I have always been a big supporter of women (especially moms) becoming physicians...but recently I've been feeling differently. We have a wonderful pedi, whom I chose in part because she is excellent and in part because she has several childeren and I felt she would be a better fit for our big family. I was not wrong.

But. She is part-time...and our practice here does not require physicians to share part-time positions. She works 3 days/week and sometimes one of those days is a half day. On top of that, she takes quite a bit of vacation.

I want to be supportive of the choices that we as women have, but .... we have had three health issues recently with our children where I was unable to get an appt. with our provider within a 2 month time frame. My 15 year old has a minor health concern that has to be addressed and there are no appointments available until March. Our pedi is once again on vacation until next week and the office won't allow us to schedule with a NP or other pedi because they say he has to see his primary for this. (Total nonsense!) They say she will be back in a week and we can check back then to see if she can squeeze us in before March or otherwise we can go to the ER (for something that would not require ER care!!!). The unspoken thought is that we can switch practices...which I have reluctantly just done after being with this pedi for 8 years. Though I like and respect her and her choices, I have to think about the healthcare needs of my children.

We are not frequent fliers, don't usually visit more than once every year or two (eeek) and are generally speaking compliant and friendly patients (with insurance I might add).

In this scenario though, we simply aren't able to gain access to our pedi when we DO need her (which is not that often). This past year has been unusual in that 3 of our children had 3 different illnesses requiring a visit....and this is sort of strike three.

I'd love to discuss this issue in the debate forum....certainly going part-time has to be an option, but how can part-time docs ensure continuity of care for their patients?

Kris

This happens with full-time physicians, too. My doctor is full-time but is fully booked about 2 months in advance. But the important difference is that someone else in the practice has always been able to see me the same day if I am sick. And a pediatric practice should be acutely aware that kids do get sick. I think your pedi's clinic needs a new policy or it will continue to lose patients.

mommd2b - I am currently a part-time peds doc (with four children of my own with my FP doc husband). I work three days a week in the office (although almost NEVER 2 and a half days). I feel that your concern is valid. Part of the problem is that even though I am "part-time" I am carrying the same patient load (that is total number of patients who are under my name) as my "full-time" counterparts who work 4 days in the office. So I often feel like I am trying to do four days of work in three! I have not taken a new patient in more than three years (except sibs of existing patients) and it is still a three month wait to schedule a physical with me. I do have to say however, for minor or even major "sick" complaints (from HA, to fever, to acne, to joint pain) a patient could schedule with me for the same day they called or at the very most, the same week.
I am soon leaving office work however for hospitalist work - for multiple, multiple reasons, although partly because I feel like I can't really do the job "right" by working only three days a week (especially with the way that our healthcare system is currently set up - high volume visits required of all primary care doctors). I have no doubt that your peds struggles with this as well. As far as I am concerned, it is the overall system that is messed-up, not just your doctor or her office!

P.S. You guys sound like dream patients! "in every year (or two)" !

It is definitely the system. We have a wonderful pedi. I have been very reluctant to address this with her because I know there isn't much she can do. I have several friends who are part-time peds and I know they all struggle. It is just hard as the patient.

It probably added insult to injury that I waited 11 minutes on hold to talk to someone and then she was not terribly friendly. I was given no option but waiting until Friday. It isn't really a good option.

We don't go in often because I don't make apptsorgor viral illnesses (obviously) and we have been very fortunate with health issues so far. We have visited the ortho for fractures!

Thanks for your perspective.

It does sound like your doctor just doesn't have good management. Too many patients and not enough cross coverage (which makes me think her partners are maybe resenting the part time thing...) leads to poor patient coverage. I agree it sucks to be the patient. We recently left our FP, who I liked, because she didn't provide coverage during her maternity leave. Of 5 MONTHS. That's right, no option for care, just go to urgent care or miss your meds or try to get in with an overworked partner for a quick visit. I certainly am not one to frown on someone taking maternity leave, but you have to plan ahead to have coverage!! She basically left her partner to try to scrounge up some help, and he is horribly overwhelmed covering patients for both of them. But anyway, I digress. Management, that is what I am saying.

mommd2b, when she comes back, you may just want to let her know why you switched: it's not because of her at all, she is wonderful, but because of the customer service issues at the clinic. She may not even be aware of them.

This is part of the issue with many of the part-time docs here, unfortunately. As I said before, I am friends with a few and at a recent baby shower, I asked the question about why they don't agree as part-timers to share a part-time position and patients. To me as an outsider, it seems logical that one doc covers mornings, the other covers afternoons and they can switch it up to fit each others schedules/needs. This way, there is always coverage each day for patients. I was laughed at and then told that it would never work and that each provider is different and wants their patients to be their patients, etc. What was missing there though (that I DID not say) was that the patient's needs come last. Another argument was that if one doc was seeing them one time and another the next there would be less continuity. That might be true, but ... there is certainly not continuity at all if one has to see a different provider who you don't know and who is unfamiliar with the patient for care in a pinch.

This, btw, is exactly what happened. My husband called the clinic and spoke with the director. An email was sent out asking if a provider would be willing to see our son. We got a response back in the afternoon from the same provider who saw our daughter with something that ultimately turned out to be a fracture a few months back. A full-time mom MD.

I would argue that our practice definitely has a management issue. Since they are just about the only gig in town, they get away with it. On top of that, there are issues with figuring out how to go part-time and meet the needs of the doc and the patient.

=)

Kris

This is definitely a big issue, especially in primary care. Continuity is very important in primary care and is lost if a doctor works only a few days a week. I would like to go part time when I find someone to bring in, but would do it by working half days, not fewer days. That way, I would always be available for same day/emergency appointments.

It is not reasonable for someone to work the hours your pedi works and not allow you to see another doc in the practice when she is not available. Children do not get sick from 9-5 3 days a week. They need more consistant availability.

What you have brought up is the basis of the question of part time docs to begin with. Where is the balance between the doc's need to "have a life" and the patients care?

I think the failure in this situation is the system's failure to appropriately incorporate part time physicians into the practice. It is not the fault of the physician who has negotiated a part time practice arrangement. Remember, this physician is being paid less than a full time physician, perhaps even less than expected on a proportionate basis (ie half time physicians often make less than half a full time physician does). So, she is being reimbursed (proportionately?) for the work she does.

To me, this experience of yours, mommd2b, shows poor management on the part of the practice as a whole. Not sure if your children's primary care doc is a partner in her practice, but the partners/managers have not done a good job here. A part time physician is NOT the same as a full time physician and coverage needs to be ensured for those days that physician is not in the office. In my practice (I am a half time pediatrician), my patients receive very good coverage by my partners when I am not in the office. They are NEVER told they need to wait until I am available, they may see another physician for physicals, urgent visits, or even coordination of care if they desire. This is just how my practice has always operated. It is a large group (ten docs and two NP's between two offices) so the patients are used to seeing a variety of providers. In fact, they seem to prefer the convenience factor to the continuity of care factor, which I do not feel always provides the best care, but it is up to the family to choose whether they want to wait until their preferred physician is available or come in when it is convenient for them. I cover my partners' patients the same way they cover mine. My practice is open four nights a week and every Saturday and Sunday, in fact we are only closed two days a year (Christmas and Thanksgiving). So, you can see, there are many, many days and evenings when our patients do NOT have their personal physician in the office, even when that person is a full timer.

I think putting down part time practice as a whole is the wrong response. The failure here is that the PRACTICE has not adjusted appropriately to having part time providers. It is possible to do, and do well.

Please speak with your children's physician about your concerns. You have known her many years. You would want your patients to come to you with concerns like this.

Just want to add, that of course I would prefer to be the one to see all of my patients for all of their needs, and that I would much rather work for a smaller, more intimate practice. However, I realize that this is not easily conducive to my reduced work schedule. So I have made a compromise in working for this larger group. I have chosen flexibility over my career goals. It works, but this is because of the structure and philosophy of this particular practice.