Published in the April 2019 issue of Today’s Hospitalist
NOT ALL OF US are cut out for working full time. You may have young children, a recent change in your household or simply feel that burnout is just around the corner. Even the seven-on, seven-off schedule that hospitalists often work can leave you exhausted and cranky at the end of those seven days on, and it may be affecting your patient care. Your family members certainly think it affects them. So how do you find a way to do the work you love, only less?
If you’re already working with a group and you want a reduced schedule, you may be surprised at the resentment that greets your first tentative request. Like many businesses, practices try to “run lean,” expecting existing members to put in extra work when things get busy rather than try to train some outsider who may earn a higher hourly rate than the regulars.
Whether you’re on staff or working locum as a part-timer, you offer practices a valuable resource. Winter comes every year, and so do summer vacations and school breaks. Smart practice group leaders know that having somebody who can step in when a physician is going through a divorce or has a kid in the hospital makes a big difference in group dynamics. Point out that you’re already familiar with your hospital or practice and the people who work there, and that you can still be an asset.
Using existing models
If you’re with a multistate staffing or management organization, you’ll find that it has already figured out backup plans. Most of these companies have subsidiaries that supply their own locums and nocturnists, and even provide malpractice insurance and help with hospital credentialing. The larger organizations have different approaches, so ask somebody in the administration how part-time doctors are considered; you may have to switch to the locums division to work on a shift-by-shift basis.
A reputation for being easy to work with will be your biggest asset.
You will, however, have to take what they offer— maybe two-week stretches, maybe locations away from home (with lodging and expenses provided, I hasten to add). Check out the bigger organizations in your area—and also track down the doctors who work for them and arrange a getting-to-know-you meeting. Applying online sounds quick and easy, but it means that the first person to read your CV is going to be a nonphysician who may be turned off by your funny name, history of working for somebody else, whatever.
Your area has other programs or practices, too. Independent practices are more common than the larger groups would like you to think, and you may find that they are far more flexible (though you may have to provide your own malpractice insurance).
How do you find them? A good way to start is with specialists who cover more than one hospital. These doctors may do consults at three or four institutions, and they often will have a good idea of the quality of local practice groups. Or visit the medical staff services office at a target hospital where there will be one administrator who knows all the docs and will give you their contact information.
As you’re polishing your CV, be sure to update your references. Put your residency director at the bottom and the leader of the well-respected pulmonary group at the top; consider adding an ER doctor you know well, especially if he or she works at a number of hospitals. When you ask references for their help, they may have other options to suggest.
And doctors are not the only people with connections. Nurses, respiratory therapists and even administrators in large hospital chains may point out that your present location isn’t far from another hospital where part-timers are accepted. They will also have a good idea of any preferences or restrictions you should know about before filling in that credentialing form.
Once you’re hired
Yes, it’s a nuisance learning a new territory, especially if the electronic health record (EHR) is new to you. But you’ve done this before, and people love giving advice. Pick up extra points by making your own list of consultants by group, noting what works in unusual situations on the EHR and making your signout notes as informative as possible. Send a copy of the consultant list to the group leader and ask for additions or warnings. And of course, you will want contact information for every member of the group.
As a part-timer, you’ll work extra hours that you can’t bill for, but that extra effort will help you stay a part of what happens. That includes department meetings, discussions with the coding people and even serving on hospital committees. Don’t forget that part-timers and moonlighters are both expensive (going rates for hospitalists start at $120/hour), so make your value known by writing detailed notes, billing appropriately and helping maintain good relationships with everyone at the hospital. An extra admission half an hour before you were going to leave? Saying, “No problem, I’m happy to help,” will go far to keep you on the job.
You need to be able to access the hospital EHR from home, and be sure to check it occasionally even in weeks when you don’t have a shift. Find out what happened after you turned those patients over to the rest of the group to add to your experience.
How will the staff know to reach you if a question comes up when you’re off? Consider handing out business cards with your cell number and maybe an e-mail address too, emphasizing that those are only for staff to use. I haven’t received any e-mails, but more than a few nurses have called me on off days when they were confused by a group’s answering service or pager system.
The long-term approach
If you can settle in with a single group, great. You may find, however, that making two or three part of your practice prevents you from having to start over when a group leader moves to another state or an administrator decides it’s easier to control one group than several. Keep your network current, form positive relationships and remember: A reputation for being easy to work with will be your biggest asset.
Stella Fitzgibbons, MD has been a hospitalist since 2002 and is very happy to be working part time with two different hospitalist groups.