In theory, the broad scope of family practice ensures comprehensive and continuous patient care, but in reality, many family physicians are now limiting their hours and restricting their practices to the office setting. They’ve relinquished hospital, nursing home and home care services for valid and complex reasons, including the need to protect their personal lives. In some cases, the result has fragmented care, stressed the doctor-patient relationship and placed heavy productivity demands on physicians, who must provide a high number of office visits to meet the high overhead costs typically associated with family practice.

Family physicians who want to provide comprehensive patient care without having to sacrifice their personal lives would do well to consider job sharing as an alternative to the traditional practice model. Our experience sharing positions with others in academic and private practice settings helped us to develop a job-share model that provides patients with an unbroken “circle of care,” encompassing the office, hospital, nursing home and patient’s home. The model also contributes to the practice’s bottom line by generating up to 50 percent of practice income from services provided away from the office, which reduces costs. Here’s how it works.

Reinventing the circle

Our job-share model requires two or more physicians to link their skills, energy and time to provide comprehensive care to patients. Ideally, the physicians should share more than just patient care responsibilities. For the arrangement to work best, the physicians should also share similar competencies and a common patient care philosophy. These characteristics will help to facilitate the careful communication that cross-coverage requires and may also help patients accept the job sharing physicians as interchangeable.

The original concept for job sharing is two part-time physicians splitting the workload of one full-time physician. Expanding that concept to include more physicians isn’t difficult and may increase the likelihood of success. "Job-share models" provides multiple examples of job-share arrangements that cover the circle of care.

Benefits

Professional. The benefits of a job-share arrangement like ours include continued professional growth and increased patient satisfaction. For example, most physicians who want a more manageable work schedule opt to limit their hours or scope, or both. But because our job-share model incorporates the full circle of care, part-time physicians continue to use the full range of their clinical skills (including obstetrics) and maintain their hospital privileges. Physicians who have let their hospital privileges lapse know too well how difficult they are to obtain again.

Patients benefit from increased access and continuity of care. In our model, physicians who job share don’t have to block out time on the office schedule to do rounds. Instead their job-share partner is delivering the baby or seeing the patient in the hospital and the office is kept open, giving patients greater access. Patient satisfaction increases because the wait for an office visit isn’t as long. And, should the patient be hospitalized or placed in a nursing home, they’ll still be seen by their physician or someone else in the practice, not a hospitalist or another physician they don’t know.

Personal. Another benefit of our model is the opportunity to structure a work schedule that balances one’s professional commitment to providing quality, comprehensive patient care with one’s personal priorities. Physicians who job share have more flexibility and better control over their schedules. For example, part-time physicians in a three-physician model could opt to compress their workweek into 2.5 days instead of spreading the hours over five days, except of course during weeks when they are scheduled for rounds and after-hours call. To that end, physicians entering into job-share arrangements should be up front with the others involved about the number of hours they are willing to work.

Drawbacks

Cross-coverage and communication can be particularly challenging in a job-share arrangement. Using a pager to keep in touch with the physician providing off-site care may simplify communication. Faxing standard forms with brief admission/discharge/transfer/procedure/change-of-status information between alternate care settings and the physician’s home or office may also enhance continuity. E-mail and personal digital assistants also facilitate communication about patient care.

Cross-coverage and communication also become more complex as more physicians are involved. When too many physicians are part of a job-share arrangement, it may actually inhibit continuity of care. The benefits of job sharing are greatest when three or four physicians are involved. When more than six physicians are in the mix, managing the job share becomes unwieldy and patients begin to get confused.

Another potential drawback is that some physicians are concerned about their skill levels diminishing if they work less than full time. This isn’t an issue with the job-share model presented here. Because physicians alternate between working in the office and in other care settings, they have ample opportunity to use a full range of clinical skills.

Finally, it’s very likely that physicians who job share will encounter patients who are reluctant to see anyone but their personal physicians. Some of these patients may eventually leave the practice. However, it’s more than likely this loss will by offset by other patients who want the convenience of increased access.

The bottom line

The fixed overhead costs for a typical family practice are enormous. According to the MGMA Cost Survey: 2001 Report Based on 2000 Data, the median overhead costs for a family practice equal approximately 56 percent of total medical revenue. Our job-share model can reduce these costs from 10 percent to as much as 40 percent depending on the number of physicians involved and the volume of outside services they deliver. Although services rendered by physicians working outside the office do involve some costs to the practice (e.g., billing support, transportation costs and malpractice insurance coverage), they are generally much lower than the direct overhead costs associated with an office-only practice.

Midlevel office visits generate relatively low reimbursement and may be among the most costly and labor-intensive service family physicians provide. At a minimum, such visits require office space and equipment, staff and a provider. In our model, since physicians are never in the office simultaneously, less office space and staff are needed. For example, in a two-physician job share arrangement (see Model 1 in "Job-share models"), support staff are needed only during the mornings when a physician is in the office. And even in larger job-share arrangements where the office is open all day, physicians who work in the office during the morning can share staff with physicians who work in the office during the afternoon.

In our experience, the job-share model generates more than 50 percent of the practice’s revenue away from the office, further enhancing the bottom line. For an example of how income in a job-share practice compares with that of an office-only practice, see the table below.

Coming full circle

Family physicians today are struggling to retain their identity, core values and financial viability. To a certain degree, providing a broad scope of services to patients of all ages still ensures us a bright future, but at what personal cost? For some physicians, providing the full circle of care independently has become too difficult. Job sharing is one way to provide comprehensive care while maintaining life balance. Physician benefits are numerous, including a competitive salary and the opportunity to maintain a wide range of clinical skills without working long hours. And patients still receive the continuity of care they’ve come to expect from our specialty. Through job sharing, family physicians can shape their careers without compromising themselves or their patients.