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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 full-time peers.
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 income generated.
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.