Job-sharing 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 practise 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 most common 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 practised, and, given that they all had full practices, it would likely mean an unacceptable increase in the number of patients without family physicians. The loss of those patients to the family health team (FHT) would result in a considerable decrease in the FHT’s roster numbers. At the same time, both of the traditional approaches would mean a substantial change in income, both in overall amount and in predictability.

Coincidentally, Celeste, a colleague with the same FHT, wished to decrease her clinical load to gain more time for her family and other interests. Celeste was 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 …” which eventually led them to an elegant solution.

Both doctors had large practices. They decided that they would each cut back their patient numbers to a level such that the total number of the combined practices was manageable by 1 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. Bob and Celeste then agreed to cover each other’s reduced practice on alternate months, resulting in half-time practices for both. Patients remaining in their practices were assured of coverage at all times through the year, with no holiday gaps. Those patients “released” from their practices were assured a new family physician if they so chose. More important, both physicians managed large inpatient loads at the local hospital and the care of these patients continued seamlessly. The hospital board agreed that Bob and Celeste could job share the chief of staff position.

We have now been practising in this way for 9 months. Most patients have accepted this solution happily, as we are both well-known physicians in the community. Sacks et al note from their literature review that “creating a successful job share requires trust, open communication, and shared beliefs.”¹ 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 (eg, laboratory results, paperwork, insurance forms, messages) is complete. We share available office appointment slots equally between the 2 practices. We each take ownership of the various challenges of the chief of staff position, copying each other on important e-mail messages. As often as possible, only one of us attends meetings.

We have learned a lot over the past months, and would endorse the list of recommendations by Sacks and colleagues.¹ 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 the hospital staff 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.