About 3 years ago, when her son was age 2, Ariela Marshall, MD, a consultative hematologist, was about to start a new job. While negotiating the terms of the position, she requested a part-time arrangement. Since her commute would be 90 minutes each way, she asked if she could work 7 days in a row each month and be off the remainder of the time. Her employer, the University of Minnesota, Minneapolis, agreed. During her on-weeks, Marshall stays in a rental apartment near the institution. While there, she can focus on her job. When she’s home, she can spend time with her son.

Marshall is in good company. A 2021 article published in JAMA Internal Medicine estimated nearly 25% of physicians work part-time, an increase of about 11% since 1993. A poll conducted by MGMA Stat in April 2023 found 47% of medical group leaders had added or created part-time or flexible-schedule physician roles that year.

Like many professionals, doctors are using reduced schedules to care for young children or aging parents, pursue outside work or hobbies, or even remain in practice as they age. And healthcare organizations are increasingly realizing they need to offer part-time options or they may risk losing valued employees. Retention is a greater concern now than ever: The Association of American Medical Colleges projects a deficit of 86,000 physicians in the US by 2036.

But there is a lack of consensus or clarity on how to handle these arrangements, said Marshall, who is leading a study on part-time faculty at an academic institution. For instance, if doctors are on a promotional track and go part-time, how often should they be expected to publish? “Departments are not providing guidance, not out of ill will but because they don’t know how to counsel people,” Marshall said. “But people are doing this. This is not theoretical. We need to know how to guide them.”

Medscape asked part-time doctors how they have made these arrangements work, and their stories highlight what employers should consider when offering less than full-time positions.

Not Part-Time, Per Diem

Seven years ago, Nisha Mehta, MD, a radiologist, decided she needed more time to work on Physician Side Gigs, an online physician community she’d founded. “For a while, I survived by using vacation days for my speaking arrangements and other things I needed to do for the business,” said Mehta. “But eventually everything required too much bandwidth.”

Mehta also wanted to spend more time with her husband and children. The couple, both doctors, decided they could afford a decrease in her earnings. So Mehta asked her employer if she could reduce her hours. The answer was no. She couldn’t work part-time, but she could work per diem. Unlike many part-time employees, per-diem employees often work on an as-needed basis and do not receive benefits.

This was only possible for Mehta since her husband’s job provided benefits for the family. So, she submitted her resignation and shifted to a per-diem schedule. Initially, she worked 1-2 days a week. More recently, she cut back those hours further to accommodate her burgeoning side business.

The situation has paid off. “[Part-time work] allows me to enjoy the best of both worlds, and I could not be more grateful for the opportunity to continue practicing medicine but on my terms,” she said.

Putting Family First

In 2001, when her first child was 6 months old, Debra Etelson, MD, a pediatrician, asked her then-employer, a hospital associated with a medical school, if she could switch to part-time. “I was nervous to talk to my boss since at the time no one was really doing that,” she said. She was relieved when they agreed, offering her Mondays off, which came with a significant pay cut. Ideally, she would have worked less, but that would have resulted in the loss of her health insurance and even more income.

Then, in 2007, when her third child was diagnosed with type 1 diabetes at 13 months old, Etelson felt she had to stop working. “I had no choice. It was round-the-clock nursing then,” she said. “It was like running a little ICU in my house.” Nearly 2 years later, another one of her children was diagnosed with the same condition.

Health insurance was a struggle. The family used COBRA through Etelson’s former employer for 2 years and was then able to get benefits through her husband who was self-employed.

Eventually, Etelson began working 3 days a week at a private practice. They were receptive to the part-time arrangement — because they didn’t have to pay benefits. “It was a gift to myself,” she said. “It was not easy economically, but I needed to do that. It was what I owed myself and my kids.”

After 10 years of part-time work, Etelson returned to full-time. Now at White Plains Hospital Physician Associates in Somers, New York, she has no regrets, but she acknowledges the financial cost. “I’m still living in my ‘starter house,’” she said.

Going Solo

Ob/gyn Eden G. Fromberg, DO, has been practicing for more than 35 years. Before the pandemic, she repeatedly joined private practices that ended up being sold. Over time, she realized the only way she could have the work-life balance she craved — and offer the type of care she wished to provide — would be to start her own independent, fee-for-service practice.

In 2021, she founded Holistic Gynecology New York. To keep her costs lower and retain her autonomy, Fromberg does not perform procedures and is no longer affiliated with a hospital. She also caps her hours at 20 per month, working primarily from her office in upstate New York. About 2 days a month, she sees patients in Manhattan at a nonmedical office space that she rents by the day.

Owning a practice has required Fromberg to learn about the administrative challenges of medicine. Although she hired two part-time remote contractors to help, she estimates she does more administrative work than many doctors. Fromberg also had to adapt to her unconventional New York City setup: a massage table instead of an exam table. “At first, I felt, ‘this is so weird’ and wondered, ‘will people not accept it?’” she said. But her patients don’t seem to mind the pelvic wedge she uses in place of stirrups. In fact, she feels “there is a huge demand for a different sort of gynecologic experience.”

Despite these issues, Fromberg feels the trade-offs are worth it. “It allows me as a 61-year-old to have more of a life…. I can exercise and do my yoga and Pilates and take country walks most days. I do pottery and garden. I cook at home.”

The Bottom Line

With its many advantages, why isn’t part-time work even more widespread? The bottom line: For physicians, there is often a drop in earnings per hour, said Stefanie Simmons, MD, FACEP, chief medical officer, Dr Lorna Breen Heroes’ Foundation, who worked in emergency medicine before transitioning to her nonclinical career. And for employers, if some of their clinicians work fewer hours, they’ll most likely need to hire more to compensate.

More employees means a higher total cost for benefits, onboarding and credentialing, and a need for more clinical support staff. However, overall expenses might be lower once they factor in the costs of replacing valued clinicians.

“If you retain clinicians due to PT work, that saves recruitment costs, which may pay for the extra benefits required,” said Mark Linzer, MD, director of the Institute for Professional Worklife, Hennepin Healthcare.

Filling a position takes an average of 6 months, and up to a year for positions in the most difficult-to-recruit regions and competitive specialties, said Tara Osseck, MHA, regional VP of recruiting at Jackson Physician Search, during an MGMA webinar. With clinician shortfalls, revenue and market share can decrease, burnout among remaining providers can increase and costs for locum tenens provider fill-ins can rise, Osseck added.

Still, part-time work is just not realistic for all doctors. “In some specialties where there are 60 primary care doctors in a town or hospital system, it can be viable,” said Simmons. “But in a small town with only two neurologists and one wants to be part-time; there isn’t a job-sharing opportunity for them.”

Even in such cases though, employers have options to offer flexibility. As one example, Linzer suggests allowing clinicians to start work a little later to drop the kids at school and make up those hours at another time. “Flexibility can be very effective, and it builds trust and loyalty to the organization,” he said.

The ease in workload may also be less than doctors imagine. Fewer clinical hours don’t always mean that nonclinical hours will decrease by the same proportion. “Many doctors go down to 80% FTE (full-time equivalent) for clinic-based work but find the administrative work expands to fill the time available,” Simmons explained.

These unpaid nonclinical work hours decrease by “approximately 14% for each 20% reduction in FTE (and presumably a 20% reduction in pay),” according to an article published in 2023 in the American Journal of Preventive Medicine.

“You might be buying a little bit of flexibility but is it at too great a financial cost?” asked Simmons. “Sometimes there’s also a career cost, like being passed up for a leadership position.” Employers should offer flexible schedules with benefits and be transparent about how compensation is calculated for part-time jobs, Simmons emphasized.

A Happier Schedule

Part-time work isn’t perfect. But it might be an effective way to keep more doctors in the field. “I love my current schedule,” said Marshall, who recently took on an additional position as the program director for the hematology-oncology fellowship at the University of Minnesota. She estimates she works an average of 30-40 hours per week, but because her new job is mostly remote, “there is a lot of flexibility. I can schedule meetings that work for me and…go to school events,” she said. “It has brought me a lot of joy. I am so much happier now.”

The experts cited in this article had no relevant disclosures.