Jacqueline, after being diagnosed with cancer the way she practiced medicine changed

Jacqueline
Age 45
Specialty: Internal Medicine

When did you work part-time?
After being diagnosed with breast cancer at age 32 (4 years into my private practice of Internal Medicine) in rural Georgia the way I practice changed significantly. Prior to my diagnosis I was on call every 3rd night and averaged 55-60 hours a week. My only child was 1 year old at the time. I was practicing with my husband and brother in-law, with the phone ringing at our house 2 out of 3 nights and weekends.

During my year of treatment I worked 3 days a week, no hospital work, and no call.

How did you transition back into working more hours?
After that year I went back to working full time in the office from 8:30 a.m. – 5:00 p.m. Monday, Wednesday and Friday and 8:30 a.m. – 1:00 p.m. Tuesday and Thursday, but no longer taking call. I did this by gradually increasing my hours over about a three month period to where I am now, working 40 hours a week. I also went on “courtesy privileges” at my hospital to get out of ER call, but to be able to admit a limited number of patients. Most of my patients that require hospitalization are taken care of by my partners or referred into a major hospital 30 miles away.

Was continuity of care an issue when you were working part-time or with your schedule of working 40 hours instead of the 55-60 hours a week you were working before you were diagnosed with breast cancer?

Yes it was an issue during the year I worked part-time. It was an issue for both my patients and my partners. I was the only female physician in our practice and many of the female patients went to Ob/Gyn physicians while I was working part-time and undergoing cancer treatment. Some of the continuity of care issues also had to do with the seriousness of my illness. Some patients who left the practice initially with my illness, did not come back because they thought I would die, not necessarily immediately but in the next 2-3 years to come. Some patients might have thought it was better to stay with the new person they were going to instead of coming back to me. A lot of the older patients did stay as we had been their medical home for years.

It helped that I was in practice with my husband and brother in-law because there was that connection for the patients and I was also able to keep up on patients by talking with my husband and brother in-law at home. So I think some of my patients still felt a connection to me even if I was in the office less.

Also, when you work less hours you tend to see more scheduled patients rather than acute care patients. I think a lot of bonding does occur during those acute care visits.

What are some things you have found that helped to increase continuity of care for your patients and yourself?

I think coming into the office 5 days a week for part of day seems to work better than not working at all some days. Patients see you in the office and know that you are there at least part of every day and that helps. Of course this isn’t what is always best for one’s personal schedule and life. Going in to the office every day does mean that you do have the paperwork and phones calls there waiting for you every day and the days can be longer than you planned.

Also, being in practice as I mentioned before with family has helped with continuity of care issues.

Do you have any advice for women physicians thinking about working reduced hours or part-time?

I tell many young medical students to consider private practice as an option. I think it can give you more control over your work and personal schedule than in an employed position with an organization or large employer. The downside is that it can be hard to find a private practice that is willing to have a part-time physician on staff. I think it is also helpful to find a practice that has another woman physician on staff.

There always is constant mix of issues that need to be addressed. For women wanting to have children or who have children I think it is really important to try and work out a schedule that gives you time to have dinner with your child or children a few days a week. I told a woman physician who works in our practice that she needed to start leaving early at 3:30 pm a few days a week so that she could go home and make dinner and sit down with her children instead of eating by herself on the fly. Children at different ages of course have different needs and it is important to work with those needs and try to adjust your schedule. Another example of this is a friend of mine who splits a call schedule with another physician so that they have more uninterrupted time at home.

What are the pluses and minuses of working in a practice with family members?

Personality is very important. My husband and I have different personalities and that seems to works out for us most of the time.

Being on call can be a negative when in practice with family members. That is why I am out of the call schedule now. When I was in the call schedule that meant that we were getting calls 2 out of 3 days at our house. Going out of town is also difficult because that means that if we are out of town half of the practice is out. Or when something happens like an illness or death in the family it can shut the practice down for a few days and we have to scramble for physicians to take call and patients.

A plus is that being in practice with family means that we understand and value our family and their needs. My husband and I are also able to schedule our work so that one of us is available at home most of the time. We do have another person in our practice now who is a “hometown girl” and she is like family too. By working with my husband, we have been able to find the best balance of our home and work responsibilities. I think even in practices not made up of family members it is important to make family a value for the staff to stay. We all value each other in our practice and our families too.

Any other advice for physicians thinking about working part-time?

Don’t go looking for part-time work. Look for the job you want and negotiate from there. Get your foot in the door first then you will be in a better position to negotiate because you will have established yourself as needed on staff and known.

Is there anything else you would like to add?

I thought of one other thing. When you face your own mortality, you don't wish you had worked harder. You wish you had spent more time on your family and doing things you really enjoy. I enjoy practicing medicine and I love my career. As a physician, I want to look back on my practice and my life knowing I
made a difference for my patients, but even more importantly that I made a difference in my family. Facing my mortality at an early age gave me a new perspective on how I practice medicine. Cancer made me a better doctor and a better wife and mother.