80% Dilemmas

February 7, 2019

I recognize I have a very good problem – I feel very lucky to be working at a place that has allowed me to work at 80% time, while still serving in a leadership role. It is possible, with time, that the residency part of my job might become an even larger slice of my responsibility pie; however, that remains to be seen.

I am currently 0.55 FTE clinical // 0.25 FTE GME // 0.2 FTE unpaid/off. The way I work this is to simply block one weekday every week as mine. I stay home, do things with the kids, record podcasts ~50% of the time, and generally get the loose end of life taken care of. I’d love to say that I enjoy a lot of self-care and extra sleep, but that hasn’t been the case — I’m more likely to be spending time with the kids or catching up on unpaid bills/budgeting or planning the next bday party or taking someone to the dr — you get the picture.

I do think it’s helpful to have that wiggle room. It also means that if I receive a notice from school that there is a performance on a random Wednesday, I can shuffle patients to my ‘off’ day and attend the performance! This was very difficult to do before when there would have been nowhere to put previously scheduled patients, even if I technically had PTO to take. I might have solved this with a random day off once/month that could be moved around, but had not yet tried that approach.

Then there is CALL. Since I am clinical 55% of the time (and the 25% of GME comes with its own share of evening responsibilities and occasional weekend events), one would think that I was smart enough to negotiate taking 55% of call. Nope. I’m taking the full share (felt guilty about giving ‘more’ to colleagues and just wasn’t sure what the protocol was). But I am recognizing that this does not make sense. First of all, I am accumulating more patients and have nowhere to put them. Second, I am getting hit with off hours events from the GME side and when that is added to call (and the occasional meeting like the one I went to on my day off last week that only lasted one hour but required two hours of driving) — and 80% is not 80%. It’s more. But my paycheck doesn’t know that.

I am trying to figure out what to do. Options include going back up to 90% (downgrading my scheduled non-PTO-days off to one every other week), staying at 80% but negotiating a change in call (I think this is fair), or even (!) going to 100% but seeing if I can do some work remotely. 100% would make the podcast very difficult, though, and I really enjoy doing it.

As you all know, I’ve also discussed writing a book on planning and have the very skeletal outline of a proposal, but that project has definitely stalled — essentially since I had G. (IE: for a long time). Honestly — it comes down to time. I can churn out a quick blog post in the morning before work in 20 minutes, but cannot get into the deeper focusing place needed to work on that. At least that’s what I tell myself. I thought I’d be able to use my days off for this, but a) they are only once/week and b) the time seems to go to other things (generally worthwhile things, but other things). So maybe I should just table that project for some time. But then I wonder if the time spent on this site/the podcast makes much sense if it’s not supporting some larger (paid) project. Maybe it doesn’t matter and I shouldn’t care. But that time adds up, and I guess perhaps I do.

Dilemmas, dilemmas. But ones I am very lucky to have!

Now to solve the issue of G waking up at 5 every morning, during my only (lucid) block of me-time . . .


  • Reply Susi F March 10, 2019 at 7:05 pm

    Wow – you could have been me writing. I too work (OK am paid) 80%, but actually work much more. Plus, my “day off” is used for family/house/admin stuff/mopping up work that I missed because I was at a docs appt or a kids event – so no self care time. I have been having the same discussion with myself and have come to no real conclusion as to what is the best option. However, I’m trying to have a “day off list” that sets out what I would like to get done on that day – it gives a structure to the day, has a couple of self-care items on there (that are generally the ones that don’t get done, but I’m trying). The “day off” does mean I don’t feel the guilt when I leave early to go to a drama performance one day – even if actually the hours I put in during such a week totals certainly 90%, probably actually over 100%!! So, I can’t offer any suggestions, but will watch with interest what you decide. Plus – you’re not alone – I promise you that!

  • Reply RedSoxGirl10 March 10, 2019 at 7:05 pm

    This is a tough one! I used to work .7 before I had kids (when I first started teaching that was the job I got). I think the nature of part time work in medicine, teaching and other jobs that can be all consuming is that it will never really be part time but it will give you a flexibility you wouldn’t have in full time work. If I were you I’d try to negotiate for less call first, and then explore other options. Also could you plan from say 1-3 every day off to be you time and fiercely protect that time?

  • Reply Marcia Francois March 10, 2019 at 7:05 pm

    First of all, the font is still super small for me (firefox browser).

    I wonder if you had a list for your free day every week with your “ideal weekend” ratios reflected if you wouldn’t feel better about your days off?

    Definitely you should have at the very most 80% of call, if 55% is not possible.

  • Reply Cbrown March 10, 2019 at 7:05 pm

    I was 80% for 6 months on my return from mat leave but in academia, I think the risk is 80% pay, 100% work. It’s not like you can write 80% of an article. I am back at 100% but try to take advantage of the flexibility of an academic job, taking most Tuesdays off with my little guy and working longer hours throughout the week or on the weekend.

  • Reply Linda March 10, 2019 at 6:59 pm

    I’m an hourly paid RN working 90% so I can’t really advise you on the 80% dilemma. I just want to say that I would really like to read your book and I would not be offended if you sole ads on your podcast to monetize it. We get to listen for free so why shouldn’t you be compensated for it

  • Reply Ali717 March 10, 2019 at 7:05 pm

    I can relate somewhat, as I have been on a 50% schedule for the past 6 years. I really do think working a reduced schedule is a HUGE sanity-saver but at the same time I have to have reasonable expectations for what I can do with my down time. I would be hesitant if I were you to go back to 100%—it doesn’t seem like the increased salary would change your life in a huge way (I don’t know your finances, but it doesn’t seem like the reduction has impacted you significantly). To me, the ability to just take care of the business of life and having flexibility for my kids is HUGE, but I don’t have something to show for it (other than just feeling relief at having wiggle room).

    It does seem like your call schedule should be adjusted to reflect this. I think you should discuss with the other providers because that is a way you are still being treated as though you’re 100%. If they can’t decrease your call, then maybe they should impact your salary somehow so at least you’re compensated.

    All this to say—you have much loftier goals with your time than I do (which is a good thing, if it makes you happy), but I don’t think you should feel as though the reduction isn’t worth it if you don’t have something to show for it. Sometimes it’s about being able to go to the dentist, or show up at a school event, etc without it being a huge ordeal. To me, I think I am a saner, more involved parent as a result of my schedule and that’s enough for me. (Not that parents working 100% aren’t involved…I just know I couldn’t work those hours and still happily volunteer for a classroom party or whatever else. I would lose my mind thinking of what all I needed to do to make up that time.)

  • Reply Sneakers March 10, 2019 at 7:05 pm

    Right after I came back from maternity leave, I was given the option of ‘buying’ a week or two of vacation in addition to normal leave So I did – which gave me time for the boards I was on (and loved being on) but was thinking I should give up because of the baby – as well as days just to ‘be’ with her. It was totally worth it that year – and I was also debating the 80% time, but realized that I would use that day to get things done – which is totally worth it, some of the time because it would free things up for the weekend and we could relax together. I rarely got ‘self care’ in there though. I’m in the tech world – so my strategy is to block a day every other week – for catch up at work and once a month or so, try to schedule personal appts (including lunch with friends) on those days too. This approach works about half the time. I do think that you doing 100% call is what can be pushing you over the edge – can you try 80% call for the next 6 months and then reassess?

  • Reply Sreedevi Sodanapalli March 10, 2019 at 7:05 pm

    you are very lucky to have dilemmas , i guess there are no rights or wrongs. being a physician on Visa , I tried to see workinmg remotely , later part time in prison medical officer , later went back to primary care in office setting 9-5 for 40 hours week . i liked the structure and predictability and less risk management . les pay though , more time off from family , but les stresful , i consider that office hours to self care filling my cup by talking to people with less medical emergencies . i wonder if hospitalist with 7 and 7 off would be a great time off to catch up with family , spending time with kids and all , i would miss 10 notional holidays my outpatient practice give . i am not that much intersted in giving my time to GME or leadershio yet in life , options options , still need to find employer who can do visa and negotiations , lets see , and job satisfaction another thing ,i serve indian people and speak the language which is unique oppurtunity only can happen in chicago , should serving my country people is contributing to my higher job satisfaction not sure , my dream job to work in some kind on mental health , thats still needs lot of contemplating ,… great to see you sharing this , putting up the dilemas here .
    thank you

  • Reply Nikki March 10, 2019 at 6:59 pm

    Hi! For both my children I returned from maternity leave at 80% for the first few months. Once I started coming in on my off days to catch up on work, that was always my cue that it was time to bump back to 100%. I work a 9/80 schedule at my organization which ends up with an off day every other week, even when full time. Before kids I worked a 4/10 which gave me an off day every week, but that long day no longer works with daycare closing times. Is a 9/80 or 4/10 schedule a potential option for you?

    • Reply Nikki March 10, 2019 at 7:05 pm

      Also – I wouldn’t mind at all if there were ads on the podcast, if that helps – I think any podcast listener is used to ads playing during podcasts, not a big deal, in my opinion, especially if it helps keep a great podcast going!! Alternatively if there was merchandise or a donation option, etc etc.

    • Reply Sarah Hart-Unger March 10, 2019 at 7:05 pm

      Nope, b/c it’s fundamentally not an hourly sort of thing. One could argue that some physicians work 10, 12 hour days already and don’t get anything ‘extra’ for that (my husband comes to mind).

  • Reply Emily March 10, 2019 at 7:04 pm

    The thing that would make me pause about the 0.9fte is that it would involve a half day at work – and it’s so easy to get stuck, stay for one meeting, run late, get sucked into email etc.
    could you have a GME day that you do from home every other week and in person on alternate weeks? That way you could do curriculum stuff, organize education sessions, review paperwork etc during non standard hours and have time for many of the things you would really lose by not having that day off.
    Also, I am very impressed with how much admin time you get for your role. I officially get 0 for the same at my institution (different speciality).

  • Reply Lily March 10, 2019 at 7:05 pm

    I’ve fallen into the 100% work, 80% pay trap before. In hindsight it was worth it for a while because I *loved* the volunteer work I was doing on the day off. But it was a flexible job in a central location so I went back to 100% and then refused to feel guilty popping out for a quick meeting or a lunch time event. Different when your work has to be face-to-face.
    To echo others below – I really wouldn’t mind if you had a couple of ads on the podcast if monetizing it would help feel like it was worth it.
    And I would *love* to read your book and if there’s few posts on here because that’s where your time is going, that would be fine too.
    But to your comment “I wonder if the time spent on this site/the podcast makes much sense if it’s not supporting some larger (paid) project”….
    if you genuinely enjoy doing it, and you don’t *need* the money, then does it matter if it doesn’t contribute to something ‘larger’? I’ve think I’ve fallen into the trap of feeling like everything in life had to be a strategic, sustainable decision toward a larger goal, and feel like I’ve lost the ability to just do things ‘for fun’ or ‘just because’. Worthy things to ponder.
    Love the hobonichi shots – a good reminder to keep working on my current systems!
    ps I’m a fan from Australia, and I thought you’d like to know that the pop up ad in the side bar that I’m seeing is a vaccination reminder from the government – seems fitting for you 🙂

  • Reply Simone March 10, 2019 at 7:05 pm

    Sounds very very familiar…
    I’ve done it all. 50%, 75%, 100%.
    I am a German lawyer. With a career. Nowadays – my kiddos being 4 y.o. and 9 y.o.- I am back to working 100%. The position I have is only in full time/100%. I had to decide if I make this career step and go back to 100% or not. And it is quite similar to you. I work 50% administration/organization/HR and 50% genuine law. But administration tends to eat up much more of my time. Obliger here…

    I really miss my day off while working 75% although my schedule nowadays is very flexible and with climbing the hierarchy ladder it’s easier to leave early/come in late. But I feel obliged (Obliger here, big time!) to do “normal” hours. And work in the evening.

    But to be honest I did not make a lot with my off day. I miss the opportunity (!) to have a self care, relaxing day off for myself. But actually this is not what happened on these days most of the time. Most of the time I took over kid responsibilities (doctor appointments, school activities…) I know tend to share more with my husband. Or I invested time to make things better/nicer (planning kids’ bday party, gardening, remodeling our house…) that are absolutely ok if not 100% perfect. It is a bit like the big BMW off road motorcycle German midlife crisis men buy: They don’t buy a motorcycle to travel to China off the path. They buy the possibility to do that.

    And: I actually used to work 100% regarding hours when just being paid 75%. I just gave myself permission to take a day off (and worked in the evenings). So over all, 75% was a good concept, but I was not able to use it for me. So I am ok with being back at 100%. But I don’t know what I would do if my position was available in 75%…probably I would give it another try and try to make it better this time.

    So…I think the best thing is to be very very egoistic on your day off and not take over responsibilities that are not genuinely for you. Make a list of things you wanna do on your day off and schedule them. And do them. If you succeed in doing so, tell my how ;-). Stay with the podcast! I love it…and I really think doing something outside your main profession contributes to happiness a lot. Regarding money…I get it. Totally. The pay difference between 100% and 75% doesn’t make a crucial difference in our household with my husband making decent money, too. So we don’t need the money. But it is fun to have it and gives me a lot of affirmation. Again, something that plays 100% in my brain, not in the real world.

    Last thing: 80% time – 80% pay – 100% call? Are you kidding me? You know that something is wrong with it, so go change it! Sooner than later!

    And: this was a good reason to think about my situation, thank you!

  • Reply Van March 10, 2019 at 7:04 pm

    I remember after having my first child, I considered going to PT (either 0.6 or 0.8), but as some of the others have commented, when I did all of the math, it didn’t make sense for me. My boss wanted me to come in for 5 hours/d, 5d/week, but I knew from other PT docs and my own experience, that leaving on time is difficult to do. Also, it would defeat the purpose of having an off day, where you gain flexibility to wake up and create a day on your schedule (and not use part of that time commuting). And, since someone else isn’t processing my patient results on my off days, but instead my work is waiting for me upon my return, in some respects, it wouldn’t really be as reduced a load as one may think. The last part of my equation was to be paid only part of a FT salary for doing more than 0.6 or 0.8 didn’t make sense when you consider everything in addition to your annual salary, like building up vacation & sick days, as well as what goes towards retirement (which adds up to much more than the salary difference when you account for compounding). So I ended up doing FT, with a 6am-330pm, 5 days/week schedule, which worked well.

    Our family moved to a different city, where I’m working a FT compressed schedule (four 10 hour days), with every Monday off. The days are long & catching up on Tuesdays is tough, but I wouldn’t trade it for anything. My logic is get the FT salary, but also accrue enough vacation days so that taking off 1-2 days/month ends up feeling like you are working part-time so-to-speak.

    I would recommend re-negotiating the call schedule, because as women, we feel much guiltier than our male counterparts. You have to look out for yourself (the practice is getting a good deal) – no practice manager or partner is going to say to you one day, “Hey, it’s not fair for you to do more call even though you are paid less!”

    Another consideration would be that if you worked FT, you could take 2 days off per month to do work on the podcast.

  • Reply Theology and Geometry March 10, 2019 at 6:59 pm

    I agree with Maria. I think if you went up to 1.0FTE, you’d actually be doing much more than that with call, evening events, etc. Doing more medical work with less flexibility doesn’t seem like it fits with your life or professional goals right now. It seems like it makes more sense to push back down toward that 80% (like negotiating down call time as you mentioned) and maybe also negotiate things like seeing if you can call into meetings like the one you mentioned where you’d spend more time driving than actually at the meeting.

  • Reply Courtney March 10, 2019 at 6:59 pm

    I would love if you did a full podcast on this! I’m currently contemplating going to a reduced schedule after having my baby #3, but I’m in a billable job (consulting) that I feel would make it easier to keep things honest on how much I’m actually working. Your idea of mapping out an ideal week actually fueled the idea that I would be much happier at 60 or 80% time.

  • Reply Marie March 10, 2019 at 6:59 pm

    I wonder if you re-negotiate your clinical / GME divide (is the GME really only 0.25 of your time?), go back to 100%, then batch your GME time and work from home one day a week on that (while still having time for in person GME meetings). Perhaps the GME expectations have grown as the program has! For what it’s worth, it seems like you really value the flexibility of being 80% more than the time off, and that would still eliminate one day of commuting a week — perhaps you could put that time towards the book? Also, given that Josh has a new job you just moved to be closer to… is there anything new he can pick up that you have been doing on Fridays? He can do budgeting, planning for birthday parties, and taking kids to the doctor’s as well!

  • Reply Maria March 10, 2019 at 6:59 pm

    Something to consider would be – if you went up to a 1.0 FTE, would work still creep up and then you’d have a 1.2 workload but still paid at 1.0? It seems like with your call, patient notes, and the extra GME work you mention this could be a possibility. So part of this might be mental framing… in a salaried job such as this, some weeks will always be heavier than your standard hours. If 80% is your desired schedule, I would probably keep that and do everything in your power to keep your hours close to matching that. (Including negotiating call time down!)

  • Reply Holly March 10, 2019 at 6:59 pm

    I already voiced my thoughts on yesterday’s post but reading this it confirms that in your shoes, I’d do 100% time but try to consolidate that .25 GME time to be on a given day. That way you can still flex patients to that day if need be for a random school event, but if not then you can maybe work remotely or at least have some time dedicated to some of the stuff that tends to creep into weekends (notes etc.) since you wouldn’t have patients.

    I also have a “big” (high earning) job and have tried to monetize various more creative side hustles but unfortunately the math never works out such that it would make sense “down shift” my time. So I keep them fun and low commitment but have to keep my day job the focus unfortunately! But budgets and trade-offs are real.

    I think at the end of the day, you need to decide whether having the day off to be a more “present” (bleh) parent makes sense, since besides the podcast (which I bet could be done in the wee weekday hours or with a early morning sitter every other weekend!), that is what you have been using the time for. I’d argue that, especially if you can take a random day off here or there, it might be worth it to just look into flexing those ad-hoc “present parent” things to a GME day and get that $$$!

    • Reply Sarah Hart-Unger March 10, 2019 at 7:04 pm

      My GME time already is on a given day – it’s not a work from home day, though, and there are often 1-2 meetings i need to attend. Or during interview season, most of the day is spent interviewing/recruiting. Currently my weeks contain 3 clinical days (one is shorter for some admin), 1 day completely OFF (that’s the 20%) and 1 day of GME stuff

  • Reply Amber March 10, 2019 at 6:59 pm

    Is it possible to work extra time each day, still get paid at 100% but have some flex days? I don’t know what your hours are now, but would it be worth it to add an hour to each day and have a day off every second week instead? No idea if that’s feasible, but just an idea. I do really like the very first comment on this post, though. you are “buying” (giving up 20% of your income) flexible time in your schedule, and in some ways that’s invaluable.

    • Reply Sarah Hart-Unger March 10, 2019 at 7:05 pm

      Not in my field – it’s not an hourly type of situation. And the idea of longer patient days has me shudder — i’m DONE by the end of my normal days 🙂

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