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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

Work-Life in the Balance

By Scott Harris

a doctor juggling clocks

It is probably fair to say that Audrey Shafer,M.D., was an early adopter of flexible scheduling. Back in 1988, after having her first child, the Stanford University School of Medicine anesthesiology professor decided she wanted more family time.

"I went to the chair and asked to cut back," Shafer recalled. "The chair had no experience with this. He was able to process it, but didn't believe it would be compatible with an academic career."

These days, thousands of others, in academic medicine and beyond, are following in Shafer's footsteps. Flexible scheduling, in which employees work less than full-time but direct their full professional effort toward the institution, is a growing trend.

Ronald Pearl, M.D., Ph.D., chair of Stanford's anesthesia department since 1999, said that of about 100 department faculty, up to 20 percent now work on some kind of flexible schedule.

"There has been an increase since I started," Pearl said. "Our graduates are much more interested in part-time positions or in positions that are less consuming of their lives. Family has a higher priority now."

AAMC statistics show that part-time schedules are the rise in academic medicine. Though still a small portion of the total workforce, part-time basic science faculty members have increased from 969 in 1990-1991 to 1,457 in 2007- 2008, while clinical faculty increased from8,857 to 19,790 over the same period. The practice appears more widespread among clinical faculty, where about 7 percent of the workforce is part-time, compared with about 5 percent in basic science.

A recent study published in the Journal of the American Medical Association found that mean weekly work hours among non-resident physicians decreased 7 percent (from 55 hours per week to 51) between 1996 and 2008.

The study authors noted that the decrease coincided with a drop in physician fees, but added that it was possible that "preferences for balanced lifestyles among younger cohorts are a partial explanation."

The issue of work-life balance extends well beyond medicine, and seems largely driven by the new generation of professionals and a desire for more time for family and personal pursuits. A 2009 study of Chicago Booth School of Business graduates revealed that mothers with the M.B.A. degrees "actively choose jobs that are family friendly, and avoid jobs with long hours."

Some evidence suggests that physicians are employing flex scheduling more widely than other professionals. The 2009 National Survey of College Graduates, administered by the National Science Foundation, found that about 14 percent of M.B.A. graduates, lawyers, and people with Ph.D.s in their late 30s and early 40s now work less than 35 hours per week. For medicine, that number is 21 percent. But as many are quick to point out, a career in academic medicine includes demands and challenges that simply do not exist for rank-and-file doctors.

"We in academic medicine do clinical work, education, and research. Part-time work might assume you can do all three of those with less time," said Deborah Helitzer, Sc.D., a professor of family and community medicine and assistant dean for research education at the University of New Mexico School of Medicine. "If you do anything for 50 percent less time, are you likely to maintain excellence? The world is moving faster now, so if you're not fully engaged, you're potentially losing opportunities."

Proponents of flexible scheduling argue that institutional policy changes could create an environment more conducive to flexible work. A task force created by the Association of Specialty Professors (ASP) recommended in the October 2009 issue of Academic Medicine that academic medical centers increase programs and policies to support work-life balance and flexibility in academic advancement.

"It's the way of the future," said Mark Linzer, M.D., head of the task force and director of the general internal medicine department at Hennepin County Medical Center in Minnesota. "There are a lot of dual-career couples now. The newer generation is very socially conscious. They want time for family and other things. The reward is once you [establish flexible scheduling policies] for them, they are tremendous contributors."

There are varying degrees of difficulty in developing these policies, depending on the mission area in question, academic medicine leaders say. At Stanford, for example, there are different "faculty lines" for clinical and research faculty, with very different cultures for each when it comes to flexible scheduling.

"In the clinician educator line, maybe half of my department is now part-time. It fits extremely well," Pearl said. "The issue that is harder is in the faculty lines that heavily emphasize research. If you only spend half as much time in the lab, you only get half as much done."

That divide seems to roughly summarize the situation across academic medicine. On the clinical side, sharing patients and on-call hours, as well as greater accessibility outside the practice, can more evenly distribute responsibilities. A 2000 study published in the Archives of Internal Medicine found no statistically significant difference between full-time and part-time physicians in 10 of 11 primary care performance measures. Physicians working more than 65 hours per week scored higher in continuity of care, but "this appears to carry a cost to those physicians in the area of personal and professional satisfaction," the report stated.

On the research side, things get trickier, as pursuing funds from sources like the National Institutes of Health (NIH), (not to mention the lab work itself), becomes more time-consuming and more important to the bottom lines of academic medical centers.

"It takes longer these days to get your first grant," said Helitzer. "Most NIH training grants require at least 75 percent of the grantee's focus. People doing research part-time are at greater risk."

But even in research, slow-moving changes are evident. The NIH recently made part-time investigators eligible for "K series" career development awards. The ASP task force recommended the NIH expand opportunities for part-time researchers.

A major hurdle also exists for part-time workers who become ineligible for tenure. According to Linzer, elongated timelines can be effective. Under this model, a five-year tenure track, for example, becomes 10 years with a part-time schedule. In other places, having a child offers the opportunity to add a year to the track.

As the pool of flex-schedule workers grows, solutions may become easier to find.

"It's a matter of logistics, and that's a challenge," Linzer said. "But if everybody comes together with a sense of trust, and of appreciating the challenges on the other side, it can be done."