Accommodating part-timers

July 1, 2007

A part-time physician can add tremendous flexibility to your dermatology or cosmetic surgery practice. But a part-timer will come at a cost if you are not prepared.

Even if you haven't previously considered putting part-time physicians on staff, chances are you'll be asked to do so before long. Baby boomers are edging toward retirement and may want to reduce office hours or call-coverage duties. Physicians from Generation X or from the incoming Generation Y (sometimes called the Millennial Generation) both seem to value having more personal time.

At what cost?

First, patient care is not a part-time job; patients' requests for appointments, medications and advice come in every day, all day. Physician job-sharing can help meet these demands, particularly if you can pair two physicians who have good communication skills and similar work styles. Second, many types of practice costs don't rise and fall in lockstep with physician work hours. Medical malpractice liability carriers don't adjust rates according to the hours a physician works, nor do landlords, information technology vendors or the many other sources of overhead expense.

You may ask, won't support staff costs - the major component of medical practice overhead other than physician compensation - drop? Unfortunately, staff hours and related costs cannot always be fully adjusted to match the reduction of the part-time physician's hours. In fact, it's common to see a higher staffing cost per hour for part-time physicians. You still need those staff around to help manage patient communication, billing and other tasks when the part-time physician is out of the office.

Considerations that may cost

Expect that sooner or later you are going to have to find a role for a part-time physician in your full-time practice.

Consider how to handle the following critical issues:

To avoid concerns about discrimination, set a policy now, put it in writing and stick to it. Make sure employment and partnership agreements spell out the decision-making roles, if any, of part-timers. Expect that part-timers will often take different views on important decisions. Would a physician working 20 hours a week and planning to retire in two years want to invest in an electronic health record - or for that matter, in any long-term capital improvement project? Not likely. Out of deference to retiring physicians, offer them a chance to go part time but install a maximum time period (e.g., one year) during which they can retain partnership and part-time status.

Many requests for part-time status are from physicians who want to wind down before retirement, which is exactly when they do not want to drastically reduce compensation. Some dermatology and cosmetic surgery practices recognize the clinical and leadership value of these soon-to-be retirees by providing them full compensation as they reduce clinical hours, but establishing a maximum "wind-down" period of one to two years.