This is the fourth in a work/life balance series written by members of the STFM Group on Women in Family Medicine.
The ACGME Draft Program Requirements for GME in Family Medicine include a requirement that all core faculty work full time. Please consider the implications of this requirement for your program now and in the future as you read this post.
So I have a confession… I really do want it all.
I want to practice full spectrum family medicine: deliver babies, round on the floors and in the ICU, care for families in the clinic, nursing home, and at home and I want to teach residents and students, have a vibrant academic career, serve as an advocate for the health of my community and I want to be an engaged and loving parent and spouse.
Is this possible?
My mentors and heroes are physicians who have delivered three generations of babies, attend funerals as a matter of course, and have literally spent thousands of hours listening to residents’ H&Ps in the middle of the night. They have served the same community for decades and are still going strong, taking call without complaint, into their sixth and seventh decades.
But, I also draw inspiration from our residents and students. They will never know the sense of accomplishment and connection gained from laboring with a mother or supporting a critically ill patient through a day and a night and day again, but they rightly expect a work environment that facilitates the healthy life habits we recommend hourly to our patients. They lack the hubris that sometimes clouds my judgment and self-care; this generation of physicians unconsciously promotes health and balance by personal example.
How do I reconcile these divergent ideals?
I work part-time.
I have read about those who say that you can’t bring cupcakes to school and still be adequately available to your patients, colleagues, or learners. In my experience, however, working part-time creates an opportunity to maintain the breadth of practice, community involvement, and life experience that is fundamental to being a family physician.
I consider medicine, and particularly family medicine, a profession. I reject the shift-work mentality. By working with a smaller patient panel and more flexibility in my schedule I feel better able to be that professional. The work-life juggle is not only logistically a bit easier, but I also have a greater emotional resilience. I can squeeze in a home visit, advise a resident in crisis, or respond to the latest administrative challenge while still being present for my kids’ dance rehearsals.
It has also been said that part-time female physicians are a waste of tax-payer’s investment in medical education. One might extend this argument to all physicians in academics who serve as only part-time clinicians. But we in academic family medicine understand the unquantifiable value of teaching, advising, advocacy, and leadership in addition to RVUs generated. Whether full-time or part-time, our contributions to community, patients, and learners are not a poor return on investment.
Of course there are the obvious challenges to working part-time. My director tells me I am “one heck of a bargain,” and I am fortunate to not be the sole wage earner in my family. I am also grateful to colleagues and patients who respect my decision not to be everything to everyone all the time.
I frankly believe that what we now see as part-time practice will soon be the new full-time. Family medicine is already pioneering the idea of teamwork in the provision of health care because it benefits patients. However, we must push the envelope further and advocate for a fundamental change in how we as physicians conceive of our roles and workload. The health care team should be flexible and sustainable, not dependent on any one individual. It is incumbent on those of us in academic family medicine to lead in this arena by example.
How possible is it in your institution for a faculty member to move from full-time to part-time status? To be hired in a part-time position? How many actual hours are worked by your full-time faculty each week? Do your job descriptions, promotions criteria, and pay structure support a part-time option? How many of your colleagues might pursue this option if it was logistically feasible (and not taboo) within the organization? For those who do work part-time, what support do you or your patients have when you are not at work? Do you job-share?
The proportion of part-time physicians (of both genders) is growing rapidly within the primary care work force. This is not a sin to combat or be ashamed of but a sea change that we should embrace and champion as an integral part of the transformation of health care. I believe the future of our discipline depends on it.
Perhaps we really can have it all…
What do you think?
Read more about part-time work in family medicine:
- Sarina Schrager, MD in Family Medicine
- Ramona G. Seidel, MD at Transformed
- Olivia Maresh in Family Practice Management
- Part-Time Providers in the PCMH – Safety Net Medical Home Initiative Webinar 2010
An insightful post. A colleague and I have been investigating how to assist residents to maintain a broad scope of practice post-graduation. We have considered many strategies, but part-time altruism wasn’t 1 of them. May your confession lead to continued professional blessings.
GREAT Post by Dr. Seymour! Only things I can think of that you won’t get from working part-time are: i) a full-time salary (may or may not be important); and ii) full-time benefits (may or may not be important). But the advantages are MANY – including high personal and professional satisfaction and much lower likelihood of burning out – so a wonderfully written post on a superb option for those lucky enough to opt for it!
preach, sister, preach!!
you eloquently captured how i feel on a daily basis!
(your post could only be made better if i got to hear your sweet voice deliver it or if i got to read it in your beautiful handwriting.)
i *love* having medicine in my life…i just have chosen not to make it the only life i have. i love being a mom, a wife, a daughter and a friend…each of those roles is a full-time position!!
that said, off i run to investigate the sound of power tools coming from the basement…boys!!
I write from Nigeria.
Seymour’s position is not only meant to favour the TOTAL woman Family Physician, it should be seen as the real way to sustain the Specialty of Family Medicine in its original and time-tested form. That we can handle an array of issues in our territory without shelfing the essence of family life for the furtherance of a fragment of the Specialty, is what I believe her position translates to.
Out from Africa, I identify with her and append a masculine signature to her position!!
Couldn’t agree more.
I recently lost my job at UMass for wanting only part time so I could practice what I preach – self care, family time, doing my share at home, etc.
We will lose many great teachers and mentors if we insist on full time faculty only. What a step backward – is this really family medicine proposing this?
While I completely agree with the sentiment expressed here in support of part-time faculty (which I also was VERY positive on throughout my long academic career) – the reality of this is that part-time faculty must be decided on selectively and most probably on a limited basis given the multiple other duties that full-time faculty have to do. We had THE BEST “part-time” (~ 60%-time) preceptor I’ve ever encountered at our site for many years – but because of “part-time”, this person was NOT on the Call schedule. As a result – full-time faculty needed to do that much more Call. This wasn’t a problem given that we did have sufficient numbers of other faculty available for Call (and it was well worth it given how WONDERFUL this person was as a preceptor) – but it COULD be a huge problem IF a substantial portion of faculty at a given program were “ratios” of a full-time slot. There are other examples of duties that part-timers did not always fulfill because they were “part-time” …. BOTTOM LINE: I think it GREAT for everyone to enrich programs with selective hiring of part-time faculty – but this realistically probably needs to be implemented on a somewhat limited basis, depending on other specifics of the particular program involved.