How to get a part-time job in medicine

I got married near the end of my last year of residency. When I started medical school, in fact when I started residency, I hadn't yet even met my husband, and I didn't have any of the 3 kids I now have. That's probably a good thing because I would surely have talked myself out of the specialty I really loved into something more "family-friendly". There's nothing wrong with family-friendly, mind you. I always read the classified ads in the New England Journal just out of curiosity, wondering whether there are more part-time jobs cropping up as women, who more often work part-time than men in general, represent a greater share of young doctors. So far, I don't think much has changed in the job advertising sphere.

When I happen to have a bad day at work, which is fortunately rare, I permit myself to back up and take a different fork in the road. In my alternate life, maybe I became a dermatologist, where "full-time" seems to be 4 days a week...but who works full-time anyway? Or infectious diseases, where every other ad seems to start "Full-time or part-time". Ah, travel clinic...seeing some healthy people and getting them ready to travel to exotic locales. Lest fear of boredom be a factor, keep in mind that the occasional traveler will come home with a fever of 40.8--is it malaria? Dengue fever? Ebola? See, that would spice things up. And clinic finishes at 3p.

But snap out of it. I became a medical oncologist, had my first baby midway through my second year of fellowship, another baby at the end of my third year, and a third baby about a year and a half into my first "real job". At some point in late second year when other fellows were beginning to do their job talks and interviews, it dawned on me that I didn't want to be away from my son and his future sibs for 60 hours a week. I didn't want to miss first steps or first words or first anythings. It didn't feel right to me that someone other than me--indeed, someone I hadn't even met yet--would be there for more of my kids' waking hours than I would, and that's exactly what working full-time meant.

I starting looking through journals, online, anywhere for part-time medical oncologist jobs. Zip. Zero. Nada. I even tried monster.com, and all I got for combining "part-time" and "oncologist" is: Busy oncologist seeks part-time front office staff. Bummer. Oh, and did I mention that I had kind of subspecialized to one particular type of cancer. And can't move out of the area because my husband is in the military, unless they tell us to move, in which case I have to pick up and leave instantly. When I told people that I wanted to work part-time, and no I didn't want to just take a hospitalist job, and no I didn't want to work in an urgent care, and no I didn't want to review charts for utilization management or do life insurance physicals for a living, and yes, I did plan to work as a doctor, and yes, I did plan to work as an oncologist, and yes, it had to be in this area, they just looked at me with some blend of pity, empathy, disbelief, disdain, and said, "Well...good luck."

Six months later, I was agonizing over my choices: one job working 3 days per week as an academic oncologist, one job in private practice oncology working 2-3 days per week, and one job in oncology public health/health policy working anywhere from 2-4 days per week. All of them were within 30 mins of my house. All of them were in the particular subspecialty of medical oncology that was my interest. None of them was advertised. None of them existed when I interviewed. So, what's the deal?

If you happen to fall in love with a specialty of medicine that doesn't bear the family-friendly label, here are your career choices at the end of your training, assuming you aren't willing to compromise on the family side:

1. Let this specialty be the one that got away and pick something that's more family-friendly.
2. Train in your specialty, but work in a more general field with your specialty as your area of expertise (e.g. take a part-time internist job with an interest in pulmonary disease--a big group private or academic practice may be glad to have one internist who likes to see all of the asthma and COPD folks, there are plenty of them, and is comfortable with critical care if patients get admitted to an ICU).
3. Move beyond the standard black or white career paths--academic or private practice--and look at jobs in the government (FDA, NIH, CDC, etc), public health, the pharmaceutical industry, hospices, and so on, many of which are more amenable to part-time employees.
4. Interview for your dream job, whether academic or private practice or whatever, and give them enough time to decide you are their dream candidate. When they start trying to recruit, play your part-time card. Most will use salary or benefits to try to sweeten the deal. What you want is flexibility or fewer hours or whatever it is that you want. Take a deep breath, picture your kids clinging to your leg as you try to leave for work in the morning, and then speak up without apology. You will surely benefit from a part-time job if that's where your heart is, but there are also benefits to the employer, and you should point them out: cost savings (part-time employees generally accomplish more on a per hour basis than full-time employees and generally cost their employers less in benefits because fewer benefits are provided), greater loyalty (from grateful doctor-moms such as yourself who are committed to making part-time work work) and therefore less employee turnover, improved staff morale, and fewer absences from work (you can schedule the kids' well-child visits and your tooth cleaning on your days off, and , if you're lucky, some of their colds and vomiting illnesses might even occur on your days off). You will likely be pleasantly surprised. I interviewed for all of the jobs I mentioned above, and they were all full-time. After I made my priorities for recruitment known, all agreed to work with me to tailor a part-time arrangement. In the end, I actually created a hybrid of 2 of the part-time jobs I had negotiated, working a total of 3 days per week, and it has been wonderful.

Bottom line: If you assume it will be impossible to find a part-time doctor job in your specialty, it will be. If you assume it will be possible, then it will be.