Robert, two part-time positions

Robert
Physician, Family Practice
36 Years Old
Married with 2 children, ages 7 and 4
Spouse profession: PhD, Math/Physics educator

Job profile:
Works for a health policy research center 4 days a week and one day a week seeing patients in a community-based residency program.

Tell us more about your specific work choices.
I spend the bulk of my time doing research that provides policy-makers with an evidence-based perspective of primary care.  Typically, our research focuses on patient safety, healthcare access, health economics, policy options for health system change, and healthcare workforce.

There are seven staff in the research center; we also host an internship program and a health policy fellowship.  I also work with residents and students both in my clinical practice and through the medical and public health schools in Washington, DC. I do not take call – which is a major time saver.  I took call the first 2 years I was here, but it was difficult to justify the added malpractice cost of doing inpatient care necessitated by taking call.

What are the advantages of working in part-time jobs?

Working part-time enables me to nurture my interests in health research and policy. At the same time, I would miss the community practice part if I gave that up because I find great satisfaction in working with patients.  Really, the two merge together nicely.  My work with patients means that I can talk knowledgably about the practice of medicine in my work in the research and policy area.  It also makes my research more practical because I can talk with clinical colleagues about policy options under consideration.

Another plus -- I can give out my cell phone number and e-mail address more because I have more time and freedom to talk to patients on days that I am not in the office.

Are there difficulties in working part-time?

Continuity in patient care can be an issue when working part-time.  Most of my patients know that I am in the office only one day a week. Nurses and others in the clinic need to help with patient follow up. But despite my only being in one day a week, I am continually amazed at the effort patients make to see me.

I also miss being in hospitals because admitting my patients creates a break in our continuous relationship—it still feels a bit like abandonment to me. I also don’t like it because it is one more break in the usual ways physicians understand what has happened to their patients.  That is, we still have such poor processes of communicating across the hospital-clinic divide that it can be very difficult to find out what happened in the course of a patient’s care while being admitted. 

Finally, I worry a bit about returning to inpatient care since I only do outpatient care now.  I would probably need to complete a reintegration program – e.g., where physicians with non-traditional backgrounds teem up with Attendings for a month to retrain – in order to get up to speed for the inpatient care setting.

What things to do you bring to the practice you work in?

I can teach -- about research, evidence-based medicine, and health policy.  And, now that my practice has adopted an electronic health record, I’m also getting involved in designing quality improvement and research projects using the new database.

What about advancement?

Professionally I’ve advanced within the center, moving from assistant director to director.  I have had a different advancement path from the usual academic track.  My faculty appointment at Georgetown has offered advancement and I was promoted to associate professor although I’m just not convinced there is tangible value to this unless I take an academic post later. 

I also help run the health policy fellowship program.  The Graham Center co-hosts a year-long fellowship program with Georgetown.  It is a solid link to the academic department.  Our center also helps support their research infrastructure.

Are there issues regarding benefits like insurance?

My benefits are now completely with the research center (it is a division of the AAFP) and are better than what I likely would experience in academic practice.  My clinical services are contracted from the Academy on an hourly basis that is subsidized by the Academy in recognition of the value it adds to my work and as a service. This arrangement keeps me “whole” within the Academy benefits scheme—a much better arrangement than previously when I had to be 20% employed by a clinical practice plan. 

My current clinic site covers my malpractice costs as a matter of our contract.  Part time practice can be difficult to arrange because many clinical entities make malpractice coverage conditional on employment or the issuance of a check to the physician.  This is particularly true of self-insured entities or federally insured entities like academic health centers and community health centers.  My experience is that this narrows part-time practice options.

Do you get asked if you are working enough?

Yes.  I tell them that it often feels insufficient for maintaining clinical experience, but it is partly balanced by my greater freedom to look things up related to my patient-care and to read journals generally.

Did family play a role in your decision to work part-time?

Family did not play into decision to work part-time or regarding call or work with the AAFP. It did impact my decision regarding whether to do OB call. I didn’t think doing OB would be fair to my patients or practice.

Do you have other advice for physicians looking for part-time work?

If you want to do it, keep testing the waters and looking at all forms of clinical practice.  It can be difficult to find balance.  My work in research and policy offers opportunities to help patients and their care-givers on a large scale, while my clinical practice keeps me grounded in the doctor-patient relationship.  Both settings feed my desire to make a difference but the transitions, in setting and in mindset, can be rough some days.  I’m glad I don’t have to give up either at this stage in my career.