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December 4, 2020

Creative scheduling

A year ago, Dr. Stacy Childs was burnt out on medicine. A sought-after urologist with a thriving practice in Cheyenne, Wyoming, Childs had been routinely seeing 40 to 50 patients a day since 1995, when he set up the practice with two partners. But after being diagnosed with prostate cancer in 2000, he decided to scale back his workload. He wasn’t sure how to make the change, but he began contemplating downshifting his career to make time for other pursuits.

One of those pursuits was skiing. Childs and his family had always enjoyed the sport and had spent time in skiing hotspot Steamboat Springs, Colorado. So when a urology colleague invited Childs and his wife, Diana, to visit them in March 2004, he eagerly accepted.

It was during that trip that Dr. Rick Brothers proposed that Childs join Urology Clinic, PC, Brothers’ growing practice in Steamboat Springs. Six years earlier, Brothers had sold his own practice in Laramie, Wyoming, and moved to Steamboat Springs to slow down, starting a new practice there. But in those six years, the workload in Colorado had again risen to the point where he wanted to scale back his hours. If Childs joined him, they could share the workload and both enjoy plenty of time to ski and relax, something Childs hadn’t done much of. The timing of the proposal couldn’t have been better.

On returning to Cheyenne, Childs gave his partners 60 days notice and began packing for a move to Colorado. Although the workload was considerably less than he had in Wyoming, when a third urologist approached the duo in 2005 about joining the practice, they happily agreed. "We decided to run a busy two-man practice as a slower three-man practice," Childs says.

The three doctors now work rotating two-week shifts and then take a week off. They each schedule their surgeries during the first of their two-week shift, so they’ll be available in case a problem arises during the second week, and use their second week to see patients in the office and set up surgeries for two weeks hence. So each week, two doctors are working and one is off. The office also closes at noon on Fridays.

Despite splitting the workload three ways rather than two, the practice has grown so quickly that Childs expects each partner will soon earn as much as he did before adding the third partner. More importantly, he says, "I’m having a blast." He now has time to take long bike rides, swim - which he never had time to do before - and is looking forward to becoming a champion ski racer within a couple of years. Now, "ski racing is my job and urology is my hobby."

Of course, with the cut in hours came a drop in income. Childs estimates his income fell about 30 percent the first year, but is now approximately 20 percent less than when he was in Cheyenne. "Now there are three of us in a two-person practice," he says, adding, "In 2006, I have 18 weeks of vacation, compared to 6 weeks in Cheyenne."

Many physicians would likely love to be able to make such a claim. Recalibrating the amount of time spent at work and home, or on personal interests, is on the minds of many today.


Since 9/11, the priorities of many Americans have shifted. For some, the importance of work has declined relative to the importance of family, friends, and other activities. A 50/50 split between time spent at work and time spent at home, once considered a balance, has become outdated. Cali Williams Yost, the author of Work+Life: Finding the Fit that’s Right for You (Berkley Publishing Group, 2004), argues that for doctors, a 50/50 split isn’t realistic. In fact, the percentage of time spent at work has climbed, in some cases dramatically, while time spent outside work has shrunk.

According to the American Medical Association’s Physician Socioeconomic Statistics book, the number of hours physicians spend on patient-care activities has risen in the last 10 years. Some have risen only slightly, as in family practice, which rose from an average of 49.7 hours/week in 1991 to 50.7 hours in 2001, and some more significantly, as in surgery, which increased from 49.6 to 58.2 hours. At the same time, reports the Department of Labor, the number of employees in all fields who work a flexible schedule has dropped, from 29 million in 2001 to 27 million in 2004.

Yet even as work responsibilities increase - or perhaps because they are increasing - physicians today want flexibility to decide for themselves when and where they will work.

Research conducted as part of "When Work Works," a project funded in part by the Alfred P. Sloan Foundation, bears that out. The study finds that 43 percent of employees who don’t currently work any regularly scheduled hours at home would like to be able to. More than 50 percent of older workers (defined as older than 58) would also like to reduce their hours to part-time, but still remain employed, while 24 percent of women and 13 percent of men currently employed full-time would like to go part-time. And new parents who want to spend more time with their babies are increasingly opting out of the workforce altogether for longer periods of time.

Yost says, "There is no one standard flexible work arrangement that works in all cases. Most successful arrangements are a blend of adjusting time spent on the job and/or location where the job is done, a blend that works in the context of an employee’s particular job."

Fortunately, in many cases, creating a more flexible work schedule does not automatically require workers to quit their job or move to another state, though those are certainly options to consider. For physicians interested in staying where they are, but working a schedule that better fits their personal needs and responsibilities, there are several steps to help define and negotiate a more creative schedule.


"Ninety percent of people don’t have a work-life vision," says Yost. That is, a picture of what the perfect schedule would look like. In a perfect world, ask yourself how much of your life do you want to spend at the office, at home, and doing other things, like traveling or volunteering.

To start, Yost advises asking yourself how you want work to fit into your life. What is your vision? For some doctors, that might mean a three-day work week. For others, that might be no weekend call. If you want to make changes to your current schedule and work obligations, start by examining what your work life is like and how you want it to be different.

"Most physicians put their head down and plow ahead" and don’t think about what they like or don’t like, says Patricia Raymond, MD, of Chesapeake, Virginia. And for 10 years, that’s exactly what she did as a partner in an internal medicine practice, working 80 hours a week, on average, arriving home around 7 or 8 pm each night.

During those years, however, she found she really enjoyed the opportunity to do public speaking - even pharmaceutical presentations - where she could apply her college theatre training. By 2001, the speaking opportunities were coming up more frequently, and even more so after she gave the keynote address at the Society for Gastrointestinal Nurses and Associates conference. She found she loved speaking so much that she began accepting weekend speaking engagements on top of her 80-hour work week. Raymond would fly out to her destination Friday evening after work, present on Saturday, and then fly back home to Virginia on Sunday morning.

After about a year of moonlighting as a public speaker, Raymond spoke to her partners about going part-time so she could invest more time in her second career. However, as a partner, she explains, everyone was paid the same, not based on performance, and her then five partners couldn’t see how they would equitably pay her. They eventually agreed to a part-time schedule whereby she worked about 50 percent of her normal schedule for 30 percent of her pay. "I ended up working too hard," she says, and in early 2003, she walked away from the group. That was also the year she started work on books, including Don’t Jettison Medicine: Resuscitate Your Passion for the Career You Loved (Carthage Publications, 2003).

For nearly a year she worked two days a week as a fill-in doctor in another practice, until she opened her own practice in April 2004. Raymond now has the schedule she dreamed of - a balance of her thriving medical and media careers. She works Monday through Wednesday at the practice and takes Thursday off. On Friday she hosts a regional National Public Radio call-in show about health, "Housecalls," and then takes a flight to her weekend speaking destination, returning on Sunday. She is also developing several medical-related products, which she markets at her Web site:

"Being able to do all the other things that are in my heart, it’s incredibly exciting," she says. And she counsels other physicians that "if there are other things you want to do, you don’t have to give up medicine altogether. It’s possible to find time for other aspects of your life that are important to you," Raymond says.

Raymond’s ability to make pivotal career and financial decisions was aided along the way by her work with a financial adviser, who helped her determine her financial needs and goals. That information helped her weigh her many options along the way, keeping in mind her available financial resources.


Finding the right blend of work and personal life also requires that you clarify your own definition of success, says Yost. What are you striving for long-term? What kind of lifestyle do you want? What other activities and pursuits would you like to engage in that you haven’t yet been able to do? What type of hospital or private practice do you aspire to join? Do you have an eye on a particular fellowship? What kind of income goal have you set? All of these questions will help you picture your ideal future.

For Drs. Les Wilson and Vicki Erwin-Wilson, a husband-and-wife team of family practioners who run Wilson Family Medicine in Tallahassee, Florida, their definition of success had everything to do with scheduling flexibility that would allow them plenty of time with their eight children, who range in age from
two to 15. To achieve that goal, the Wilsons were willing to sacrifice a significant amount of income, says Les Wilson.

But even before they established their own practice, the Wilsons were able to coordinate their schedules to a much greater degree than other couples by asking their former community health director if they could job share. Although job sharing is not very common in medicine, explains Les Wilson, "[the director] was thrilled to have access to two qualified physicians." And because they were trained in the same specialty, they could also cover for each other.

Today, the Wilsons have raised job sharing to near art form. The only two physicians in their practice, Les and Vicki schedule month-to-month and ensure that one of them is always in the office. One month, Les is in the office on Mondays, Wednesdays, and Fridays all day, while Vicki works only through early afternoon. On Tuesdays and Thursdays, Les works the shorter shift while Vicki works all day at the office. At 2 pm, whoever is off picks up the kids at school and shuttles them to a laundry list of sports and extracurricular activities-basketball, baseball, volleyball, cross-country, gymnastics, soccer, as well as piano, trumpet, and clarinet lessons.

Though they may seem the model of scheduling flexibility, the Wilsons implemented an electronic medical record system (EMR) in October 2004 to further enhance their productivity and flexibility. "[The system] allows us to have access to patient records from anywhere," says Vicki Erwin-Wilson, "so we can do work from home at 11 pm or charting at 5:30 am, as well as review notes from staff or lab notes." Les says the move to EMR saves them, on average, two hours of office time per day, because "we don’t have to finish every bit of work at the office."

Such efforts to reduce office time are guided by their first priority-spending time with their children. Having that shared goal makes work scheduling somewhat simpler.


As you examine your work-life fit vision and your definition of success, try to identify aspects of each that you can change, says Yost. Just as important is knowing which elements you can’t change. Look for ways to make adjustments within the realm of possibilities. You can’t realistically work a 40-hour week in two days, but maybe your salary goal doesn’t need to be as high, giving you more flexibility on the work side of the equation.

For example, the Wilson’s goal was to spend more time at home with their children, while continuing to manage a thriving family practice. Their most recent investment in EMR supports that goal, freeing up more family time without impacting patient care. But there are many solutions to each individual’s situation.

Elizabeth "Beth" Frates had planned to go into business after college, but when her father suffered a stroke shortly after she arrived on campus at Harvard her freshman year, her interest in medicine was fueled. Although she wanted a challenging career, Frates also knew she wanted to get married and have children, so during med school she invested a great deal of time in choosing a specialty that would be conducive to having a family. After considering several options, from pediatrics to neurology to cardiology, she came across physiatry, a lesser-known specialty that combines physical medicine and rehabilitation. In addition to providing an appealing work-life balance, Frates also found she could develop a specialty in working with stroke patients, her personal interest.

In 1999, during her fourth year of residency at the Spaulding Rehabilitation Hospital, Frates unwittingly tested the bounds of flexibility when she became the first resident in that department to become pregnant. It didn’t impact her career plan, however, and once she joined the staff at Spaulding, which is affiliated with Mass General, her plan was to get a full-time nanny for her son, John. But once she had the baby, "he changed my life incredibly," she says. "I knew I wanted to be with this baby," and not at work full-time.

Approaching her department chairman, Dr. Walter Frontera, she was nervous about the reception she would get to her request for time off. His response: "What do you want to do? We’ll figure out a way to make it happen." As long as she was willing to continue to contribute to the department in a significant and meaningful way, such as by performing research, publishing articles, writing books, or teaching medical students and residents, Dr. Frontera would support her. Relieved and thankful, her response was to take six months off, during which she wrote articles and cared for her newborn. Once that time was up, she asked to teach at Harvard Medical School, which she loved, as well as to do some writing and research. Again, Frontera’s response was, "You tell me what you want to do and I’ll support you.

Frates’ schedule now varies based on whether she’s teaching or not - during those months, September through November, her parents step in to help care for John and Peter, who arrived 21 months after John. When she’s not teaching, a typical day consists of taking care of the boys during the day, then writing or doing research from 7 to 10 pm. She also works weekends from home, writing while her husband takes care of the children, for a total of about 25 hours a week. That figure jumps to around 40 when a writing deadline looms, however. Her book, Preventing a Second Stroke, was released in March (Johns Hopkins University Press, 2006).


Clearly, Frates’ boss is a forward thinker. He is the chairman of the department of physical medicine and rehabilitation at the Harvard Medical School and Spaulding Rehabilitation Hospital in Boston. His willingness to accommodate his staff’s changing career and scheduling needs is rather unorthodox, but he argues that it is necessary in order to attract and keep top performers.

"If we want to keep people happy, we have to come up with ways of understanding their situations and accommodating their needs as much as possible," says Frontera. At Spaulding, "there’s benefit to the faculty, to the school, and the department and field in allowing a creative schedule…I don’t see the downside."

Yost agrees. "Helping your employees address both their work and personal responsibilities makes good business sense."

Marcia Layton Turner lives in Rochester, New York. This is her third feature for Unique Opportunities.


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