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Sick of the part-time debate yet?

There’s been a lot of fallout over this weekend’s New York Times Op-Ed piece about doctors, particularly female doctors, working part time. I enjoyed reading the multiple reactions and reader comments and have been thinking about it quite a bit over the past few days. On my recent half day off I joined one of my partners at a conference reviewing Rheumatology board questions with the residents. Afterwards, since I was close to the office, I stopped by to sign some papers, review labs and make a few follow up calls.

Walking in, my partner says, “Hey, what are you doing here? Isn’t this your day off?”

Me: “Yeah, well, haven’t you heard? I’m ruining medicine with this part time nonsense!”

What exactly is part-time? In this world of “widget” medicine where we’re only paid for patients seen face-to-face in the office, we need to assign a value to the hours of uncompensated time outside normal office hours. Indeed, my “time off” is often spent attending meetings, participating in teaching sessions, reviewing research projects, filling out patient forms, catching up on labs, phone calls and emails and coordinating care for patients with difficult or complex cases. Things I maybe didn’t have a chance to do or couldn’t do before the office opens at 8am or after the doors close for the day. Fortunately or unfortunately, the fact that I can access my EMR from my laptop means I’m (and probably a lot of other “part-timers” are) never really away from work.

Is it easier to work a full-time schedule in more of a shift-based specialty like anesthesia, hospital medicine or EM where there seem to be less demands outside of one’s actual on-site work? I certainly don’t want to speak for my colleagues in primary care, as I know my office paperwork burden is a fraction of theirs. However, until there is less bureaucracy in medicine, compensation for time spent in non-contact care coordination and, yes, malpractice reform, physicians (male and female) will continue to seek part-time work or explore other practice environments. I applaud those who have made this lifestyle choice, whether to spend more time with kids, write a book (or blog) or pursue other interests related or not related to medicine. Thanks to those who have echoed Dr. Centor’s assertion that he would rather see a committed part-time doc than a full-time doc who is burned out.

Here are some links to related articles:

Dr. Centor –


WSJ Blog


Dr. Au’s response

NYT parenting blog


Information Overload

A few weeks ago I suddenly noticed that I wasn’t getting a couple daily medical e-newsletters to which I subscribe. In fact, I wasn’t even sure how long it had been. A week? A couple weeks? A month? I get a lot of blog ideas, journal club articles or just ideas to ponder or share with patients from these newsletters. After making a few phone calls, it seems something in the emails was flagged as spam on our end and the addresses were blocked. Some behind the scenes tweaking by IT and about a week later, they retuned.

Now I had the day’s headlines:

US Expected to Face Growing Shortage of Healthcare Workers

CDC Data Show Asthma Prevalence in the US is Rapidly Increasing

Being Overweight at Midlife May Increase Risk for Developing Dementia Later

Experts Warn of Primary-Care Physician Shortage as Baby Boomers Age

Shortages of Key Drugs may be Endangering Patients

Well . . . maybe that silence was a blessing in disgiuse, although just the same could be the ostrich sticking her head in the sand. I didn’t have to see the scary headlines for a while and life seemed much more calm. It’s often said that mastering the information taught in medical school is like trying to drink a sip of water from a fire hose. Sometimes it seems that the daily deluge of emails, Twitter, etc could be described the same way.

So far, my strategy has been to scan the headlines, save important stories in an email folder for later and try to clean out that folder from time to time. The same holds true for Twitter. The information is out there and we can’t ignore it, but taking time out for a “media cleanse” now and then can be helpful.

Research Graveyard

Pile of posters after the ACR annual meeting

The difference between men and women?

Many of the medbloggers I follow have chimed in on the recent discussion about the difference between male and female physicians’ salaries. However, I thought I’d repost the entry from KevinMD for some of my non-medblogger readers. Really fascinating and I totally agree! Here’s the post in its entirety, but also the comments are worth a read. Thanks, Dr. Kevin!

Female doctors make less than male physicians.

That conclusion gained major media traction recently.  A recent post on by medical student Emily Lu had some great conversation discussing some reasons why women make less money in medicine.

To recap, the study from Health Affairs concluded that,

newly trained physicians who are women are being paid significantly lower salaries than their male counterparts according to a new study. The authors identify an unexplained gender gap in starting salaries for physicians that has been growing steadily since 1999, increasing from a difference of $3,600 in 1999 to $16,819 in 2008. This gap exists even after accounting for gender differences in determinants of salary including medical specialty, hours worked, and practice type, say the authors.

Everyone hypothesized all sorts of reasons.  Female doctors prefer more family-friendly hours and less call, which may impact their salary.  Women are simply worse negotiators than men.  Blatant sexism exists when hiring new physicians.  Money isn’t as important to women as it is to men.

All of which may, or may not, be true.

Of course, the reasons probably are multi-factorial.  But there’s one that I haven’t seen discussed much.

Women, in general, spend more time with patients — up to 10% more.  Pauline Chen, in a New York Times column last year, noted stark differences in how men and women practice medicine, and whether, in fact, women make better doctors by spending more time in the exam room.

So, even though women may work the same number of hours as their male counterparts, they’re likely to see less patients during that time.  And since physician compensation is still mostly based on fee for service or productivity-based incentives, women doctors are going to come up short on compensation scale.

As I commented to CBS News, “By spending more time with patients, female physicians are financially penalized by seeing less patients during the day.  It’s another reason why we need to change the way doctors are paid, and reward them for spending time with patients, instead of penalizing them.”

What’s on your doc’s wall?

I’m not a fan of institutional decorating. Who is, really? Those muted mauve or mint green tones, framed paintings of anonymous landscapes or flowers, carpet with flecks and speckles to hide the dirt. In a perfect world, my office would have funky architectural elements with sleek and modern decor. But does it really matter to patients? As long as an office isn’t in shambles, do you notice the decorating?

I mention this because when I started my job, I brought in a poster for each of my exam rooms to replace whatever had been hanging there for the last decade. One is a large framed embroidery from a friend’s trip to Central America. I love it for the bright colors and also because my friend, a family physician, is truly a healer and seeing that piece of artwork reminds me of her fabulous outlook on life.

The other poster is a crazy, fun picture I’ve had forever and could spend hours trying to decipher. I highly recommend checking out the artist’s site.

Funny thing is, almost nobody notices these. Once every few months someone notices the Proverbidioms poster, usually to say, “That’s really odd!” This week a toddler was enthralled with it. I think he’s got good taste!

Trans-Fat Santa

An action shot and one of the “masterpieces” from today’s activity with a crew of preschoolers – decorating cupcakes for Santa.

Merry Christmas to all . . .

Too Many Rheums!

Brace yourselves for one of the world’s largest, if not THE world’s largest, gathering of Rheumatologists! The American College of Rheumatology’s Annual Meeting is November 6-11. Check out for more information. Here’s where I talk about what a Rheumatologist does in the hospital. Also, November 10th is “I need my Rheumatologist” call-in day where you can take some political action if you so desire.

Follow twitter hashtag #ACR2010 during the meeting!