Practices must cope as more physicians work part-time hours

The trend could impact the culture of overwork but squeeze doctor supply.

By Myrle Croasdale, amednews staff. Oct. 21, 2002.

Pediatrician Jennifer Shu, MD, wants it all: career, family and the time to enjoy both.

So far, she's been able to accomplish this feat thanks to a husband who draws a good salary and a medical practice that lets her work two shifts a week.

Where the women are
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"It's awesome going part time," said Dr. Shu, who came back from an 18-month leave of absence in September. "If you can live without the full second income, it's ideal."

Dr. Shu worked five years at Sharp Rees-Stealey, a large multispecialty medical group in San Diego, before taking time off when her son was born. Now she works 10 to 16 hours a week for the group's after-hours clinic.

She is one of a growing number of women whose desire to work fewer hours is challenging the profession's traditional workweek. Experts believe that as the number of women physicians continues to increase across specialties, medicine will face some major cultural changes and may need to expand its work force to continue to ensure patient access.

Pediatrics is the leading edge of this trend, since the specialty has the highest percentage of women, said Richard Cooper, MD, director of the Institute for Health Policy at the Medical College of Wisconsin in Milwaukee.

15% of pediatricians worked part time in 2000, up from 11% in 1993.

"Conventional wisdom is that the distribution of genders in medical school will eventually be 50-50 like the population, but that's wrong," Dr. Cooper said. "Colleges are seeing that more than 50% of their students are women. So it follows that medical schools will be more than 50% women in 10 to 12 years."

This could lead to a physician shortage, he said.

"If they're only working two-thirds time, then you'll need three part-time doctors instead of two full-time ones." Dr. Cooper said. "We count physicians as if they're all working full time. So will there be enough primary care physicians, since these tend to attract the majority of women medical school grads?"

Not part time for life

Assessing the impact on the work force is also likely to be complicated by the fact that those who work reduced hours may only do so for a portion of their careers.

Carl Getto, MD, chair of the Council on Graduate Medical Education, and associate dean of hospital affairs at University of Wisconsin Hospital & Clinics in Madison, said experts are divided on whether a shortage will develop.

However, he said, there's little doubt that younger doctors are looking for more balance in their lives.

"The tendency for younger physicians to work fewer hours than their predecessors will certainly affect the physician work force in the future," Dr. Getto said. "The current generation of physicians want what they perceive as a healthier lifestyle."

A study, done by the American Academy of Pediatrics Workforce Subcommittee on Women in Pediatrics in collaboration with the AMA's Women Physicians Congress and published in the June Pediatrics, reported 15% of practicing pediatricians in 2000 defined their positions as part time, up from 11% in 1993.

This increase in part-time doctors was in line with expectations based on AAP data, which showed a jump in women in the specialty from 36% in 1993 to 45% in 2000. Women also make up more than a fourth of several other specialties, including internal medicine (27.6%), family practice (28.5%), ob-gyn (35%) and psychiatry (29.5%), according to the AMA.

Pediatrician Carmelita Britton, MD, of Albany, N.Y., co-author of the AAP study, agreed that the growth of a part-time work force in pediatrics will eventually impact all specialties.

"The desire to have alternatives to working 100 hours a week is not specific to pediatrics," she said.

For now, those who want to work part time face myriad issues when they seek to make the switch. And the reaction from colleagues is mixed.

Colleague support key

Carolyn Fein Levy, MD, is a pediatric subspecialist in hematology and oncology at Brooklyn Hospital Center in New York. She felt like she was bucking the system when she searched for a 40-hour, four-days-a-week position.

"My director laughed at me," she said. "He said those kinds of jobs did not exist." But when negotiating for a 40-hour schedule, she was surprised when her division chief actually encouraged her to work three 10-hour days a week instead for four.

That kind of support carried through into her office with her two full-time partners.

"When you work part time, you always worry that the people around you feel like you aren't pulling your weight," she said. "I was confiding this to my nurse the other day, and she said one of my partners describes me as part-time doctor with a full-time attitude. It's nice to know they don't feel like I'm slacking."

Not everyone, however, finds such support. When pediatrician Altagracia Tolentino, MD, wanted to reduce work hours, the initial response from co-workers at a New York City community health center was negative.

"It wasn't received that well," she said. "But they said they preferred to allow me to do this than to have me leave."

Some of the obstacles are financial. Practices may be reluctant to pay benefits and salaries to several part-time physicians rather than fewer full-time ones. And liability insurance rates are not prorated by the number of hours one works. The full-time physicians in the practice may also resent that they will inevitably have to pick up some extra work.

"I was one of the full-time doctors before," said Dr. Shu. "I was working with the part-timers, refilling their prescriptions, making their hospital rounds. In my group we were happy to do that ... and we had creative ways to work around the imbalance."

Whether more part-time physicians will make the practice of medicine better for all physicians remains to be seen.

Pediatrician Mariana Glusman, MD, works three days a week for the Uptown clinic of Chicago's Children's Memorial Hospital. She hopes what she is doing will help make the world of medicine a more pleasant one for doctors. "I do feel I'm an example to the residents," she said. "When they complain about their hours, my answer is that you can have a career and a family, but you might not be able to be the head of the hospital. When you see what it's like to have a life, to go on the school field trips, you realize it's actually a good idea.

"I hope that not just women ... will think about this. We advocate for our patients' parents to be involved in their kids' lives. We have to practice what we preach. I don't know how this will impact medicine in the future, but it will impact my family."

Even if the profession accepts the idea, more effort may be required to bring patients into the fold.

"A larger concern is what are patients going to think about this?" Dr. Getto said. "Will they accept a physician who is only there 15 to 20 hours a week? Certainly there is literature that suggests patients don't look kindly on doctors who hand off their care."

Pediatrician Judy Lucas, MD, Albany, N.Y., was able to take over a departing physician's part-time schedule of 2 1/2 days a week. To keep her patients happy, she is selective about what days she takes off.

"There's been a tiny amount of grumbling from patients," she said of her limited hours. "I've been careful about selecting what hours I work. I never have a four-day chunk when I'm away, and if I'm not at work I'm at home, so if there's a complicated patient [the office] can call me."

ADDITIONAL INFORMATION:

Where the women are

As the number of women physicians increases across specialties, medicine may see more doctors working part time and a need to expand its work force to ensure patient access. Specialties with the heaviest concentrations of women in 2000:

Internal medicine: 37,073 (27.6%)
Pediatrics: 30,322 (48.6%)
Family practice: 20,401 (28.5%)
Obstetrics-gynecology: 14,124 (35.0%)
Psychiatry: 11,648 (29.5%)

Source: AMA Physician Characteristics and Distribution in the United States.

Weblink

Abstract, "Pediatricians Working Part-Time: Past, Present and Future," Pediatrics, June (vol. 109, issue 6) (http://www.pediatrics.org/cgi/content/abstract/109/6/1015)