Is it possible to work ~20 hours a week after residency?

[Law2Doc]

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The attending doctor i was speaking with has worked just about 2 years as an attending physician of oncology/hematology. (Yes he's quite a newbie). He is all smiles when I talk to him about his current work load. On the other hand, when I ask about his residency experience at USC, he was all frowns...

I don't think you want to draw conclusions based one a single data point. There are outliers in every field. As your due diligence, talk to young guys in private practice in multiple specialties, you will get a very different perspective. (Ignore hospitalists and other "short term" career detours -- you can definitely find a laid back couple of years, but these jobs are more equivalent to fellowships you aren't going to stay at for long than longterm career paths).

 

[Gut Shot]

I think the admissions process favors those who can tolerate service, not those enjoy it. Personally, I hate working with patients who drink, smoke, chew, eat fast food, AND never exercise. Not just one of those things. All of them. And *gasp* they have health problems. This ain't rocket science, folks. That said, my PS is about how this experience has "transformed" me and how I want to practice general internal medicine and serve a medically underserved population. 😉

Also, I am opposed to indirect forms of payment. If you listen to some of Rand Paul's ideas on healthcare...I think he's spot on. Insurance companies negotiate reimbursement rates for certain services such that there's no reason for providers to innovate and lower costs. The healthy subsidize the unhealthy, which is unfair. And the simple fact that insurance companies generate profits is proof we're all getting colletively screwed over. I'm in favor of cash or in-kind payments for medical services upfront, prior to receiving the service (just like buying groceries).

Yep, troll.

 

[neoevolution]

Wouldn't EM have flexible shift work for their entire career, unlike a short-term move for a hospitalist? I thought ICU and trauma surgery were starting to develop some shift based positions as well.

 

[Fed]

Yep, troll.

Is this man wrong?

[YOUTUBE]http://www.youtube.com/watch?v=YHkfITHeJss&feature=related[/YOUTUBE]

 

[Fed]

does your family background happen to be rich, white, and Republican by any chance? 😛

What does this have to do with anything? Most of my patients at the clinic are white. People all of stripes make poor lifestyle choices.

 

[thelaw986]

What does this have to do with anything? Most of my patients at the clinic are white. People all of stripes make poor lifestyle choices.

Well? Do you come from a rich, white, and Republican family? It was a simple question.

 

[Fed]

Well? Do you come from a rich, white, and Republican family? It was a simple question.

Upper-middle class, white. My parents are somewhat conservative, I think. Me, I vote for liberty.

 

[BigBlueBear]

Is this man wrong?

Obviously. If you are reasonable, you're a troll.

 

[Fed]

Obviously. If you are reasonable, you're a troll.

Okay ... well I have to disagree. Yes, we need safety net programs for those who can't afford healthcare. There's no doubt about that. But I think innovation, efficiency, and lower costs will be a result of more competition, not more government intervention. I might be wrong, though.

 

[JESSFALLING]

One more idea for OP: It might be possible to work from home as a radiologist (e.g. teleradiology).

 

[Law2Doc]

One more idea for OP: It might be possible to work from home as a radiologist (e.g. teleradiology).

Average hours for private practice radiology seems to be 55-65 hours a week according to medscape and other recent surveys. If you aren't in a full time job, you are basically freelancing/moonlighting, which means you dont have any job security or know when/where your next paycheck is coming. Can you do a series of odd moonlighting jobs for 20 hours a week and piece together a decent salary some weeks/months? Sure. But it's pretty *****ic to finish med school and a five year residency and probably a fellowship only to do odd jobs without a steady paycheck, only to face the reality that moonlighting gigs come and go, and the needs one month don't exist the next. This meets the definition of short term, dead end job, even moreso than hospitalist. If you are willing to work full time, but do some of those hours at home, that is certainly possible, but that's a far cry from working 20 hours/week.

Again, it's simply a bad idea to push forward with medicine if your goal is to only work 20 hours a week. This isn't a good profession to go into if your goal isn't to practice full time. There are other jobs where the entry barriers are far less, and career options for part timers are far greater. some premeds these days seem to think that medicine is a more flexible career than it really us, and that they can shoehorn a medical career around their lives and not the other way round. It doesn't usually work that way.

 

[Gut Shot]

Is this man wrong?

About some things, and misleading about others. He does make a great case for the individual mandate, however.

Since I had to watch Rand Paul, why don't you read this Krugman piece and see if you can spot the major deficiencies in Paul's argument?

 

[Jelloh]

Wouldn't it be possible, since in most fields people need doctors at all times of the day and not just during the typical work/school day, to have a full-time job but arrange it so that you do most of your work while your kids are at school?

Like if you could have your spouse or a sitter get the kids up and dressed and to school in the morning and you started seeing patients at 7 am, that would be convenient for people who work office jobs and want to be seen early. You could see patients until 3, which works out the same number of hours as if you had been in 9-5, which I realize is much less than most people work, but is definitely more than 20 hours/week.

Schools usually get out around 3-4 pm (you might have to look around a little to find a preschool/kindergarten that goes all day but they definitely exist) so you could go get your kids and have the whole afternoon/evening with them. Chances are they don't want your 24/7 attention anyway, so you can do administrative stuff while they have playdates/do homework/go to baseball practice.

is this a total fantasy?

at any rate, I was raised by two parents who each worked 60+ hours a week. I never felt neglected because in the time that they were home, they made it a priority to spend time with me. It's not necessarily about the quantifiable amount of time you are home with your kids.

 

[oldbearprofessor]

Again, it's simply a bad idea to push forward with medicine if your goal is to only work 20 hours a week. This isn't a good profession to go into if your goal isn't to practice full time.

The American Academy of Pediatrics recently reported that over 20% of pediatricians accepted part-time jobs. This is extremely common and many of these pediatricians, both specialists and general practitioners will return to the full-time work force after a few years. This is widely accepted by nearly everyone in pediatrics.

In my opinion, which has no particular value, there is nothing wrong with this at all and isn't all that much different than academic folks like me who only work clinically part-time and spend the rest of our time in research and other academic and public policy pursuits.

Of course, not everyone is cut out to be a pediatrician.

 

[NickNaylor]

does your family background happen to be rich, white, and Republican by any chance? 😛

I didn't realize that being frustrated by what is in many, many cases stupid personal choices on the part of your patients was limited to any of those demographics you mentioned.

(sent from my phone - please forgive typos and brevity)

 

[tantacles]

I didn't realize that being frustrated by what is in many, many cases stupid personal choices on the part of your patients was limited to any of those demographics you mentioned.

+1

And might I say (unrelated to your post N-dawg) that I am EXTREMELY excited to be berated by people in health care who are jealous that I have time to raise two children and be an amazing doctor while only working 20-30 hours per week?

 

[Law2Doc]

The American Academy of Pediatrics recently reported that over 20% of pediatricians accepted part-time jobs...

the flip side of your post is that even in one of the most part-time friendly specialties, 80% are working full time, and by your own admission, many of those 20% of part timers end up back at full time status at some point down the road.

Also part time in medicine can be well above 20 hours a week. So I'm not sure your post really suggests that a 20 hour a week gig throughout ones career is very realistic.

 

[oldbearprofessor]

Also part time in medicine can be well above 20 hours a week. So I'm not sure your post really suggests that a 20 hour a week gig throughout ones career is very realistic.

I don't necessarily disagree with that statement.

You said "This isn't a good profession to go into if your goal isn't to practice full time." That sentence doesn't limit your view to a 20 hour week.

I noted that over 20% of pediatricians don't practice full time (the actual % is probably 25-30% or so, but it's a hard number to get exact and the number is much higher for women than men). How many hours they practice is highly variable, but one wouldn't expect a pre-med to get that number clear. Most part-time general pedi jobs are about 25 hours/week, some more, some less, but the OP wasn't that far off.

So, understanding what I believe to be the meaning of the OP is whether she could take time while raising small children to work part-time as an attending. The answer, in pediatrics, is unquestionably yes and this is equally unquestionably an answer supported by pediatric leadership almost universally.

My question for you is whether you believe it to be inappropriate for a person to attend medical school with the plan of working a part-time job (regardless of what that means exactly) for lets say, 5-10 years after finishing residency?

 

[DrDori]

Part-time.. It is certainly worth considering at least temporarily.. depending on family situation/needs.. even if career comes first.. sometimes your family depends on you completely and needs you more than your work does !

 

[DrDori]

my bad ! or actually my browser's i saw ur post a little too late.. thnx!

 

[tn4596]

About some things, and misleading about others. He does make a great case for the individual mandate, however.

Since I had to watch Rand Paul, why don't you read this Krugman piece and see if you can spot the major deficiencies in Paul's argument?

His argument about why healthcare cant be sold like bread is arguable. He is right that people wont know when they will need a high-cost surgery, but the fear of paying for one may deter people from living the sedentary lifestyle they are now. I personally felt that the "safety net" of insurance and big goverment care will allow people to rely on these things to actually make their life worse. Isnt prevention better than trying to cure a problems after it has alrdy occured?
My family havent had insurance for years. Whenver we go to the clinic, we pay cash. when my dad who is 55 year old find out his blood pressure is just a little bit high, he immedately pick up on his exercise and look after his diet. Also, we have money saved just in case of emergency.
We are from a third world country, there were no goverment support whatsoever. I do sometimes felt that people in America felt so entitled to our govement that they do not know how to take care for themselves.

 

[cowme]

Not sure why so much hate on this thread.

There are plenty of part time gigs available, especially in family practice, emergency medicine and hospitalists/nocturnists. It was also pretty common in rads, but I think part time gigs are harder to lock down there.

 

[Law2Doc]

...

My question for you is whether you believe it to be inappropriate for a person to attend medical school with the plan of working a part-time job (regardless of what that means exactly) for lets say, 5-10 years after finishing residency?

first, the initial thread was based on a 20 hour a week concept, so I think when you redefine the question to be "part time... Regardless of what that means exactly" ( which in medicine could potentially even be close to 40 hours a week), you change the question pretty significantly, and avoid answering the actual question posed in the thread. The question wasn't whether some part time role for a finite temporary period if time could be found in pediatrics, but whether a "20 hour a week job after residency" in medicine, generally, could be obtained.

As for "inappropriate", I wouldn't use that term, as I'm not the gate-keeper and appropriateness is really a notion of "best use" and up to those who want to get good return on their investment, in this case a residency slot. I would, and did, rather use the term "unrealistic" as to the notion of working 20 hours a week.

 

[Gut Shot]

His argument about why healthcare cant be sold like bread is arguable.

Not really. The only areas where health care has been successfully commoditized are elective outpatient procedures (like LASIK). You may note that Rand Paul used LASIK as an example of applying the free market to health care in general, which is a pretty misleading argument.

He is right that people wont know when they will need a high-cost surgery, but the fear of paying for one may deter people from living the sedentary lifestyle they are now. I personally felt that the "safety net" of insurance and big goverment care will allow people to rely on these things to actually make their life worse. Isnt prevention better than trying to cure a problems after it has alrdy occured?
My family havent had insurance for years. Whenver we go to the clinic, we pay cash. when my dad who is 55 year old find out his blood pressure is just a little bit high, he immedately pick up on his exercise and look after his diet. Also, we have money saved just in case of emergency.
We are from a third world country, there were no goverment support whatsoever. I do sometimes felt that people in America felt so entitled to our govement that they do not know how to take care for themselves.

You have brought up at least three issues here. You pay cash at the local clinic, great. But notice that Krugman states (emphasis added): "The big bucks are in triple coronary bypass surgery, not routine visits to the doctor's office; and very, very few people can afford to pay major medical costs out of pocket." He's right, doctors visits are small potatoes. Look at a breakdown of health expenditure through the population:

So one person in a hundred sucks up almost a quarter of all health care dollars, and five take almost half. Treating hypertension is dirt cheap until therapy inevitably fails, and you have and MI or hemorrhagic stroke, or live long enough to get a malignancy. The real money is in the ICUs and all the last-ditch cancer therapy.

Your concerns about insurance divorcing people from the consequences of their actions is termed moral hazard. You might enjoy this very readable exposition by Malcolm Gladwell on the shortcomings of this approach. In a nutshell, the answer to dealing with the chronically ill isn't to increase the barriers to obtaining care.

Finally, the relationship between prevention and expenditure is anything but clear cut. Check out this seminal New England Journal of Medicine article on the long term fiscal consequences of smoking cessation. If you poke around PubMed there are more. One can make a good argument that the most costly lifetime consumers of health care are those of below average weight and generally good physical condition.

 

[oldbearprofessor]

As for "inappropriate", I wouldn't use that term, as I'm not the gate-keeper and appropriateness is really a notion of "best use" and up to those who want to get good return on their investment, in this case a residency slot.

What if you were the gate keeper and we stopped focusing on the OP's 20 hours and instead focused on the inexactly defined "part time" terminology? If you were the gate keeper (adcomm, residency director, premed advisor, etc) and someone said they wanted to work "part time" for 5 to 10 years after residency, what would you say or recommend as far as selection to your school/program or career advice? This is as open ended as I can make the question.

 

[tn4596]

Your concerns about insurance divorcing people from the consequences of their actions is termed moral hazard. You might enjoy this very readable exposition by Malcolm Gladwell on the shortcomings of this approach. In a nutshell, the answer to dealing with the chronically ill isn't to increase the barriers to obtaining care.

Finally, the relationship between prevention and expenditure is anything but clear cut. Check out this seminal New England Journal of Medicine article on the long term fiscal consequences of smoking cessation. If you poke around PubMed there are more. One can make a good argument that the most costly lifetime consumers of health care are those of below average weight and generally good physical condition.

The New England articles and similar ones are just interesting reads. After all, neither you or I would want our fellow citizen to die quicker so our healthcare spending cost would be reduced.
Also, "In each age group, smokers incur higher costs than nonsmokers. The difference varies with the age group, but among 65-to-74-year-olds the costs for smokers are as much as 40 percent higher among men and as much as 25 percent higher among women". I wold argue that comparing these data based on age group will provide a more accurate relationship between prevention and expendature.
Prevention is still our goal. Isnt this the point of the Gladwell article? Which bring us to the point of moral hazard. I would say that this article has convinced me. But the truth remained that the rate of obesity is 30% in the U.S. Which mean that there are people will lead a sedentary life without regard for their health and future cost. If you want universal healthcare, is this fair that most of us who lead a healthy life have to subsize these costs under this current system and universal healthcare? I would rather have each person take their own fiscal responsibility and save money for those high cost procedures.
Also another point, do you think that medical procedure are so expensive right now because of the inefficiency in our system? Wouldnt a free market drive down these cost therefore make healthcare affordable?

 

[Gut Shot]

But the truth remained that the rate of obesity is 30% in the U.S. Which mean that there are people will lead a sedentary life without regard for their health and future cost.

In the past 60 years the food supply has changed, portions have changed, occupations have changed, and so on. Obesity is far more complex than a simple decision to lead a sedentary lifestyle.

If you want universal healthcare, is this fair that most of us who lead a healthy life have to subsize these costs under this current system and universal healthcare?

If you accept the premise of the NEJM article, the healthy aren't the ones subsidizing the unhealthy. It's the other way around. From a financial standpoint, the ideal Medicare recipient is the one who dies on his 65th birthday, as that person paid into the system his whole working life but won't extract a dime.

I would rather have each person take their own fiscal responsibility and save money for those high cost procedures.

That's the function of insurance.

Also another point, do you think that medical procedure are so expensive right now because of the inefficiency in our system? Wouldnt a free market drive down these cost therefore make healthcare affordable?

No, not for anything big dollar. Even when consumers are given a health care choice (I'm thinking big ticket items, here) they usually go for the most expensive option because of some perceived benefit, not the least expensive on that meets their needs. It's not like purchasing a DVD player. Look at da Vinci. People read the brochure and want their surgery done robotically. It doesn't matter that the success and complication rates are the same as the old way, but now every podunk hospital has to buy one of these damn things or see demand wane. And they aren't cheap.

Speaking of podunk, how should the free market operate in areas with only one hospital? Does every town need two, with redundant equipment and staffing? How is that going to make things more affordable?

 

[Law2Doc]

What if you were the gate keeper and we stopped focusing on the OP's 20 hours and instead focused on the inexactly defined "part time" terminology? If you were the gate keeper (adcomm, residency director, premed advisor, etc) and someone said they wanted to work "part time" for 5 to 10 years after residency, what would you say or recommend as far as selection to your school/program or career advice? This is as open ended as I can make the question.

My personal view is that most of medicine is neither as flexible as people like to suggest on premed boards, or something you can dabble in and still be competent, so seriously reduced hours are not something you can or should really bank on. Some specialties are more amenable to part timers, peds being one example. But I've known relatively few med students who knew for certain, without wavering at least once, which specialty they wanted before they got to see more specialties first hand. The guy who thinks they love peds going into med school may quickly realize tht peds ortho is really their thing, and that a part time gig isnt going to work, etc. So yeah, I basically would advise someone who doesn't plan to spend a substantial portion of their adult life working to avoid professions such as medicine.

 

[NightGod]

No, not for anything big dollar. Even when consumers are given a health care choice (I'm thinking big ticket items, here) they usually go for the most expensive option because of some perceived benefit, not the least expensive on that meets their needs. It's not like purchasing a DVD player. Look at da Vinci. People read the brochure and want their surgery done robotically. It doesn't matter that the success and complication rates are the same as the old way, but now every podunk hospital has to buy one of these damn things or see demand wane. And they aren't cheap.

Speaking of podunk, how should the free market operate in areas with only one hospital? Does every town need two, with redundant equipment and staffing? How is that going to make things more affordable?

Watch the Indian Hospital series by Al-Jazeera English on YouTube. Very interesting approach to medicine and finances. I'm not so sure it would work equally as well here in the States, mostly because of the legal costs of doing medicine these days, but the concepts of commodities of scale being used to keep costs low (A few thousand dollars for heart valve replacement surgery vs $50K + here, for example) makes for some interesting viewing.

 

[Revolver1045]

My cousin works as an anatomical pathologist and only works 24 hours a week. 6 hours each day Monday thru Thursday. She had full scholarship to med school so loans aren't an issue for her, but for some people loans will be an issue. She still makes 200k+ at only 24 hours a week. When i asked why only 24 hours she responded " why would I work my ass off to become a doctor? to work harder for the rest of my life as one? I enjoy medicine but I'd like to enjoy my life too." some probably won't like it, but I agree with her

 

[USCTrojan11]

Take this anecdotal evidence with whatever weight you'd like.

The hospitalist I know works 3 hours/day 7 days per week with little call (has to answer but doesn't have to come in though he lives across the street anyway). Makes a good 140k, malpractice is covered, benefits from hospital, free meals and prime parking spot.

My dad works 15 hours a week, he's 25 years out of residency. He owns a private practice and worked 40 hour weeks with lots of call before the practice got off the ground. But now that it's off the ground, he takes it easy.

 

[starsworld]

I understand if you had a private practice or were to join a private practice, there would be a lot of overhead/ things that take up time so that you would have to work more than 20 hours a week, but what if you worked for a hospital? If you work for a hospital, wouldn't you be able to work 20 hours a week?
Also, in a separate question, would it be possible to work 40-50 hours a week after residency or is this unrealistic?