Could part-time improve physicians’ quality of life?

Mixing business and pleasure

In the corporate world, it’s known as the "mommy track" career path: Otherwise promising executives find their career growth stunted when they take time out to deliver and raise children. Some opt for day care and a continued career, often worrying about the long-term effect on their children and feeling a lot of guilt in the process.

But there is an answer, and one which can not only benefit young mothers who happen to be physicians, but any doctor in your practice who wants more time away from work — part-time practitioners.

Seven years ago, Ponderosa Family Physicians in Aurora, CO, was a busy practice with four full-time physicians. But they had too many patients for the four to handle, according to the practice’s former administrator, Deborah Duncan-Milburn, CMPE, now group practice administrator for Total Health Care in Colorado Springs. "[The practice] decided to hire another doctor, and we found the perfect candidate," recalls Duncan-Milburn.

But there was a problem. This physician was a new mom who wanted only part-time hours and no on-call duty. It was up to Duncan-Milburn to design a program that worked.

Her main concern was finding a way to compensate the other four physicians for taking the call that the new doctor wouldn’t handle. "We decided to look at it as an expense," she says. "The doctors who took call were credited with the production units it entailed, and the doctor who did not take it was charged that value as an expense."

The system worked. Shortly afterward, another part-time physician was hired, working under the same rules. Both of these physicians were eventually brought into the practice as owners, and they continue to have part-time hours. Ponderosa now has eight physicians — four are full time, three half time, and one works about three-quarters time.

While most of the users of the program at Ponderosa are women, the system has allowed others to take advantage of part-time hours for short-term needs. One physician who is single and without children, works part-time in order to provide more time for volunteer work and other outside interests, says Duncan-Milburn. "If a physician wanted to train for the Olympics or to climb Mt. Everest, there is a method for that person to work shorter hours."

Another physician wanted to take six weeks off. The practice already knew how to calculate the value of the missed call time, so that doctor knew he either had to pay a certain amount of money to cover the call or trade off the duty with other physicians prior to his leave. For some people, time is more of a priority than money, she says. "Now, there is a way to accommodate people’s lifestyle choices."

Others who could make use of a part-time program are practitioners at the end of their careers, such as Walter Diaz, MD, an ophthalmologist in New Orleans who has been in practice for 57 years. Now 82, Diaz started cutting back his hours when he turned 65. "I told myself in the beginning of my career that I wouldn’t operate once I hit 65," he says.

He further reduced his time about 10 years ago so that he could spend long weekends at a country house. Now, he works Tuesday through Friday and only works past 11:30 a.m. one day a week.

For Diaz, it was just a matter of finding the right partner who would support his decision and take any call for him. "It wasn’t that hard for me," he says. "Most of my patients were starting to get old, and a lot of them have died." Many of the physicians who referred to his practice also retired or passed away, he adds, making his step-down easier.

Benefits for all

Whether it is for new moms, for people with an interest in spending one or two days a week volunteering, or for a physician on the verge of retirement, a part-time program can be beneficial not just to the doctor but to the practice as a whole. "The part-time program really paid off for us," says Janet Peterson, MD, one of the original four physicians at Ponderosa.

She currently works half-time, as well. "We have a flexibility that other practices don’t have." For instance, if the practice is busy, a full-time physician really can’t do anything to alleviate the situation, she says. "But the part-timers can put in another half day or some extra hours."

There are other benefits to the practice, too, such as higher morale among physicians, which Peterson says makes them more productive. "I also think that it demonstrates to our staff and our patients our commitment to the family," she adds, noting that patients have been very supportive of the program. "When we apologize for not being able to schedule an appointment at a preferred time due to the part-time hours, the patients uniformly understand. They say, ‘you were with your family, and that is more important.’"

Perhaps most important, says Duncan-Milburn, is the ability for a practice to keep its best practitioners throughout their careers. "You have to ask yourself if you are willing to lose a good physician because you don’t like the idea of him or her working part-time. For some doctors, that part-time schedule can keep them involved in the practice. Remember what a valuable asset a good doctor is."

In developing a program, be sure you clearly define for the physicians what part-time work means. "You have to make sure that no doctor is going to say ‘she doesn’t work as much as me’ a month into the program," says Duncan-Milburn.

You also have to make sure you have a plan for how other physicians will handle phone calls, prescription refills, and call for the part-time doctors. At Ponderosa, the part-time program has evolved. Physicians who opt for part-time work now usually have call duty they have to fulfill — either themselves or through arrangements with temporary replacements, says Peterson.

If you decide you will charge doctors for not taking calls, then you have to have a way of valuing that call. Duncan-Milburn says she initially looked at charging call at so many dollars per hour, based on how many dollars per hour are brought in during practice hours. "That turned out to be a really high amount," she says. Instead, the doctors together decided on an amount they felt was fair. "It doesn’t matter how you determine that amount, as long as the physicians are happy with it."

Duncan-Milburn says that while she realizes many practices balk at the idea of having part-time physicians, it is a trend she sees growing. "Life balance is getting to be a big issue," she says. "This is a way to get and keep quality physicians who work well with the practice and meet their own personal needs. It shows the physicians that we understand what valuable assets they are."

Deborah Duncan-Milburn, CMPE, Group Practice Administrator, Total Health Care, Colorado Springs, CO. Telephone: (719) 776-3041.

Janet Peterson, MD, Ponderosa Family Physicians, Aurora, CO. Telephone: (303) 690-4891.

Walter Diaz, MD, Ophthalmologist, New Orleans. Telephone: (504) 891-4094.