Like many of us, I chose neurology because it was the most captivating of all my rotations, and I was fortunate enough to have inspiring teachers who loved their jobs. At the age of 24, I hardly gave a thought to work hours or how I would juggle professional and family life. After my second child was born, I realized the demands of my call schedule were less than ideal, and I eventually carved out an outpatient practice that was far more flexible.
These days, there appear to be a variety of work opportunities that cater to physicians who want to work part-time. Many employers, both in academe and private practice, are structuring alternatives to accommodate those who want to work fewer hours than a full-time equivalent (FTE) employee, rather than leave positions unfilled.
Indeed, many liability carriers offer some type of reduced premiums for physicians who practice part-time. In general, 20 or more hours per week is considered full time and less than 20 hours is considered part time. The availability of reduced premiums varies by carrier, location, and specialty.
While it's unclear exactly how many neurologists work in a part-time capacity, the Bureau of Labor Statistics 2010-2011 Occupational OutlookHandbook indicates that 9 percent of all physicians and surgeons did so in 2008. And in a 2009 AAN survey of nearly 1000 respondents, 3.6 percent of neurologists reported that they work 20 or fewer hours per week, and 10.3 percent said they work less than 40 hours per week.
Stephanie R. Lash, MD, has worked as a 0.8 FTE for the past 14 years. She structured her hours that way, working from 7 AM to 3 PM when her first child was born, and continued the schedule when she changed practice locations from Bangor to Rockport, ME, in November 2010. “For me, finishing mid-afternoon allows me to be free when children are likely to need me the most,” she explained. It is a style that has worked well for the mother of 14- and 11-year-old boys, especially so when she became a single parent last year after her husband passed away.
Although Dr. Lash's schedule had shorter days than the other neurologists with whom she worked in Bangor, she had also served as the managing partner for her practice for the last eight years, a position that led to emergency calls at any given hour. After her husband died, she felt a need to try to simplify the demands on her time. Because there is only one other neurologist who takes call for her current group, she continues to take 50 percent of the call. Indeed, agreement on proportion of call seems to be the most variable factor in part-time arrangements, ranging from no hours to the equivalent of a FTE share as with Dr. Lash, who felt it would be unfair to put a greater burden on the only other member of her call group.
Part-time contracts also vary in terms of schedules, nonclinical responsibilities, salary structure and benefits. “It's a negotiation,” said Vicki L. Wheelock, MD, director of the Huntington's Disease Society of America Center of Excellence at University of California-Davis (UC-Davis). “You have to make a convincing argument that demonstrates your added value in order to be seriously considered for a part-time position by an employer,” she explained. She considers herself fortunate to have had a sympathetic chief of neurology at Kaiser Northern California who allowed her to work a 60 percent schedule back in 1989 when she had her first child, because no other employee was working less than full time. After she had her third child, she took four years off, keeping up by reading journals and Continuum issues and attending neurology meetings so as not to lose her skills. She also volunteered as a clinical faculty member at UC-Davis, and that half-day a month led to a job offer when she was ready to return to work and ultimately to a full-time position. “I stress the importance of networking to my residents and medical students,” said Dr. Wheelock who for the past year as served as neurology residency program director at UC-Davis.
Her story is typical of many working women who start out with traditional full-time positions and decide to curtail their hours only after they begin to feel the pressures of busy professional lives.
ACCOMMODATING FAMILY DEMANDS
In 1985, when Diane D. Wirz, MD, joined Associated Neurologists of Danbury, CT, she was initially quite certain that she wanted to work full-time. Her first child had been born during her neurology residency and she seemed to be juggling things well. When her second son was born, she began to feel the strain of balancing work and family responsibilities. “I felt that I didn't get to see enough of my children, and when I did spend time with them, I was often tired,” she said, adding that her health began to suffer when she tried to “do it all.”
Dr. Wirz is grateful that her partners, initially three neurologists, were very supportive of her decision to work three and one-half days a week. The group has since grown to ten, and she is paid a percentage of what she brings in. Dr. Wirz does not take call, and although increasing her hours a bit, has continued the part-time arrangement even though her children are now grown up. She still loves neurology and is happy with the field, stating that the specialty does lend itself nicely to part-time work.”My patients are very seldom hospitalized, so the fact I don't go to the hospital isn't a problem; I think it would be much harder to work this way if I were in a surgical specialty,” she said. “Being part-time gave me the balance that I needed. I was able to be there for my children as well as my patients,” she reflected.
Six years ago, when Yolanda F. Holler, MD, director of the Brain Injury Program at Akron Children's Hospital married a single dad with three teenagers, she began working four days a week as a .85 FTE. She took full-time call from 2003-2010, but this year the division director decided that employees would be able to take call according to their FTE status. Her compensation is 0.85 of the salary of a full time neurologist and the RVU expectations are also 0.85 of a full time neurologist.
“This is a busy practice, and I did not feel that I was meeting the needs of my patients and my family in a timely manner when I worked full time,” Dr. Holler said. “Now that I am part time, I have met my RVU goal, I am involved in clinical research and quality improvement projects, I am able to read journals, my paperwork is completed in a more timely manner, and my family is happier.” The schedule also allows her to be in community collaborative projects for traumatic brain injury during her free time, she added.
None of the women interviewed expressed any regret about working part time as they were raising their children. If any remorse was voiced, it was about working at all while their children were young. Danette C. Taylor, DO, still recalls one Halloween when she had promised to be at her son's kindergarten class party, and just as she was leaving the emergency room to head over there, a voice over the loud speaker implored all physicians to wait at the hospital premises; there had been an explosion at a nearby chemical factory and they were expecting many wounded. Of course, she did.
“One of the biggest issues I've had has been the guilt of leaving my children in order to go to work and being unable to be with them 24/7,” she said. So, too, did she hate to miss out on their important events.
The movement disorder specialist, who now works for Henry Ford Hospital system outside Detroit four days a week as an 80 percent FTE, has chronicled her reflections on the daily juggle in the blog www.mothersinmedicine.com. When her sons were very young she did work full time and had a busy call schedule, something she now regrets. Dr. Taylor also wishes that she had taken more time to nurture her personal friendships, as many of those relationships became casualties of her busy schedule and desire to focus on her family when off work.
“I thought I needed to prove that I could be just as hard-working as my male colleagues back then, but I have since realized that I would have been just as successful if I had worked part time,” she explained.
WOMEN'S ISSUES IN NEUROLOGY
University of Texas Southwestern Assistant Professor of Neurology Jessica D. Lee, MD, understands all too well the struggles of neurologists trying to manage it all. She had her first child at age 24, six weeks before starting medical school, and her second child while she was a third-year medical student. By the time she had her third child she was doing her residency 3000 miles away from family and friends. “There were a few times when I had to take the children to clinic with me because they were sick,” she recalled, adding, “It was definitely not easy.” As current chair of the AAN Section of Women's Issues in Neurology, she is focusing on helping women neurologists focus on career development and find mentors in the field. The section currently has nearly 300 members. To join go to www.aan.com/communities/, select the Women's Issues in Neurology Section, and click “Join the Community.”