Do part-time positions even exist any more?

[HemorrhagicShock]

The thread title pretty much sums up the question.

With COVID19 and the resultant drop in volumes, we all know (and feel) the reduced physician hourly demand across the United States. At my site (pacific northwest) we've completely gotten rid of any part-time guys as the full-timers are now easily able to cover all shifts. Hell, we are relatively overstaffed to that end.

What is your experience with where you're at? Do part-timers even exist any more? Has anybody seen any demand or requests for part-time docs?

What do you think the trend will be over the next few years?

With my wife back to work and the kid getting older I want to move to part-time but it's increasingly not an option given decreased demand.

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[GeneralVeers]

We have no more part timers. Used to have 5-10. Even now they are looking to fire some full timers.

 

[CliveStaples]

At my site we have two PRN individuals who have had privileges here for a while. Our medical director likes having them because it gives a few options to fill vacancies when the full time crew can't/doesn't want to. One of them just PRNs around a couple sites but has a medical side gig (some concierge medicine thing) that is quickly becoming his full time gig. The other one has a full time spot somewhere else but likes to work a ton so picks up as much as we will give. They both work at least a couple shifts every month. They're the first ones to get the squeeze when the full time folks want to schedule some extra shifts to make more money, though and so they're working here less than they used to.

We are also "fortunate" in that two of our full time people have either left or are in the process of leaving to move across the country for some family obligations. If they weren't leaving we wouldn't have enough shifts for all of the full time staff, much less the PRNs.

 

[WilcoWorld]

I know several people with part time appointments - they're all either in academics or senior members of their SDGs.

 

[hoot504]

I have a part-time gig in the boonies that was previously locums. After cross-credentialing some docs from a nearby medium-sized city, the folks in charge basically told me to either sign a new contract as part-time, or risk never getting shifts. I could see this becoming a trend nationwide.

 

[bravotwozero]

I got forced into 'part-time' from a full time position, but still get enough shifts to be full time, lol. I've also signed part time/prn contracts at 3 other places. I think i've bit off more than I can chew, as scheduling is about to get complicated. But that's a good problem to have IMO. Allows me to maintain a certain level of control/security, instead of my employer.

 

[Porfirio]

We have PRN docs. They take shifts our FT docs would love to have. Sadly, the medical director likes them (long time friends) over the current FT docs. So he f*cks over a few of the FT docs for his friends. But a few of the FT docs are getting tired of it and are jumping ship.

Medical director ran away good FT docs for bad PRN docs (lazy, bad patient reviews, etc).

 

[RoyBasch]

I have a part time position, but it is with an academic shop. It entitles me no benefits, and no hope for academic advancement, only pay per shift.

 

[Angry Birds]

I am technically per-diem and have not had an issue, but I also work nights, which makes me more desirable.
They just canned one of our other per diem guys... basically, by just not scheduling him.

 

[clibby]

I have 2 part time gigs. They still exist, they just aren't advertised as much and it helps to know someone. I doubt many places are looking now given the lower volumes and recent hires over the summer, but they will come back.

 

[emergentmd]

I had a bunch of Part time spots but they are all gone. No reason to keep credentialing me and any admin cost if they are overstaff.

Heard USUcks in my part of the woods are firing docs, cutting pay, cutting hours, and replacing with APCs. What a terrible job this must be but better than being unemployed or going to the boonies.

How things have changed in 20 yrs, really the last 5 yrs.

 

[Brigade4Radiant]

Luckily I’ve been able to work at my two PRN sites while maintaining my full-time gig. My site got rid of one of the doctors who was really slow when I see patients and all the nurses hated that doc.

My site the volumes are now sort of close to their normal but they’ve cut our hours are used to be a 10 hour job now it’s only 10 on certain days but usually eight and sometimes nine hours.

 

[sylvanthus]

My per diem hours are drying up. I was doing some shifts at a community site in BFE, the town blows, but they are apparently fully staffed now. My freestanding ED gigs are also drying up. I may have to start looking around for some side gigs, I dont want to purely work in ICU and not work in ED for awhile and then be that guy that sucks when I come back.

 

[Fox800]

If you're young and can travel, now's the time to do locums or travel to far away places to make your coin.

 

[HemorrhagicShock]

My per diem hours are drying up. I was doing some shifts at a community site in BFE, the town blows, but they are apparently fully staffed now. My freestanding ED gigs are also drying up. I may have to start looking around for some side gigs, I dont want to purely work in ICU and not work in ED for awhile and then be that guy that sucks when I come back.

Do you recommend CCM? I am quickly burning out on EM and trying to relocate back to my wife's home state has been difficult given a lack of good jobs. I understand this would be a hit of two years "attending" pay, but if it allows me to practice for another 20 years it might be worth it. I doubt I could continue being an EM grunt for even another 10...

 

[HemorrhagicShock]

I am technically per-diem and have not had an issue, but I also work nights, which makes me more desirable.
They just canned one of our other per diem guys... basically, by just not scheduling him.

Have you actively sought out additional per diem / part-time nocturnist spots since the pandemic started, or mostly just stayed the course at your current gigs?

 

[AlvinKamara]

Do you recommend CCM? I am quickly burning out on EM and trying to relocate back to my wife's home state has been difficult given a lack of good jobs. I understand this would be a hit of two years "attending" pay, but if it allows me to practice for another 20 years it might be worth it. I doubt I could continue being an EM grunt for even another 10...

Isn’t critical care practice subject to a lot of the same stressors as EM? Lots of shift/night work, sick patients? Is it really gonna add 20 years to your longevity? Plus CC fellowship isn’t just 2 years of pay cut, but 2 hard years of training.

 

[miacomet]

We have part time positions and offer them preferentially. A fair amount of pressure not to be full-time, FWIW. For some reason, after a slow spring and fall, our numbers are up statewide. Breaking records with all the outdoor rec and new residents.

 

[Angry Birds]

Have you actively sought out additional per diem / part-time nocturnist spots since the pandemic started, or mostly just stayed the course at your current gigs?

Staying tight at my ongoing gig... too risky to make any moves right now. Plus, I'm happy where I am.

 

[sylvanthus]

Do you recommend CCM? I am quickly burning out on EM and trying to relocate back to my wife's home state has been difficult given a lack of good jobs. I understand this would be a hit of two years "attending" pay, but if it allows me to practice for another 20 years it might be worth it. I doubt I could continue being an EM grunt for even another 10...

I do, but also am biased. I find the burnout is different. Its a nice break from ICU to work in the ED and not deal with bedbound vented GOMERS that family wants everything done on and theyve been in the unit for weeks. But its also a nice break from the ED working in the ICU as I can only handle so much press gainey, non urgent, frequent flier, drug addict, LOS, door to doc, nonsense. So, its still burnout, but spread it out into burnout for different reasons. So, ya, I think it would help with longevity, and the way the market is now, I think itll help with job prospects.

 

[HemorrhagicShock]

I do, but also am biased. I find the burnout is different. Its a nice break from ICU to work in the ED and not deal with bedbound vented GOMERS that family wants everything done on and theyve been in the unit for weeks. But its also a nice break from the ED working in the ICU as I can only handle so much press gainey, non urgent, frequent flier, drug addict, LOS, door to doc, nonsense. So, its still burnout, but spread it out into burnout for different reasons. So, ya, I think it would help with longevity, and the way the market is now, I think itll help with job prospects.

Thank you for the perspective!

Additional evidence that perhaps a CCM fellowship is in the cards is the fact that I still see CCM docs in their 50s and 60s. You just don't see that in the ED.

Was fellowship basically PGY4-5 in terms of "indentured servitude?"

 

[sylvanthus]

Thank you for the perspective!

Additional evidence that perhaps a CCM fellowship is in the cards is the fact that I still see CCM docs in their 50s and 60s. You just don't see that in the ED.

Was fellowship basically PGY4-5 in terms of "indentured servitude?"

I went the EM/IM/CC route so it was all combined into one residency program with the 6th year being “fellowship”

 

[The Knife & Gun Club]

I went the EM/IM/CC route so it was all combined into one residency program with the 6th year being “fellowship”

What are the hours like during CCM fellowship?

12hr x 6d/week is what one fellow told me, but that seems brutal for 2 straight years.

 

[GaBulldog]

What are the hours like during CCM fellowship?

12hr x 6d/week is what one fellow told me, but that seems brutal for 2 straight years.

I'm EM PGY-3 starting anesthesia CCM next year. It really varies by program - some places pound you with call, others you just do shifts. My core ICU months will be 6a-6p M-F. Few months of night float, lots of elective months. Plenty of time to read and moonlight.

 

[WilcoWorld]

I agree, and I'd put it this way.

If you're young and can travel, [that]'s the time to do locums or travel to far away places to make your coin.

 

[WilcoWorld]

I'm sorry to be a bit off topic, but DANG, some people have a lot of uncertainty these days. That's tough.

 

[The Knife & Gun Club]

I'm sorry to be a bit off topic, but DANG, some people have a lot of uncertainty these days. That's tough.

Watching our 3rd years hunt for jobs has been scary. Our grads have typically had pick of the littler, could find a job in almost any market, decent to excellent pay, etc.

This year things are different.

 

[alpinism]

I'm EM PGY-3 starting anesthesia CCM next year. It really varies by program - some places pound you with call, others you just do shifts. My core ICU months will be 6a-6p M-F. Few months of night float, lots of elective months. Plenty of time to read and moonlight.

Personally I would't plan on doing a ton of moonlighting shifts with that fellowship schedule.