Same job, fewer hours

Part-time options are growing, but finding or creating the right job still can be a challenge. Recruiters, employers and part-time hospitalists offer tips for making part-time hospital medicine work for physicians and practices.

Some of them are semi-retired. Others want to do medical research, shape health policy or practice outpatient medicine. A few have nonmedical outside interests. And many just want to spend more time with their families.

Part-time hospitalists are a diverse—and growing—group. “Until probably a year and a half ago, I didn't see a lot of opportunities out there for part-time,” said Michael Tucker, a senior search consultant with Cejka Search. Today he sees more physicians looking to work reduced hours and more hospitalist groups interested in employing them. “It's on the increase on both sides,” he said.

While hospitalists are usually going part-time in the interest of work-life balance, employers are trying to get an edge in a tough recruiting market. “I think that's probably why now organizations are saying, ‘We need to be more flexible in the hours we are offering. We need to be more flexible in the kind of schedules we offer,’” said Mr. Tucker.

The possibility of part-time can help in scheduling and retention as well as hiring, experts said. “A program being willing to incorporate part-time providers allows more flexibility, which can end up improving retention and reducing burnout,” said Tom Bohannon of recruiting firm Merritt Hawkins.

Even as hospitalist employers warm to the idea, finding or creating the right part-time job still can be a challenge. Recruiters, employers and part-time hospitalists offered a few tips for making part-time hospital medicine work for physicians and practices.

Where to look

The first step, obviously, is finding a hospitalist program that wants to hire a part-time clinician. The experts had a wide variety of advice on that topic, some of it contradictory.

Steer away from the popular, selective programs, some said. “If they tend to find lots of candidates when they're interested, they're probably less likely to consider adding part-time employees,” said Mr. Tucker.

However, noted Mr. Bohannon, those big, successful programs are also more likely to have 24/7 coverage, which means they'll have a lot of slots to fill in the schedule.

But don't forget those small hospitals just jumping into the hospitalist game. “I'm also going to look at hospitals that are looking to build a program. When they're starting from scratch, a lot of hospitals take what they can get while they're acclimating their primary care doctors to working with a hospitalist model. They're going to have, during that ramp-up period, the ability to just plug in people here and there,” Mr. Bohannon said.

Some practice models have more natural part-time holes—for example, hospital-owned groups that offer vacation. “When you have a practice that does offer that vacation time, they're going to be more likely to need part-time people. If somebody takes a vacation, it throws their rotation off,” Mr. Bohannon said.

More time off for full-time hospitalists often means a space for part-timers. At Middlesex Hospital in Connecticut, part-timers were hired to work weekends and to fill in for the full-timers who worked weekends. “When someone works a weekend, I needed a way to allow them to have a couple of days off in the next week. Otherwise, they were working 12 days in a row,” said Jesse Wagner, ACP Member, chief of the hospitalist service.

Mostly, he said, you'll never know whether the option is there if you don't ask. “For every job you can think of, there is somebody out there who says, ‘Yes, that is the schedule I want.’” Most of the part-time hospitalists interviewed for this article proposed their roles to employers, rather than applying for existing positions.

Mr. Tucker noted that many of the positions he recruits for could be part-time if the right candidate came along. “I don't think I have a single client now who would tell me they're not interested in looking at a part-time candidate. I would recommend the candidate present exactly what they're looking for and be forthright,” he said.

Ask for what you want

While being forthright is good advice for anyone, the specifics of how to find a part-time position depend on what kind of job you're looking for. William D. Surkis, ACP Member, found that employment with a big health system best suited his unusual part-time hospitalist track.

After residency, he realized that his practice interest was traditional, general internal medicine. “I love my outpatient life but I also love taking care of patients in the inpatient setting. Working in a big city, there are not many opportunities for people who want to do what I would call old-fashioned internal medicine,” Dr. Surkis said.

So he found an employer who let him create his own schedule. Dr. Surkis went to work for Cooper Health System in New Jersey, practicing one week as a hospitalist, the next as an internist in an outpatient clinic. Except on Fridays.

“Every other Friday, I would have to round like a crazy person in the morning so I would be done by 12 o’clock. I'd jump in my car and drive to the office. My outpatient partner would jump in her car and come to the hospital and go to resident clinic,” he explained. The next week, their roles would reverse.

Finding a colleague who wants a similar schedule can be key to setting up a part-time gig. When Amanda Lenhard, MD, became pregnant during the third year of her residency, she started thinking about working part-time. She approached the other pregnant woman in her program about sharing a job.

Being a team gave them a good marketing pitch in interviews with hospitalist programs, she thought. “You don't have to worry about filling in another half-time slot. Here we are. If she's sick or I'm sick or my kid's sick, we can cover for each other, so we're even a built-in coverage system,” Dr. Lenhard said.

The two-for-one approach has worked well enough that Community Hospitalists, an Ohio-based hospitalist company, has adopted it as standard procedure for part-timers.

“We generally will put two of them together to create a full-time equivalent. That gives them the option to have a little bit more time at home with their families, but still allows us to meet that full-time obligation that we have to the patients at the hospital,” said Christine States, vice president of operations.

Scheduling variety

Because they split a job, her part-timers are able to fit into block schedules, something that can be a challenge for other part-time hospitalists. At first, the system was for one doc to take four days in a seven-on/seven-off schedule and the other to take three, reversing on the next rotation.

To improve continuity of care, the part-timers switched to alternating rotations, each taking one per month. “You have no change in the continuity, because if it was a full-timer they would have been off the week before. It gives them a little longer block of time to get in their groove with the clinical stuff,” Ms. States said.

Kathleen Coppola, MD, a hospitalist with Temple University, works in even longer blocks. She started out sharing her job with a physician who had also been her co-chief resident. Her job share partner moved to outpatient medicine, but Dr. Coppola continued in her part-time role.

“I generally work a month full-time and then I'm off for a month,” she explained. The system fits well into an academic setting. “I like doing four weeks at a time because most of our residents and students have blocks that are a month long. It gives me continuity not only with the patients but with the residents and the medical students,” Dr. Coppola said.

Academic medicine can be a good parallel to explain (to potential employers or others) some kinds of part-time employment, Amy E. Boutwell, ACP Member, has found. “I had always envisioned a career that would be modeled on my mentors' in academic medicine who were doing research, which would be about 80% research and 20% clinical practice. I am not in academics so I took that model and kind of exported it to my field,” she said.

Dr. Boutwell spends four days a week working on health policy and health system redesign for the Institute for Healthcare Improvement, and every Friday as a hospitalist at Newton-Wellesley Hospital in Massachusetts.

In addition to meeting her interests, the hybrid job improves her skills in both roles, she said. “Whenever I get to the end of the week and I go to the hospital, I'm not burned out. I feel like I have the wherewithal to help out a little bit more or to be a little bit less beleaguered by the incredible volume that everyone else is dealing with on a full-time basis,” she said.

Dr. Surkis, who now divides his time as a hospitalist, associate program director and clerkship director at Lankenau Hospital in Pennsylvania, agreed. “I'm always excited to get back on service because typically it's been a while. I have a freshness and excitement about it,” he said.

The transition can be even more refreshing for those who have been even farther from medicine in their off time. “I enjoy being there because it's a total break from my other obligations,” said part-time stay-at-home mom Dr. Lenhard. “I give an order and people don't cry.”

The downsides

Practicing part-time is not all fun and games, though, she noted. “The hardest thing is I do take more CMEs. You feel like you might need a little more CME than the guys who are working seven on/seven off.”

Staying, and getting, up to date on clinical knowledge is an issue, said Ms. States. “For folks coming right out of residency, the learning curve for practicing in the private sector is longer when you're only doing it on a more limited basis. That would probably be the one downfall,” she said.

Actually, there are a couple of other drawbacks to practicing part-time, she continued. “Given this economy, I guess I would worry that they might be the easiest way to cut if you had to. They might be the first to go,” she said.

The economic crisis may also limit new employment options for part-time hospitalists, according to Mr. Bohannon. “We're seeing people be more willing to pick up extra shifts to make more money. That may actually make it harder for someone to break into the role of a part-time hospitalist,” he said.

Part-time hospitalists are also often giving up some benefits. The rule of thumb is that if someone works at least 0.8 FTE, they usually get full-time benefits; less than that, they don't, said Mr. Tucker. “The threshold typically lies at 32 hours per week.”

Many part-time hospitalists pick up benefits from their spouses, which can be a selling point and cost savings for potential employers. Overall, however, half a hospitalist usually costs more than half of what a hospitalist costs, Ms. States explained.

“We have to pay two med-mal policies. When you lump them back together, they tend to cost a little more than one full-timer. In the long run, the med-mal costs more than the medical benefits,” she said.

Dr. Wagner has noticed a couple of disadvantages in addition to cost. “There are issues you need to pay attention to and work on, which are continuity, communication, handoffs and length of stay.” Running the numbers, he's found that part-time hospitalists tend to be a little slower to discharge.

They're faster, however, to leave the job. “People tend to [work part-time] two to three years and then move on to something else,” Dr. Wagner said. That's not always a problem, though. “We have a number of people who have done that and then become full-time hospitalists with us.”

Dr. Lenhard is familiar with that scenario. “The programs keep growing and need more and more time. They keep asking us, ‘Can you pick up a shift there? You sure you don't want to go full-time? How about full-time?’”

Once her kids are in school, she's not sure what her answer will be. “Maybe I'll be part-time forever and I'll find some other interest—more of an administrative role,” she said.

In the meantime, she's more than satisfied with the current setup. “Part-time hospitalist work gives me the ability to fulfill both my goals—being a mother who is present for her children and somebody who's contributing to her company, her community and her hospital. They used to say you can't do both,” she said. “I feel like I found a loophole.”