Are 2 heads better than 1?

The article by Sacks et al in the January 2015 edition of CFP highlighted what we think may be a growing trend in our profession as baby boomers age, and younger physicians try and find new and creative ways to balance professional and personal demands on our time and energies. We feel it is important that readers not in academia consider similar solutions and so present Bob and Celeste's Story.

Bob and Celeste's story

Two years ago Bob was approaching the traditional age for retirement and it was clear to him that he was not interested in continuing to practice with the same intensity as had been his pattern for the past 40 years. As a community family physician with a large practice he decided that neither of the commonest solutions to this problem - complete retirement or doing locums for others - were attractive. Complete retirement would place a huge burden on his colleagues in the small rural community where he practiced, and given they all had full practices, would likely mean an unacceptable increase in the number of patients without a family physician. The loss of those patients to the family health team would result in a significant decrease in the FHT's roster numbers. At the same time both of the traditional approaches would mean a significant change in income, both in overall amount and in predictability.

Coincidentally, Celeste, a colleague in the same family health team, wished to decrease her clinical load to gain more time for her family and other interests. Celeste was the Chief of Staff at the local hospital, a position Bob had held for a number of years previously. They began a conversation that started with "wouldn't it be nice" and eventually led them to an elegant solution.

Both doctors had large practices. The decision was made that they would each cut back their patient numbers to a level such that the total number of the combined practices was manageable by one physician. This was made much more attractive by the fact that a new physician was scheduled to open a practice in the community and agreed to take on all of the patients released by both Bob and Celeste. We then agreed to each cover the others' reduced practice alternate months resulting in half time practices for both. Patients remaining in our practices were assured of coverage at all times through the year, with no holiday gaps. Those patients "released" from our practices were assured a new family physician if they so chose. Importantly both of us managed large inpatient loads at the local hospital who would continue to be cared for seamlessly. The hospital board agreed that we could job share the Chief of Staff position.

We have now been practicing in this way for 9 months. Most patients have accepted this solution happily as both physicians are well known in the community. Sachs et al note from their literature review that "creating a successful job share requires trust, open communication, and shared beliefs". To this list we would add a common work ethic and practice style. Each of us strives to ensure that at the end of our work month all administrative work (labs, paper work, insurance forms, messages) is complete. We share available office appointment slots equally between the two practices. We each take ownership of the various challenges of the Chief of Staff position, copying each other on important emails. As much as possible only one of us attends meetings.

We have learned a lot over the past months, and would endorse the list of tips set out by Sachs et al. We have managed to work half time and our income is settling in at roughly 50% of what we earned previously. Our patients, colleagues and hospital are pleased with our arrangement thus far. We recommend consideration of a similar solution to community family physicians who have need of greater time away from their practices for whatever reason.

Conflict of Interest:

None declared