This Calgary, AB, general practitioner has never practised
full time. She's shared a practice with her father right
from the get go. "I was married in medical school and
planned to have children. I valued family life at least
as much as my professional life. When my father suggested
I practise with him, I jumped at it."
Now in her late 30s, she has two
children, ages eight and four. She practises three days
a week putting in about nine hours on each of those
days. It's been the same arrangement since the beginning
except for the six months she took off after each child
was born. Initially the challenge was increasing the
size of the practice enough to compensate her without
overburdening it. For the first three years her father
continued to work a full five days a week. He's cut
back to four days a week recently and, now in his early
60s, has plans to reduce that to three. "So far it's
been an ideal arrangement," he says, "very little conflict.
But then I think it helps that we've kept it all in
the family."
CHANGING
TRENDS
The trend to part time practice has accelerated in the
last five years as more women join the profession and
overworked doctors in their 50s look longingly at cutting
back. Also, there's a new ethic sweeping through medical
schools that sees students planning to enjoy life more
and practice less. One sign is the popularity of specialties
with shorter more predictable hours (see "Punch-clock
docs" NRM No 3 Vol 1 for details).
Part time practice only works if
full-timers and staff are all on the same page. Here
are some guidelines that practices use to keep operations
on track.
Compensation Fee-for-service
for part-timers, with each MD billing the provincial
plan and keeping the proceeds, works fine but raises
the question of how overhead expenses are to be divided
(see below). Other methods such as salaries, per diems
or hourly rates can also work successfully.
One complaint of part-timers on
fixed compensation is that they often work more hours
than they bargained for. Says one Dartmouth, NS, ENT,
"My deal is that I work from 8:00am to 1:00pm four days
a week, that's 20 hours but I can't remember when I
didn't put in a 24 or even 30-hour week."
Working full days The consensus
is that it's better to work whole days rather than portions
of them. Three full days a week is generally better
than, say, five hours a day for five days. Patients
and staff know exactly when a given doctor is going
to be in and find it easier to adjust schedules, space
requirements and so on.
Good protocol It's worth
spending some time making sure you get such things as
compensation, work standards, hours worked, use of examination
rooms, on call responsibilities (a tricky one), correct
from the start.
Share of overhead The simplest
way to go is to ask part-timers to share overhead equally
with their full time colleagues. In practice, they may
balk at it, arguing that they make less so they should
pay less. They've got a point. One solution is to have
part-timers share fixed expenses and divvy up variable
charges such as telephone and staff salaries.
Respect Many part-timers
say that they don't get the respect that goes to full
time physicians. There's no easy fix for this one. Says
one Mississauga, ON, rheumatologist, "I look at it this
way. The extra time I have with my family more than
makes up for the few shots I take about my so-called
'slacker' lifestyle."
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