Published in the December 2007 Today’s Hospitalist
Sanjiv Panwala, MD, is a bit of a trailblazer. At a time when more and more hospitalists are seeking a work/life balance, this father and nocturnist has set a precedent within his hospitalist group for working only part time.
For the past four years, Dr. Panwala has worked an average of two nights a week at Providence St. Vincent Medical Center in Portland, Ore. While the hospitalist program previously hired only full-time physicians, today around one-quarter of the 25-member group are part-timers.
“I was the first part-timer there, and I came on clearly with the intent of working part time,” he says. “It works well for those who want to be able to flex their time and accommodate their families.”
Because hospital medicine is populated by so many physicians with young families, a growing number of hospitalists are looking for part-time options. And practices that are short-staffed, growing or just trying to retain good physicians are finding that part-time schedules are one strategy that helps keep their hallways stocked with quality hospitalists.
That doesn’t mean that part-time physicians are being welcomed into every program. But as hospitalist staffing continues to stretch to try to keep up with seemingly insatiable demand, experts say that part-time schedules are becoming more attractive to physicians and programs alike.
A growing trend
The growing ranks of part-time physicians are a phenomenon being seen throughout medicine. In 2006, for example, the American Medical Group Association (AMGA), which represents multispecialty practices, and Cejka Search, a national physician recruiting organization, conducted a retention survey of more than 90 AMGA groups nationwide.
Ninety percent of the groups responding to the survey reported having at least one part-time physician on staff. A total of 20% of the groups’ staff now work part-time shifts, up from 13% in 2005. The study also found that flexible or part-time schedules were one of the top three most effective retention strategies
What’s driving the trend toward more part-timers? Women now comprise one-half of new medical school graduates and, as in many industries, most part-time hospitalists are female.
But more male physicians are interested in working part time, and not just to meet family obligations. Some have other part-time jobs, while others want time to travel. Some work part time until they decide what career path to take, and some are phasing out of full-time careers.
Because so many hospitalist services rely on shifts, hospital medicine lends itself to part-time employees, points out Bradley Bryan, MD, medical director for Providence’s hospitalist program. According to Dr. Bryan, the fact that many hospitalist programs now welcome part-time physicians helps give hospital medicine a recruiting edge.
“There is a trend in primary care and hospital medicine, especially for female physicians with families who want to split a job,” he says. “And finding an office practice to split is more difficult.”
That said, Sam Karam, regional vice president for Merritt Hawkins & Associates, a national physician recruiting firm based in Irving, Texas, says he has seen the demand for part-time hospitalists come and go.
There was, for example, a boom in hospitalist recruiting in 2005. Fledgling groups were using part-time physicians to get their programs up and running while they gauged quality-of-care issues and the political climate with local physicians.
“To ease the transition, we were called upon to recruit internists who work part time as hospitalists,” he says. “We primarily don’t recruit part-timers, but were asked early on to search for part-time people.”
Once programs were more established, Mr. Karam adds, the call from clients to recruit part-timers, at least at his firm, almost disappeared. At the same time, the number of searches for full-time hospitalists handled by Merritt Hawkins tripled between 2004 and 2006.
Other recruiters report that the availability of part-time schedules typically depends on factors including the size, culture and scheduling needs of each hospital or group.
Avery Poe, a recruiter of 19 years who works with some of Atlanta’s largest hospitals, including Northside Hospital and Piedmont Hospital, says that he hasn’t seen much interest in part-time shifts from either hospitals or physicians.
The larger hospitals he works with, he explains, have enough bodies to cover downtimes and will often use locums when they need to fill scheduling gaps.
And part-timers are often scarce at academic centers. Dennis McCulloch, director of public and government relations at the University of Kansas Hospital in Kansas City, Kan., says that when the hospital began its hospitalist program in 1999, administrators studied the standard practices at other teaching hospitals and found that most hospitalists worked full time. Though these physicians may only work part time in the hospital, they fill the rest of a full-time schedule with teaching and other duties.
Mary Frances Barthel, MD, medical director for the hospitalist program at Gunderson Lutheran Medical Center, pointed out her group also doesn’t have any part-timers at the teaching hospital in LaCrosse, Wis.
The reason? “We have almost no turnover,” Dr. Barthel says, “and a majority of our new hires come out of our residency program.”
Only the toughest shifts?
Most of the part-time opportunities that Mr. Karam’s firm handles are in smaller, rural communities where there is not enough volume to support a 24/7 in-house program. Others, however, may be in larger communities seeking nocturnists.
“It is extremely difficult to find a full-time nocturnist,” he says. “The difference between having a legitimate program and not having one is fixing the night-shift problem.”
But while many hospitalist groups use part-timers like moonlighters to staff the least desirable shifts, that is not always the case. At Providence, where part-timers typically work eight to nine shifts a month, Dr. Bryan says that some part-time schedules include five day-time and three “off-hour” shifts, like swing or night-time coverage.
“There are people who lean toward working evenings or weekends based on their family needs,” he points out, “but that is the same for full-timers.”
But having physicians to cover the least popular shifts is one of the factors that Dr. Bryan says he appreciates the most about part-timers. The hospitalist group began aggressively recruiting part-time hospitalists once the practice realized that it was part-timers, more than full-time physicians, who were willing to pitch in during holidays, sick days and staffing shortages.
“We have found,” he says, “that when we are really in a tight bind, someone who is working only eight shifts per month is more likely to volunteer to cover than someone who works 14 to 15 shifts per month.”
Salaries and benefits
Part-time hospitalists can cost more to staff than full-time physicians because their benefits, pension and credentialing costs end up being equal to that of full-timers, even though they work only a partial schedule.
What can part-time physicians expect to earn? At Providence, part-time hospitalists are paid according to their rate of experience times their full-time equivalency, says Dr. Bryan. In addition, they earn a partial CME stipend, while their benefits are prorated, based on their number of hours.
According to Merritt Hawkins’ Mr. Karam, a typical first year, part-time nocturnist salary runs between $100,000 and $125,000 a year, with some groups offering a guaranteed component along with a production bonus.
Mr. Karam also says that part-time hospitalists should expect to receive the same incentives that full-timers would be offered, including a relocation package and a sign-on bonus.
There is also the issue of how to keep part-time physicians up to speed on quality improvement and other initiatives. Josh Maybar, physician recruiter for Cooley Dickinson Hospital in Northampton, Mass., points out that part-time physicians receive frequent e-mail updates and attend monthly staff meetings.
“If there is a new initiative that needs to be communicated,” he says, “physicians are contacted either before or after their shifts on the days they work.”
Programs that use part-timers say that the benefits more than offset any additional costs or educational concerns. For instance, Mr. Maybar says that part-timers allow the group to patch schedules together to cover the rapidly growing program.
“We have all of the different staffing options, and we find arrangements that work best for everybody,” he says, adding that he is seeing a great deal of interest from physicians who want to work part time. “Part time really does complement the picture and can work for both sides.”
At Providence, Dr. Bryan says that the group is particularly interested in physicians who can work a 0.6 FTE schedule and who may be able to work more when called upon to do so. He also creates the schedule two months in advance, and he prefers to work with physicians who are able to commit working that far
He adds that the large body of part-time physicians has been extremely valuable in two areas where hospital medicine is most vulnerable: recruiting and retention.
“I really do look at it as being advantageous,” he says, “to have 20% to 25% working less than full time.”
In the 2006 AMGA study, physicians who left an organization voluntarily were asked why they did so. Seventeen percent said incompatible work schedules and excessive call schedules were the primary reasons.
At hospitals like Providence, Dr. Bryan says that the growing program simply couldn’t afford to let good physicians go because it couldn’t fit them into their schedule.
“We were seeing a lot of good candidates who wanted to work part time and we didn’t want to exclude good people,” Dr. Bryan says. “Many don’t want to say they are part time because it will make them less attractive, but it makes them more so for us.”
Tammy Worth is a freelance health care business writer based in Kansas City, Mo.
Tips for working as a part-timer
Looking for a part-time position? Here are tips from recruiters to help you in that
- How up-front should you be? Some physicians think it’s a good idea to obscure the fact that they want only part-time work until they’re further in the recruiting process. Not so, recruiters say: Instead, be up-front about the schedule you’re looking for.
- What should you stress on your resume and in your interview? As with any other job, the more you bring to the table as far as experience “such as time spent covering an ICU “the more interested program leaders will be in offering you a part-time schedule.”Any other inpatient service you can provide would be a higher value,” says
Sam Karam, regional vice president for Merritt Hawkins & Associates, a national physician recruiting firm based in Irving, Texas.
- How much should you ask for and expect? Your salary will probably be pegged to the number of shifts you work and the percentage that those are of a full-time equivalent. But be sure to ask about other incentives “like signing bonuses “that full-time physicians receive.
- What about program expectations? While part-timers need to attend staff meetings, expectations vary on how much they’re supposed to participate in committee meetings, for example. Some part-timers, as a portion of their part-time schedule, take on extensive committee work as a paid service to the rest of the hospitalist group.