The Work Week... Reinvented

Working Less Than Full Time Is Not for Everyone, But It Is for Me

Monisha M. Vora, MD

It’s early Friday morning. I get myself ready, walk to my daughter’s bedroom, and begin her morning routine with her. My son calls out to me from his room. He knows I am nearby and insists on screaming at the top of his lungs to make his presence known. I take him out of his crib, change his diaper, and bring him downstairs, where my husband has a plate of waffles and plenty of maple syrup ready. The kids eat while my husband and I catch up with each other. After breakfast, I walk my daughter to school. The rest of my day is taken up with errands, a workout, making dinner, and child care. This day would not be possible without my 4-day work week.

NOT FOR EVERYONE

Working less than full time is neither possible nor desirable for everyone. The model, moreover, will not suit every private practice or academic institution. Finances, the rising cost of living, familial support, and a partner’s or spouse’s job demands largely dictate whether working less than full time is an option. I also doubt that employers will change their hiring patterns for physicians.

My purpose in writing this article is to highlight how flexibility in my professional life has allowed me to be more present in my personal life. It has improved my quality of life, reduced my potential for burnout, and permitted me to design a life I always imagined leading. I hope my experience provides inspiration and courage to colleagues who are negotiating their first formal positions out of training and those at a later stage of their careers who are ready to ask for what they want and need.

I also know several clinicians both in- and outside of ophthalmology who have either started with or transitioned to schedules that are less than traditional full time; their comments can be found in the accompanying sidebar on the previous page.

WHY 4 DAYS?

Conversations about the 4-day work week became popular during the COVID-19 pandemic. Advocates suggest that, when implemented, worker satisfaction and productivity increase. The experiment has already been successful in some European countries. Dozens of UK companies that conducted a 6-month trial of the 4-day work week planned to make the shorter work week permanent. The pilot programs, launched in June 2022, demonstrated success in measures of financial productivity and overall employee wellness.¹

Juliet Schor, an economist and sociology professor at Boston College, leads research at 4 Day Week Global, a not-for-profit community responsible for initiating many of the pilot programs launched in the United Kingdom as well as in the United States, Canada, Australia, and New Zealand. One of her objectives is to determine the feasibility of reducing work hours. In an interview with NPR, Ms. Shor described an experiment in which nurses in Sweden shifted to 6- versus 8-hour days. The nurses were happier, but extra staff had to be hired to cover the hours. A lot of the additional salary costs, however, were offset by lower health care costs and unemployment for the existing workforce.²

MY EARLY EXPERIENCE

When I negotiated my first contract out of fellowship, I requested a 4-day work week of my future employer. I was 29 years old, married, and had no children at the time. Colleagues who had already entered practice urged me to consider a 4-day work week immediately because they knew firsthand how hard it is to scale back your days later. I told my future employers that this request was at the top of my list.

Being married to another physician means we both have demanding schedules and must manage our time effectively. My husband had been in practice as an emergency medicine physician for a few years before I finished my training; he was already working full time. I knew that securing flexibility in my own schedule would benefit our personal lives greatly.

As I prepared to write this article, I reached out to Michael Johnson, an attorney from Wisconsin who specializes in physician contracts (check him out on Instagram @physiciancontracts). He encourages physicians to negotiate a 4-day work week into their contracts. “It is highly likely that your employer will allow you to expand in the future but may push hard on you to not reduce your work time,” he told me. “Your best leverage to obtain a specialty schedule is before you sign your first contract.”

Mr. Johnson, who is married to a physician, has experienced how a 4-day work week helps support his spouse’s freedom and flexibility. He encourages physicians to explore different compensation structures, such as having a mix of W2 and 1099 income because it “opens up more options for tax-advantaged retirement accounts and diversification of income streams.”

MY RECENT EXPERIENCE

I recently joined a different practice. When negotiating my contract, I stated that I would likely join the practice only if my 4-day work week were maintained. The proposition represented a cultural shift for them; I would become the first physician to work less than 5 days a week. Thankfully, I received the full support of the managing partners. Moreover, they offered the option to any of the other physicians who desired to make the change.

Based on my experience, I encourage young physicians who are evaluating their first employment contracts and are interested in flexible schedules to negotiate for a reduced work week earlier rather than later. You won’t know if you don’t ask.

Imbalance Helped Me Find Work-Life Balance

Blake K. Williamson, MD, MPH, MS

I have always thought that work-life balance was an impossible goal for someone in my shoes, and I am not complaining. I am the managing partner of a large practice with eight locations, 20 doctors, and 192 employees and a co-owner of our ambulatory surgery. I am also a high-volume anterior segment surgeon who performs 75 to 100 procedures a week. When I get home from work, I am a father and a husband, and I have Zoom calls, webinars, consulting hours, and commitments to write articles like this one on my schedule. Maybe on the weekend is when I will have time for myself. The problem is I seem to travel every other weekend to speak at various ophthalmic symposia around the world or visit with industry members trying to launch new technologies.

When my senior partner started to take more time off and I began to increase my surgical volume about a year ago, I decided my weekly schedule had to change for me to sustain my productivity. Management gives all our doctors one half-day off per week for personal time, but I had not availed myself of this offering in the past. I had become far busier, however, than I had been a few years ago, and I had three young sons at home. I was (and still am) out the door to surgery before the boys wake up and back home as they are bathing before bed. I felt I needed to do better for my family.

After reading a couple of books and listening to countless TED talks on the subject, I elected to try a 4-day work week. I no longer see patients or perform surgery on Fridays. Instead, I work from home. My core team that travels with me to our different office locations also works from home on Fridays.

A LIFE-CHANGING EXPERIENCE

At least 1 day each week, I get to wake up and have coffee with my wife, fry eggs for my boys, and drive them to school in my 1977 Ford Bronco while blaring “Great Balls of Fire” (Figure). It’s awesome, and they love it. I get some work done at home on the computer and then do yoga with my wife and take her out to lunch. In the afternoon, I typically edit some surgical videos and do some journaling/meditation about my business before picking the boys up from school. We listen to the Top Gun theme song on the drive home.

The scheduling change has not harmed my surgical volume or production. My scribes and technicians come to work energized each Monday morning because they have had 3 full days off.

CONCLUSION

It has been possible for my team and me to get our work done in 4 days with the right game plan. At times, it can be stressful in the clinic because we are squeezing 5 days’ worth of work into 4, but we accept that. We work hard, and we try to have a great time when we are not working.

Being totally imbalanced helped me to find work-life balance.