Should young physicians be allowed to work part time?
Los Angeles anesthesiologist Karen S. Sibert, MD, created a stir last year when she raised concerns about the number of young physicians, particularly women, working part time. In an editorial in The New York Times, she noted that the part-time physician workforce had expanded by 62% since 2005 and wrote, “This may seem like a personal decision, but it has serious consequences for patients and the public.”
Given that women earn nearly half of all medical degrees today and a large proportion of them pursue primary care, the fact that so many are not working full time will exacerbate the physician shortage, Dr. Sibert warned in her column. She argued that such physicians displace future full-time physicians from medical school and residency positions.
“Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine,” Dr. Sibert wrote. “It’s fair to ask them—women especially—to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency.
“They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.”
In 2011, 44% of female physicians and 22% of male physicians worked part time, according to a survey from the American Medical Group Association and Cejka Search.
‘It’s a calling’
Barbara D. Dougherty, DO, took note of Dr. Sibert’s comments. “I agree with the author and have voiced that opinion to many of my colleagues,” says the Sewell, N.J., anesthesiologist. While Dr. Dougherty is working just four days a week now after more than 30 years in practice, she believes recently trained physicians should make a full-time commitment to medicine.
“A new physician who works part time takes away a spot from someone who would work full time,” Dr. Dougherty says. “You have to decide whether this is your profession or whether it’s just going to be a job. Medicine is supposed to be a full-time commitment. It’s a calling.”
Dr. Sibert points out that because tax dollars support medical education, particularly in state-supported medical schools and Medicare-funded residencies, the public has a financial stake in training the next generation of physicians. “I don’t see a recognition of the public good, of the social responsibilities that go along with becoming a physician, among young physicians who choose to practice part time,” Dr. Sibert told The DO. “There seems to be this prevailing sense that this is my spot, it’s my education, and I can do whatever I want with it.”
Members of the osteopathic medical profession are divided on whether new physicians should practice part time. Some praise young physicians for having the courage to prioritize their families, as well as their patients, and blame the medical profession overall for demanding such long hours from those practicing full time. Others concur with Dr. Sibert and Dr. Dougherty that because medicine requires significantly more training than other careers, it requires extraordinary dedication.
More on work-life balance
To learn how some DOs and osteopathic medical students structured their work schedules to pursue other interests, see these articles:
- In this feature on how young women are balancing medicine and motherhood, osteopathic medical students and DOs share the challenges they’ve faced, such as pumping breast milk while on a surgical rotation and carving out time for themselves.
- Shannon C. Scott, DO, discusses her move from a large family medicine practice to an academic position that allows her more time with her family.
- Bethany V. Chernich, DO, talks about becoming an osteopathic manipulative treatment specialist in Montana after she grew overwhelmed by the long hours and high stress of her family medicine residency.
- A flexible schedule as an emergency physician allows Ivan M. Raimi, DO, to take multiple days off at a time to pursue a screenwriting career.
- After three years as the medical director of a safety-net health center in Florida, Joanna L. Drowos, DO, MPH, decided to pursue a part-time position in academia so she could spend more time with her two young children.
But even those who are nonjudgmental express concern that the growing ranks of part-time physicians could affect the projected physician shortage. “I’m not saying that this trend is good or bad, but the fact that more and more young physicians work part time and make other career decisions based on achieving work-life balance has not been thoroughly accounted for in calculating future physician workforce needs,” says Marc B. Hahn, DO, the dean of the Kansas City (Mo.) University of Medicine and Biosciences College of Osteopathic Medicine.
Penchant for balance
Because both male and female medical students and new physicians say they value work-life balance, some contend that young women have been unfairly singled out for criticism. Although women in medicine are more likely than men to work part time to care for children, the desire for work-life balance is generational, not gender-specific, says university administrator Karen D. Johnson, PhD, who researched this topic for her doctoral dissertation. “I have found that both women and men are much more interested in choosing specialties and forging careers that include more balance than were prior generations of physicians,” says Dr. Johnson, the vice president for university relations at Midwestern University in Downers Grove, Ill.
Rather than deploring this trend, Dr. Johnson thinks the medical profession should adapt to it. Medical employers should develop part-time opportunities for men and women physicians, she wrote in her dissertation. Given the growing number of part-time physician positions promoted online, the profession seems to be heading in that direction.
The trend has been a long time coming, observes one chief academic officer. “The quest for work-life balance among young physicians is admirable,” says Robyn Phillips-Madson, DO, MPH, the dean of the Pacific Northwest University of Health Sciences, College of Osteopathic Medicine in Yakima, Wash. “This millennial generation values relationships, especially with family. As a result, society needs to redefine what commitment to practicing medicine means today.
“While those of my generation bemoan the fact that there is a lack of the ‘level of dedication’ that so many of us exhibited by ridiculously long work hours and time away from family, I’ve heard many express that they wish they had had the fortitude to draw similar boundaries.”
But Dr. Sibert argues that young male physicians may say they value work-life balance but still work many more hours than female physicians on average when they begin practice. “In my experience, the young men are the hardest workers there are,” she says. “They may talk a great game about work-life balance, but when push comes to shove, it usually doesn’t work out that way for them when they get into practice.”
When he hears complaints about female physicians who practice part time, Philadelphia anesthesiologist Michael Green, DO, is bothered by what he perceives as a “double standard.” His wife, also an osteopathic anesthesiologist, works less than 40 hours a week so she can spend more time with their two children. While she faced criticism for reducing her hours, he has noticed that few people find fault with male physicians who practice part time for various reasons.
“When a man wants to get an MBA and decides to work two days a week in the operating room and three days in a week in an office somewhere, do people criticize him for contributing to a physician shortage?” Dr. Green asks. He knows one 36-year-old man with a family who reduced his practice hours by 40% to serve as the chief medical officer of a pharmaceutical company. While supporting his friend’s choice, Dr. Green can’t understand why that arrangement would be considered more acceptable than a reducing one’s workload to care for kids.
Dr. Green also knows several men and women who are working part-time hours toward the end of their careers in anesthesiology, a physically demanding specialty. “One physician I know turned 69 this year and has been working part time for at least 10 years,” Dr. Green says. “He tells me that his ability to work part time extended his career by several years. So in this respect, part-time practice is having a positive impact on the physician workforce.”
The availability of part-time physicians can also help hospitals meet their needs more cost-effectively, Dr. Green says. “In anesthesiology, we have other physicians scheduling our days, and what they schedule determines our needs,” he explains. “Having part-time employees gives us increased flexibility and allows us to reduce costs.”
Strategic career planning
Dr. Sibert, who raised four children, says she understands the struggles of young women who are balancing medicine and motherhood. But rather than pursue part-time positions, women can find full-time positions in medicine that have manageable work hours, she maintains.
When her children were young, Dr. Sibert chose to work full time for a large academic medical department, in which many physicians shared call. “Unless you were on call, your days were very predictable,” she says. “Now that my children are grown, I work for a private practice group, which is more lucrative, but my days are unpredictable. This would have been a terrible arrangement for me when I had young children.”
Dr. Sibert believes that women in medical school are receiving bad advice and are being presented with a false dichotomy that they can either practice part time and have time for their families or practice full time and have no family life.
What’s more, women who practice part time early in their professional lives often fail to realize how this will adversely affect their long-term career prospects, Dr. Sibert says.
“In general, women are cutting back their hours at the same time the young men who are their peers are putting in longer hours and taking extra cases,” she says. “So the women are falling behind in terms of gaining experience, getting known in their field, working on difficult cases and developing a good referral base.
“If you enter medicine part time, you probably aren’t going to advance or make top-tier pay. You’re not going to get responsibilities. You’re not going to get the most interesting cases. You’re not going to be the go-to person. You’re going to be looked at as ancillary.”
The growing number of young women practicing medicine part time is already creating a backlash against other new female physicians, she says.
“One young obstetrician-gynecologist recently told me that when she was looking for a job, she was just offered part-time work, even though she wants to practice full time,” Dr. Sibert says.
With the millennial generation of physicians just embarking on their careers, the full impact of their choices cannot yet be assessed. But some individuals in the osteopathic medical profession are speculating.
Today’s young physicians, because they make more time for exercise and personal interests, may end up being better role models for their patients, Dr. Phillips-Madson suggests. “What will be most interesting to track is whether physicians’ suicide, burnout and depression rates decrease as a result,’ she says. “On the flip side, will the trend have a positive or negative impact on the health of patients?”
Dr. Phillips-Madson points out that the proliferation of part-time physicians could have adverse effects on continuity of care if precautions are not taken. She says some problems have already been noted among hospitalists and other shift-work physicians when patient handoffs are not handled carefully and methodically.
“Patients want physicians who will be there for them,” Dr. Sibert adds. “They want to be able to get hold of and talk to you.”
But given the high cost of medical education and exorbitant debt load of many physicians, some members of the profession suspect the trend toward part-time medical practice may be short-lived.
“With the tuition indebtedness that students have, working full time will probably be seen as the better option,” says Jerry Cammarata, PhD, the dean of student affairs for the Touro College of Osteopathic Medicine in New York City.
The issue is complex, Dr. Dougherty acknowledges. She notes that her daughter, an osteopathic pediatrician, may end up practicing part time so she can spend more time with her new baby. Her previous practice arrangement forced her to work unreasonably long hours even while pregnant. When Dr. Dougherty herself was juggling medicine and motherhood, she relied heavily on her husband, who for several years was a stay-at-home father.
For Dr. Green, the issue boils down to the medical profession as a whole making room for individualism and self-determination. “I think it’s OK for people to choose their own path,” he says. “Not everyone fits the same mold.”