When a doctor wants to work part time

A urology group in Georgia was woefully unprepared and needed to call in a practice management consultant to sort things out. When the 67-year-old senior doctor notified his three partners that he planned to cut his patient load by half, drop call, and considerably reduce the number of procedures he did, he also told them that he saw no need to adjust the group's compensation formula.

The younger owners saw things differently, however. While wanting to reward the senior partner for his loyalty and hard work building the practice, they weren't willing to ransom the group to ease him out. With the help of Max Reiboldt, CEO of the healthcare consulting firm The Coker Group in Alpharetta, GA, the urologists worked out a compromise that also became their semiretirement policy. In exchange for giving up call, the senior doctor agreed to relinquish his share of ancillary revenue and his voting rights. "We also tweaked the compensation formula so that income was more closely tied to individual productivity instead of a nearly equal division of profits," says Reiboldt.

The challenges of meeting such work schedules are not inconsiderable, however. Doctors working half time struggle to generate enough revenue to offset their portion of the group's fixed overhead expenses. And prorating call based on the number of hours a part-timer works usually leaves the rest of the doctors grumbling about taking more than their fair share.

Yet part-timers can also be a valuable asset to a group. In one six-physician neurology practice, the doctor moving into semiretirement happily took all the patients requiring high management, spending over an hour with each one. "This doctor was beloved by the group, patients felt well taken care of, and he allowed the younger doctors to be much more productive and see a greater number of patients," says Jayne Oliva, principal of The Croes-Oliva Group in Burlington, MA. "The other physicians had no trouble sharing some of their revenue with him-he was paid quite nicely-and they wanted the arrangement to last as long as possible."

Part-time doctors can also help groups increase their capacity and extend their office hours. And they might be the perfect answer for groups that don't have the patient volume to support a full-time physician, such as the dermatologists who gratefully recruited a part-time Mohs surgeon.

What to do about call

Perhaps the most difficult issue groups confront with part-time physicians is figuring out how to divide the call schedule. One equitable solution is for the group to place a monetary value on call and then either deduct that amount from the income of part-timers who don't take it or increase the compensation of those willing to accept more. "But," warns Geoffrey T. Anders, president of The Health Care Group in Plymouth Meeting, PA, "if you permit the buying and selling of call, you need a policy on how much an individual can take." Otherwise, physicians who want larger paychecks may take on too much call and become overworked, jeopardizing patient safety. Another approach, in lieu of the buy-and-sell strategy, is to excuse part-timers from a full call schedule but require them to take call on nights when no one else wants it.