Part-time doctors shaking up small practices
■ A column about keeping your practice in good health
Increasing numbers of physicians are seeking part-time positions with flexible hours, resulting in higher turnover rates for some small practices that do not adjust to the trend and challenges for those that do.
A 2010 Physician Retention Study released in April by Cejka Search and the American Medical Group Assn. found that turnover rates are increasing slightly despite the poor economy. The trend has been fueled largely by young female and pre-retirement male physicians, including many who are seeking part-time positions. The survey found that 13% of male physicians and 36% of female doctors practiced part time in 2010, compared with 7% and 29%, respectively, in 2005.
"Given the high demand we're seeing, the notion of a part-time physician is one small practices will need to look at," said Kenneth Hertz, principal consultant at the Medical Group Management Assn.
But it isn't always an easy adjustment for small practices to make. Full-time physicians, especially if they are partner-owners, could feel they are taking the brunt of the workload without sufficient compensation. The hours the physician wants to work may not correspond with patient flow. The doctor may want part-time hours but full-time compensation. And other full-time physicians in the office may believe a precedent has been set and expect the same privilege, experts say.
So how does a small practice adjust to this growing trend and make the part-time physician work for the practice and the patient?
First, practices need to set up a plan that is appropriate for the physician and the practice, one that keeps in mind the continuity of care for patients.
"The practice needs to look at the practice's cost structure and the physician's expectations, and it needs to come up with a system that incentivizes the physician to remain productive," Hertz said. "The plan needs to reward the part-time physicians yet fairly compensate the practice so its overhead costs and expenses are covered."
Creativity is important, added Mary Barber, vice president of Cejka Search.
Barber said one way to use part-time physicians without disrupting an office's patient load is to have them visit patients in the hospital while full-time doctors see patients in the office.
Other possibilities include:
- Job sharing, in which two part-time doctors work different days of the week or hours of the day.
- Having part-timers do specialized work, such as pediatrics or geriatrics, in a family medicine practice.
- Having part-time physicians take same-day or urgent care calls.
If the practice also does nursing home visits, the part-time physician can take that role, too, said Deborah Walker Keegan, PhD, author of "Innovative Staffing for the Medical Practice" and president of health care consulting firm Medical Practices Dimensions, near Asheville, N.C.
The part-time physician who wants to spend more time at home with young children also could do e-consulting and e-visits and fill prescriptions from home, Keegan said.
One point that needs to be worked out from the beginning is call. Some full-time physicians who are about to retire and want to lessen their workload will want to give up call, putting that responsibility on the remaining full-time physicians, said Jennifer Metivier, executive director of the Assn. of Staff Physician Recruiters in St. Paul, Minn.
Talking about pay
Compensation is another point that needs to be discussed upfront. Robert Wolfson, MD, president of Wolfson Consulting in Lakewood, Colo., said some part-time physicians will work on a purely contract basis, with no benefits or retirement plan, saving a small practice money. However, experts say pay is usually based on salary and some productivity formula.
"Some offices pro-rate based on the number of hours worked," said Patrice Streicher, president of the National Assn. of Physician Recruiters and associate director of VISTA Physician Search & Consulting "Some base pay on collections. The physician gets a percentage after a certain threshold."
Wolfson said the pay would be based on a percentage of the amount a physician brings in, minus overhead costs to run the practice.
Jenny Liebl, physician recruiter for Pacific Memorial Clinics near Seattle, said Pacific Memorial pays part-time physicians a guaranteed salary for the first two years, after which it goes to a production model.
And then there is the situation where the part-time physician is a partner in the practice, which Walker Keegan said opens up a whole new set of complications.
"Should the person continue to be a partner once they are part time? How long should they be a partner? Should it be forever? Who is taking call for them? Are they still paying their full share of the practice's costs? There are a lot of questions to ask," she said.
Family physician James Valek, MD, who formerly operated Vista Family Medicine in Chicago before selling the practice to Little Company of Mary Affiliated Services, discovered the challenges of hiring a part-time physician as an employee with the idea that the doctor eventually would become a partner.
He said the relationship lasted 1½ years before he decided to sell the practice.
"Were we wildly successful? I would say no," Dr. Valek said. "As the owner of the practice, I had more responsibilities forced on me. A partnership implies splitting, but when one is full time and one is part time, it is difficult to use that term."
He said he wouldn't have done anything differently. "But a doctor looking for a partnership, it is pretty hard to do unless everyone shares the same load," he said.
Dr. Valek said he decided to sell for a variety of reasons, but the biggest factor was the realization that the burden always would fall on him.
"Almost all the people I interviewed wanted to work part time with a full-time salary," he said. "No one wanted to be paid on productivity. I found it extremely hard to grow a practice in that sense."
Note: Caffarini is filling in for Victoria Stagg Elliott.