Mark Puglisi, M.D., works a block schedule of seven days on and seven days off as a hospitalist with Baptist Primary Care Inpatient Services in Jacksonville, Fla. He lives in a historic Jacksonville neighborhood a few miles from Baptist Medical Center, so he’s close to work. But on his weeks off, he heads south to Orlando, where he owns a small condo within walking (or jogging) distance of a lake, restaurants and a grocery store. “It’s the best of both worlds because the group has been so flexible with my schedule,” says Puglisi.
It took Puglisi a few jobs to get to his perfect work/lifestyle situation, but when he made the move to “the job I would have forever,” he shot for his most desirable places to live and then worked with the group to create a schedule that would allow him to enjoy the location. “They wanted essentially Monday through Friday and one weekend a month from physicians,” says Puglisi. The group also paid extra for weekend and holiday work. When he interviewed, the practice had about a dozen physicians and wasn’t quite ready to accommodate his request. “But they told me that when the group had enough people, they would let me do it,” he says. With more physicians on board, Puglisi now is enjoying his new schedule. It’s helped him and the group, because he essentially works twice the number of weekends, which frees the schedule for others.
The key to Puglisi’s satisfaction is flexibility. It’s the reason more employers and practices are offering part-time and other nontraditional schedules to attract or retain good physicians.
PeaceHealth, a Catholic health care ministry in the Pacific Northwest, employs more than 800 providers and offers flexible schedules to anesthesiologists, OB/GYNs and primary care physicians.
“We began offering these schedules in response to requests by medical staff who were interested in a change of pace,” says Tiffanie Davis, an in-house provider recruiter for PeaceHealth in Ketchikan, Alaska.
That’s likely a smart move, as primary care positions become tougher to fill and physicians begin looking for nontraditional approaches to work to achieve some balance in their lives. The high demand for primary care providers continues. The Association of Staff Physician Recruiters (ASPR) 2013 In-House Physician Recruitment Benchmarking Report revealed that nearly 70 percent of organizations responding searched for a family medicine provider in 2012, and that other primary care specialties were among top searches conducted. The report also found that of all physician searches, nearly 33 percent remained open at year’s end, and nearly 35 percent of positions in organizations located in small populations (10,000 or less) remained open at the end of the year.
And a survey released in spring 2012 from Cejka Search and the American Medical Group Association (AMGA) stated that the percentage of physicians who work less than full time has more than doubled since 2005.
Why flexibility matters
Research often cites the bulging demographics of new female physicians and aging male physicians winding down as the reasons for a shift in emphasis to part-time and flexible scheduling. This is partially true, but there are physicians from all age groups and both genders who express the desire for flexible schedules. “As I speak with candidates, I find that flexible schedules are appealing to people from all walks of life,” says Davis.
Farzanna Haffizulla, M.D., who manages a concierge solo practice in Davie, Fla., agrees. “Everyone wants quality of life,” Haffizulla says. “Part of striking that kind of balance and pursuing your passion happily comes from having the right balance in your setup.”
Haffizulla is an internal medicine physician, national president-elect of the American Medical Women’s Association and founder of BusyMomMD.com. She began her career in private practice with her husband and father-in-law. But she had another business model in mind that would provide her patients more time for care and give her more flexibility as a mother.
Haffizulla has been married for 16 years and has four children. After child number three, she began her concierge practice, which has been growing for five years. She also remains involved in academic and community activities.
As for her husband, whom she met while in medical school, “he marvels that I am doing this and breaking out of the mold,” she says.In Haffizulla’s case, the decision to change up her practice was professional and personal.
Haffizulla and Puglisi agree that physicians receive little preparation in medical school for the business aspects of practice, yet production, reimbursement and other business-related issues often cause a great deal of stress for physicians.
“There are a lot of stresses and pressures on physicians,” says David Ross, D.O., an emergency physician with Front Range Emergency Specialists in Colorado Springs, Colo. He mentions financial pressures from compliance with regulatory or accrediting bodies, along with reimbursement and efficiency. Ross, who wears many hats for his practice, hospital and local emergency services, says that emergency medicine tends to be more flexible in scheduling because of the demands of the job. Though all specialties have their share of clinical stress, some involve higher degrees or periods of stress that necessitate quality breaks between shifts.
Ross worked in the emergency department for many years and eventually began providing medical director services for local emergency medical services, ambulance companies, and for a time a local helicopter service. He spends most of his time in EMS direction duties, essentially juggling three jobs, and works only five to seven shifts a month in the ER. “My partners who don’t do administrative work typically have a maximum of 15 shifts a month and about 15 days off,” he says. He wears many hats, but can perform much of his administrative work, such as chart reviews, from home or anywhere with computer access. “Much of what I do is pretty flexible, and that’s what I like about this job,” Ross says.
Ross says his wife has reminded him over the years when he has had to miss holidays with his family that he knew doing so would be a drawback of going into emergency medicine. Having a flexible schedule gives physicians a certain degree of control and balance.
Puglisi loves the ease with which he can schedule travel. “If I want to go somewhere, I don’t have to look at the schedule and request the time off; I know I am off in six weeks,” he says.
Haffizulla sets her own hours to balance time with patients and family, using technology and organization skills to maximize her time. She makes the occasional house call if a patient needs it, but also uses e-mail and telephone consults. “I have freedom in my hours and I can be there for my children,” she says.
A work/life balance also can be about pursuing passions, such as volunteer work, hobbies, travel, sports and recreational activities or the outdoors.
PeaceHealth Ketchikan Medical Center is located on an island in Southeast Alaska. “Some of our providers had a strong desire to break from the remoteness a few months of the year to travel and pursue other interests, such as overseas mission or volunteer work,” Davis says. Flexible schedules made it work, retaining valuable staff and providing the balance they need. “PeaceHealth as an organization strongly supports a healthy work/life balance for all employees,” says Davis.
Perhaps the most cited reason for flexible work arrangements, physicians seek a work/life balance to achieve more time for self and family. Ross points to the outdoor activities in Colorado Springs and Puglisi notes that he lost weight after his move to Florida and new block schedule. He credits much of that to additional time for exercise and decompression.
Want to ensure or restore some balance to your life? There really is no one-size-fits all approach, but here are some of the common options, along with pros and cons of each.
Part-time work. Haffizulla encourages working mothers to consider part-time arrangements to stay current in their professions. “If there is a moment of time when you lose touch with the profession, you can end up behind a desk, perhaps reviewing charts, and miss that patient interaction,” she says. Ross agrees, and adds that part-timers have to work harder to keep up their skills and remain current. “Keeping up your CE is even more important for somebody who doesn’t work full time,” he says.
Large physician-owned practices are the most likely to offer part-time work, according to the Cejka/AMGA survey. 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 flexible arrangements. Some physicians wanting part-time clinical hours might be able to offset the time with administrative tasks outside the office, 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 job-share 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.
Haffizulla sees job sharing as an excellent way to maintain clinical skills while seeing patients part time. Job sharing usually requires an exceptional working relationship and level of communication between the two physicians, along with good staff support.
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. Block schedules similar to Puglisi’s are becoming more popular with hospitalist groups in particular, with physicians working five days on and five days off or seven on and seven off.
Physicians in block schedules often work 12-hour shifts. “I’ve read that burnout can be high with people who work seven on, seven off and work 12-hour days,” says Puglisi. His days are closer to eight or nine hours long, though the group allows physicians to stay longer as needed to accommodate hospital needs and individual production levels.
In fact, Puglisi’s group overcomes one of the hurdles to flexible scheduling presented by many private practices—concerns about fairness and production—with complete transparency. “Our group releases our numbers [to physicians] every quarter in a spreadsheet showing how many weekend hours each person worked and how many RVUs each produced so we know how much everyone makes,” Puglisi says.
Use of hospitalists and mid-level providers. Interestingly, Puglisi, who is board certified in pediatrics and internal medicine, became a hospitalist after working long days in rural Missouri to fulfill a loan obligation. Double-boarded physicians were helping with call coverage for 19 physicians, along with some support from a three-physician hospitalist group. “I liked my job better when I had hospitalist coverage,” says Puglisi. He eventually joined the hospitalist group, working a block schedule that allowed him to commute from Kansas City, where he went to medical school.
Hospitals and physicians in many specialties employ mid-level providers to help them accommodate flexible schedules. Anesthesiologists often employ certified registered nurse anesthetists to work block or evening shifts, for example. According to Davis, the mid-level providers employed at PeaceHealth complement the practice, and add another layer of continuity for patients.
Puglisi couldn’t keep his days under 12 hours without the help of mid-level providers. “We stop being open to ER admissions at 4:30 each day, and calls are diverted to a nurse practitioner at 5 p.m. during regular days,” he says. A lead physician handles matters such as transfer calls.
Locum tenens work. Physicians who prefer truly flexible scheduling might choose locum tenens work. It’s the least secure financially, but a great way to try a practice on for size and often leads to job opportunities. Locum positions are great ways to maintain clinical skills and patient contact when physicians can’t work more traditional schedules for personal reasons. Physicians seeking a practice that might offer a future relationship of a more permanent nature might consider locums work for fact finding. Haffizulla says, “I recommend to residents doing a locum tenens or moonlighting in that practice for a period of time; it gives them a true view of the day-to-day working of the practice and what would happen if they became married to the practice.”
Concierge model. Haffizulla also consults with physicians interested in her hybrid concierge model. She advocates for use of technology to optimize reach and time management, along with creativity. “Think outside of the box; you don’t have to be confined within the walls of the office. You can choose to practice in a way that works for you and your lifestyle,” she says.
Though generally best reserved for established physicians, Haffizulla says that recent graduates can join with a physician who has an established concierge practice. She offers a further caution to any physician considering the concierge model: Have a contract lawyer review your first offer and contract. “If you have restrictive covenants in these contracts, you won’t be able to practice within a certain radius of the office you started with,” she says.
No matter the flexible schedule you choose, there are opportunities for creative approaches, and physician groups and employers are listening to physicians’ requests for more balance in their lives. “I think keeping people as happy as possible given the constraints of real-world medicine is really important for longevity,” says Ross. “So the amount of time we can be flexible in how we schedule people and in how they work, we can hopefully keep them in the business and it will be good for patients.”
Teresa Odle is a former business development director for a large radiology practice and community relations specialist for a health care system.
What’s it worth to you? bit.ly/TDt6RX
Finding a practice that fits your life bit.ly/12RB2XB
Will work for travel bit.ly/1kDgvJG
Concierge physicians bit.ly/1j0jSyZ
Keeping burnout at bay bit.ly/xOnf6u