Do part time doctors worsen the primary care shortage?

More graduating doctors are making family and personal life a priority, and opting for part-time work.

But when primary care doctors are needed more than ever, is that contributing to the shortage?

That’s a question that Dr. Gwenn asks over at Better Health. In pediatrics specifically, more “are now opting for part time work right out of the gate, just after training or during, in their 30s. And, that more men are going part time as well as subspecialists along with the women and generalists that have been steady part timers for a while. All tolled, as of 2006, 23% of the pediatric work force was documented as part time – and growing!”

Not only are more pediatricians working part-time, but a growing number are entering non-clinical fields — recent statistics estimate the rate to be 12%.

These aren’t the type of numbers the government, which spends large sums of money to train these doctors, is hoping for.

It’s no secret why. Primary care is difficult, tedious work; made worse with the growing bureaucratic impediments obstructing patient care. Morale is low, with little hope on the horizon. Why spend more time working in this environment?

Of course, there’s no way to coerce primary care doctors to work more hours. Perhaps by improving their work conditions, however, more can be convinced of doing so.

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  • AnnR

    What’s part-time?
    I know lawyers who’re part-time and that’s 40 hours a week.

    Just because someone in their 30s presumably with a family opts to work less doesn’t mean they won’t ever work more.

    They may even be a better practitioner for having spent some time being a family member!

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    But haven’t you heard?

    Good Pediatricians (especially in North Carolina) are “a dime a dozen”.

    That’s what an over-rated, overpaid small town hospital executive in North Carolina thought.

    The Federal government spent large sums of money to recruit me back to my hometown, and then let three small-town good-ole-boys destroy everything I built . . . AND turned a deaf/dumb/blind eye as I was subjected to an on-going mediolegal nightmare from which I’ve yet to wake up. It’s something that could be fixed with a few phone calls from the Justice Department and some hardball with the hospital that did me wrong.

    Why should anyone invest themselves in a career when it’s been made virtually impossible to have one?

    The government needs to get its head out of its butt.

    Instead, everyone is still clinging to the same, tired worn-out formulas (which usually involve throwing a lot of money at new physicians to repay their loans and ZERO oversight of the programs doling out the money – or hospitals employing the physicians) to fix the problem.

    I understand that Obama is going to try to sweet-talk Congress back into some kind of reform measure. He could start by chatting up some of us who have been burned-and-burned-badly in the dance of primary care . . . ON THE GOVERNMENT’S WATCH . . . instead of ignoring us and burying our stories.

  • MN

    One of my closest high school friends works part-time as a pediatrician (part-time = 3 days/week). She does so for all the reasons any mother might choose to do so. Unlike many of our friends, however, she has a significant advantage: her part-time salary is larger than most full-time salaries.

    She is a happy person and no doubt an excellent physician.

    As an aside, I wish I could afford to work part-time. I’m sure I’d like my job a lot better (typical schedule for me = 5-6 days/week, 8-12 hours/day).

  • Frank2941

    MN

    Maybe you ought to talk to your old high school friend and ask her to tell you the secret(s) as to how she manages to have a 3 day a week salary that is greater than most full time salaries.

    Then you could also be a happy person, along with being an excellent physician.

  • MN

    To clarify: my friend is the pediatrician.

    I am not a physician. I am both a happy person and excellent in my own field (though I’d be happier if I worked fewer hours). I make more money working full-time than my friend does working part-time (my salary is above average, though). If my friend were working full-time, however, she would make more money than I do.

  • Well on the way to $200K

    I’m on my way into a primary care specialty, but I’m pretty sure that I’m spending more for my medical education than the government will pay some hospital for my residency training (and subsidizing the interest on a small fraction of my loans). If I can manage to spend some time with my family once I’m past the point where 80 hour work weeks are considered by some to be too light, you can be darned sure that I’ll take a serious look at that option.

    • bladedoc

      The government spends an average of $110,000/yr per resident. So unless you’re spending $330K (assuming a 3 year residency) your assumption is wrong. And if you did spend $330K for medical school, your medical school choice was wrong.

      • alex

        Let’s not pretend that it really costs 110k to hire someone to work twice as many hours as a midlevel for half as much money. Medicare GME subsidies are primarily there because otherwise academic hospitals that have to take all patients regardless of insurance would go bankrupt due to their terrible payer mix. They call it GME but it’s safety net funding.

      • k

        do you think any resident gets paid $110,000? try less than half that. gross. then you pay taxes. don’t pretend that residents don’t need to pay rent, eat, and pay bills. try paying down $200,000 after that.

  • jsmith

    Working full-time in family practice is usually not sustainable in the long run. Most in the field know this. I have seen many of my colleagues try, with obesity, depression, alcoholism, self-neglect, messed up kids and divorce as the predictable results.
    The few that can seem to be able to handle it have stay-at-home wives who handle all the kid stuff and home stuff. These docs also tend to be the few family docs who make the big bucks (>200k per year).

  • Greg

    In primary care residencies, it’s becoming increasingly common to see new graduates take part-time jobs, even if they are paid less, and lose benefits like health and malpractice insurance because they aren’t full-time.

    When I ask new graduates why they are forsaking steady work, especially after so much investment of their time (7-8 years AFTER college) and money ($200K and up debt) into becoming primary care doctors, this is what they tell me:

    -Paperwork/Bureaucracy: are absolutely stifling. They hate that they spend more time on a patient’s paperwork than with the patient themselves.
    -Defensive medicine: They feel that when they see a patient, they also see a potential litigant, and have to over-test and over-consult specialists to ensure that if a bad outcome occurs, they have covered their behinds.
    -Hostile patients: there is so much animosity against physicians nowadays, and primary care doctors often are the convenient targets for it. Practicing primary care is more like being the “customer service” department of a corporation – you spend your day being yelled at and complained to, from the same people that you’re supposed to muster the compassion to help. The residents say they can only do it so long before they get burnt out.

  • http://fertilityfile.com IVF-MD

    “These aren’t the type of numbers the government, which spends large sums of money to train these doctors, is hoping for.”

    If this truly reflects the government’s position on this, one can’t help but laugh at the hypocrisy.

    First of all, the government commits the immoral act of self-imposing monopoly control over people who want to learn how to help heal others, essentially saying “If you wish to dedicate your life to healing, then you must do it according to our terms, rules and regulations”. And then they complain when those they seek to control choose to make individual decisions regarding their personal work/family balance.

    Sorry if that comes off as overzealous, but I fully empathize with the physicians, patients and people of this country who are frustrated that a few elite people far far away think they can make decisions about everybody’s lives better than the individual people themselves can.

    By the way, although I, myself am an MD, who gets to personally profit from this state-imposed monopoly, I still empathize with those who are being harmed by this unfair abuse of power. I trust I am not alone in wanting some relief from the bureaucracy and coercion of big government.

  • http://reetaluthra.com/blog/ Reeta Luthra

    Everyone’s entitled to make decisions that give them a good lifestyle with time for family so can’t begrudge them for choosing to work part-time.

    It’s a shame however if it’s poor working conditions, controlling government and a litigious society that’s causing the trend because if newly graduating doctors are being pushed towards part time work for these reasons, how are they going to pick up – on a timely basis – the volume of essential and practical experience that turns them into the great doctors that they probably dreamt of becoming?

  • Manalive

    Shhh, Kevin! You’re dangerously close to a politically incorrect point:
    Women doctors eager to work part-time (usually 9 – 3 weekdays) bid down the wages for the rest of us.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    O Good Lord. Here’s another (hopefully just as politically incorrect) point for you, Manalive:

    Women who work full time and who are just as willing to go the extra mile as men are CRAPPED ON.

    I WISH i had given more consideration to my personal well-being and happiness way back when I was being someone’s indentured servant – all for the greater good.

    Yeah right. Putting bonus money in some suit’s pocket.

  • t petrusick

    The problem with part-time is you still have all the same expenses such as insurannce , licensing, support staff. If not taking call, resentment from full timers in the same practice.

  • medcat

    Part time also means less responsibility…When I worked per- diem at a group of clinics I only saw acute patients, thus leaving the chronic pain, back, neck, pseudo-depressed, etc., patients to the regular full- time docs. In the 2 years I worked like this…the turn-over of the “permanent” staff was amazing. But, I kept working and was somewhat content because I could control where I worked and when… We are just factors of production…therefore must use that anyway we can.

    • jsmith

      I’ve seen this too, doing locums here and there way back in the 90s. They gave me the easy pts, the full-timers got the chronics.And urgent care paid as well as FP and was much much easier. At bottom, full-time, full-spectrum family medicine and internal medicine are exceedingly painful professional experiences compared with the alternatives, and those that do them are either saints, suckers or both. I predict society will do nothing but give lip service to this cancer at the heart of medicine and that doctors will gradually hand off primary care to the nurse practitioners and PAs, if they’ll take it.

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