.

What practice leaders and physicians should keep in mind, however, is that part time is not for slackers.

Counter to what it may seem, physicians (or other practice employees, for that matter) looking for a reduced schedule must, in many cases, be even more disciplined, dedicated and reliable than their full-time counterparts.

As the NEJM piece points out, many part-time doctors concede to working upwards of 35 hours a week to see patients and keep up with paperwork, email, phone calls and "schedule creep." It's up to the individual physician to complete these tasks, even when they push up against time that is otherwise spoken for.

"I generally work about 12 hours instead of 10," Matthew Drewry, MD, said of his three weekly workdays. "And there's always at least a half-hour of paperwork each day, whether I'm there or not. I think that the amount of paperwork and e-mails are about the same whether you're part time or full time."

In addition, many part-time physicians maintain full-fledged call duty, for the most part to remain in the good graces of their colleagues. "I think that if you're part time but share call equally with your colleagues, any of the political or other issues work their way out," Bray advised other doctors.

Nonetheless, physicians who can work out the logistics--mostly feasible for PCPs and less so for intense surgical specialties--accept the tradeoffs. "It's a lot easier to sprint for three days than for five," admits Drewry. And while some physicians hesitate to even track how much unscheduled time goes toward work, they acknowledge that the flexibility to handle calls and other administrative tasks from home makes it more manageable.

As a professional who has run the gamut of alternative work schedules, as an employee and now a freelancer (whose current office hours are primarily 4 to 7 a.m.), I feel for physicians who bend over backwards to accommodate priorities other than work. (Disclosure: I'm a Gen-Xer with zero qualms about this hierarchy.) I understand the pull to work harder to ensure others feel the smallest impact possible of my working less; the dilemma of whether to turn on the out-of-office assistant or carry a BlackBerry; wrestling with the prevailing misconception that being available to take my kids to the park means my day is, well, a walk in the park.

As far as I'm concerned, there are two critical elements to making part time work: compromise and trust. All parties involved need to be able to bend, to acknowledge that a schedule is nothing more than a guideline and to share a faith and commitment that, one way or another, the job will get done and get done well.

Have you worked as or with a part-time physician? What are your secrets to success? - Deb