he number and percentage of physicians desiring to work less than full time is increasing.¹ Reasons include changes in how physicians perceive themselves professionally, increasing numbers of women physicians, societal changes in the traditional roles of men and women and decreasing satisfaction with many aspects of the increasingly regulated American health care system.² Medical practice generally and surgical services in particular are more complex and demanding than ever before, and many physicians feel “burned out.” Some are pursuing interests outside of clinical medicine, especially in business and administration, which require a part-time level of their medical practices. Many would like to transition into retirement with a reduced clinical workload and on-call commitment. How anesthesiologists and anesthesia groups are dealing with part-time work requests was the subject of a panel at the ASA 2007 Conference on Practice Management. Joanne Jene, M.D., Genie Blough, M.B.A., Shena Scott, M.B.A., and I participated. Conference attendees showed great interest in this topic.

The evolution of the private-practice anesthesia group over the past two decades provided the foundation for panel and attendee discussions. The shift from indemnity health insurance to network-based health plan models in the 1980s and 1990s — and the corresponding importance of physician service contracts with these plans and with hospitals — drove private anesthesia groups from loose affiliations of independent practitioners sharing a call schedule toward integrated businesses. The business structure of an anesthesia group and the collective philosophy of its members are major factors as to whether the group can accommodate and find advantages in part-time scheduling. Policies for distributing call and vacation, dividing income, providing benefits and governing the group are primary considerations. Of course large institutional practices and academic departments have always had sufficient size, diversity and business integration to accommodate individuals seeking part-time positions. Smaller-scale anesthesia groups in private practice settings often faced challenges when part-time issues arose. Unless part-time positions worked well with the business structure and philosophy of a group or had been considered in advance, dealing with such requests often caused problems. Developing a plan is particularly relevant to senior anesthesiologists (which hopefully we will all be at some time) who want to continue to contribute to, and benefit from, their group affiliation but with a lesser workload. Many groups find part-time workers helpful. Advances in minimally invasive surgery are driving an increasing amount of surgery to ambulatory surgical centers and offices, making flexible work scheduling for anesthesia providers more desirable.

Based on data that Blough and Scott reported in 2003³ and updated in a survey completed shortly before the conference, several work patterns for anesthesiologists are emerging. Most groups, regardless of size or practice setting, have part-time scheduling or are now attempting to deal with it. More than 70 percent of responding groups allow part-time positions using a variety of approaches. Larger groups, with their inherent size advantages, offer more diverse work opportunities than smaller groups, where there is a tight fit of available anesthesia providers to the daily work demand. Lean structures increase individual productivity but limit scheduling flexibility. Approximately half of the practices responding cover one hospital, a third two or three hospitals and just under one-fifth four or more hospitals. Another factor that can affect scheduling flexibility is the compensation structure for shareholders. Compensation structures that allow some individual determination of vacation time, and that facilitate the trading of assigned call, have advantages for allowing part-time work. However, nearly 60 percent of respondents reported “equal share compensation” with an expectation of equal work contribution; an even greater majority reported that physicians took an equal number of vacation weeks. Slightly more than 20 percent reported some type of “productivity based formula that is not influenced by payor type,” and only two percent reported straight case collection-based individual compensation. Among factors facilitating or complicating the ability of providers to trade call, advance (four to six months) publication of the call schedule was most helpful, while imbalances in the willingness of members to trade among themselves was most detrimental. A cohesive group philosophy facilitates call sharing.

While most anesthesia groups have considered part-time work for some individuals, in many cases this has been limited to preretirement or situations of partial disability. In nearly half of private practices, a reduction or elimination of shareholder status and voting rights has followed for physicians working less than full time. Among groups that have a plan for preretirement work reduction, most do not have a minimum age requirement, but they do define eligibility, require advance notice and limit the period until complete retirement is expected. Because anesthesia groups have unique histories and business structures, approaches to part-time work scheduling have to be individualized. Planning ahead clearly helps to craft them.


References:
1. Froom JS, Bickel J. Medical school policies for part-time faculty committed to full professional effort. Acad Med. 1996; 71:91-96.
2. Konrad TR, Williams ES, Linzer M, et al. Measuring physician job satisfaction in a changing workplace and challenging environment. Med Care. 1999; 37:1174-1182.
3. Bierstein K. Creative scheduling for anesthesiologists: Physician retention in a tight market (part 1, survey results). ASA Newsl. 2003; 67(3):27-28,30.

Mark A. Singleton, M.D., is Adjunct Clinical Professor, Stanford University Medical School and is in private practice in San Jose, California. He is President, California Society of Anesthesiologists.