Baby bias: Setting policies that are fair for workers

Managing a practice that is family-friendly but still equitable to non-parents can be a tough balancing act. But it can be done.

By Pamela Lewis Dolan — Posted Jan. 1, 2007

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During her career as a family physician, Dineen Greer, MD, has spent time on both sides of the battle between parents and non-parents in the workplace.

Dr. Greer spent her first five post-residency years as the only childless physician in a busy private practice in Seattle where she often scheduled time off around school vacations, took less-desirable on-call shifts and covered for co-workers called away for family emergencies.

Now a family doctor and faculty member of a family medicine residency program in Sacramento, Calif. and the mother of a 3-year-old son and 6-month-old twin daughters, Dr. Greer is the one who is juggling home and work responsibilities, while her childless co-workers help fill the gaps she is sometimes forced to create.

"I expected to someday have children, so was I conscious of being good about when you do have kids, things happen," Dr. Greer said of her childless days. And her co-workers were also cognizant of the fact that she didn't have kids but still had a life, so they didn't just dump things on her, she said.

Most of Dr. Greer's colleagues now are non-parents or parents of adult children, and their understanding of her hectic schedule also comes from their own experiences. But others have learned that trying to recognize the needs of parents without burdening those without kids can become a balancing act.

Experts say that kind of flexibility is key if you want to have a practice that is family-friendly, but not unfriendly to those without families. Practices can be flexible with scheduling and time off, as long as what is good for the mother or father also is good for the childless employee. Otherwise, experts say, a family-friendly office can foment just as much resentment as one that chains employees to the practice no matter what is going on in the outside world.

Consider this familiar scenario: It's late in the afternoon, and the waiting room is full of sick patients. In between taking blood pressure readings from one patient and waiting on lab results for another, the only nurse on duty gets an urgent call from her child's day care and has to leave immediately.

Under most circumstances, the practice manager would likely be cross-trained to help out doing things like blood pressure readings, taking phone calls and charting. But what if the office manager is out that day, or has to leave by 4 p.m. to get to school, where she is taking classes toward a master's degree? Do you force the manager to miss her class so the nurse can get to her sick child?

Assuming there were no emergency cases, "the patients would just wait," said Katherine White, a registered nurse who has been consulting physician practices in management issues for more than a decade. "It's the last thing you want to do, but you can do it."

Forcing the manager to stay, experts agree, would be sending a message that her life is less important because it doesn't involve kids.

Sometimes things just happen, and no amount of preparation can prepare you, White said. But there are safeguards that practices can have in place so that when stuff does happen, it's less likely to become a dire situation.

Cross-training and effective scheduling are among the best ways to prepare to expect the unexpected, White said.

Office managers can provide the best buffer in a small practice if someone has to leave or calls at the last minute unable to come to work, White said. Designating half a practice manager's time on a fixed schedule and making the other half variable, for example, provides a lot of flexibility for practices unable to hire on-call staff, she said. Other staff, such as receptionists or assistants, can be cross-trained as well, to fill in on things like taking patient blood pressures or temperatures. And employees should all be willing to do this for one another, White said.

"There is a quid pro quo, and this is it. We want you to be good at cross-covering each other," White said, The groundwork needs to be set as each new person is hired, she said.

More staff, more options

Christine Sinsky, MD, an internist at a multispecialty group in Dubuque, Iowa, said it helps being part of a larger group where there are more people to pool together. Dr. Sinsky's office is designed in specialty "pods" where each unit operates fairly independently from the others. But in tight situations, nurses from other departments can be called to fill in for a day or a few hours.

The most important thing for employers to remember is that everyone has a life, regardless of parental status, said Thomas Coleman, executive director of Unmarried America, an information service for unmarried workers. Coleman is quick to point out that 65% of the work force does not have children at home. "Parents are a minority in the work force," he said. So more employers need to adopt "work-life" balances as opposed to "work-family" balances, he said.

In her 2004 study, "Beyond Family-Friendly: Singles-Friendly Work Cultures and Employees," Wendy J. Casper, PhD, assistant professor of management at the University of Texas at Arlington, wrote that equal respect for non-work life is defined as "the degree to which similar importance is placed on the non-work roles of employees with or without families." Dr. Casper found that 35% of childless employees felt their non-work responsibilities were perceived as unimportant despite the fact 65% provided financial assistance or direct care to extended family, friends or pets.

Dr. Sinsky said physicians in her practice realize everyone's life is important, and the employees realize it as well. Although a master schedule is prepared every month, Dr. Sinsky said she gives nurses the freedom to trade shifts and cover for each other as needed on an informal basis. And they've always made it work out, she said.

White said one way to encourage that cooperation is to offer practicewide incentives based on customer satisfaction.

With an incentive, "People are willing to invest what it takes to get it done," she said, "That is very progressive, but it can be done."

Dr. Greer believes a progressive use of technology is making things easier for the physician parent. She said her practice's decision to implement electronic medical records was a huge relief. The EMR allows her access to patient records through a secured Web site from home, so she can complete administrative duties without being stuck at the office late into the evening.

If she has to stay home an entire day, she and another physician will team up. The in-office physician does the exams while Dr. Greer calls patients, checks lab results, fills prescriptions and completes patient charts from home.

A study conducted by Women in Medicine and WebMD found that only 37% of women physicians are satisfied with their work-life balance. A 2004 study by the Academy of Pediatrics similarly found only 43% of pediatricians were satisfied with the time they have to spend with their children.

Creating a good work-life balance for everyone is just good business, experts say. Especially as more physicians look at leaving medicine, or moving to part time.

The 2006 Massachusetts Medical Society's Physician Workforce Study found a mean of 46% of physicians in that state are dissatisfied with the number of hours they work compared with the amount of time spent pursuing other interests. One-third of those physicians said they were considering a career change. The state society called this finding "worrisome."

As nursing shortages have reached a critical level in some areas, many practices, especially in the primary care setting, are allowing nurses to walk into a new job and write their own schedules, White said.

Several studies, including a 2002 study by the American Academy of Pediatrics, have found the number of physicians going to part time continues to rise.

Sharing the load

Dr. Greer is currently on the search for someone to enter a job-share with her. She said the person will split her current 70% schedule, which is 40% administrative and teaching and 30% clinical. The job-share concept has become a popular one in her group, she said, and has allowed many physicians to continue working after starting a family. Most of the job sharers at Dr. Greer's medical group are working mothers, but there is one male doctor in a work-share arrangement, she said. Dr. Greer said ideally her work-share partner will be someone with a similar philosophy of work-life balance so they can better appreciate each other's needs.

Before job sharing became mainstream, Dr. Sinsky said she and her husband, also an internist, created their own job-share. When their kids, who are now grown, were little, she and her husband together created the equivalent of a full-time physician. One took the day shift, the other took the evening shift, and many times they handed off the kids in the parking lot, she said.

While their careers meant a great deal, it was important to her and her husband to always have someone there to get the kids off to school and someone there to greet them when they returned home.

Dr. Sinsky said it's important for employers to value families. It's not only good for the parents, but it also helps retain good employees and helps with employee morale.

But White warns that patient satisfaction should be closely monitored, especially if the practice is creating new family-friendly policies or scheduling.

"Staffing for efficiencies usually don't reflect what employees want or need to work," White said.

So the right solution has to be carefully balanced. If current policies have caused patient satisfaction to lag, or you find yourself with high staff turnover, it's time to try something new.

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It's all in how you word it

Experts recommend creating "work-life" programs for employees, as opposed to "work-family" programs.

Instead of ...You offer ...

Subsidized health insurance for dependents"Cafeteria-style" benefits package that includes credit for unused benefits

Maternity and paternity leaveSabbatical program that can be used for parental or educational leave

Preferential vacation time for parentsSeniority-based vacation preference.

Paid sick time that can be used to care for a sick childPaid time off that can be used for any purpose

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Out of balance

A Massachusetts Medical Society study included asking physicians how satisfied they were with the hours they worked versus the time they had for other interests. Responses varied by speciality, with surgical subspecialties falling at both ends of the spectrum. Those who say they are dissatisfied or very dissatisfied:

Anesthesiologists 37%
Cardiologists 50%
Emergency medicine specialists 42%
Family physicians 44%
Gastroenterologists 47%
General surgeons 57%
Internists 53%
Neurosurgeons 34%
Ob-gyns 41%
Orthopedic surgeons 63%
Pediatricians 35%
Psychiatrists 43%
Radiologists 50%
Vascular surgeons 67%

Note: Results are based on 1,266 mailed surveys that were completed and returned, an 18% response rate.

Source: Massachusetts Medical Society, "Physician Workforce Study," June 2006

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What Doctor Moms have to say

MomMD, a career site and association focused on woman physicians, conducted a 2004 survey about various aspects of work-life balance. Of the more than 500 respondents:

22% were dissatisfied with their work-life balance.

24% reported that other than not working at all, working 30-40 hours per week seems the optimum point for feeling very satisfied.

27% said they experienced discrimination or negativity from students, residents, professors or physicians because of their parental status.

67% of those working more than 40 hours per week reported being dissatisfied with their balance.

67% of respondents with more than five children reported feeling satisfied with their balance.

Source: MomMD (link)

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