Physicians have no trouble citing compelling reasons to reduce their work hours—stress, bureaucracy and the feeling of missing out on one’s personal life, to name a few. But they can also face high hurdles to making the switch to a lighter workload, including medical school debt, career aspirations and pressure from employers. A health-care couple who made the break from full-time work shares 10 lessons they learned along the way.

In “Thinking about working part time? Here are some tips,” in the winter 2017 issue of Physician Family, Marsha Holleman, MD, MPH, a family doctor, and Warren Holleman, PhD, the director of a wellness program, wrote that part-time work isn’t for everybody. “But for us, it was the best decision we ever made. It reduced our stress and probably saved our marriage.”

Although one major reason Drs. Holleman and Holleman made the switch was to have more time with their children, their advice also applies to physicians without children who are trying to achieve work-life balance. It covers both the time leading up to a change in employment status and the time after it:

Know how much money you need to be happy. “If you decide to work part-time, you won’t be able to afford the same material possessions as your [full-time] colleagues. You’ll have a smaller house, a less expensive car. … If these prospects trouble you, then it’s a no-brainer: Keep working full time. If, on the other hand, you’re willing to live on a budget, then working part time may be right for you. The good news is that physician salaries are high enough that you can work part time and still live comfortably.”

Decide whether your professional goal is prestige or satisfaction. “How important is it to you to be regarded as a ‘top gun’ in your field? In many organizations, working part-time carries a stigma of not being fully invested in your career. … We both worked in academic medicine, where career success was defined in terms of being promoted to administrative positions such as committee chair, medical director, department chair, etc. Working part time probably helped us avoid promotions that would pivot us away from work that filled our lives with meaning and toward administrative work that gave us headaches.”

If you have children, determine what role you want in their lives. “Time and again we found ourselves ‘outsourcing’ parenting responsibilities and asking, ‘Why bother to have children if we aren’t going to raise them?’ So, working less and parenting more felt right for us. We have friends who chose differently, delegating more parenting responsibilities to nannies and grandparents. And some of our friends have negotiated more flexible (full-time) work arrangements, allowing them to more easily juggle parenting and work.”

Carefully consider who you ask for advice. “If work-life balance is the reason you’re thinking of working part time, find role models who practice good self-care and are engaged with their family, friends and community. If parenting is a primary concern, get advice from friends and colleagues who’ve raised their children well. Don’t limit yourself to the health professions; get a broad range of viewpoints and life experiences. … Today’s bosses and mentors are more likely to be part of a two-career couple, but that still doesn’t mean they slice the pie the way you do. Consider a variety of perspectives before making your decision.”

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Be realistic about your time constraints. “Many of our colleagues are satisfied with a shorter list of non-work activities. Others hire more outside assistance with chores, errands and child care or arrange to have live-in nannies or grandparents. And some simply require less sleep than we do or ... integrate work and life more effectively. The key is to accept reality—you can only slice the pie so many ways. More time at work equals less time for non-work activities.”

Be assertive but also flexible with your employer. “When you propose to work part time, most bosses will say ‘no.’ So when you negotiate, you must be willing to walk away from your job. Sometimes that’s the only way to convince them to make an alternative work arrangement. Or come to them with a job offer from another organization. If neither of these tactics works, seek work elsewhere. You can bloom in someone else’s garden.”

If you have a life partner, share the workload evenly. The most straightforward way to be fair is for each spouse to take equal amounts of time away from work. … Where that isn’t feasible or desirable, a lot of discussion and negotiation is needed to assure that one doesn’t do too much giving or the other too much taking. Whether we’re aware of it or not, we keep ledgers on our partners, and if one of us stores up too much capital, we develop anger, resentments and regrets. These will destroy a relationship.”

Know that part time might not be much less than 40 hours per week. “In our experience, it was a constant struggle to set and maintain boundaries—or to accept that we’d always be working uncompensated hours. We never found a perfect solution, but our best was to schedule full days of work alternating with off days, rather than half days of work, which tend to spill over and become a full day. One physician we know took this to the next level and worked every other week.”

Strategize to keep the parts of your job you like. “When it was Warren’s turn to shift from full time to part time, he was director of a community health center and a large portion of the job was fundraising and attending meetings, which he found increasingly burdensome and unfulfilling. So he resigned his director position and went to work as a member of the clinic staff. This proved helpful on multiple fronts. He rediscovered the clinical and teaching work that gave his life joy and meaning. It allowed others to take on leadership roles while he assumed a mentoring role. And it prevented him from burning out.”

Be grateful that you have a choice. “As health professionals, we make good incomes that allow us the option to work part time and still support ourselves and our families. The majority of the world’s population doesn’t have that option. We remind ourselves each day how fortunate we are, and we try not to take these privileges for granted.”

The winter 2017 issue of Physician Family also features a broader piece by the Hollemans on “Why we decided to ‘throw away our promising careers’ and work part time,” as well as guidance from members of physician families on using triage to lead a more balanced life, working with a significant other, traits of families who are financially prepared, and how to save time buying a home.

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