Written by Jesse Lopez MD • in Career Choice
I discovered Job Sharing from a good friend who started job-sharing two years ago. I just finished a difficult time in my career and I was looking for something different so I decided to try it myself. Here is what I found.
Physician Job Sharing is where two or more physicians share one position and divide the work in a fair and equitable manner as to not disrupt the existing group or practice. It has many advantages over full-time employment such as reduced work hours, greater physician satisfaction, enhanced employer satisfaction, and possibly better patient outcomes.
Job sharing is a type of part-time employment or work but it differs in that it requires cooperation with other physicians participating in a job-share group. Job sharing is an additional strategy to participate in reduced work hours if part-time employment doesn’t exist in a practice or group.
Since neither job-sharing nor part-time employment exists in my practice and I wanted to reduce my hours, the only solution would be to attempt to invent it. Once I had the resolve to go part-time I set a deadline of 9-12 months to make it happen. I knew it would be challenging so I sought out the help of other physicians in the community who had already achieved this in another practice. The journey and outcome both amazed me. I learned quite a bit about human psychology, emotions, business and negotiating in the process.
What I learned from others about Physician Job-Sharing.
Medical communities are tight-knit and everyone either knows everyone else or knows of everyone else. I trained as an intern with another physician who would go on to become an Anesthesiologist. We completed our residencies in different programs in different cities and ended up at different hospitals in the same town. Since we knew each other from our internship on a chance encounter we became friends again.
We would have lunch from time to time, sharing stories from our workplace that were eerily similar. This included long workdays, challenging cases while working in equally challenging work environments. On one occasion he seemed happier than usual and he told me why… he joined a job-share group.
He is a partner in a group owned practice and other members in his department who were trying to slow down their practice started a job share years ago and an opening came up. He had only been 15 years into his career but like me felt like it had been 30+. He jumped at the opportunity and fortunately the subgroup accepted him and were people he trusted and generally liked.
The Job-share 4:3 split
The job share group was created by 4 Anesthesiologist who wanted to reduce their hours while maintaining their partner status, practicing medicine and having more flexibility in their schedule. They created three job place holders Doc 1, Doc 2 and Doc 3 in place of full-time Anesthesiologists. These placeholders act as full-time equivalents(FTE) in the corporation. Each FTE earns and shares the exact income and responsibilities of every other full-time member of the department. The four physicians then divided the work and income equally between themselves. The result demonstrated by the table below would be four physicians working the total workload of three FTEs or 4/3 = 75%.
| Doc 1 | Doc 2 | Doc 3 | |
| Physician 1 | |||
| Physician 2 | |||
| Physician 3 | |||
| Physician 4 |
Three FTEs/four physicians or ¾= 0.75 or 75%
In order to make some sense of this, I think it would be helpful to look at some imaginary numbers and scenarios to understand what 75% looks like based upon 2018 Medscape Compensation Report*
4/3 Call, Hours and Income Table based upon an Average Anesthesiologist*
| Wkday call \year | Weekend Call \Year | Hours \Week* | Benefits | Income | |
| Full Time | 138 | 12 | 51 | 21K | $368,000 |
| 4/3 Split | 103 | 9 | 38.25 | 21K | $276,000 |
| Delta | 35 | 3 | 12.75 | 0 | $92,000 |
The hypothetical data above demonstrates several things. I make the assumption that the imaginary FTE takes 3 calls/week, 1 weekend/month and works 51hours/week and $368K per year. I then multiplied each by 0.75. I then calculated the difference between the full-time versus 4/3 split.
In summary, it will cost ~$92K of pre-tax dollars to have 35 fewer call days, 3 fewer work weekends and 12.75 fewer hours per week.
This table makes many assumptions but what if rather than reducing workweek hours, what would the 4/3 split look like if the hours were the same but the weeks were divided equally among the four physicians?
4/3 Job-Share with Weeks off only
| Vacation | Off Weeks | Work Weeks | Not Working | |
| Full Time | 6 weeks | 0 | 46 | 6 Weeks |
| 4/3 Split | 4.5 | 13 | 34.5 | 17.5 Weeks |
How can a physician have 17.5 weeks off?
Physicians work very long hours and average about 51 hours a week according to the Physician’s Foundation. If physicians worked more than 40 hours a week over the course of a year condensed in a week then it makes sense they should have more weeks off. The 4/3 split seems to be the closest system I have ever seen that accomplishes this.
How much does it cost to have 17.5 weeks off as a physician?
It will cost $92,000 to have 17.5 weeks off or $5257 per week. This needs to be carefully weighed on a per case basis depending where you are in your career. If you look at the two groups of physicians who work part-time* they consist of older males and younger females. Older male physicians most likely havd accumulated a decent nest egg which would not be as impacted by a drop in salary. Likewise physician mom’s may choose to spend more time with their children rather than paying someone else. In both situations, it makes sense to pursue a part-time option.
Why having 17.5 weeks of time off is important as a physician?
If on the other hand, a physician can afford to reduce their salary by 25% it will definitely give them access to more time away from work that they hadn’t experienced since before medical school and gives them ample time to recover from a demanding career. The surveys of physician satisfaction almost never have income the key to happiness. The top 3 include physician-patient relationships, being good at what they do (as physicians) and making the world a better place. I would argue the key to staying happy as a physician is having enough time off to recharge my batteries when I am feeling depleted or burned out.
How are benefits impacted by working part-time or in a job share?
Employee or group benefits usually include health and retirement packages. Since most physicians are high-income earners the impact on the benefits package is essentially ZERO.
If you look at a group practice, all benefits and retirement are based upon a group rate and the income of the physician. The income doesn’t decrease sufficiently to impact retirement benefits so long at the income does not below a certain threshold. In my hospital employed job, for example, anyone earning more than $200k gets a full contribution to the pension and employer contribution of the 401k.
In both the employed and group practice retirement benefits also stay the same since the max individual contribution will not change based upon income. Likewise, most group practices will allow maximum employer contribution up to the IRS limit. When I went part-time my retirement contributions through my employer haven’t changed at all.
How are health benefits impacted by working part-time or in a job share?
As far as health benefits are concerned, this will depend on the group or employer. Most hospital-based practices will have extensive HR policies and requirements. My hospital requires that an employee work greater than 32 hours a week or equivalent (78.5%) to receive discounted healthcare benefits as a full-time employee. Since I am below that threshold working 75% or the equivalent of 30 hours per week(which is ironic since I work more than part-time…) I still qualify for benefits but have to pay a slightly higher rate. This to me is nearly zero since it translates to an extra $50 per pay period.
Unfortunately in my institution anyone working less than 50% or 20 hours a week does not qualify for health benefits. Make sure you check with your group or practice to know the thresholds.
Group practices typically pay for their benefits with pre-tax dollars or some other arrangement where the practice pays directly for routine care plus catastrophic insurance. Either way, the benefit gets deducted from the gross income and typically does not have minimum income requirements that will be impacted by working part-time.
Are there other forms of Job Sharing?
The discussion so far has been about the 4/3 split but it doesn’t necessarily mean that there are no other options. For example during the past year, one of the 4 docs decided to retire. The job share group considered shrinking the job share to a 3/2 split and would ask the group to hire a new full-time FTE. This would effectively decrease everything to 66% instead of 75%. Having 22 weeks off sounded appealing to two of the members but the third could not fathom doing this for $121K reduction in income so they recruited another member from the members at large. Either way, the practice had no issue with either decision.
In my hospital-based practice, I found the sweet spot to be a 5/4 split which placed me at 80% FTE equivalent but also placed me above the threshold to get health benefits without the extra expense. Unfortunately, this did not survive during the negotiation process since they felt that 80% was “not in the spirit” of working part-time. This continues to be a work in progress but for now, I get to enjoy working at 75%.
How do physicians approach a job-share?
I have mentioned two ways physicians could job share by either splitting up the days or splitting up the weeks. Both are very challenging since the group and employer need to know when and who will be working well in advance of creating a working schedule. Likewise depending on the type of physician or specialty matters considerably. As an Anesthesiologist, my skill set and abilities are very predictable and other members of the department can perform my duties interchangeably. The same can be true of many other specialties like ER, Radiology, Pathology, General Surgery, Trauma Surgery, GI, Nephrology, Internal Medicine and many others. The problem arises when a physician goes a little too far in specialization.
I have a good friend who has specialized to the point of only being able to work in major metropolises in major institutions who have the resources to purchase very specific equipment. At the time of choosing the residency and fellowship, they guaranteed they had niched-down to the point of being irreplaceable. In doing so they are now irreplaceable such that they cannot find someone to job-share or in most cases even cover the call.
The more interchangeable the specialty, the easier the ability to job-share.
However, everyone else has the opportunity to job-share if they so desire, it will just take more effort and more negotiation.
Do employers like job-sharing?
The physician burnout epidemic coupled with ongoing physician shortage in the U.S. has impacted hospitals and groups as much as it has impacted physicians. Many older physicians who are dissatisfied with the current changes in the healthcare system and medical licensing requirements are electing to retire early. These physicians have years of invaluable experience which help to maintain good patient comes but also keeps the institutions that employ them with good standing in the community. Not to mention we need these physicians to mentor the next generation of physicians who desperately need it.
By reducing the work burden on these physicians hospitals and groups are extending their careers thereby avoiding costly replacements of continuously hiring new and sometimes inexperienced physicians. Hospitals and groups lose money every time they lose a productive physician to the tune of ~1.5million per year plus the cost to recruit, hire and train them. Keeping these productive physicians working makes good financial sense. It also allows these practices to have a larger medical staff with a much larger collection of medical knowledge and experience.
The same holds true for mid-career physicians which seem to make the bulk of the physician burnout epidemic according to Medscape Lifestyles Report 2017. These physicians report burnout in direct relationship to hours worked. These physicians often become disenchanted and exhibit signs of Maslach Triad: emotional exhaustion, depersonalization and decreased personal accomplishment. The result is either the physician quits or delivers substandard care. Either way, it hurts the employer or practice. It would be wise to identify these physicians and provide them with counseling and some sorely-needed time off so they can recharge their depleted batteries. As a result, part-time work may be able to solve this problem for this group as it has for me.
I have often heard from skeptical physicians that employers will resist any discussion of part-time work and many have. Don’t let anyone say that your employer will not go for it. IF they are wise they will jump at the opportunity. Sometimes they just need to be reminded of the aforementioned facts and a little negotiation skill will go a long way.
Employers like Job-Sharing and if not they should!
What are the main advantages of Job Sharing?
Finding a part-time job in medicine can be challenging and convincing your group or employer to work part-time also holds true. This is the quickest solution that can be designed and implemented in many situations. Therefore the main advantage is accessibility. The second greatest advantage comes from the “off-time” created by the extra person working. The group or practice only expects 3 people to be available at any given time in the 4/3 split scenario. This means one of the 4 will never be at the workplace. This gives massive flexibility to the members of the group who share this shadow off position. The third advantage doesn’t seem obvious but once you have it, things start to become clear. You have a bank of time in the form of weeks or days that can be traded or exchanged for better days, better calls or even more money depending on group by-laws or policies.
Advantages of Job Sharing
- The easiest route to go part-time
- Greater flexibility
- Bank of Time
- More personal choice
What are the main disadvantages of Job-sharing?
Nothing is perfect in life and unfortunately, neither is job-sharing. One of the biggest challenges to practicing medicine is dealing with people. Some people are easier to deal with than others given their personality type and how it is comparable to your personality type. If you don’t know the big 5 of personality types I suggest you take a look before any sort of disaster falls upon you. The biggest disadvantage of job sharing comes from the fact that you must cooperate and coordinate your efforts to share the positions in a way that doesn’t disrupt your group or practice. Also, the group must be created with very clear rules and expectations of all the members as to not unfair take advantage of each other.
For example, one way to distribute the work could be giving each person a bank of days off which are then divided in a fair and equitable manner. Think of it as a round-robin of time off not unlike a football or sports club draft. Once the days are divided they then can be traded or used. IF one of the members is untrustworthy and they can find a way to cheat the system they definitely will. So the biggest disadvantage is trust.
The second disadvantage comes from executing the job share. Many people find it hard to make decisions about very simple things like where I’m going on vacation this year or what will I eat for dinner. Now try taking these same people and have them make decisions on who is going to work what days, who will represent the job share group and what happens if a person can no longer participate in the group? The point is that this group must be cohesive in thought and execution which can also be very challenging.
Disadvantages of Job Sharing
- Working closely with others
- Making collective decisions
What are some strategies for implementing a job-share in my practice?
This will be the subject of a future blog post but quickly these elements must exist to even consider going forward.
- Multiple physicians who are willing and serious about reducing their hours.
- A group or employer who sees the benefit of part-time work.
- A group of individuals who have values and beliefs that are in alignment.
- Work that can be interchangeable amongst the participants.
- A very positive, non-defeatist attitude when negotiating the terms.
- An unselfish attitude toward your partners, patients and group/employer.
- Willingness to have a semi-permanent reduction in income for a long period of time.
- The realization that Time is a much more valuable asset than Money and youth is fleeting.
Do I need a new contract or service agreement to start job sharing?
Changing employment in a meaningful way will almost always require some kind of written agreement. Employers are bound by Stark and Anti-kickback laws that govern physician reimbursement that protect both the physician and the employer from civil and criminal litigation. I highly recommend having your attorney review any contract revision as a result of a job description change. It also may be a good idea to speak with an accountant to see how reducing your income can impact your overall economic outlook.
Conclusion:
Job sharing has been practiced by physicians long before I even considered trying it. Physicians who would like to reduce their hours and have others in their practice or department who are willing to share work interchangeably while working in an open-minded environment should consider this option. There is a direct correlation between working fewer hours and physician satisfaction. Therefore the same should hold true for job-sharing. Job-sharing is not for everyone, especially those who do not have their financial house in order. This strategy should be reserved for those who have taken a detailed examination of their life, finances and career options before considering this.
I personally have been working part-time for the past year after going through the entire above process myself and I can say with certainty it was one of the best moves I have ever made at this point in my career.
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