schedule flexibility in private practice vs. academics?

[docdoc2012]

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Hey Guys!
First off congrats to the newest members of this awesome profession!
Just had a couple of questions for residents and those currently practicing. Having just gotten over the halfway hump of intern year, I am beginning to have some schedule questions. I keep hearing the internal medicine residents talk about doing 1 week on 1 week off or 6 months on 6 months off or somwhere in between and it just got me curious about the opportunities in ophtho to do this, specifically to escape the 9-5 48-52 weeks a year for the rest of your life (if thats not your thing)

1. How flexible are private practice's in general in regards to scheduling? Is it possible to work or take off certain days of the week? On a weekly basis, how much free time would you say you have to devote to your family/other pursuits?

2. does schedule flexibility vary between private and academic practices? I know that academic physicians in theory have protected research time and such but if anything they have always seemed incredibly overworked and busy to me (from my limited perspective)

3. if you wanted work hard for 3 months with 1 to 2 weeks off in between, is this even feasible with current reimbursement pressures?

4. what about part time work? do you or anyone you know work only a few days a week or a few weeks a year? was it pretty difficult to find this position?

Im looking forward to ophtho but really want to do international medicine while still being a successful practicioner in the USA. Just looking to see what kind of options are really out there!!

Thanks in advance for the responses

 

[TheLesPaul]

+1 very interested in a response to this

 

[JMK2005]

Ophth is outpatient, so you are restricted to m-f. I consider it a plus, but you are not able to pack in your hours like ER or hospitalists who do 12 hours shifts.

You can work 80% (ie take one day off a week). But you make less money.

Saturday hours maybe, but realize you need staff to help you.

 

[guttata]

1. As an associate, you are bound by the rule of the owners/partners. You are typically salaried and have a predetermined number of vacation days. If you are paid by production (paid a % of the money collected from your services), you may have more flexibility. But, it is difficult to build up a practice if you only practice part-time. A fair number (if not most) of OMDs work 4.5 day work week.

2. With some exceptions, you have greater flexibility in private practice. In academics, you have less control over your schedule (and everything else). Protected research time does not mean free time.

3. You can take off as much time as you like. But if you aren't seeing patients, you aren't generating income. Good if you are salaried (and can get that much time off), bad if you are not salaried. A lot of docs take four weeks off and still do very well. If you want eight weeks, your compensation will drop. With decreasing reimbursements, you will have to work even harder on your workdays (longer days and more patients) and/or work more days and/or cut overhead.

4. Sure, part time work is available and most part-timers work a few days per week. Some practices are just busy enough to bring in someone part time but not gangbuster busy to recruit a full time doc. Some practices may want you to staff a satellite office.

You could also consider locum tenens work, where you travel to different states/clinics to fill a temporary need (doc out on vacation, maternity leave, retirement, etc). Some positions last one week, others may last a few months.

But, there is no way you can keep up your surgical skills if you want to work only a few weeks per year (second part to your last question)

As for the internal medicine residents, I am pretty sure they were talking about hospitalists or critical care docs. They can often work one week on/one week off (and deserve the week off).

 

[hurdlepup]

Im looking forward to ophtho but really want to do international medicine while still being a successful practicioner in the USA. Just looking to see what kind of options are really out there!!

Thanks in advance for the responses

I have heard of a practice built around international medicine like this. The attendings all plan to cover your patients for the month you are gone each year. Not saying it is common, but I do know it exists. Could probably find something like this in any specialty though.

 

[TheHero]

I am a medical student so I don't know the exact numbers and facts, but I think even if you take as much time off a year in ophtho (not 6 months of course!) you'd still make more money than IM. If money is not the main issue for you, then to make as much as IM you can work less in ophtho.

 

[Eyefixer]

Guttata is pretty much spot on. The only way you can manage tons of time off in ophtho is when you are in a setting like Kaiser, VA or some academic centers; that is where patients are less interested in seeing YOU but are mostly interested in getting SEEN. If you are in private practice having large blocks of time off is not practical as patients will quickly realize that you are not readily available when they need to be seen and will go somewhere else. This will be damaging to your clinic volume, surgical volume, surgical skills and reputation. Where I practice most people take 4 weeks of vacations or less and usually in 1 week blocks (just like residency). I am not aware of any ophthalmologist who goes out of town for a few months at a time, associate or partner.

 

[Visionary]

I'll echo some of what's been said. If you're practicing in an academic institution or in a health system (or if you're an associate in private practice), you are a salaried employee and can use your allocated vacation within restrictions of your contract. I doubt many scenarios exist that would allow you to take large blocks of time, though. As a partner or solo practitioner in private practice, you are essentially your own boss and can take time off as you please...to an extent. As solo, you will still have to pay your overhead (lease, payroll, etc.) while you're gone doing (unpaid) volunteer work. You can imagine how that can add up. As others have said, you will also rapidly lose referrals from the community, if you are unavailable for long periods of time. If you're a partner in a group, you may be able to get away with large blocks of time off...if your partners are agreeable. In my practice, for instance, I'm required to work a minimum of 1400 hours per year. If you take too much time off, your partners will end up covering an unfair share of overhead expenses. Now, could you get into a partnership where the partners trade off time to do volunteer work? Perhaps, but that will be very difficult to find. Short answer: don't plan on taking large blocks of time for volunteer work. A week here or there is feasible, though.

 

[Dusn]

I am a medical student so I don't know the exact numbers and facts, but I think even if you take as much time off a year in ophtho (not 6 months of course!) you'd still make more money than IM. If money is not the main issue for you, then to make as much as IM you can work less in ophtho.

This is completely wrong. Ophtho and IM have pretty comparable salaries. IM probably makes more on the east and west coast because of less saturation and more job availability and job options. A hospitalist will probably have a larger starting salary than ophtho but less room for growth. Ophtho only makes more when it's high volume (ie. mid-west, south, not in a large city) and that can only work in a non-saturated area and you need to be a partner in your own business (not an employee). And some IM subspecialties will make more than ophtho on average (GI, Cards..).

Re: the OP. Ophtho is a great field for international work. It's not good at all if you're looking for "shift work" type hours.

 

[TheHero]

This is completely wrong. Ophtho and IM have pretty comparable salaries. IM probably makes more on the east and west coast because of less saturation and more job availability and job options. A hospitalist will probably have a larger starting salary than ophtho but less room for growth. Ophtho only makes more when it's high volume (ie. mid-west, south, not in a large city) and that can only work in a non-saturated area and you need to be a partner in your own business (not an employee). And some IM subspecialties will make more than ophtho on average (GI, Cards..).

Re: the OP. Ophtho is a great field for international work. It's not good at all if you're looking for "shift work" type hours.

Really?? On this forum: http://forums.studentdoctor.net/showthread.php?t=967093
They said based on 2012 MGMA Physician and Production Survey book, the average ophtho income is $388K (and much higher for retina or cornea, and even higher in the midwest, as you said). Medicine hospitalists make this much?
I agree regarding the medicine subspecialties, but the shift work referred to in the initial post is usually for general medicine hospitalists.

 

[JMK2005]

Do a forum search on ophth salary. You must not have been on the forum very long.

 

[TheHero]

I did look at the salary forums, and they mention that this is true for average (not starting) so I understand that initially general optho and IM starting salaries are the same, but as Dusn said the growth potential in ophtho is bigger than in medicine and in few years the salary gap between the two will be much bigger. And if you do a one-year fellowship (vs 3 years in medicine) you can have a starting salary that is much higher.

My initial point was that while a hospitalist (general medicine) can have more time off, they are making less than an average ophthalmologist (not a starting ophthalmologist) so if an ophtho doc wants to take more time off, they can end up with a salary similar to a generalist.

 

[Dusn]

To get to those salaries in ophtho, you need to be willing to move wherever in the country the job is and the need is. Or you need to find an area in a large town where there are few ophthalmologists of your specialty and have the business gumption to start you own office, by taking out even more large loans, and working your butt off to operate at a loss until your business picks up. In this scenario it's hard to take time off in the early years. If you're working part-time then you're an employee. If you're employee that means that your boss is going to want to make money off you and your salary will be cut significantly, until, and if, you make partner. You will only make partner if the group needs you, values you, and you were smart enough to not sign an initial contract that lets them fire you in several years and re-higher someone cheap and fresh out of residency. It's hard to see someone making partner if they work part-time. In addition, cataract reimbursements have also been cut, yet again.

As a hospitalists, there's a need in far more places in the country. If you don't like your job or salary as a hospitalist, you can just move to the next hospital. You can be an employee and work part time with a much higher salary than a part-time ophthalmologist. Part time in shift-work based fields like ER or anesthesia, still makes a lot and the salary is proportional to the number of hours worked. In ophtho, working part time will cut your salary and your job opportunities to a much greater extent.

 

[Eyefixer]

You will only make partner if the group needs you, values you, and you were smart enough to not sign an initial contract that lets them fire you in several years and re-higher someone cheap and fresh out of residency.

This is a big issue that, IMHO, is much much more severe in ophthalmology than any other specialty.

 

[Eyefixer]

As a hospitalists, there's a need in far more places in the country. You can be an employee and work part time with a much higher starting salary (albeit less opportunity for growth). It's a lot like ER or anesthesia (both higher paying fields than ophtho). If you don't like your job or salary as a hospitalist, just move to the next hospital. Granted, I don't know what the future hold for these types of jobs and I don't see too many older hospitalists.

Actually, future of primary care specialties and hospitalists looks bright. With ACA coming down the pipe line and more patients with insurance the need is going to skyrocket.

 

[TheHero]

I guess you're right. Not too late for me then 😉 But too bad internal medicine is too boring and ophtho really fun!

 

[Dusn]

Good. In that case I'm sure you'll like ophtho. It is a very cool and interesting field. Just go into it with your eyes open. Take advice about ophtho from ophthalmologists in different levels of their training. Don't try to get advice from non-ophthalmologists (who often think they know what it's like in ophtho based on stereotypes but they don't).