White Coat, Black Art

Part-time doctors defend their work: 'It doesn't make us any less valuable'

Not many doctors plan on working part-time. But more are choosing to do so. This week, Dr. Brian Goldman speaks with two part-time doctors who explain their choice.
Dr. Michelle Cohen at her family practice office in Brighton, Ont. Cohen said non-MDs using terms such as 'family medicine' is 'deceptive' to patients. (Submitted by MIchelle Cohen)
Listen to the full episode26:29

Few doctors plan for a future that involves part-time work while they're in the throes of a gruelling medical school education, but even then, Michelle Cohen knew it would be a part of her plan at some point down the line.

"I never really wanted to be — especially with a young family — to have that kind of 60-plus-hour-a-week work," Dr. Cohen told Dr. Brian Goldman, host of White Coat, Black Art.

The 30-something family physician in Brighton, Ont., shares a practice with a semi-retired doctor who wanted to reduce his hours. The arrangement lets her spend time caring for her three children.

"I don't want to push myself to that extent and not be a part of my family life and not enjoy my life now that I'm finally out of school," said Cohen, who worked full-time work previously when her husband took parental leave.

Dr. Michelle Cohen, shown with her three children, says working part-time allows her to spend more time caring for her family, but it's a constant juggling act. (Submitted by Michelle Cohen)
Part-time work is becoming a fact of life in Canada. A recent look at job stats shows that the greatest number of positions being created are part-time. It's something we accept when it comes to our supermarket cashiers, nurses and even our children's teachers.

But it's also becoming more common among doctors.

An estimated 15 per cent of physicians work part-time, some as a means of reducing burnout. Others, like Dr. Michelle Cohen, planned for it.  

Dr. Michelle Cohen says when she teaches residents, she speaks to them about what it's like to be pregnant while training and about working part-time. (Submitted by Michelle Cohen)

'Part-timer guilt'

Cohen said her decision to go part-time was easy, but it still came with some baggage, which she labels "part-timer guilt."  

You take up a spot [in medical school], and then you go and you have a baby, and then you spend time with your baby that you should be spending with your patients.- Dr. Michelle Cohen, talking about the attitude of some of her colleagues to doctors who work part-time 

"It's that sort of message that I've received: You take up a spot [in medical school], and then you go and you have a baby, and then you spend time with your baby that you should be spending with your patients," she said.

While no one has directly accused her of being a "slacker," she believes part-time doctors were unfairly targeted in a recent letter in the journal Canadian Family Physician, written by a retired doctor.

The letter suggested part-time doctors should pay extra for medical school, that they work a 15-hour week for "lifestyle" reasons, and aren't serving their patients well.

An excerpt from the letter published in the journal Canadian Family Physician:

Many GP-FPs, male and female, seem to focus on not working more than 15 to 20 hours a week to maintain a lifestyle! It does not seem appropriate for Canadians to share the financial cost of their medical education. Perhaps those who wish to practise outside of Canada or work only 15 to 20 hours a week should pay the real cost of their education (presumably considerably higher than current medical tuition fees). Those willing to work 35 to 40 hours a week in Canada, with six weeks of holidays and two weeks of refresher courses a year, could pay greatly reduced medical student fees with the obligation to practise as FPs in underserviced areas (like Woodstock, Ont., which is hardly remote) for five years. Those physicians who derive very high incomes, along with other Canadians who make more than $200,000 a year, would be taxed at higher rates to pay for medical education and other essential services in a functioning democracy.

Cohen took to Twitter to respond, explaining what her work week involves: looking after children, her home, teaching and working with the local public health unit as well as remotely on days off.

"I tweeted about it because it occurred to me … that this is so ridiculous," she said.

"To say that the only meaningful work that I'm doing is the work that I do when I'm in my office seeing patients and the rest of it is just kind of a joke … [it's] really insulting."

Working part-time as doctors 'doesn't make us less valuable as workers' 1:03

"It comes off as quite sexist because this is traditionally woman's work. Just because … in the '60s and '70s … you were able to just let your wife handle all of that stuff while you devoted yourself to full-time office practice and then some doesn't make [my work] any less work or any less meaningful or any less important."

She believes her patients are well-served by the shared practice.

"Our pretty large shared practice still has somebody in the office every single day and still has somebody meeting those needs, which is not something that every full-time practice is able to do."

Dr. Michelle Cohen responded via Twitter to a letter written to a medical journal about doctors who work part-time. (CBC)

Part-time work as a remedy to burnout

Dr. Frank Warsh also wanted to give his patients the best care he could when he was a full-time family physician in London, Ont.

But after suffering a hip injury and becoming overwhelmed by the demands of the work, he knew he was depressed and on the edge of burning out.

Dr. Frank Warsh, shown with his family, moved from working as a full-time family doctor, to part-time coroner, in part to help raise his family. (Submitted by Dr. Frank Warsh)

"There comes a point where you sort of have to admit to yourself, I can keep plugging away at this and make myself miserable, make my family miserable and not really serve my patients to the best of my abilities,"  said Warsh, who admitted to having thoughts about faking his own death just to leave his practice.  

"I finally said, 'You know what, I can't do this. It's either leave or become an alcoholic.'"

I finally said, 'You know what, I can't do this. It's either leave or become an alcoholic.'- Dr. Frank Warsh

He said much of his stress came from bringing home the issues his patients were facing around "social diseases" like addiction and trauma, and being unable to "fix" them.

As he detailed in his book, The Flame Broiled Doctor: From Boyhood to Burnout in Medicine, he gave up his full-time position and switched to working as a part-time coroner.

Dr. Frank Warsh wrote about his experiences as a family doctor and reaching a crisis point in his book, Flame Broiled Doctor: From Boyhood to Burnout in Medicine. (Submitted by Dr. Frank Warsh)

A recent survey by the Canadian Medical Association found that one in four doctors reported suffering from some form of burnout.

A new generation of MDs

Warsh said part-time work can be one way to address the issue, adding he's "past the point" of being insulted by anyone who thinks part-time doctors contribute to the shortage of family doctors in Canada.

"If there's any thought that you know we're trying to eat bonbons [and] make a certain amount of money and live the life of Riley, I don't know any doctor that does that, that wants to do that, that would take any pride in that."

Cohen agreed.

"If we have a problem of not enough resources in our rural areas and in our northern regions … that is not because the individual practitioners are just not working hard enough. You can't patch those holes with a few heroes who are going to work so much that they neglect themselves," she said.  

Both are happy to be a part of a new generation who wants to usher in a more humane way of practising.

"Just because we're in this generation choosing to do it in a different way doesn't make us less valuable as workers," Cohen said.

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