4 day workweek in retina

[CivilDisobedience MD]

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Hi all,

Millennial here. Is a 4 day workweek possible in surgical retina? Or, if it is perhaps not possible as part of a first job negotiation, once one is established at a practice could it be possible to make the change? Possible at a PE firm?

Also, is it hard to get a surgical retina job in NYC/CA/Chicago? I know the salary will be lower, but are there places hiring? Does doing a highly ranked fellowship positively impact one's competitiveness for these jobs?

Thank you.

 

[MstaKing10]

4 day work week is definitely doable. Some places (especially PE practices) are offering this as an incentive to join their practice. The drawback will be lower pay but if that doesn’t matter to you all that much then it’s not a dealbreaker. Other practices are set up so that days off are earned based on years of service. Those practices would not allow you to work 4 days a week from the start. Everything’s negotiable though so not an absolute.

If I was hiring I would be very hesitant to hire someone who off the bat wants to work less than me. Would be a dealbreaker from my standpoint but different practices have different philosophies.

Big city practices in desirable areas are hiring but as you mentioned pay may be less and cost of living is more. Those jobs are more competitive so may have less bargaining leverage to get your 4 day work week.

 

[CivilDisobedience MD]

Understood, I don't mind the idea of working at full tilt for 5-10 years so long as de-escalation is possible later. I definitely like retinal pathology the most, and just want to know that long-term it is also possible to do the job in a large metro with a good lifestyle.

 

[Slide]

Yes there are places where you could work out a 4 day work week, but I don't think you'd be able to wiggle out of taking weekend call. You'd have to ask around - best bet would be places that need coverage compared to a saturated area; you won't have leverage with the latter. I know some who are doing 4 days or are transitioning to 4 days, but they've put in their time for the first 5-10 years and are partners in the practice.

Also there's always someone hiring in the NYC/LA/Chicago area but it may not be what you would like. You could always set up your own practice but I think working only 4 days a week would kill your practice's momentum early on.

 

[RetinaDude]

Yes it’s 100% doable to only work 4 days per week, if you are with a retina group. I’ve been doing it for years. I used to take off on Wednesday, so I could get family stuff and “chores” done midweek, and have transitioned to taking Mondays off, over the past few years, instead. As MstaKing10 mentioned, there’s no way you could do this your first few years in practice because you really need to focus on building up a patient base. You want to be available to referring docs.

I’ve mentioned in my other previous posts that retina is a great lifestyle if you are in with a group. Solo retina would probably suck because you are always “on” or always have to be available. But, in a group, we all cover and help each other so we have great hours

 

[CivilDisobedience MD]

Thank you both for your replies. A last question - is fellowship prestige important for securing desirable private practice jobs?

 

[Slide]

Thank you both for your replies. A last question - is fellowship prestige important for securing desirable private practice jobs?

Only in certain areas or practices. The bigger practices in major cities prefer fellowship prestige. But there are practices that'll take someone with fellowship training and a heart beat. For the areas you are looking, prestige may matter but it'll only get you an interview or your first job only. There are plenty of private practice jobs that are great that don't require prestigious fellowship training - in fact in some other places the "prestige" may hurt you because some of these prestigious fellowships do not train you well for the rigors of actual medical practice. I know some people want to debate this, I'm not trying to start a fight I'm just stating actual opinions from my colleauges.

 

[RetinaDude]

We don’t really care too much about the prestige of a fellowship. We have a great, cohesive group so we get a lot of our future partners through word of mouth…..”this is a great guy/gal”. We also want the new doc to be well trained, both medically and surgically. We learn about this aspect from word of mouth as well (usually one of our docs know one or more of the docs at different fellowship programs)

 

[MstaKing10]

Prestige is not a priority in our private practice, rather, excellent clinical and surgical training is. Some fellowships are geared more to research and while important, this is low on our priority list when looking for a new associate. We found most of our docs due to word of mouth, one colleague or friend to another. All of us partners are looking for slightly different things during the interview process but for me, the most important is “will this doc fit in, are they pleasant, and will they work hard?” Most of the time once we are interviewing you it’s because we know your training is excellent.

 

[docdoc2012]

I would say fellowship prestige used to matter for the 'good jobs' in private practice. The shiny practices always wanted to add people from known fellowship.
Well, now most of the shiny groups especially in big cities have sold to PE. Initially they were hanging on to this pretense, now it seems they have relaxed thst tremendously as it's getting harder and harder to recruit.

 

[Slide]

I would say fellowship prestige used to matter for the 'good jobs' in private practice. The shiny practices always wanted to add people from known fellowship.
Well, now most of the shiny groups especially in big cities have sold to PE. Initially they were hanging on to this pretense, now it seems they have relaxed thst tremendously as it's getting harder and harder to recruit.

In fact, it appears the big PE groups are open to anyone these days...the practices have to recruit a certain number of physicians in order for them to receive their bonuses in the next few years.

 

[eyeeye_captain]

Same as above, prestige doesn’t matter much. It might be helpful in those locations if you trained with Chang/Schwartz/Mieler and you want to stay in town because they’ll probably know a guy who knows a guy who’s hiring. Also your licensing and insurance panel stuff will be significantly easier/quicker if you stay in state.

Agree that PE will probably bend over backwards to try to hire you. Don’t believe a word they say unless it’s in a contract. I’ve absolutely heard of them promising jobs in nice locations only to send the new hire to the BFE offices.

It’s good that you say you can do 5-10 years at full speed. Similar to the above, I don’t love the idea of hiring someone who wants part time immediately because you’ll only begin to work less as time goes on. You also need about 5 years to grow a full practice unless someone hands you a reasonably full panel. At that point 4-4.5 days a week makes sense and you’re used to the busy days you’ll end up with.

I think Slide is the only academic doc here so I’m no expert, but that’s usually a 4 day week automatically if you don’t count the admin and research.

 

[Slide]

Same as above, prestige doesn’t matter much. It might be helpful in those locations if you trained with Chang/Schwartz/Mieler and you want to stay in town because they’ll probably know a guy who knows a guy who’s hiring. Also your licensing and insurance panel stuff will be significantly easier/quicker if you stay in state.

Agree that PE will probably bend over backwards to try to hire you. Don’t believe a word they say unless it’s in a contract. I’ve absolutely heard of them promising jobs in nice locations only to send the new hire to the BFE offices.

It’s good that you say you can do 5-10 years at full speed. Similar to the above, I don’t love the idea of hiring someone who wants part time immediately because you’ll only begin to work less as time goes on. You also need about 5 years to grow a full practice unless someone hands you a reasonably full panel. At that point 4-4.5 days a week makes sense and you’re used to the busy days you’ll end up with.

I think Slide is the only academic doc here so I’m no expert, but that’s usually a 4 day week automatically if you don’t count the admin and research.

Eh, academics is all over the place, it's not what it used to be 10-20 years ago. Academia has started to turn towards the productivity model more and more so functionally it's becoming more like Kaiser/PE. It's all about RVUs and production now - the good part is that pay is becoming more production and merit-based but it's still not as good as private sector. The push towards production has meant the traditional things like admin and research are either done on your free time or not at all. My schedule is actually somewhat similar to many people in PP - I see 50-65 pts a day in clinic, 4 days a week (unless at satellite) and have scheduled OR once a week with 4-7 cases weekly.

For OP, the 4 days a week thing might work in academia but to be honest, it wouldn't be in your favor. The scenarios for starting off are like in private practice - either you start slow and work your way up, or you hit the gate running due to taking over someone's volume. Some departments may be negotiable about the 4 day thing but the flip side is that you'll have to sacrifice a lot of your flexibility as a result (such as hours worked, moving pts around, etc). If you had a situation like being the caretaker of the family requiring a 4 day week, you may get sympathy to pull it off but unfortunately unlike in other fields, the retina stuff comes in on their schedule, not yours unfortunately, and you may get pressure to work some on your day off. The other thing is that expect your pay to be pretty poor relative to the work you put in for a 4 day work week.

I could see a scenario (both in academia/PP) where you would work 4 days a week, but the 4 days would really suck (10-12 hour clinic days).

 

[linevasel]

Civil Disobediance...
I remember being a first year resident (not sure what level you are) asking questions about post fellowship life and being poo-poo-ed to sto majoring in the minor and focusing on the major. I am glad that none of the responses here did that with you. 4 days a week is a possibility and a reality. More and more practices will have to consider it. I know of at least three practices that offer 4 day a week work options including my own. None of these practices are in the "coastal elite" cities. Surg Retina in its current form is wildly variable in terms of partner pay (600 - 2 mill), schedule ( no weekday night calls - covering globe/trauma call q2wks), clinic (no scribes, no scribes with dictation, scribes+), and pratice setting (PE, PP, Academics). It will likely be this way for the next 5-10 years, I imagine. You can have any sort of lifestyle and practice you want so long as you are prepared to live anywhere--- and i do mean anywhere. If you need to live on the coasts where there is not much demand for your labor, then you will have to tolerate less flexibility for your preferences. They know there is another eager beaver who also needs to be on the coast. And i'm not knocking the coasts. I grew up in NYC, but it is important to really think about if you need to be there because there are definitely some tradeoffs.

 

[Andrew_Doan]

If your compensation is based on billing and productivity, anything is possible. You'll simply make less for a 4-day work week, and your colleagues will expect that you cover your overhead.