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Part-Time Employment

Working part-time as an internist is increasingly common. This can be standalone or part-time work in addition to a full-time position for extra income or other personal or professional reasons.

Part-time work may be possible in clinical practices and academic medical centers. They can be receptive to the idea of part-time employment, for example, 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 inpatient services, increase the capacity for work-in patients, and allow extended office hours.

Changing a full-time position to a part-time arrangement often need to be discussed between an individual physician and their direct physician supervisor, such as a medical director or section chief. While part-time careers allow flexibility for a variety of reasons (e.g. for family or caregiving reasons, or to pursue other non-clinical interests), the arrangement also must be discussed and potentially negotiated to specifically address compensation, call, and clinical duties. The part-time employee needs to be aware of these issues and carefully negotiate the employment contract.

Part-time work can also be done as an independent contractor. This can involve clinical work, which can be done standalone or in addition to a full-time position (e.g. locum tenens, telemedicine, etc), or non-clinical work, such as paid consulting, service on an advisory board, starting one’s own company, etc. Such decisions are typically personal and require careful consideration of both the financial consequences and the potential conflicts of interest with respect to the part-time work and its relationship to any clinical services provided in any setting with any employer. Conflicts of interest should be clearly declared as necessary to avoid violations of ethical principles in medical professionalism.

The following should be carefully considered before transitioning to or accepting a part-time position, if working as an employed physician:

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. Many physicians may 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 personal or family circumstances, for example, whether certain benefits may be available to a physician via their spouse’s employment and 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 can 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 smaller. 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 working hours are arranged. Similar to full-time work, part-time work may also experience “work creep.” In other words, a scheduled four-hour commitment may be longer due to additional patient care or other practice needs that may unexpectedly arise during scheduled hours. As is the case for full-time work, in such situations, it helps to have some flexibility to accommodate the needs of the group or to cover unexpected problems and unanticipated patient demand. Consideration could be given to negotiating such possibilities into a part-time contract.

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. 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.