Schedule variations exist for operating a full-time eye clinic
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“Any man demanding the forty hour week should be ashamed to claim citizenship in this great country. ... The men of our country are becoming a race of softies and mollycoddles.”
— Chairman of the board, Philadelphia Gear Works, 1926
Everyone reading this month’s column has grown up in an era in which the 5-day, 40-hour workweek was the standard of the land. It wasn’t always so.
At the country’s founding, when most Americans worked in agriculture, an 80-plus-hour week was common. By the early 1800s, with the coming of the Industrial Revolution, this was trimmed to “just” 70 hours or so. It took labor strikes in the late 1800s to trim this further, and by the 1920s, the Ford Motor Company progressively instituted the 5-day workweek, which could still mean more than 50 hours on the job.
President Hoover urged an even shorter workweek to keep more Americans employed during the Great Depression, and labor shortages during World War II gave workers the bargaining power needed to simultaneously raise wages and trim hours.
This long, steady improvement in work-life balance halted and has now changed course since the 1960s. Rising living costs have encouraged workers to seek more overtime and take second jobs. And of course, in the present always-wired environment, it is not just doctors who are on evening call. We are always on the job.
Is there another way? Over the last 40 years, I have examined client settings in which shorter workweeks are the norm. Trimming hours — even a full day or two — from the week can indeed work, but with some important caveats.
- You probably will not optimize MD-owner total annual income.
- You may optimize owner income per hour worked, especially if the entire team is able to be more energetic and efficient within the reduced workweek.
- While some staff will love fewer work hours, others will not, unless you increase hourly wages or adopt something along the lines of a “work 36 hours and get paid for 40 hours” model, as illustrated below.
- A few patients and referral sources may complain unless you keep staff on the phones during normal business hours.
Let’s look at examples of how a truncated office schedule works economically.
Example schedules
Imagine a clinic that closes down every Friday at noon. This is a modest variation on a “normal” week and is often something that a smaller practice edges into when one or more providers are at a career stage in which tapering hours is appealing personally. There are at least a couple of ways you can arrange this, each with their own financial outcomes.
The following three condensed annual spreadsheets show a baseline 40-hour solo practice, the same practice trimmed to 36 hours that pays staff only for hours actually worked, and a practice that cuts 4 hours from the schedule but preserves a full week’s pay for support staff.
Baseline: A solo MD working a full 40-hour, 5-day week, with 4 clinic days per week, taking 6 weeks off a year and seeing an average of 35 patients per day worked. This practice has eight lay staff full-time equivalents who are paid an average of $22 per hour inclusive of taxes and benefits (Table 1).
Baseline minus 4 hours and lower staff costs: The same practice as the baseline but operating 36 hours and paying staff only for the hours they actually work. Because the practice loses a half day of clinic per week out of 4 days for the baseline, patient visits fall by 12.5% unless more patients can be compressed into each clinic session. Note that staff hours are only cut by 10%, so there is a mildly adverse disproportionality vis-à-vis the drop in patient volumes. Also note that the solo doctor is working a 10% shorter workweek but earning 23% less as compared with baseline (Table 2).
Baseline minus 4 hours while preserving 40-hour staffing costs: The same practice as the baseline but operating 36 hours and paying staff for 40 hours in order to preserve their annual wages (Table 3).
Of course, it could be argued that the profit drop occurring with a shorter workweek does not have to be as great as these general illustrations.
For example, although facility costs are fixed, one might be able to rent out the office to a subspecialist for 4 hours each week. Marketing costs might drop a bit because the practice’s capacity for new patients is smaller. General and administrative costs can always be trimmed here and there.
But the gross impression remains the same — it is quite costly to trim hours. (And, of course, it is quite profitable to add patients, no matter how long or short your workweek, because most costs are fixed. For example, in the typical anterior segment practice, a doctor adding just three patients to each clinic day will generate an extra $100,000+ in annual profits.)
Other variations
There are numerous variations on this theme for surgeon-owners who want a better work-life balance.
- The 4-day eye clinic: Why stop at shortening the week by 4 hours? How about trimming 8 hours? Or alternately, you could preserve total hours worked by staying open 9 or even 10 hours daily and closing down completely on Friday or Monday.
- A seasonal or experimental reduction in hours: A long-ago client in Chicago was an avid golfer. He had to get on a plane in the winter months to play. So, he found a great solution. In the cold months, he worked full time and extremely intensely. But come spring, he closed down two afternoons a week. Great for his handicap, and a nice break for staff to look forward to, as well. You can painlessly try this same approach in your own office setting on an experimental basis.
- A seriously part-time practice: In an extreme case, a bachelor client with low living costs decided on a 3-day week. This can work but results in a disproportionately low personal income — he worked 40% less than his peers but earned well under half of their salary because of his still-high fixed costs. But I do have to admit, he was a very happy doctor.
Two years of pandemic life have taught us that patients, staff and providers alike can be more flexible than we ever thought possible. We have learned resilience and rolling with the punches. COVID has also reminded the most fortunate of us the value of time and the precious, sometimes fragile nature of life. As we all shake off the masks and mandates, it is a good time reexamine the place that work should properly take in our lives, irrespective of the financial considerations.
- For more information:
- John B. Pinto is the author of several books on ophthalmic practice management, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
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