It helps that rheumatology is amenable to flexible work arrangements, compared with other specialties. That said, the benefits of rheumatology as a specialty often depend on how each practice determines scheduling. What is motivating rheumatologists to consider part-time work or reduced hours, and how exactly do alternate work arrangements affect a practice?
Why Part Time?
Starting a family is often a big reason rheumatologists seek a part-time work arrangement. “Other than my first two years after my fellowship, I’ve always wanted to work part time,” says Dawn Santora, MD, clinical assistant professor of medicine at the University of Pittsburgh Physicians, University of Pittsburgh Medical Center Arthritis and Autoimmunity Center in Greensburg, Pa. Dr. Santora, who is married to a fellow physician, says someone had to be home to raise their three children. “I enjoy my job, but I enjoy other things, too. I’m also busy with my kids and volunteer work,” says Dr. Santora, who is the sole physician at a satellite office.
“Most of the part-time rheumatologists I know made that practice choice to balance work and family, specifically to be home with children,” says Julie Levengood, MD, a rheumatologist at Reliant Medical Group in Worcester, Mass. Dr. Levengood has worked part time and has written about work scheduling choices on her blog, The Doctors’ Rheum (http://thedoctorsrheum.wordpress.com).
Just like in the corporate world, if you’re not 110% committed, you could be marginalized. A doctor who is not in the office every day is in an outer orbit, and it takes effort to stay in the loop.
—John Pinto
Rebecca M. Shepherd, MD, FACP, a rheumatologist with Arthritis and Rheumatology Specialists, Lancaster General Health, Lancaster, Pa., was hired at a time when the practice only wanted part-time help. “I could have gone full time, but by then I had two small children. I wanted flexibility,” she says. Dr. Shepherd worked part time for five years and is currently in a temporary position as vice president of physician services, where she oversees 225 doctors at 25 practices. About a third of the 225 physicians work part time.
Sometimes scheduling can be a challenge. Annemarie Whiddon, MD, a rheumatologist at the Denver Arthritis Clinic in Colorado, works part time in a setting where inpatient consults are not handed off to other providers, which can lead to childcare challenges. “Fortunately for part-time physicians, rheumatology is primarily an outpatient specialty, but specialties that are based more on shift work—such as emergency medicine—are probably easier in terms of a more predictable schedule and fewer responsibilities once one leaves the hospital or clinic,” she says.
Part-time work also has an appeal for rheumatologists eyeing retirement, or for those looking to scale back while still staying active—a trend that’s growing. “Physicians who are not ready to fully retire can continue to practice on a part-time basis, which is critical during this time of physician shortage,” says Barber.
“They are no longer interested in taking the financial risks of maintaining a solo, private practice on their own, but they’re not quite ready to hit the golf course every day,” says James A. Jenkins, PhD, managing partner of rheumRx, a rheumatology practice-management consulting service based in Manhattan Beach, Calif., says of physicians who scale back their work hours when nearing retirement. “So, they sell their practice to a younger physician but continue to come in, perhaps a day or two a week, to see patients,” he says.
Scheduling Considerations
In a quest for flexibility, rheumatologists who want to work part time should also be flexible about their scheduling arrangement, because part-time work as a physician doesn’t necessarily mean clocking in for 20 hours a week and signing off at the end of a shift. It could mean reduced hours, one extra day off a week, or job sharing. Dr. Santora is at her practice three days a week. When Dr. Shepherd was working part time, she was off on Mondays and worked 8 a.m. to 3 p.m. three days a week, and 8 a.m. to noon on a fourth day. Similarly, Dr. Whiddon works two days a week for a private practice and takes calls two or three weeknights a month and for one weekend every six weeks.
All physicians interviewed for this article say their days off rarely mean they are truly out of touch. Days out of the office still often involve administrative tasks and phone calls. “Having an electronic medical record is helpful because I can check labs and phone notes from home. However, that is also a double-edged sword, because if I am working at home then I am not spending time with my children,” says Dr. Whiddon.
On her days at home, Dr. Santora still checks in with the office a few times, and she’ll take administrative work home. If a patient calls on Monday afternoon with a problem, she can usually see the patient on Wednesday. If the problem is emergent, she’ll refer the patient to the emergency room. She also says she can operate with her current hours because she has a great staff and a nurse who can triage problems on the days she is not there.
Dr. Shepherd says she likely lost patients with her part-time schedule, because she could not work in the late afternoon. She suggests that rheumatologists who want to work part time may do better if they are open to varying hours—8 a.m. to noon one day and noon to 5 p.m. the next, for example.
In addition to reduced hours, job sharing with another physician is viable option, Pinto says. He has even seen an arrangement outside of rheumatology where two husband-and-wife teams alternate working on different months. Although this is an unusual situation, they have made it work, he says.
Other Considerations
Rheumatologists who work part time should be prepared to put in a little extra effort when they are in the office, says Dr. Levengood. “When you are not in the office every day, each day back is a little bit like returning after a vacation with a backlog of phone calls and paperwork. My colleagues who work part time have shared that they have to spend some of each day not in the office catching up on these administrative details,” she says. Dr. Whiddon agrees, noting that she has to work especially efficiently on her days in the office—whatever work she doesn’t get done she needs to take home.
“Just like in the corporate world, if you’re not 110% committed, you could be marginalized,” says Pinto. “A doctor who is not in the office every day is in an outer orbit, and it takes effort to stay in the loop.” Rheumatologists working part time should make sure they are available for as many off-day meetings as possible and get copies of minutes from any missed meetings, Pinto suggests.
At Lancaster General Health, Dr. Shepherd says there are required meetings, and all physicians are expected to be on a committee. This can be a good thing for part-timers: Such requirements can be positive ways to stay in touch, says Pinto.
Pay is another consideration when working part time—be it pay as it affects a family’s bottom line or pay and profit for the practice. On the practice level, full-time physicians may gripe about part-timers because they have the same overhead expenses as others but don’t bring in the same amount of revenue, Dr. Shepherd says. “You might barely cover costs or not cover costs, and that can affect your full-time partners,” she says. In those situations, job sharing or targeting a practice that’s specifically looking for a part-time physician may be better options, Pinto says.
All in all, rheumatology typically offers a predictable daily schedule, and few emergencies that are “drop-everything-and-run situations,” says Dr. Levengood, making rheumatology a specialty lends itself fairly easily to part-time work arrangements.
Vanessa Caceres is a freelance medical writer in Bradenton, Fla.
Managing Part-Time Rheumatologists
If you’re on the other side of the desk and you’re managing rheumatologists who want to work part time, your ability to offer a flexible work schedule can be an enticement when recruiting.
“A significant number of our clients see part-time or flexible schedules as a recruitment and retention strategy,” says Mary Barber of physician recruiting firm Cejka Search. “Physicians entering practice are usually interested in a full-time schedule, but knowing that the culture of the practice permits flexibility later in their careers can give the practice a competitive edge.”
When managing physicians who are working or who want to work part time, keep your expectations clear, recommends practice-management consultant John Pinto. Have as many policies as you can in writing so there are no questions about protocols. If you have requirements about participation in special committees or activities, make sure all physicians know that, he says. Another solution may be enlisting the help of nurse practitioners or physician assistants when possible.
Also consider the financial implications for part timers, says Rebecca M. Shepherd, MD, a rheumatologist who has worked part time herself and who currently oversees a large staff that includes physicians with reduced schedules. “As a medical group, we are moving from [relative value unit] RVU to revenue/expense [compensation], and the part-timers will take a hit,” she says. “It’s an administrative challenge.” Job sharing may be the solution in this situation, she adds.
