Flexible medicine

Shifting attitudes among physicians means work/life balance is becoming an even bigger career concern than income among new physicians.

“There is a big emphasis on quality of life now,” says Lisa Freda, director of physician recruitment for Chen Medical and JenCare Neighborhood Medical Centers. “The whole climate is changing.”

Freda says location and scheduling flexibility trump all other considerations as health care employers compete for physician candidates.“Organizations that can be flexible have an advantage,” she says.

Across the board, physicians are asking for flexibility. How they achieve it is unique to each situation and ranges from working with a potential employer to striking out on their own. The options illustrate the wide variety of today’s practice choices.

We spoke with a few physicians about how they approached their desire for flexibility, and to in-house recruiters about if and how to incorporate it into your next practice search.

Reducing time spent on insurance paperwork

Years ago, Doug Nunamaker, M.D., chief medical officer at AtlasMD in Wichita, saw that physicians were burning out because they spent too much time on insurance paperwork. He asked what he could change and came to the conclusion that patients needed to be responsible for their financial decisions.

“We don’t purchase anything else the way we purchase health care,” says Nunamaker. He cites car insurance as an example: The owner pays for gas and vehicle upkeep, and insurance only comes into play when an accident or other event necessitates repairs.

Nunamaker envisioned a similar system for medicine. He thought routine care should be cheap, and insurance should only cover catastrophic injuries or illness.

So Nunamaker introduced a membership-based system at his practice, where patients pay a monthly fee for unlimited access to the physician. There are no co-pays for appointments, and patients pay wholesale fees for lab work. The practice does not accept insurance, but Nunamaker sometimes works with insurance companies to help patients lower their premiums.

Whereas other practices often have 2,500 to 4,000 patients, the four physicians at Nunamaker’s practice take on no more than 600 patients.

He usually works about 45 hours a week, instead of the typical 50 to 60, and sees five to six patients a day. As a result, he gets more time with his family.

But for Nunamaker, the new model isn’t just about reducing his workload. “It’s what you do in those hours that really matters,” he says. Because he has fewer patients, he can spend more time researching solutions. He finds that “patients don’t have to come back as often.” And when they do, he has time to spend 30 to 90 minutes with each.

“It’s not the money that’s a priority, but being both personally and professionally satisfied,” he says of his practice choice. “Improving patient care while improving my personal family time is a key motivator for this kind of medical practice.”

Another scheduling option: a concierge practice

Sarah Davis, M.D., of Park Cities Personal Physicians in Dallas, based her career decisions partly around spending time with her young children. After completing her residency in family practice at the University of Florida at Gainesville, Davis started working at a private practice. However, she felt unfulfilled because she didn’t get to spend enough quality time with patients.

Davis heard about concierge practices that limited their patient rosters and charged an annual fee for 24/7 physician access. That model appealed to her, so she set up her own concierge office.

Instead of seeing 40 patients a day, her practice serves only 100 in all. Some weeks, she has few patient appointments and can be out of the office as long as she can be available if needed.

Although patients have her cell phone number and email address, they try not to bother her during evenings and weekends unless there’s an urgent issue. “The nice thing is that I don’t have patients stacked up in the office,” says Davis. “The downside is that when a patient needs you, you drop everything to see them.”

The concierge model also appealed to Joseph T. Barry, M.D. In January 2015, Barry started offering concierge services at his practice in Camillus, New York. “I was looking for quality of life,” he says. His business partner continued to manage traditional operations, and this two-tiered model allowed clients to choose between traditional and concierge services.

Then the concierge network SignatureMD approached Barry about joining their network, and he opened his own concierge practice. He now benefits from their operational support.

Barry now works in the office from 8 a.m. to 5 p.m. four days a week and uses Wednesdays to see patients in nursing homes, hospitals or their own homes.

Concierge patients pay $1,800 per month for access to Barry, who says that the nationwide average for monthly concierge payments is $1,500 to $5,000. Insurance does not cover any of that fee, although funds from a flexible spending account or Social Security can be applied.

By limiting his patients to 300, Barry can devote more energy to each. “I have time to think about patient problems,” he says. Those 300 patients get nearly unlimited access to him.

Often, he can give them a same-day or next-day office visit and an immediate phone call. He finds this easy access appeals to professionals, who don’t have time to sit in a waiting room, and older patients, who want same-day appointments. At the practice, a secretary greets each of Barry’s patients by name and offers them fresh fruit.

He also makes himself available outside the office. Every other Tuesday, he walks with patients on the Erie Canal. He meets them at the local farmers’ market to talk about healthy eating and offers cooking classes to demonstrate vegetarian or Mediterranean cuisine. In addition, he keeps in touch with a monthly newsletter.

The change has also helped him balance his life. “When I’m done with work, I’m done,” he says. “It gives me a more regular schedule so that I can make time for jujitsu, racquetball and saxophone lessons.” Perhaps most importantly, he says, “I feel better about being a doctor.”

Building a satisfying career

The search for schedule flexibility leads some physicians to trade a standard arrangement for a more creative one.

After completing her residency at St. Christopher’s Hospital for Children in Philadelphia, Cheryl Wu, M.D., opted to work a few part-time roles for maximum control of her time.

Wu started as a locum tenens pediatrician in a federally funded clinic while moonlighting in a pediatric emergency room for a couple of years.

When she became pregnant, she needed more stability, so she interviewed for hospitalist shift positions and took a locum tenens spot in Pennsylvania.

She worked a 40-hour shift from Friday night to Sunday morning once a month during her pregnancy and her son’s infancy. “In terms of lifestyle, it worked,” she says.

As her son grew, Wu’s needs changed, too. She wanted a 9-to-5 job with a predictable schedule that would help her arrange childcare more easily. She joined a private practice for a few years, but still didn’t feel she had the control she needed over her schedule.

“I realized the most important thing for me was being able to work and take off when I wanted to,” she says. She also felt restricted because she could only take one of her four vacation weeks at a time. “I wanted to be able to travel, to see my family in Asia, which I couldn’t do in just one week of vacation.”

So Wu decided to leave the practice—and found a job that had everything she was looking for at 139 Medical PC, a thriving practice in Chinatown.

The practice offered per diem pay and malpractice insurance, and Wu only has to commit to two days a week and one Saturday a month. Best of all for her, she doesn’t have to work weekends or be on call.

Wu continues to moonlight in an emergency room two or three times a month in the evenings and on weekends. She can work more days when she wants to, but says there’s no pressure to do so. She earns nearly the equivalent of a full-time salary by piecing together shifts that are convenient for her.

Looking back, Wu remembers she and her medical school and residency colleagues talked more about careers than physician work-life balance.

Occasionally, they discussed how certain medical specialties like anesthesiology and radiology offered more desirable lifestyles, but it wasn’t a top focus until she finished her residency. She says: “Lifestyle becomes a much bigger deal once you’re done.”

Learning about your options

Part-time work

This can be a good way to put in extra time at home while staying current in your profession. Large, physician-owned practices are the most likely to offer part-time work.

Employment arrangements likely work better for those seeking part-time schedules, unless the physician already is an established partner in a group, but more and more practices are trying to work with their physicians to offer fexible arrangements.

Some physicians wanting part-time clinical hours might be able to offset the time
with administrative tasks outside the offce, for example. The key is to consider the needs of patients, the employer and practice as well.

Job-sharing

One arrangement that can work for part-timers and minimally affect patient scheduling is job-sharing. In this arrangement, typically two physicians share a full-time position.

Practices might advertise jobshare opportunities to allow a current partner or employed physician to begin or maintain a reduced schedule. The new physician also works part-time, but together the physicians cover the hours and patient load of a full-time physician.

Nontraditional scheduling

Sometimes, all it takes is some extra time off between shifts to help prevent burnout or allow for extra family or down time.

Some specialties lend themselves more easily to something other than Monday through Friday, 9-to-5 scheduling. Physicians in block schedules often work 12-hour shifts.

Use of hospitalists and advanced practitioners

Hospitals and physicians in many specialties employ mid-level providers to help them accommodate flexible schedules while providing another layer of continuity for patients.

Locum tenens

Physicians who prefer truly flexible scheduling might choose locum tenens work, though it’s the least secure fnancially. Locum positions are great ways to maintain clinical skills and patient contact when physicians can’t work more traditional schedules for personal reasons.

Concierge model

Though generally best reserved for established physicians, recent graduates may want to consider this model by joining a physician who has an established concierge practice.

Consider your scheduling needs

Before activating your job search, no matter what kind of schedule you picture, take some time to evaluate what’s a must-have, and what is just a preference.

Once you start to network with employers, be prepared to talk upfront about any of your must-haves—including any special scheduling requests.

“When the physician finds out about the job and the expectations of call and such, it’s good to talk about it upfront,” says Michelle Forray, a physician recruiter with NorthShore University HealthSystem who has been recruiting for almost 20 years. “If they come in, do an interview and then mention it later, it may not look very favorable for the candidate.”

The most common requests for flexible schedules at NorthShore is for less-than-full-time hours—such as a full-time equivalent (FTE) of .6 or .5.

A flexible schedule works better for some specialties than others. Specialties with high inpatient and consultative responsibilities, for example, might not be as flexible as others.

The Tradeoffs. It’s also important to understand the potential consequences of choosing to work something other than a traditional arrangement.

“Sometimes patients, if it’s a primary care physician, could be turned off by a physician only being available three days a week,” Forray says. “And that could affect their ability to build the practice as fast as they’d like.”

Physicians with prorated schedules need to understand their call coverage responsibility, too. A part-time schedule does not automatically mean part-time call.

The best scenario, Forray says, is when candidates are open as to what their exact schedule would look like. For example, a request for one day off per week instead of, say, every Wednesday. Remember, the ability of the group to provide flexibility depends in part on what’s already scheduled.

If your practice type or schedule hasn’t followed a traditional path and you’re looking to return to full-time employed work, be open with the recruiters with whom you’re in contact about why you chose your path. A frank conversation can help ease any concerns about a nontraditional path pointing to lack of career direction.

NorthShore accommodates that search for work/life balance through more than part-time hours. After 32 bookable hours, physicians get an administrative day where they can work off campus—a perk that certainly can add to a well-balanced life.