John Hartline, MD
What job responsibilities are fulfilled by associates in a neonatology practice?
The purpose of this section is to delineate and discuss the "on-the-job" duties assumed by associates in practice. To some degree, specific responsibilities and duties may be delineated in an employment contract, but in some instances the contract may not be so specific. The contract may be vague: "the employee will assume those responsibilities assigned to him/her by the employer," leaving many of the details unstated. The mission(s) of the practice determine the spectrum of responsibilities and to a large degree, the weight given to each. To discern the full scope of a practices' missions may require you to go to some depth in your exploration of a practice's interests. Yes, some groups may have delineated a comprehensive list of responsibilities incorporating the areas we will discuss. For other groups, duties have been assimilated into practice time without an in-depth analysis of their impact on the total practice work output.
Individuals within the practice may be assigned or accept more activity in some areas, eg, clinical for newer associates, or administrative duties for more senior associates, and, to balance the workload, less time is spent in other activities. When discussing these duty areas, it is useful to inquire as to the entire work product of the practice, the specific duties expected of a new associate, and the process through which the practice reviews its mission(s) and delegates the workload over time.
The classical divisions of work within most practices of Neonatal Perinatal Medicine may include activities in the following areas:
- Administration is a major responsibility and time consumer in all practice types and involves activities at the practice, unit, hospital, possibly faculty or university levels.
- Clinical care (including collaboration with nurse practitioners, physician assistants or house physicians working within the practice) in several forms comprises the largest overall time commitment within neonatal practice at all levels.
- Education/teaching (clinical supervision of medical students, residents and/or fellows; lectures or courses; outreach to regional hospitals) is part of a majority of all practice types.
- Scholarly activities, including clinical and/or laboratory research, are universal requirements in academic settings and variable among other practice types.
- Citizenship activities, or other professionally-related activities outside of the primary practice venues, are part of the practice life of neonatologists in practices of all types, but the degree to which these activities are incorporated into the practice varies greatly.
When analyzing practice activities, it can be useful to try to approximate the "on-the-job" duties and time over a yearly basis. The time distribution of practice activities among practice associates will rarely allocate the efforts in each area equally. Considering differences in interests and abilities of associates, this is a good thing. But, if associates assume disproportionate shares of time spent in the non-clinical (and often non-revenue producing), yet essential,l practice commitments, and they also are expected to share the clinical load equally, discord eventually will result. Equitable distribution of time recognizes the trade-offs needed to accomplish and balance practice responsibilities so associates feel that each member is pulling an equitable share of the weight. Time spent by colleagues in organizational activities and in fulfilling practice commitments to citizenship needs to be factored in this calculus.
We'll now look at each of these areas of responsibility and bring out some greater details about each. First, clinical duties will be examined, for they comprise the largest set of practice-related duties and are estimated to consume nearly 70% of total neonatal workforce time. Of educational, administrative, and scholarly endeavors, each comprise about 10% of the total work in neonatology, with a small percentage dedicated to citizenship or organized medicine. Time committed to volunteerism, medical-legal review, some authorships, etc., may fall outside of practice time, but discussion among colleagues is important if these activities influence one's availability or flexibility in serving the practice's needs.
American Academy of Pediatrics