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Working Part-Time Medicine, Forever

There is no reason why you can’t practice medicine part-time. Part-time medicine isn’t advertised widely, but most medical groups and employers will allow for some sort of part-time work.

Whether it’s something you can apply for directly or something that you have to strategically engineer is what we’ll discuss here.

 

Part-time Medicine

A colleague whom I used to moonlight with had been practicing part-time or per diem medicine since the 1980’s. He lived out of both SoCal and Hawaii and spent most of his time traveling and working on his rental income properties.

Whether you’re a radiologist, oncologist, neurologist, orthopedist, or family medicine doctor, there is a way to practice part-time medicine.

Benefits

Benefits are overrated which I’ve discussed before. There are no benefits offered by an employer which you can’t create yourself. Everything from a 401k to a cash balance plan, to disability insurance.

1.0 FTE is the term used for full-time employment – ~40 hours per week. 50% part-time or 0.5 FTE would be the part-time equivalent.

Most employers will offer you some benefits even at 50% of full-time employment. If they don’t, it’s probably something you can negotiate.

Employers want us to stick around by waving the benefits carrot in front of us. If you are choosing a particular gig for the benefits alone, then it’s most likely a bad decision. If you’re suffering with a full-time schedule then it makes little sense to do it for the benefits.

Per Diem vs Part-time

Benefits, a set schedule, and job security are the main advantages to practicing part-time medicine as opposed to working per diem.

Most physicians who work per diem can eventually petition their employer for part-time work. Starting work as a per diem is a great way for the employer and employee to court each other.

The main disadvantage I recognize with part-time work is that your employer often will have a non-compete verbiage in your contract, preventing you from picking up shifts at other medical groups.

 

Full-time → Part-time

You are miserably working a full-time schedule as a pediatrician and the thought of another well-child exam makes you want to quit. Before quitting, consider switching to part-time. You can always quit later.

Your employer will often tell you that there is no part-time position available in order to dissuade you. This is a standard reply to your part-time request and I’ll discuss how to address it.

Discuss with Upper Management

Talk directly to your chief and give them some time to work on it. Let them know with clear words, ideally written words, that you would like to drop down to a part-time schedule.

I suggest citing personal reasons such as burnout. Burnout is a hot topic and one that employers are sensitive to. Be clear. This isn’t the time to drop hints and hope your employer can read your mind.

After discussing it with the chief bring it up with the regional/area medical director. Beyond that, discuss it with the HR and CEO or president. By escalating the matter up the chain gradually you won’t ruffle any feathers.

Exceptions are Always Made

Kaiser Permanente is a massive HMO and physicians who work for KP are convinced that no exceptions are ever made for employees. The truth is that KP spends a lot of money onboarding full-time physicians. They will do everything possible to lose on that investment.

I have seen part-time medicine jobs offered to colleagues even though no part-time position was available, nor “approved” by regional Kaiser. Bullshit. Exceptions are always made for the right employee.

Negotiate Terms

First figure out why you want to work part-time.

  • Are you trying to spend fewer hours seeing patients?
  • Are you trying to work fewer weekends/evenings?
  • Are you exhausted by the fast pace of your work?
  • Are you trying to do less of one thing and more of another?
  • Do you want to work shorter shifts or longer shifts but fewer days?

Once you figure this out then you’ll have some arsenal for your negotiations. It’s miserable for an employer to sit across from an unhappy employee who doesn’t know what they want.

Work in Different Departments

Your department, let’s say proctology, can only offer you 10 hours a week of part-time medicine work. Is there a way for you to pick up the other 10 hours from another department? Could you do a few colonoscopies or handle patient messaging for another department? Could you get on the hospital’s QA or emergency preparedness committee?

From an HR standpoint, as long as you have enough working hours then you can qualify for a benefited part-time position. They likely won’t care where those hours are coming from.

 

Per Diem → Part-time

One way to land a part-time position is to whore around as a per diem for a while. Sell your ass to different medical groups for a few months/years and then figure out which company you like the most.

Next, contact HR or your medical director and ask if a part-time position is available. They already know you and if you are a good candidate then they’ll create something for you or at least begin negotiations.

Job Security

The reason that a part-time position is more secure than a per diem position is that there are more laws protecting employees. Independent contractors, as sole proprietors, are treated as business entities.

Furthermore, per diems are managed by a different group in the HR department. Managers in charge of per diem clinicians are always a little less involved and not as committed.

Part-time physicians, however, are often managed by the same team as the full-timers. This is why it’s hard to escape office politics as a part-time clinician.

Strategize

Some medical groups don’t have a part-time position or aren’t willing to offer one to per diems. Consider transitioning from per diem straight to a full-time job. It’s often easier and allows you to switch to part-time later on.

After working the full-time role for a few months you can request to go part-time due to personal reasons or because of burnout. This poses a little moral dilemma so I’ll let you battle that on your own.

 

Part-time Forever

Can you be a part-time clinician forever? Of course. The only thing limiting you are finances. Budgeting and saving adequately for retirement can allow you to remain in part-time medicine forever.

I’ve known an OB/Gyn who’ve never worked a full-time schedule in her life. Maybe that’s why she has been able to stay employed for as long as they have.

After Residency

There are part-time positions available for medical professionals but it may not be at your ideal medical group.

In the past I believed it was important to work a ton of hours immediately after residency so that you can solidify your skills. I have since realized that the hard skills in medicine are less valued by employers and patients. The soft skills are what keep your customers and bosses happy.

Tax Advantage

If you are earning only $125k a year versus $300k, not only are you enjoying more free time but you are keeping more of your earnings.

Paying 35% on most of your earnings versus 25% because of our progressive income tax code, means you’ll have a higher hourly take-home pay than your full-time colleagues.

 

Negotiation Strategies

You should always be your own strongest advocate. Your job doesn’t care about you as much as they claim. You are dispensable when it’s no longer convenient for your employer to keep you on.

I don’t want to foster bitterness, just understand that your employer is your customer. Just happens that they are your only customer for your chosen expertise. You can quit and leave at will and they can terminate you at will.

Recognize Your Value

Employees of value are the ones who create the least headache for their managers. They have decent patient satisfaction scores, not too many bad patient outcomes, don’t call in sick excessively, and get along with staff and colleagues.

If you’re the one who is always complaining to your boss, a slow provider, and perpetually in contention with colleagues, then you may not have a whole lot of wiggle room.

If you happen to be a hot commodity then you should capitalize on it. Capitalism – the word used to describe our economy. Capitalizing on your skills and making sure you are fairly compensated for them is what fuels our economy.

Threaten to Leave

Threatening to leave might seem drastic. But anytime you negotiate, it’s necessary to present an end-point to the opposing party. They need to know what they stand to lose, what do they stand to gain.

It’s important to be firm – as in, you definitely want a change in your employment status. But remain flexible with negotiations.

Never phrase it explicitly that you would quit because it will often be your death sentences. It’s better to say that you must cut back on your clinical hours in order to be able to continue working. That you enjoy the work but that the hours are incompatible with your current situation.

Threaten to leave without actually making the threat.

Get Creative

You should, step-by-step, escalate the matter up the management chain. This will often yield an option that you never even thought of. Your HR might have dealt with a similar situation previously and they were able to come up with a favorable solution.

Talk to other departments, talk to the per diems, and talk to your colleagues. They may have suggestions which you didn’t consider. Their longer tenure might offer you valuable insight.

Leave of Absence

Ask for a leave of absence. This is an unpaid amount of time – often up to 3 months – where you are guaranteed your same position upon your return.

It isn’t terribly hard to get approved for this. More importantly, it allows you more negotiation room. Would your employer want you to take a leave of absence and possibly quit after or would they rather agree to a part-time position?

 

Missing out on Benefits

Even though physicians are in high demand, few employers are willing to negotiate physician salaries. They won’t offer you a higher salary in return for decreased benefits unlike in other professions.

I have friends who are engineers, earning incomes similar to physicians who enjoy much more salary wiggle room.

Pensions

I don’t think it’s worth it to suffer working full-time just for the sake of benefits. Benefits have a price tag. It’s better to figure out that price tag and pay for it yourself or take a proportional pay-cut for it.

If you can work part-time or per diem for 50 years, sustainably then is a pension necessary? It’s okay to pass on a pension. With a healthy enough work-life balance and decent funds in your retirement accounts, there is no reason why you would need a pension.

Partnership

I have practiced medicine for the past decade and I’ve been a finance nerd since 2012. I still can’t figure out the purpose of making partner with these larger medical groups.

It’s never a real partnership; just like you don’t really own Coca-Cola because you purchased their stock.

Sure, the income changes from a W2 wage to a K1 salary. But because you don’t own the business, you can’t write anything off.

SCPMG Kaiser in SoCal has a weird rule that you must make partner otherwise you can’t even stay on as an employee. I never understood that.

Health Insurance

It seems that mandatory health insurance is a thing of the past. That might open up the opportunity to purchase catastrophic insurance once again.

Purchasing your own health insurance policy might be expensive, but if you are earning $100-$200/hour then it makes little sense to unnecessarily remain full-time for its sake alone.

401k & Cash Balance Plan

I don’t see how a cash balance plan would be beneficial to a physician unless you are earning a ton of money. For the rest of us, a pension or these cash balance plans can be replaced with solid retirement investments.

I have written about how you can open your own individual 401k. Such solo 401k retirement accounts can allow you to put even more aside than the $18k your employer limits you to.

In summary, don’t let the benefits keep your from switching down to part-time if that’s the right career move for you.

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