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Understanding MOC Requirements
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April 11-13, 2019
Internal Medicine Meeting 2019
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ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
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by Patrick Alguire, MD, FACP
Senior Vice President, Medical Education
Although it is not exactly clear how many internists work
part-time, it is becoming a popular career option for many
physicians. For example, in a survey of family physicians, 12%
opted for part-time careers and nearly half did so for family
reasons. In another study, 37% of women pediatricians reported
working part-time at some point in their careers, and 21% were
currently working part-time. Recent evidence suggests that
part-time employment is rising. Additionally, there is some
evidence that part-time physicians have different work experiences.
For instance, part-time women academic physicians are less likely
to have research and administrative responsibilities and more
likely to have teaching responsibilities as compared to their
Many practices and academic medical centers are receptive to the
idea of part-time employment, especially if the position can be
shared or if the working hours can be arranged to maximize
utilization of office-space. Part-time physicians can lessen the
office workload for practitioners with busy in-patient services,
increase the capacity for work-in patients, and allow extended
office hours. Despite wose continuity and access, patients of
part-time physicians report a better experience with part-time as
compared to full-time physicians.
While part-time careers allow the flexibility to pursue family
and educational interests, it also raises important issues around
compensation, call, and clinical duties. The part-time employee
needs to be aware of these issues and carefully negotiate the
employment contract, or risk entering a disastrous relationship.
Part-time physicians in academic medicine are generally less
satisfied with growth opportunities, compensation, and benefits
compared to full-time academic physicians. The following should be
carefully considered before accepting a part-time position.
Income: Many models are available to determine
compensation for part-time work. They may be based upon a percent
of a full-time salary, generated revenue minus overhead, or a
percent of the profits. Most physicians feel comfortable
establishing the salary for a full-time equivalent, and allocating
the appropriate percentage for the part-time work.
Benefits: There is great variability in
part-time benefit packages, ranging from benefits prorated
according to the percentage of effort to no benefits at all.
Benefits may or may not be important depending upon whether a
spouse is employed with full benefits. If this is the case,
modification or reduction in the benefit package may possibly be
negotiated for a higher income. Malpractice can be purchased from
most companies prorated for the number of hours worked. This is
particularly important if the insurance is the responsibility of
the employee. Money and time for CME is becoming more difficult for
even full-time physicians to negotiate, and the opportunities may
be quite limited for the part-timers. However, a strong negotiating
point is that licensure is dependent upon accruing the full
allotment of CME credits by all physicians, whether they are part
or full-time. This fact should be stressed when negotiating CME
benefits with the employer.
Overhead: Some groups share all overhead
expenses equally, regardless of the hours worked. Naturally, this
puts the part-time physician at a financial disadvantage, since
their consumption of resources that generate overhead is relatively
small. In this regard, the part-time physician should try to
negotiate an arrangement where the overhead is calculated by the
hours worked in the office, the utilization of staff and space, and
Working Schedule: Careful attention should be
paid to how the working hours are arranged. Working only part of a
day soon leads to dissatisfaction as the four-hour commitment
stretches to five or six hours. If at all possible, arrange to work
full days to minimize "work creep," but at the same time remain
flexible to the needs of the group to cover unexpected problems and
unanticipated patient demand.
Call: Most part-time employees prefer not to do
call, and this can usually be arranged with the practice. However,
a no-call policy may translate into a lower salary for the effort,
and is the expected price to pay for being free evenings and
weekends. A part-time employee might consider offering to take
telephone calls from home at night and on the weekends and delegate
hospital admissions and in-patient calls to a back-up physician.
This effort will be greatly appreciated by most groups.