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Hi Everyone,

I'm wondering if anyone can provide insight to the flexibility of lifestyle for attending physicians? For eg, the attending general surgeon at a hospital, or an attending cardiologist, are they able to take vacation/time off based on their own preferences? There are a few things I would like to clarify: this question is more focused towards physicians on a fee-for-service model, I understand the less you work, the less you get paid (ie financial incentives are a separate issue), and I'm assuming these physicians cover the mandatory call schedule that is set by their group.  In other words, can attendings pick how much time off they get and when they want it? Are they allowed to work part-time? Thanks!

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Unfortunately, this question cannot be answered in a general manner. It will vary widely based on what specialty, inpatient/outpatient, rural/urban, specific province, billing model as you note, and specific contract. If you are in a discipline that doesn't require hospital privileges you can just show up and hang a shingle doing fee-for-service as you say, and start seeing people on whatever hours/schedule you like (with the caveat of maintaining professional responsibilities, ie. finding locum coverage if you establish an ongoing care relationship then decide to take a 6 month sabbatical, etc.).

Alternatively you can join a practice group that will have a contract that will dictate vacation/schedule etc. and whatever that contract says will be your limitation. Or, if you're more hospital based, you work for a hospital group or health authority, depending on the province, and your contract with them will dictate how much and how vacation/hours are scheduled, as well as call. As an example, a general pediatrician who does inpatient coverage typically will also do some outpatient as well. Depending on the city/hospital, they could have a contract that dictates how many weeks a year of inpatient/call coverage they do, as well as how many hours of clinic a week, how much academic/research time, etc. They would work within their group to request time off in whatever system they used. This will vary, as non-tertiary care centres they may also be on home call as frequently as 1 in 3 nights for neonatal or ER coverage. Some places you have a contract with the hospital/health authority for a specific number of weeks of inpatient coverage but outside of that your time is your own and you can have a private outpatient clinic with your own hours/schedule, etc.

In the pediatric context, if you really desire flexibility, you could just do outpatient clinic exclusively. This may (or may not) mean that you make less money, relatively, and have less avenue for research/academic career progression, but that that trade off is up to you. I think this holds true for most non-hospital based disciplines, like a cardiologist can just have an outpatient practice but if they want to do inpatient coverage or have access to do interventional cardiology then they will have to have a relationship with a hospital and contract that will somewhat limit their freedom. If you're a surgeon or anesthesiologist or ER doc then of course you won't really have an option to set your own schedule, but how flexible the schedule is will be based on the specific hospital/region/contract.

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12 hours ago, bearded frog said:

In the pediatric context, if you really desire flexibility, you could just do outpatient clinic exclusively. This may (or may not) mean that you make less money, relatively, and have less avenue for research/academic career progression, but that that trade off is up to you. I think this holds true for most non-hospital based disciplines, like a cardiologist can just have an outpatient practice but if they want to do inpatient coverage or have access to do interventional cardiology then they will have to have a relationship with a hospital and contract that will somewhat limit their freedom. If you're a surgeon or anesthesiologist or ER doc then of course you won't really have an option to set your own schedule, but how flexible the schedule is will be based on the specific hospital/region/contract.

Out of curiosity, would you be able to take 6 months off at a time without a locum as a pediatrician?

 

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The issue is mostly for follow ups. Obviously you can stop accepting consults at any time but once you see someone you owe them a duty of care with an ongoing relationship if there's something that requires following up. If you know a year in advance you can only accept referrals that are unlikely to need follow up, or you can refer to other pediatricians for follow up, but like there's usually patients with chronic conditions like NF or T21 who need to be seen somewhat regularly and often its the pediatrician doing the care coordination which makes things difficult. To be fair it is rare for a pediatrician to work alone (the overhead is a lot cheaper if sharing office/staff/equipment), so it doesn't really come up much, and the requirements are different from the province/CMPA in terms of ethical expectations if its a short notice LOA for a health problem, for example. I do know a few pediatricians and pediatric subspecialists that took year long sabbaticals to work overseas in agreement with their group/hospital, so it happens.

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  • 2 weeks later...
On 2/15/2021 at 10:35 PM, MDinCanada said:

Out of curiosity, would you be able to take 6 months off at a time without a locum as a pediatrician?

 

If that is your plan I would just provide locum coverage for other pediatricians who are taking their various breaks and vacations.

Most flexibility in lifestyle across specialties is going to be a multi-practitioner outpatient practise, so that your folks have coverage in your absence.

As soon as you add in hospital anything, things get trickier for long breaks unless you have some arrangement sorted out (sabbatical, etc).

 

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