Women physicians find ways to make "part time" work

Erin Tracy, MD, MPH, works full time in a large ob-gyn group. If she could afford it, she'd love to cut back. Several of her colleagues already have. As a young physician active in the American Medical Association's Women Physicians Congress, Dr. Tracy has a strong sense of what is happening among her peers.

"There is a great interest among a lot of people of my generation to work less hours, to spend more time with family, but figuring that out is difficult," Dr. Tracy said.

Pediatrician Paul Stricker, MD, agrees. A specialist in sports medicine for kids at Scripps Clinic, a large multispecialty group in San Diego County, he just started working part time two weeks ago, after a year of negotiations with his employer.

"I feel very relieved," Dr. Stricker said. "Now I'm going to be able to use my time in both worlds."

One world is his clinical work; the other covers a range of professional and personal pursuits, including being actively involved in several sports medicine societies and writing a book on kids in sports.

Arrangements such as Dr. Stricker's are likely to become more commonplace as the upcoming generation of physicians moves into practice. Women began the trend of flexible medical careers, and more young physicians, men and women alike, are likely to follow suit in the quest for more balance in work and life.

There aren't yet a lot of resources to help physicians attain this practice mode, but organized medicine is in the process of filling the gap. The American Academy of Pediatrics and the AMA's Women Physicians Congress, in particular, have begun collecting data and compiling resources on the issue. Leaders in academic medicine say there's a move under way to encourage more medical schools to offer part-time tenure tracks. In the meantime, physicians rely on a network of those who have gone before them for guidance.

Hilit Mechaber, MD, an internist and assistant professor of medicine at the University of Miami School of Medicine, went from full time to 50% time when she had her first child. She now spends 2½ days a week at a clinic for the indigent and teaches third-year medical students.

She encourages physicians looking to reduce their hours to identify their goals before approaching the boss.

Dr. Mechaber's primary goal was to maintain her dual role as medical educator and clinician. Long term, she wanted to be on track for promotion as an academician; her school is in the process of creating a part-time faculty track.

In return, Dr. Mechaber took a pay cut and gave up her benefits.

Janet Bickel, visiting associate dean for faculty at the University of Wisconsin Medical School, encourages physicians to emphasize their commitment to the practice or institution and the value they bring when they begin negotiating to work fewer hours. "Make it clear that you see yourself as an active professional for the next five decades."

Give examples of what you hope to achieve in your career and in the department in which you are working, Bickel said, such as, "I value my clinical practice, and I want to build my diabetic patient base."

Then you might segue into your goal to work less. One approach, Bickel said, might be: "Another important value to me is my family. I want to make a long-term investment in you, and I want you to make a long-term investment in me. I'd like to prorate my salary and take Fridays off."

"Whatever it is, put it on the table in a positive and professional way. The tone to avoid, and one that many young people are unaware of, is coming in and thinking you are entitled to whatever it is you want," she said. "Realize it's a negotiation. Help them want to make a long-term investment in you."

Part of the practice's investment might include paying for full medical liability coverage, even though you'll be seeing fewer patients. The hours cut-off for qualifying for a less expensive policy varies from state to state.

But Bickel advises not letting such costs deter you. The alternative of advertising for another physician and bringing in candidates to interview is also costly.

Employers stand to gain, too

Frances Brokaw, MD, assistant professor of internal medicine at Dartmouth-Hitchcock Medical Center, said that ultimately, the employer gains, because part-time physicians are highly productive.

"If most division chiefs are honest, they get more productivity per FTE [full-time equivalent] from somebody working part time than someone working full time," Dr. Brokaw said.

"Someone working part time is more likely to have a little extra to keep patients a little happier or add in an extra patient here or there. People who are part time have a little more reserve."

Dr. Brokaw, who works 80% of full time, said working less gives her more head room, especially on days when the patient schedule falls apart. She might not be spending more time with patients, but she finds she can focus on them better and is less distracted by the other tasks waiting for her.

Of course, there is a risk that you'll be paid for part time but end up working full time.

Dr. Mechaber's administrative work is not factored into her hours, just as it isn't for most full-time faculty. After having her days off get eaten up by these responsibilities, she decided to spend no more than five hours of her own time on it per week.