Older physicians trim hours in lieu of retiring

By Myrle Croasdale
Internist Randol Barker, MD, looks forward to long weekends, which start on Friday with a day devoted to caring for his 9-month-old twin grandchildren.
When he was younger, Dr. Barker didn't have the luxury of taking a regular day off to spend with his own children. He remembers many nights when his three daughters were in bed by the time he got home.
"It was far too many nights," said Dr. Barker, 68. "It leaves you feeling hijacked from the pleasure of family life."
Later in his career, he made changes that gave him more family time. In 2005, he stepped down as co-director of the general internal medicine division at Baltimore's Johns Hopkins Bayview Medical Center and made the leap to "limited full time" at Hopkins.
Today, Dr. Barker fits his clinical and teaching responsibilities into three 12-hour days. That allows him to maintain his passions: treating his long-time patients; running the Hopkins faculty development program for clinical teachers; and overseeing 40 residents in clinic.
The adjusted schedule frees him up for four-day weekends and his weekly baby-sitting gig.
A 2006 survey reported 21% of physicians older than 50 worked part time.
"It's that Goldilocks feeling," he said, adding that life seems just right these days.
Dr. Barker is among doctors 50 and older who are seeking a better balance between their personal and professional lives.
According to 2006 research from the Assn. of American Medical Colleges' Center for Workforce Studies, 21% of physicians older than 50 worked part time and another 46% were considering going part time or would like to, but it was not an option in their practice.
Retirement forecasts from the Health Resources and Services Administration, based on data from the late 1990s, estimated that 27% of physicians older than 50 would retire by age 60 and 51% by 65.
But Edward Salsberg, the AAMC center's director, said his group's 2006 survey found that 33% of physicians 50 and older reported they were likely to retire by 60 and 69% by age 65.
The retirement shift could hasten a physician shortage, experts said. They estimate that by 2020 the nation will need from 85,000 to 200,000 more physicians than the existing pipeline can produce.
Those predictions prompted the AAMC in 2006 to ask medical schools to expand enrollment 30% by 2020, and Congress to approve funding for a 15% increase in residency and fellowship slots.
Declining reimbursement rates, lack of professional satisfaction and rising medical liability insurance premiums are driving earlier retirements, according to Salsberg and his colleagues.
About half of physicians older than 50 said they could be enticed to practice longer before retiring if flexible scheduling or working part time allowed them to work fewer days.
"If you offer part-time work, some doctors will practice longer than they would otherwise," Salsberg said. That would be one way to help ease the physician shortage, he added.
That's what happened at Guthrie Clinic in Sayre, Pa., according to Joseph Scopelliti, MD, CEO of the 240-physician multispecialty group.
Eight years ago, some physicians approached him with part-time proposals. As a result, the clinic created policy calling for part-time physicians to take call based on the number of hours they work. Health benefits and vacation are maintained as long as the physician works 1,040 hours a year.
Since the policy was set, 12 physicians older than 50 have opted for part-time schedules.
"We want to help people who want to be working to stay with us," Dr. Scopelliti said.
Making change not always easy
While physicians in larger practices are likely to have policies on reduced practice hours, physicians in small groups have more barriers to overcome. For example, on-call schedules are the biggest challenge at such practices, experts said.
General surgeon James Rice, MD, works in a small practice and is preparing to make the switch to part time this summer.
At 58, Dr. Rice finds it more difficult to recover after working all night on an emergency case and then seeing patients the next day.
"The burden of call is what's most destructive," Dr. Rice said. "It's the sleep deprivation. I simply cannot maintain this pace."
But cutting back is more complicated than lopping a couple days from his week.
One of nine surgeons at Muskegon Surgical Associates in Muskegon, Mich., Dr. Rice takes call every fourth night and every fourth weekend, covering three hospitals. If he sheds his call schedule, there are few financial incentives for his partners to pick up the slack.
"I've been in practice for 25 years," Dr. Rice said. "We get paid half of what we used to for hernias, for example, and our overhead has doubled."
The solution was to hire another general surgeon, who starts this summer. That will allow Dr. Rice to give up the weekday call schedule and leave him with call every fifth weekend. When the new surgeon starts, Dr. Rice's schedule will drop from five days a week in the operating room to four, with two half-days in the office, down from three.
But he is paying a steep price for the reduced schedule. He said he expects his income to drop significantly.
Not all physicians can adjust their schedules in the way Dr. Rice will. When part-time work is not feasible, some resign, then join the locum tenens market, where they can take breaks between assignments.
Patrick Donovan, president of the National Assn. of Locum Tenens Organizations and president of Linde Healthcare in St. Louis, said his company has seen the over-50 crowd grow from 26% to 34% the past year. He said demand for locum tenens across the country is strong as physician shortages develop.
Suseela Kumar, MD, 53, a general internist and geriatrician, left her full-time administrative career this fall and is a locum tenens hospitalist in Vancouver, Wash.
Her friends say she looks younger since she started this new arrangement. She feels more relaxed because she can leave work at a hospital and not take it home with her.
Laughing frequently as she discussed her new life, Dr. Kumar said the change has sparked a desire to explore the country. Hawaii and Alaska are on her destination list.
Eventually, she would like to work half the year and volunteer internationally the other half with an organization such as Doctors Without Borders.
"I don't think I'll ever stop being a doctor," she said.

ADDITIONAL INFORMATION:

Going part time
Younger physicians are not the only ones who want more balance between their work and personal lives. A 2006 survey of physicians age 50 and older found that two in three respondents work part time or are interested in doing so.
21% work part time
22% would like part-time work, but it's not offered in their practice
24% are considering part-time work
19% are not interested, even though part-time work is available
14% are not interested, and it's not offered
Source: Assn. of American Medical Colleges' Center for Workforce Studies, 2006 survey