Hilit F. Mechaber

Part-Time Physicians…Prevalent, Connected, and Satisfied

ObjectiveThe health care workforce is evolving and part-time practice is increasing. The objective of this work is to determine the relationship between part-time status, workplace conditions, and physician outcomes.DesignMinimizing error, maximizing outcome (MEMO) study surveyed generalist physicians and their patients in the upper Midwest and New York City.Measurements and Main ResultsPhysician survey of stress, burnout, job satisfaction, work control, intent to leave, and organizational climate. Patient survey of satisfaction and trust. Responses compared by part-time and full-time physician status; 2-part regression analyses assessed outcomes associated with part-time status. Of 751 physicians contacted, 422 (56%) participated. Eighteen percent reported part-time status (n = 77, 31% of women, 8% of men, p < .001). Part-time physicians reported less burnout (p < .01), higher satisfaction (p < .001), and greater work control (p < .001) than full-time physicians. Intent to leave and assessments of organizational climate were similar between physician groups. A survey of 1,795 patients revealed no significant differences in satisfaction and trust between part-time and full-time physicians.ConclusionsPart-time is a successful practice style for physicians and their patients. If favorable outcomes influence career choice, an increased demand for part-time practice is likely to occur.

A good career choice for women: Female medical students' mentoring experiences: A multi-institutional qualitative study

Purpose The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students. Method In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students’ mentoring relationships and the impact of gender on those relationships. Results The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students’ thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power. Conclusions Gender appears to play a role in female medical students’ expectations and experience with mentoring relationships and may influence their decision making around career planning.

Professional Characteristics and Job Satisfaction Among SGIM Members: A Comparison of Part-time and Full-time Physician Members

BACKGROUNDAs more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians.OBJECTIVECompare factors associated with job satisfaction among PT and full-time (FT) academic physicians.DESIGNCross-sectional survey.PARTICIPANTSMembers of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.RESULTSFifty percent (1,396 of 2,772) of SGIM members responded, 11% work PT. Compared to FT, PT physicians were more often female (85% vs 38%, p < .001), clinicians (Cs) or clinician–educators (CEs) (84% vs 56%, p < .001), and of a lower rank (77% vs 61%, p = .001). Job satisfaction was similar between PT and FT Cs and CEs. For PT Cs and CEs, record of publication (11% vs 21%, p = .04) and local and national recognition (24% vs 36%, p = .03) were less important to overall job satisfaction compared to FT Cs and CEs. In multivariate analysis, academic rank (odds ratio [OR] = 7.18, 95%CI = 1.40–36.50) was associated with higher satisfaction among PT Cs and CEs.CONCLUSIONSPT and FT C and CE SGIM members report similar satisfaction, but different factors contribute to satisfaction. Knowing what motivates and satisfies PT physicians may allow medical centers to retain faculty and create positions to help them to fulfill their potential.

Lifestyle factors and primary care specialty selection: comparing 2012-2013 graduating and matriculating medical students' thoughts on specialty lifestyle.

Purpose To compare how first-year (MS1) and fourth-year students (MS4) ascribe importance to lifestyle domains and specialty characteristics in specialty selection, and compare students’ ratings with their primary care (PC) interest. Method In March 2013, MS4s from 11 U.S. MD-granting medical schools were surveyed. Using a five-point Likert-type scale (1 = not important at all; 5 = extremely important), respondents rated the importance of 5 lifestyle domains and 21 specialty selection characteristics. One-way analysis of variance was used to assess differences by PC interest among MS4s. Using logistic regression, ratings from MS4s were compared with prior analyses of ratings by MS1s who matriculated to the same 11 schools in 2012. Results The response rate was 57% (965/1,701). MS4s, as compared with MS1s, rated as more important to good lifestyle: time off (4.3 versus 4.0), schedule control (4.2 versus 3.9), and financial compensation (3.4 versus 3.2). More MS4s than MS1s selected “time-off” (262/906 [30%] versus 136/969 [14%]) and “control of work schedule” (169/906 [19%] versus 146/969 [15%]) as the most important lifestyle domains. In both classes, PC interest was associated with higher ratings of working with the underserved and lower ratings of prestige and salary. Conclusions In the 2012–2013 academic year, matriculating students and graduating students had similar perceptions of lifestyle and specialty characteristics associated with PC interest. Graduating students placed more importance on schedule control and time off than matriculating students. Specialties should consider addressing a perceived lack of schedule control or inadequate time off to attract students.

Primary Care, the ROAD Less Traveled: What First-Year Medical Students Want in a Specialty

Purpose Medical students are increasingly choosing non-primary-care specialties. Students consider lifestyle in selecting their specialty, but how entering medical students perceive lifestyle is unknown. This study investigates how first-year students value or rate lifestyle domains and specialty-selection characteristics and whether their ratings vary by interest in primary care (PC). Method During the 2012–2013 academic year, the authors conducted a cross-sectional survey of first-year medical students from 11 MD-granting medical schools. Using a five-point Likert-type scale (1 = not important at all; 5 = extremely important), respondents rated the importance of 5 domains of good lifestyle and 21 characteristics related to specialty selection. The authors classified students into five groups by PC interest and assessed differences by PC interest using one-way analysis of variance. Results Of 1,704 participants, 1,020 responded (60%). The option “type of work I am doing” was the highest-rated lifestyle domain (mean 4.8, standard deviation [SD] 0.6). “Being satisfied with the job” was the highest-rated specialty-selection characteristic (mean 4.7, SD 0.5). “Availability of practice locations in rural areas” was rated lowest (mean 2.0, SD 1.1). As PC interest decreased, the importance of “opportunities to work with underserved populations” also decreased, but importance of “average salary earned” increased (effect sizes of 0.98 and 0.94, respectively). Conclusions First-year students valued enjoying work. The importance of financial compensation was inversely associated with interest in PC. Examining the determinants of enjoyable work may inform interventions to help students attain professional fulfillment in PC.

The impact of working part-time on measures of academic productivity among general internists.

BACKGROUND There is increased interest in part-time (PT) positions at academic medical centers (AMCs). Faculty and institutional leaders may have concerns about the potential for academic advancement among PT faculty. Our objective was to determine the impact of working PT on measures of academic productivity. METHODS A cross-sectional survey was mailed to PT and full-time (FT) physicians in U.S. divisions of general internal medicine. Outcome measures included publications and funding. We used multivariate analysis to identify factors associated with academic productivity. RESULTS The response rate was 63% (176 of 279); 91% of respondents were women (160 of 176). Compared with FT faculty, PT faculty were more often clinicians (Cs) or clinician-educators (CEs) (78% vs. 96%, p < 0.001), were less likely to be fellowship trained (44% vs. 23%, p < 0.001), and reported less academic support, including administrative assistance (84% vs. 67%, p = 0.008), mentoring (71% vs. 54%, p = 0.02), and research support (43% vs. 25%, p = 0.01). PT faculty spent a greater percentage of their time in patient care (55% vs. 45%, p = 0.01) and teaching (32% vs. 23%, p = 0.01) and less time in research activities (5% vs. 15%, p = 0.01) compared with FT faculty. Among Cs and CEs, FT faculty reported more publications (median 2, interquartile range [IQR 5] vs. median 0, IQR 1, p < 0.001) and funding (odds ratio [OR] 2.85, 95% confidence internal [CI] 1.36-5.98). Multivariate analyses showed that fellowship training, mentors, academic support, and number of total years worked were associated with publications and acquisition of funding. There were no associations between working PT and publications or funding. CONCLUSIONS PT faculty report fewer publications and grants. This may be related to insufficient training and academic support. AMCs wanting to facilitate the success of their PT faculty may need to expand the support available to them.

Having and Raising Children During Physician Training: Medical School

There is so much to consider when having and raising children during medical school, that the thought alone can be overwhelming. Some will come to medical school having already experienced the joys and challenges of motherhood but are about to see some of those stressors explode exponentially. As a student affairs dean for over 9 years and medical student mentor and advisor for almost two decades, I have advised and supported karthick many medical students who have successfully managed to have children during medical school. In this chapter, one of my former students Ashley shares her incredible story about managing all 4 years of medical school as a single parent by choice. Others, though, will want to hold onto the hopes of having control in planning for their futures. Why not? We are so used to meticulously crafting every next step of our personal and professional lives, so planning for children should not be any different. If planning is an option and in your favor, then timing of children in medical school can potentially make a big difference. Yet each woman is an individual, and factors important to one may be less important to others.