Abstract
OBJECTIVE. The goal was to monitor the number of pediatric residents seeking part-time employment after graduation and to examine the difficulty of their job searches, compared with residents seeking full-time employment.
METHODS. As part of the American Academy of Pediatrics Graduating Resident Survey, national random samples of 500 graduating, categorical pediatrics residents were surveyed from 2003 through 2005, between May and August of each year. Responses were pooled to examine resident interest in and experience with part-time employment. Totals of 308 (62%), 307 (61%), and 281 (56%) residents completed the survey in 2003, 2004, and 2005, respectively. Analyses focused on residents who applied for nonfellowship jobs.
RESULTS. A total of 51% of residents applied for nonfellowship jobs. Of those who applied for such jobs, 38% reported that they applied for part-time positions and 21% actually accepted part-time positions. Residents who applied for part-time positions were more likely to report moderate or considerable job search difficulty (part-time: 36%; full-time: 25%). The average starting salary for residents who accepted part-time jobs was almost $34000 less than that for residents working full-time (part-time: $71615; full-time: $105598). Residents who accepted part-time positions expected to work 15 hours less per week in practice (38 vs 23 hours) and were more likely to accept a position in the same city/area as their residency (part-time: 60%; full-time: 47%).
CONCLUSIONS. Approximately 4 of 10 pediatric residents seek part-time employment after graduation, and 2 of 10 accept part-time positions. Strong interest in part-time positions is likely to continue, and this important trend has implications for the pediatric workforce.
Part-time or reduced-hour employment has become an attractive career option for many professional women,1 including physicians.2–6 It should not be surprising that medical specialties with greater proportions of female physicians tend to have the largest numbers of physicians working in part-time or reduced-hour positions.7 In the United States, pediatrics is among the leading specialties in this regard, with >50% female active physicians and 69% female residents.8,9
In 2000, 15% of US pediatricians reported working part-time, and 44% of graduating pediatric residents were interested in arranging a part-time or reduced-hour position within 5 years after graduation.10 Female pediatricians were 7 times more likely than male pediatricians (28% vs 4%) to be working part-time and female residents were 3.9 times more likely than male residents (58% vs 15%) to be interested in working part-time within 5 years after graduation. The most common reason why women wanted to work part-time was to spend more time caring for their own children.
Growth in the number of pediatricians working part-time has important workforce implications for pediatrics. If pediatricians work fewer hours, then more clinicians may be needed to provide medical care for children. There remains disagreement about how great an effect this may have on the available supply of pediatricians.11,12 Increases in the number of part-time pediatricians also may affect the geographic maldistribution of pediatricians,13 if part-time pediatricians are less likely to locate in underrepresented areas.
In this article, we examine part-time employment among recent pediatric graduates, focusing on the experiences of residents seeking nonfellowship positions after graduation. Specifically, we identify predictors of seeking part-time employment, and we contrast the job search experiences of residents seeking part-time employment with the experiences of residents seeking exclusively full-time employment. We also describe the characteristics of the part-time jobs that residents are accepting after graduation.
METHODS
We analyzed data from 3 years (2003–2005) of the American Academy of Pediatrics Graduating Resident Survey. This survey was fielded annually to a random sample of 500 graduating pediatric residents from Accreditation Council for Graduate Medical Education-accredited, categorical, pediatrics programs in the United States. Residents were included regardless of American Academy of Pediatrics membership status. Residents from dual-degree programs, such as internal medicine/pediatrics programs, were not included. Up to 4 mailings of the survey were conducted from May through September of the year in which each group of residents completed their residencies. Two mailings each were conducted before and after the July 1 turnover of residents. US Postal Service mail forwarding was relied on to reach residents once they left their residencies. No remuneration was provided to respondents. All surveys were reviewed and approved by the American Academy of Pediatrics institutional review board.
This article focuses on a series of core questions asked each year about residents' job search experiences and their future positions. There were 2 primary outcomes of interest, namely, (1) whether residents included part-time or reduced-hour positions in their job searches and (2) whether residents accepted part-time or reduced-hour positions. The exact wording for these key questions was as follows. “Did you seek any part-time or reduced-hours positions in your job search (yes or no)?” “Is your new job a full-time or a part-time/reduced-hours position (full-time or part-time)?” The determination of whether a position was part-time was based entirely on residents' self-report. Only residents who were actively seeking nonfellowship positions as 1 of their top 2 most desired positions were included in our job-seeking and job-acceptance analyses.
Descriptive statistics, including frequencies and means, in tandem with χ2 and t tests were used to contrast the experiences of residents seeking and residents not seeking part-time positions and to compare the characteristics of the part-time and full-time positions that residents accepted. A multivariate logistic regression model was developed to explain which characteristics of residents were predictive of seeking part-time positions. Candidate predictor variables included in the model were female gender (yes or no), age (continuous), having children (yes or no), marital status (single, spouse/partner is physician, or spouse/partner is not physician), international medical school graduate (yes or no), program size (continuous), having a mentor who provided career advice (yes or no), US underrepresented minority (yes if black, Hispanic, or American Indian and from US medical school; no if from international medical school or if white or Asian/Pacific Islander), educational debt greater than $50000 (including spouse/partner debt; yes or no), and survey year (2003, 2004, or 2005). These characteristics were chosen because they provided a demographic profile of residents and because many were linked previously to resident job search choices.10,14,15 All candidate predictors were screened univariately, and those with P values of >.10 were not included in the multivariate model. P values of ≤.05 were considered statistically significant for all inferential tests. The number of cases in each statistical analysis varied slightly because of missing values for specific questions.
RESULTS
Response Rate
Of the 1500 residents who were surveyed in 2003 through 2005, a total of 896 (60%) from 180 different training programs responded. The response rate did not significantly vary across survey years (2003: 62%; 2004: 61%; 2005: 56%; P = .331). Respondents' age and gender were compared with those of the target sample to assess nonresponse bias. The age of survey respondents was comparable to the age of the target sample (31.5 vs 31.6 years; P = .155); however, respondents were more likely to be female, compared with the target sample (70% vs 67%; P = .006). A total of 51% of respondents (n = 457) applied for nonfellowship jobs. Among residents entering fellowship positions, almost all (98%) planned to train full-time.
Profile of Job Seekers
Characteristics of the residents who applied for nonfellowship jobs are presented in Table 1. Three fourths of the job seekers were female (75%). Relatively few of these residents were international medical graduates (15%) or in the US underrepresented minority group (13%). The mean age of the job seekers was 32 years, the average program size was 17 residents per class, and the average amount of educational debt, including spouse/partner debt, was $91579. Three fourths (75%) of these residents reported that they were married, and 38% had children. Most (80%) reported that they had a mentor who provided them with career advice.
Demographic Profile of Graduating Residents Applying for Nonfellowship Positions (n = 457)
Seeking Part-time Jobs
Overall, 38% of residents on the job market sought part-time or reduced-hour positions. Gender, having children, and marital status emerged as predictors of seeking a part-time position in our multivariate models (Table 2). A total of 45% of women, compared with 15% of men, sought part-time positions (adjusted odds ratio [OR]: 4.40; 95% confidence interval [CI]: 2.46–7.88). Residents with children were more likely than residents without children to seek part-time employment (50% vs 30%; adjusted OR: 2.44; 95% CI: 1.52–3.92), and residents who were married to another physician were more likely to seek part-time positions (52% vs 38% [married to a nonphysician] or 29% [single]; adjusted OR: 2.01; 95% CI: 1.06–3.85). The proportion of residents seeking part-time employment increased to 60% among residents who were female and had children and to 74% among residents who were female, had children, and were married to a physician (Table 2). As more predictors were combined, fewer residents were part of each subgroup. The factors that were not predictive of residents seeking part-time employment were age, international medical graduate status, program size, having a mentor, US underrepresented minority, educational debt greater than $50000, and survey year.
Predictors of Residents Seeking Part-time Positions
Job Search Experiences
The majority of the residents who sought part-time positions accepted part-time positions (Fig 1). Overall, 38% of the job seekers sought part-time positions and 21% accepted part-time positions (55% of those seeking part-time positions). Women with children represented a subgroup that was especially likely both to seek (60%) and to accept (45%) part-time positions. These values translate into a 75% acceptance rate for this prevalent subgroup.
Success in obtaining part-time positions, according to gender and having children.
Some differences and some similarities were apparent in the job search attitudes and experiences of residents seeking part-time positions and residents seeking only full-time positions (Table 3). Residents seeking part-time positions were slightly less likely to rate job security and acceptable income as essential or very important factors for their job selection, but the differences were not statistically significant. Residents seeking part-time positions reported similarly high rates of having a mentor who provided career advice (∼80% for both groups) and willingness to choose pediatrics again if they repeated residency (>90% for both groups). Residents seeking part-time positions were more likely to include urban inner cities in their job searches (59% vs 47%; P = .027) and were less likely to include rural areas (5% vs 12%; P = .031).
Job Search Experiences of Residents Seeking and Not Seeking Part-time Positions
Residents seeking part-time employment were more likely to report moderate or considerable difficulty in their job searches (36% vs 25%; P = .017). Residents seeking part-time employment were also more likely to report not having a job when surveyed (11% vs 5%; P = .013) and to report limitations related to spouse/partner career plans and family situation (75% vs 56%; P < .001). Residents seeking part-time positions sent out approximately the same total number of applications as did residents seeking full-time positions (11.2 vs 11.4 applications; P = .949).
Characteristics of Part-time Positions
Table 4 contrasts the characteristics of the actual full-time and part-time positions that were accepted. As should be expected, residents who accepted part-time positions anticipated working fewer hours than did residents who accepted full-time positions. Specifically, they expected, on average, to work 15 hours less per week in their practice (23 vs 38 hours), 4 hours less per week performing rounds (7 vs 11 hours), and 6 hours less per week on call (17 vs 23 hours). There was considerable variation in work hours in both the part-time and full-time groups. The SDs for practice time per week were 11 hours for the part-time group and 13 hours for the full-time group. The starting salaries for part-time positions were $33983, or 32% less than the starting salaries for full-time positions. Residents working part-time also expected to see fewer patients per day (25 vs 29 patients; P = .015).
How Do Part-time Positions Differ From Full-time Positions?
Part-time and full-time positions differed in several other dimensions as well. Part-time positions were more likely to be in the same city/area as the residency, with 6 of 10 residents who accepted part-time positions staying in the same city/area as their residency, compared with 47% of residents with full-time positions (P = .028). Part-time positions were somewhat less likely to be accepted in small cities/towns and rural locations, but this difference was not statistically significant (23% vs 14%; P = .087). Concerning job sites, residents accepting part-time positions were less likely to accept positions within multispecialty groups (2% vs 11%; P = .019) and were more likely to accept positions within academic settings (25% vs 15%; P = .030).
DISCUSSION
There is strong overall interest in part-time or reduced-hour positions among graduating pediatric residents. Approximately 4 of 10 residents in the nonfellowship job market applied for part-time time positions, and 2 of every 10 residents accepted part-time positions. Residents who obtained these positions did report more difficult job searches.
Although the total number of hours (practice, rounds, and call) for residents who accepted part-time positions (47 hours) was much less than the 72-hour workweek anticipated by residents who accepted full-time positions, this workweek still exceeds common, nonphysician workloads of ∼40 hours per week.1 The average expected numbers of hours for both full-time and part-time work are consistent with average work hours actually reported by practicing pediatricians.10 It should be noted that there was considerable variability in working hours in both the full-time and part-time groups. With a mean of 23 practice hours and a SD of 11 hours, many of the residents who considered themselves to work part-time worked <20 practice hours and many others worked >30 practice hours per week.
Certain subgroups of residents were especially interested in part-time positions. Six of 10 female residents with children sought part-time positions, and 75% of those who sought part-time positions succeeded in obtaining one (resulting in 45% of the subgroup accepting part-time positions). An important part of this finding is that women with children represented a fairly large subgroup (26% of job-seeking residents). Furthermore, the next highest rates of seeking (37%) and obtaining (20%) part-time positions were for women without children, who represented the largest subgroup when the gender and parenthood variables were crossed (just under one half [48%] of job seekers). With pediatrics continuing to attract large numbers of women and with increasing numbers of women entering medical school, it is likely that the numbers of residents in these subgroups will remain large in the future. Being married to another physician was another independent predictor of seeking part-time positions. This tendency may reflect the difficulties of balancing work responsibilities for dual-physician families and a desire to find more time outside work.
It is also possible, however, that some residents did not prefer a part-time position but considered part-time work in response to challenging job markets in certain geographic areas.13 This may explain the fairly high levels of interest in part-time employment among men and residents without children. Residents seeking part-time employment reported greater job search difficulty, but it is impossible to determine from our survey whether the residents really wanted to work full-time and had some difficulty finding those opportunities. Residents might first have experienced job search difficulty in their preferred geographic area and then expanded their job searches to include part-time positions, such as moonlighting roles, locum tenens work, and urgent care shift work. A combination of these factors is likely driving the strong interest in part-time work.
Association of part-time work with the specialty of pediatrics could affect recruitment of medical students. On one hand, the high prevalence of part-time work and the greater acceptance of it within the specialty may make the specialty more desirable than other specialties to some medical students. The continued success of pediatrics in the annual match suggests that part-time work has not had a harmful effect to date.16 On the other hand, as more pediatricians work part-time, average salaries within the field may fall further beneath those of specialties with fewer part-time workers.17 Part-time salaries can be adjusted to full-time equivalencies, but the unadjusted numbers may push some students away from pediatrics. Another possibility is that the total number of students entering pediatrics will not change but those valuing part-time work will self-select to pediatrics at greater rates, reducing the variety of future pediatricians. With the acceptance of part-time work in pediatrics, medical students may see the lifestyle as more controllable.17,18
Across the full career of a pediatrician, it is very possible that he or she will shift between full-time work and part-time work at different stages. For example, working part-time during the younger years may decrease stress19 and increase the total number of years worked. At this time, the changes in work roles that occur across a pediatrician's career are not well understood, and tracking studies examining individual pediatricians' career shifts are needed.
It is also unclear how interest in part-time work among younger pediatricians influences part-time interest among older pediatricians. The predominantly male pediatricians in the baby-boom generation who are nearing retirement could choose to taper their workloads at greater rates because of increased acceptance of part-time work in the specialty overall.20 If this pattern occurs in combination with the strong interest in part-time work among predominantly female, younger pediatricians, then there may be a dramatic increase in the overall group of part-time workers.
Our study also provides data related to pediatrician maldistribution. Residents seeking part-time work were more likely than residents seeking full-time work to accept part-time positions in the city/area of their residency, and they were less likely to apply for jobs in rural areas. There was also a reduced likelihood of part-time workers accepting jobs in multispecialty groups, which suggests that other specialties may be lagging behind pediatrics in the acceptance of part-time work and further establishes pediatric offices as the main employers of pediatricians.
The strong interest in part-time employment among residents calls into question whether sufficient attention to part-time paths is being given during residency training. There are data suggesting that very few programs have embraced residents working part-time during their training.21 Future discussions of pediatric training should consider whether there is an overall culture of acceptance of part-time employment as a common career path and whether the unique practice management skills that part-time employment requires are addressed.
There are many limitations to the current study. First, all data, including part-time status, were self-reported, and work hours were expected values rather than actual values. Second, we do not know from our data how long residents will stay in their part-time positions. Third, we do not know how many of the residents seeking part-time employment preferred part-time employment and how many considered part-time employment as a second choice. Fourth, some nonresponse bias was apparent, with respondents being more likely to be female. This might have increased the estimates of part-time interest to some extent, although the amount of greater response among women was very consistent with that seen in other American Academy of Pediatrics surveys.22
CONCLUSIONS
Many pediatric residents seek part-time employment after graduation, and 2 of 10 accept part-time positions. There are several independent predictors of interest in part-time positions, including female gender, having children, and being married to another physician. Strong interest in part-time positions, whether because of lifestyle preferences of young physicians or challenges finding full-time work in some job markets, is likely to continue. This important trend and its implications for the pediatric workforce and pediatric training will need to be monitored.
Footnotes
- Accepted July 16, 2007.
- Address correspondence to William L. Cull, PhD, Division of Health Services Research, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: wcull{at}aap.org
The authors have indicated they have no financial relationships relevant to this article to disclose.
REFERENCES
- Copyright © 2008 by the American Academy of Pediatrics
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