I Have a Confession

Cheryl
Seymour, MD

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.

Doesn’t everyone?

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