"A good physician works full-time?" - a mixed-methods study on (mis)conceptions about part-time work in hospitals.

Abstract

Study aims: While part-time employment is commonly discussed as a way to recruit and retain physicians, the average workload of hospital physicians has barely decreased in the past decade, and hospitals face persistent difficulties in adopting part-time work. This study aims to examine the attitudes of hospital physicians across various specialties and positions towards part-time employment, and to identify factors that hinder or facilitate the successful implementation of part-time arrangements in hospital settings.

Methods: We conducted an exploratory mixed-method study, combining a qualitative interview study with reflexive thematic analysis of 19 participants, and an online quantitative survey of 553 physicians. Data were collected between August and November 2023 in seven public hospital organisations in Switzerland.

Results: The quantitative data revealed a widespread desire for workload reduction across all roles, specialties, age groups and sexes, with an average ideal workload of 81%. Contrary to some statements in the qualitative interviews, the youngest cohort of physicians reported the highest ideal workload (88%). Most respondents (60%) believed they would be granted a workload reduction, yet an equal percentage at least partially agreed that working part-time would negatively impact advancement opportunities within the hospital. Other concerns about part-time work included the additional workload it might place on colleagues (76.5%) and a potential decline in medical quality (17.5%). These concerns varied across specialties and positions. The qualitative interviews identified both organisational and cultural barriers to the implementation of part-time work for hospital physicians, such as complex scheduling, additional effort and the prevailing "ideal physician norm" that prioritises physical presence and professional obligations over personal life. Conversely, factors facilitating part-time work included a supportive culture for part-time models and flexible organisational structures and processes.

Conclusion: Addressing current perceptions of physicians' part-time work may be an essential first step towards establishing sustainable part-time solutions in hospitals. This includes the assumption that a physician's competence depends solely on his or her availability. Furthermore, the redesign of workplace structures, including shift schedules and training programmes, may be necessary to accommodate varying workloads. When accommodating part-time solutions for hospital physicians, implementing one-size-fits-all solutions may not be expedient, given the varying circumstances of different specialties and positions. Therefore, we recommend that solutions be tailored to the specific needs of each clinic and developed through a participatory process.