Burnout Prevention Archives

Going part-time is a Choice I have been practicing medicine for 19 years going on the big twenty. Where did all the time go? It went by working and working very hard at that. When I first started the novelty of taking on the role of the professional and helping my patients gave me a strong sense of accomplishment and I felt I was well compensated for the work I produced. Now the work feels more like a chore and the satisfaction in relation to the income has dissipated. Making the choice to cut back hours is not an easy one since it has social, professional and financial consequences. I came across an article written by Heidi Moawad, MD of the same title as above. The basic premise is that going part-time is not necessarily a good idea for these reasons. And while I disagree with her conclusions, I understand how she developed her premise. Going part-time maybe a bad idea for some clinicians but a great idea for others especially if they are financially independent. The professional consequences of going part-time There are essentially 4 reasons going part-time can hurt you professionally You will not be available for your patients when they need you most.You will lose respect from your peers.Getting promoted is nearly impossible compared to full-time equivalents. Your Network shrinks in your absence. I agree with the above statement with caveats. First, practicing medicine is complicated especially if you have a close personal relationship with your patients. This is especially true for solo practitioners who by definition have to be available for their patients or arrange for coverage for their care. I think this type of practice today is exceedingly rare and most groups already have cross coverage. Many specialties don't even have patients tied to any particular provider like Anesthesiology, ER, Radiology or Acute Care Surgeons. In most cases, the patients don't even notice when these physicians are absent. If anything giving a physician enough time to recover especially if they are overworked or burned-out will enhance patient care. Losing Influence and Respect from physician peers I used to be extra conscientious of the opinions of my peers. I discovered over many years that their opinion of me doesn't necessarily have anything to do with me. Like most people, they have biases and core values that will differ from mine and unless I am totally like they are they will have a mixed opinion of me. Therefore I respect the opinion of my peers but only as it pertains to my clinical abilities and my trustworthiness. Beyond this, I have learned to not take anything personally. I believe this is rule number #3 of the Book of Agreements. "Never take anything personally." As far as respect goes, I practice anesthesiology and I don't remember ever having respect, so I guess I won't miss it!?! I also suspect most part-time physicians have little to no interested in moving up the chain of command or have a great interest in leadership roles. In fact, I would guess many want to back off of clinical medicine due to the more administrative and interpersonal burdens associated with modern medical practice. So I would agree that part-time work could hurt these types of prospects. On a personal level, since going part-time many of the new and aspirational leaders frequently come to me for advice and/or seeking out my time to take on some new leadership role. My response is always the same..."no thank-you!" Will your professional network shrink when you go part-time? Your network either expands or contracts which depends on how much effort you put into it. The part-time physician will definitely see fewer people at work and will have a contraction in this aspect. However, if the time outside of your job is used to pursue other professional activities then the amount of network lost at work will be dwarfed by the new network you create. Since I have started blogging, podcasting, professional investing and working as a Locum physician, my network has exploded. I have met more interesting and well-connected people in the past two years than I have in the past 5 years in my current organization. My old network didn't take any of my interests or passions into consideration while my new network is filled with amazing like-minded people who have similar values and goals in life. In a way, losing some of my old network gave some space to pursue new relationships and opportunities. I even attend professional conferences that are actually fun in comparison to the highly regulated and very dull medical conferences. The Lifestyle Effects of Working Part-Time Everyone has a reason to pursue part-time work and many would like to pursue a life of more leisure at least that is what they think will happen. Physicians are doers and not the type to sit around and watch tv. Many of my peers who have "retired" realized this after the first year or so. It is hard to sit around and do nothing when life is happening all around you. I personally know I am much busier working part-time since work was considered sacred. My wife and family generally had little expectations from me outside of work since I worked such long hours. Now that I am "free" I spend more time running errands and have become the de facto family chauffeur to my unlicensed children. So in this regard, I agree with Dr. Moawad that I spend more time becoming a "jack of all trades" but I kinda like the title and the time I invest in raising my kids will pay off in great dividends in my relationship with them. The Financial Realities of Working Part-Time Clearly working fewer hours results in less income, at least less income as a practicing physician but it doesn't mean less income on an hourly rate nor does it mean less cash flow from a total financial balance sheet. When I first looked into working part-time I performed my due diligence and realized there are many benefits working less hours but first what are the potential hazards? Financial Hazards of working part-time according to Dr. Moawad: Part-time workers make less per hour than full-time peers. Many part-time physicians are not eligible for conference/educational time, benefits or paid vacation.Administrative time and commuting may take disproportionate unpaid time I know some physicians who make less per hour than their full-time peers but it has to do with the type of work they perform. For example, all RVUs and ASA units earned typically are based upon total production and not some arbitrary number based upon seniority. Second many part-time physicians my choose easier work or case type. Third weekend and night call command higher hourly income or salary and it should since it is onerous. A part-time physician may choose to forego this in exchange for less money. Some physicians can have the best of both worlds by commanding near full-time pay with part-time work depending on specialty and the ability to perform very specialized work. CareerCodeBlueHq.com describes "how much will I earn as a part-time or job share doctor?" Looking out how the part-time job is structured matters. Benefits and Vacation To be fair Dr. Moawad's article was written in 2016 well before the looming physician shortage and boy have things changed. I have researched every large physician group and hospital organization in my immediate community and they all still provide insurance, vacation and CME benefits to both physicians and advanced practice employees so long as they work a minimum threshold. It most cases it is 26 hours a week. In my organization at 75% of my original job, I still continue to receive 100% CME benefits in terms of time off and stipend. My paid vacation has been reduced by the ratio of my work reduction. I receive unpaid time-off for the rest. If you lose these benefits I recommend finding a new job since there is no reason to suffer when the job market will accommodate you. Administrative time and commuting may take disproportionate unpaid time Working part-time has some disadvantages but administrative time is not one of them. If anything it will require less time. For example, I no longer attend any non-mandatory meetings nor do I volunteer for extra interdepartmental or company personal relations. The burden of documentation and authorization compliance will always be there but it could potentially be reduced depending on the work you choose, like locums for example. I hate commuting too so I make it a point to work full or even long days in order to have complete days off. So instead of working a 6-hour shift, I prefer a 12 to 24-hour shift and take the next day or two off. Therefore, on the whole, I commute less. The Financial Realities of working part-time Answered The practicing medical professional has no ability to scale their income like other professionals unless they invent a product or leverage their position to claim a stake in a large company or surgery center. Consequently, our pay is in direct proportion to our productivity. Physicians in this position must labor and labor until they have a large enough nest egg that produces more income than their efforts and becomes financially independent. Therefore, it is imperative that any physician who desires to work part-time take a hard look at their finances and as Grant Cardone says, "Get your money right!" This means to make sure cash flow is positive and bad debt is eliminated. Since I have gone part-time in the past 18 months I continue to have positive cash flow while funding all my investments, maintaining my emergency fund, and maintaining a relatively comfortable lifestyle. The hardest thing about going part-time was adjusting my budget to accomplish these goals. This included reducing spending on eating out, taking less expensive vacations and cutting out needless purchases. It didn't reduce any expenses that mattered like my kid's education fund, charity or helping family members in need. Had I not been able to accomplish this I am not sure I would have gone part-time. Full disclosure, I am not fully financially independent from an ideal perspective but I am well on my way. Using financial calculators and projections I will be at 120% financially independent in 8 years. To be fair, I could continue to work full-time and a little extra to cut this in half. Instead, I have chosen to spend this extra time I have gained by spending more time with my wife and kids. I still sometimes miss a boy scouts meeting or Jui-Jitsu practice but I have never missed a campout or tournament thanks to my part-time choice. Choosing part-time employment is a choice and must be weight with financial solvency, professional endeavors, and personal beliefs. I agree with Dr. Moawad that it is not a good idea for some people but a great idea for others, especially me! How much money should you have saved before you choose to work part-time? What sacrifices do you have to make in order to make it happen? What happens if the worst-case scenario happens? What do you think?

Category: Burnout Prevention

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