Disclosures: The Wyanoke Group is the parent company of Healio and SLACK Books.
“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 wimps and mollycoddles.
– Chairman of the Board, Philadelphia Gear Works, 1926
John B. Pinto
Everyone reading this month’s column grew up in a time when the 5-day, 40-hour work week was the nation’s standard. It has not always been so.
When the country was founded, when most Americans worked in agriculture, an 80-plus-hour week was common. In the early 1800s, with the advent of the industrial revolution, this was reduced to “only” around 70 hours. It took labor strikes in the late 1800s to further reduce this, and in the 1920s the Ford Motor Company gradually instituted the 5-day work week, which could still mean over 50 hours of work .
President Hoover called for 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 to simultaneously increase wages and reduce hours.
This long and steady improvement in work-life balance has stalled and has now reversed course since the 1960s. The rising cost of living has encouraged workers to work more overtime and to accept a second job. And of course, in today’s always-on environment, it’s not just doctors who are on call at night. We are still at work.
Is there another way? Over the past 40 years, I have examined client environments where shorter work weeks are the norm. Reducing the hours – even a full day or two – of the week can indeed work, but with some important caveats.
- You probably won’t maximize the MD owner’s total annual income.
- You can optimize the owner’s income per hour worked, especially if the whole team is able to be more energetic and efficient during the reduced work week.
- While some staff will appreciate fewer working hours, others won’t, unless you increase the hourly wage or adopt something like a “work 36 hours and get paid for 40 hours” model. as shown below.
- A few patients and referral sources may complain unless you keep staff on the phone during normal business hours.
Let’s look at examples of how a truncated office schedule works economically.
Examples of schedules
Imagine a clinic that closes every Friday at noon. This is a modest variation from a “normal” week and is often something a smaller practice addresses when one or more providers are at a career stage where reduced hours are attractive personally. There are at least two ways to organize this, each with its own financial results.
The following three condensed annual spreadsheets show a basic 40-hour solo practice, the same reduced 36-hour practice that only pays staff for hours actually worked, and a practice that removes 4 hours from the schedule but preserves the full week’s salary for support staff .
Baseline: A physician working solo for 40 hours, 5 days per week, with 4 clinic days per week, taking 6 weeks off per year and seeing an average of 35 patients per work day. This practice has eight full-time equivalent lay employees who are paid an average of $22 per hour, including taxes and benefits (Table 1).
Baseline minus 4 hours and lower staff costs: Same practice as baseline but operating 36 hours and paying staff only for hours actually worked. Because the practice loses a half clinic day per week over 4 days for baseline, patient visits drop 12.5% unless more patients can be squeezed into each clinic session. Note that staff hours are only reduced by 10%, so there is a slightly unfavorable disproportionality to lower patient volumes. Also note that the physician working alone works a 10% shorter workweek but earns 23% less compared to the baseline (Table 2).
Baseline minus 4 hours while preserving staff costs of 40 hours: The same practice as the base but operating 36 hours and paying staff for 40 hours in order to preserve their annual salary (Table 3).
Of course, one could argue that the decline in profits that occurs with a shorter workweek need not be as large as these general illustrations.
For example, although the facility costs are fixed, the office can be rented to a subspecialist for 4 hours per week. Marketing costs could go down a bit because the practice’s capacity for new patients is smaller. General and administrative costs can always be reduced here and there.
But the raw impression remains the same – it is quite expensive to reduce hours. (And, of course, it’s very cost effective to add patients no matter how long your workweek is, because most of the costs are fixed. For example, in typical anterior segment practice, a doctor who doesn’t ‘ adds that three patients each clinic day generate over $100,000 in additional annual profits.)
There are many variations on this theme for surgeon-owners who want a better work-life balance.
- The 4-Day Eye Clinic: Why stop shortening the 4-hour week? How about cutting 8 hours? Or alternatively, you can preserve the total number of hours worked by staying open 9 or even 10 hours a day and closing completely on Fridays or Mondays.
- A seasonal or experimental reduction in hours: A longtime customer in Chicago was an avid golfer. He had to fly in the winter months to perform. So he came up with a great solution. During the cold months, he worked full time and extremely intensely. But in the spring, it closed two afternoons a week. Ideal for his disability, and a nice break for staff to look forward to as well. You can try this same painless approach in your own office on an experimental basis.
- A Serious Part-Time Practice: In an extreme case, a low-cost-of-living single client opted for a 3-day week. It may work but results in a disproportionately low personal income – he worked 40% less than his peers but earned far less than half their salary due to his still high fixed costs. But I have to admit he was a very happy doctor.
Two years of pandemic life has taught us that patients, staff, and providers can be more flexible than we ever thought possible. We learned resilience and taking the hits. COVID has also reminded the more fortunate among us of the value of time and the precious, sometimes fragile nature of life. As we shake off all the masks and mandates, it’s time to re-examine the place that work should have in our lives, regardless of 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 Develop and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Competence, Performance, and job 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: firstname.lastname@example.org; Website: www.pintoinc.com.