Med School Uncensored
The Insider’s Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room
Slowing Down: Locums Tenens, Semi-Retirement, and Beyond
Reluctant to Retire
Despite having above-average salaries, physicians are notorious about working until they’re full of white hair and can barely move. There are many reasons for this.
First, despite the gloom-and-doom rhetoric, physicians have historically really liked their jobs. The satisfaction of interacting with patients, immediately improving peoples’ lives through surgical intervention, and bringing new lives into the world cannot be underestimated. Unfortunately, many forces beyond physicians’ control are adding an increasing number of onerous, administrative tasks to the more enjoyable clinical work, which does sometimes tip the scale and “force” senior physicians into retirement.
Second, contrary to the grumblings of some older docs, physicians are still treated with a great deal of respect in most hospitals and clinic settings. The degree to which most hospital and clinic employees will cater to physician preferences and requests usually far exceeds the level of compliance most doctors get when they go home to their spouse and children. In other words, many physicians appreciate the authority and autonomy they enjoy on their home turf in the hospital or clinic.
Third, most physicians can physically perform most duties well into their 60s and 70s, if not beyond. Certainly, overnight call duties become increasingly difficult with age, as does standing at the OR table for twelve hours straight. But most physicians can modify their schedules and duties so they can continue practicing well beyond what most professions might consider a normal retirement age.
Fourth, physicians generally earn enough income that it is worthwhile to continue working. Once the big expenses such as housing and kids’ college tuitions are paid for, a physician working even half the year can earn enough money to pay for several nice vacations. Physicians are also infamously bad with finances and saving money—so the pessimist might say that’s a more likely explanation.
Finally, physicians tend to be hard-working overachievers with Type A personalities. Personally, I always thought I had a Type A personality—until I went to med school and realized I had the work ethic of a ski bum compared to some of my colleagues. Most physicians work hard in college, spend countless hours studying and on rotations in med school, then routinely work 80-hour weeks in residency—with frequent 24-hour calls and overnight shifts. Practicing doctors usually work upwards of 50-60 hours per week. That kind of work ethic doesn’t shut off like a light switch. It’s sometimes a hard sell to convince aging physicians to sit at home all day and sleep in on a regular basis.
Like many things in medicine, doctors use the fancy Latin term locums tenens (translated literally: “to hold a place”) to describe what everyone else calls “part time.” These jobs are available in almost every specialty, and many recruiting and staffing firms specialize in pairing physicians interested in locums work with appropriate hospitals and clinics. Like most part-time work, locums jobs usually don’t include benefits or retirement contributions—but they do sometimes cover malpractice coverage.
Most locums physicians sign an agreement with one or more hospitals or clinics to be available for locums work. Each facility contacts the physician at some regular interval (monthly, weekly, etc.) and offers possible dates to work. The physician can choose which dates she wants to work. A locums shift typically assumes a set amount of hours, with additional payment for extra time worked.
Locums pay is competitive, and it really isn’t a bad arrangement so long as one isn’t depending on a specific income requirement to cover monthly expenses. From the employer’s perspective, locums physicians offer a convenient way to fill coverage gaps due to illness, vacation, or retirement. Sometimes these gaps aren’t large enough to justify hiring another physician, which is a very expensive outlay considering income, benefits, and other employment expenses.
A locums arrangement is ideal for physicians in the semi-retirement phase of their careers. For free-spirited physicians, it can facilitate easy travel to other parts of the country, such that a locums physician can work at one hospital for a few months and then move on to a different facility. All that is required is a medical license in the state of active practice. It also is a good option for physicians in dual-income relationships, in which flexibility is sometimes more limited than finances.
Job Sharing and Full-Time Equivalents (FTEs)
Many hospitals and physician-owned groups also offer part-time work in the form of job sharing. A physician’s workload is often described in terms of full-time equivalents (FTE). A full-time physician working whatever is considered full-time in his group (typically 50-60 hours per week) is considered to be 1.0 FTE. A group of physicians is quantified by describing the total number of FTEs. For example, a group of hospitalists might be described as having 14.2 FTEs on staff.
Job sharing is a mechanism by which two, three, or more physicians can pool their time together to equal one or more FTEs. For example, consider an anesthesiology group that requires 14 FTEs in order to adequately staff a hospital’s operating rooms and off-site facilities. The group could have 14 FTE anesthesiologists, each working 55 hours per week. Alternatively, the group could have 10 FTE anesthesiologists working 55 hours per week and five 0.8 FTE anesthesiologists, each working 55 x 0.8 = 44 hours per week. In both cases, the anesthesiology group has enough physicians to fill approximately 55 x 14 = 770 hours per week of work. But in the second arrangement, five of the physicians are working 80% the time as their full-time colleagues, combining their hours together to equal the work of four full-time anesthesiologists.
You probably noticed that in almost all of my examples, an FTE is well in excess of 40 hours per week. This is the reality of medical practice in the United States. In most specialties, a full-time position as a physician is historically considered somewhere in the neighborhood of 50-60 hours per week. As such, a part-time physician working 0.8 FTE is working roughly 44 hours per week, which is still in excess of the “normal” 40-hour workweek.
The details of any job-sharing arrangement depend on the specific group or employer. Sometimes job-sharing physicians will work one less day per week. Other times, they will work fewer hours each day or fewer full-time weeks per year. It all depends on the needs of the group and the arrangements made among the job-sharing physicians.
Trends in Part-Time Doctor Work
Similar to locums tenens work, job-sharing positions are commonly held by semi-retired physicians nearing the ends of their careers. In recent decades, these positions have also been held by physicians devoting significant time at home to care for children. Finally, in recent years, job-sharing arrangements have been increasingly popular among early- and mid-career physicians who are simply looking for a better work-life balance and a full-time workweek that is more in line with standards from other professions.
While the increasing flexibility of physician work schedules is a good thing for physicians seeking a better work-life balance, it does have ramifications for national physician staffing. In terms of raw numbers of physicians, many parts of the country and many specialties are already facing significant shortages of physicians. This problem is not going to get any better as long as the trend continues for younger physicians to work significantly fewer hours than prior generations of physicians.
Still, the trend of physicians working fewer hours is likely to continue. Some specialties that didn’t even exist a few decades ago are very popular with today’s residents in large part because of their more controllable schedules and better work-life balances. Most emergency medicine physicians work well-defined shifts averaging somewhere around 40 hours per week. Many internal medicine residents are seeking employment as hospitalists, a relatively new field of in-hospital internists who provide continuity of care to inpatients by working an entire week on, followed by a week off. As such, many hospitalists work roughly 80 hours per week, but they only work every other week—providing roughly 26 weeks off per year.