Part-time Practice

Published in The New Physician, March 2005

(sidebar to Babies on Board)

There was a time when Dr. Erin Harris dreamed of becoming “a full-fledged country doctor, delivering babies, that sort of thing.” But four draining years in medical school, one year of family practice residency and one infant later, that’s all changed.

“Now I realize that I really can’t do that and have the life that I want,” says Harris, who became a mother in her third year at East Tennessee State University James H. Quillen College of Medicine and is in her second year of residency there. “I’m going to find a practice where I can structure things the way that I want them to be. I want to do three days a week, part time.”

Ah, yes, there are the magic words: part time. It is, for many mothers who also happen to be physicians, the holy grail of working conditions. Although only 19 percent of respondents to a survey reported being in a job-share or part-time position, 61 percent of those who weren’t wanted to be. So what holds them back? Several factors, including an inability to find a partner with whom to job share and concern over maintaining medical expertise and the respect of their peers.

But Dr. Michael Worzniak, assistant professor at the University of Michigan Medical School and program director of the family practice residency at Oakwood Hospital in Dearborn, Michigan, says those problems don’t arise with the right formula. Worzniak, who has been job sharing since he began practicing family medicine, has come up with a model he believes answers most, if not all, concerns.

In his blueprint, “A Job-Share Model for the New Millennium” (Family Practice Management, September 2002), two or more physicians establish week- or two-week blocks in which they rotate part-time work. One or more physicians work half-days in the office while the other provides half-day, out-of-office services such as hospital rounds, nursing-home visits and after-hours call. The latter, Worzniak says, not only keeps office overhead low but also maintains a part-time physician’s inpatient medicine and surgery skills—something many physicians who choose part-time work at urgent-care clinics lose.

Establishing week or more blocks provides time for parents to arrange family and babysitter schedules in advance. Drawbacks exist, of course. Communicating shared patients’ needs can be challenging. But it is doable, with a good system of communication between physicians in the office and physicians off site. Using the right technology, including faxes and e-mail, is key.

And job sharing is not for everyone: “It’s something that you could not do if you are a surgeon, for example,” he says. “This model absolutely will not work for anyone who is a referral physician.” The best way to get started? Finding physicians of like minds in your residency class who have similar office and practice styles and with whom you can agree on approaches to medication and care, “because your patients need to see the two of you as though you are one,” he says.

But the most essential component to the plan, he says, is that other physicians in the practice must respect a part-timer’s hours away from the office; otherwise, the whole model falls apart. “The whole team must come to an agreement and accept the idea that the part-time people, when they are off, they are off. There can’t be an inclination, when you need help, to call them.”

Copyright 2005 American Medical Student Association