This column could be titled “Champagne Problems and How to Solve Them.” Having the ability to work part-time as a physician is incredibly good fortune, and it is also a great gig. You get to enjoy practicing medicine without getting ground down (as much) by all the nonsense, and you get to enjoy your life. You can spend time with loved ones and have hobbies. You can do the mundane but important stuff like exercise and laundry. We in the trades call this “diastole.”
I’ve been part-time since finishing residency. First, it was because my husband had a full-time job, we had three little kids at home, and we found two full-time physician careers to be untenable. Now, our kids are out of the house, and I’m still part-time because, honestly, I can be. I’m still plenty busy. Also my husband has said all our lives are better when I’m not . . . I can’t remember his exact words . . . something about half-crazed, cranky, exhausted.
For your part-time job to meet all your expectations for work-life balance, you have to structure it right. If you don’t, you might just find that your work commitments bleed over into all that free time you thought you were going to have and that you are in the unenviable position of working full-time for a part-time salary. The advice below comes from my experience as an employed pediatrician, in both private practice and academics. Some of these points won’t apply to shift workers like ED, self-employed physicians, or those paid solely by productivity.
Here is what you should think about as you create your ideal part-time physician job.
The Partnership
I have a friend in private practice who went part-time (actually, she went from 60 hours a week down to 40, #obstetricianlife), and one of the senior partners told her she would have to sell her shares in the practice back to the group. This was not in the partnership agreement but she is nothing if not a team player, so she sold her shares and gave up her partnership dividend. Six months later, that same senior partner decided to cut back her own hours—and kept all her shares. The moral of the story is: know what is in your partnership agreement and don’t let anyone tell you different.
Ideally, you clarify rules and expectations around FTE as you negotiate your partnership track, without tipping your hand that you hope to work part-time someday. Some especially old-school practices disapprove of partners under the age of 80 cutting back—you can choose to see this as a red flag or not. If you are already locked in, you may have to re-negotiate these aspects of your agreement.
More information here:
7 Reasons I Practice Medicine Part-Time
Why I Designed My Life Working Part-Time 931 Miles from Home
Call
This might be the stickiest point in creating a part-time position.
I once had a half-time job with full-time call. That would have been fine if call was primarily from home, but we covered deliveries, the newborn service, and a weekend clinic. Call was crushing. I was working the same number of nights and weekends as my colleagues for exactly half the pay. I was a new grad at the time and didn’t know any better.
There are many ways to structure call—or whatever other burden is onerous, like weekend clinics or night shifts—that are fair. These include:
- Paying a flat rate per call
- Paying for RVUs generated on call
- Paying a “call-in fee” that kicks in if you go into the hospital during your call
- Pro-rating call by FTE
Please note that these solutions are fair for all involved. You are not asking for a special carve-out for your special self, thereby inviting scorn from those who have been around longer than you. If you are already locked into a less-than-ideal call situation, remember that other options exist and other practices have optimized call for everyone.
A way that this isn’t fair: making the newest hire take the worst shifts. Let’s stop passing on our generational trauma.
Benefits
I currently work 0.8 FTE. This qualifies me for health and dental insurance. My salary is too high for the HSA match but too low to let me contribute to the 457(b), which is annoying. Maybe I should work either more or less to fix that.
Know your employer’s thresholds for getting health insurance, a retirement match, and the like. Check to make sure you will get adequate CME money, because the cost of maintaining your license is the same whether you are full- or part-time.
Skills
If you are in a procedural speciality, make sure you know how many of each procedure you need to do annually to stay current. It’s generally a good idea to keep future options open unless you are sure you are segueing to retirement and are willing to let some skills fall by the wayside. Consider some targeted CME to keep you current if you can’t get enough cases.
The Inbox
Results and patient phone calls will come in every day of the week, and your colleagues will not thank you for signing everything out to them. Unless you job share, you will have to log in when you are not in the office to check your inbox.
You can explain to your staff and your patients that you will respond to non-urgent matters in (choose some reasonable number of) days. If you lose a patient because you took two days to respond to their question about gut inflammation as described in a TikTok video, you are probably better off.
The Commute
Getting to work takes the same amount of time whether you are working 12 hours or four. It takes me a full hour door-to-door to get to work if I factor in parking. I love my half-days, but from a strict efficiency standpoint, a full day of work would make more sense. If your commute is truly awful, it might be smart to consolidate your schedule into fewer days per week.
More information here:
Stuff You Should Take with You When You Leave Your Job
Help, I’m a Doctor in a Cubicle: Auntie Marge Explains It All
Should I Feel Bad About Taking Time Off?
The Committee Meeting
Actually, I recommend that all physicians avoid these. If you really can’t, at least ask for a remote option. If your presence is truly required or needed for you to get to do something else you really want to do, maybe you can work your schedule around those meetings to make the trip to the office worthwhile. If you have to come in on what should be a day off, you are working for free.
The Three-Day Weekend
When I didn’t work Mondays, I always thought it was just a teensy bit unfair that my colleagues who had Monday clinics got several paid holidays per year that I didn’t. I never said that out loud because it seems petty. It is petty. But it is also true.
The solution to this is to wrangle a schedule that includes Mondays, or just be the bigger person and appreciate all the Mondays you get to enjoy from home.
There you have it, my best advice on creating an ideal part-time gig. You will be very fortunate if you can combine all these into one job, so think of this as a wish list. Not discussed here is the financial foundation you need to work part-time. That’s why the rest of WCI exists. If you are in the trenches of residency or full-time work, all of these may seem impossibly aspirational. Hang in there. One day, you too can have champagne problems.
Do you work part-time? What are the benefits? What are the drawbacks? Are you happy with your schedule?