Such thing as a part time GS?

[mtwop]

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So I've searched multiple threads about this this topic with no luck. I've heard through the faculty at my school that some hospitals are moving towards a sort of acute/shift work schedule for general surgeons (similar to the ER), but none of these faculty had any solid information. If this is the case, would these surgeons be able to work more of a part time schedule relative for general surgery (ie 3 12 hour shifts)? Advice from residents and/or attendings is appreciated.

 

[Smurfette]

The new "acute care surgery" model is highly variable by location.

Most that I am familiar with do something like 1 week on, 1-2 weeks off. As in continuously on call for surgical emergencies at the hospital when 'on' (home call). Places with higher volume where you have to be in-house, or that combine trauma with acute care (depending on acuity level) may do shift work that is on days or nights for a week (12 hour shifts), then off for 1-2 weeks prior to the next week on. Some places may do a week as a full 7 days, while some do weekdays and weekends as separate entities.

Some places are shifting more towards these models than traditional call schedules. However, these positions are generally still full-time positions. Because these are newer systems, there is some degree of trial and error going on to determine which scenario is best for a given group/hospital.

Being truly 'part-time' is (IMO) risky as a surgeon...you may be perceived as someone who isn't a team player and not an equal partner. Generally speaking is not something that would go over well when interviewing for a practice...I haven't seen job openings for 'part-time' surgeons. There are locum tenens (sort of like moonlighting) positions out there as well, that can pay for short stints as a 'fill-in' surgeon. Locums positions in the US or abroad will pay for your travel and expenses (furnished apts or hotels) in addition to a salary.

 

[blue2000]

The other way I saw "part time" general surgery practiced is in rural communities in desperate need of general surgery call coverage. In two relatively small towns, I was offered "part time" general surgery (1 full day of clinic, 1 day of OR, and in a place that didn't have GI, 1/2 day of scoping) but with full time call responsibilities (1 in 3 for one and 1 in 4 for the other). Both of these were employed positions in hospitals where senior general surgeons with busy practices had been ground down by 1 in 2 or full time call. They were interesting, but ultimately I opted for a different practice model.

 

[IheartCaffeine]

The new "acute care surgery" model is highly variable by location.

Most that I am familiar with do something like 1 week on, 1-2 weeks off. As in continuously on call for surgical emergencies at the hospital when 'on' (home call). Places with higher volume where you have to be in-house, or that combine trauma with acute care (depending on acuity level) may do shift work that is on days or nights for a week (12 hour shifts), then off for 1-2 weeks prior to the next week on. Some places may do a week as a full 7 days, while some do weekdays and weekends as separate entities.

Some places are shifting more towards these models than traditional call schedules. However, these positions are generally still full-time positions. Because these are newer systems, there is some degree of trial and error going on to determine which scenario is best for a given group/hospital.

Is this trend something you see becoming more common in the future? I'm assuming that when you mean off, it's really off, and you don't have to go to clinic or something like that? If that were the case, to be honest, it seems like the perfect job. Work your butt off for 1 week and then decompress/travel for 1-2 weeks.

 

[Smurfette]

Well, some places have you in your 'off weeks' do clinic and scheduled (i.e. non-emergent cases). Some places work it where, when you're off, you're completely off. The majority I'm familiar with are usually the former, while the latter tends to be in an employed model (i.e. not private practice) with an every-other-week type of deal (but since SOMEONE needs to see these patients post-op, there would be a clinic requirement; either during your 'on' or 'off' week). Obviously, there are a lot of different ways that this can work depending on the group size and hospital volume.

 

[treehorsio]

I would hazard to say that this model is most common in the academic world.

Like many programs, we have an "emergency surgery" service which includes some, but not all, of the trauma/critical care attendings. That means that there are attendings who purely do emergency surgery, no trauma, no critical care.

One in particular is on service every other week. However, she also has an NIH RO1 so she is really quite busy outside of clinical responsibilities, not to mention being in the call schedule for ES q4 when not on service.

Similarly, our other trauma/CC/ES generally have a schedule like this:
week 1: on trauma service through weekend (no call)
week 2: on ES (likely in the call schedule a few days/weekends)
week 3: rotating in SICU (in the call schedule)
week 4: "off" aka academic week, but again, still are in the call schedule, have to teach conferences, go to grand rounds, do research.

As has been discussed recently, this service has little clinic - in fact, only one day a week - which is shared by all 4 attendings. No show rates are quite high. All attendings are essentially expected to go to clinic every week.

Plus, as has been noted, despite a "lighter" work schedule on paper, their call nights are VERY busy and unpredictable, and the patient population is hardly conducive to a long, fulfilling patient-physician relationship. Trauma patients aren't the ones bringing bottles of wine and thank you cards to their follow up clinic visits (or for that matter, when they get their second ED thoracotomy a year later for another GSW). So this is why burnout is relatively higher for these specialists (like ED).

 

[SocialistMD]

Trauma patients aren't the ones bringing bottles of wine and thank you cards to their follow up clinic visits (or for that matter, when they get their second ED thoracotomy a year later for another GSW).

Statistically speaking, patients who have a second ED thoracotomy don't tend to bring anyone anything ever again...