Citizenship and Organizational Activities​

John Hartline, MD, FAAP​

Colleagues often participate in professionally-related activities outside of the practice site. In many cases, these are considered parts of the job, i.e., time spent is included in the calculus of time committed to the practice. All associates accept and understand this practice component. In other cases, individuals pursue activities outside of the practice that are professionally-related, but the time spent is not a specified practice component.

Although many neonatologists become interested and participate in these activities, practices vary as to whether the time spent comes out of the practice, or if the individual needs to limit the activities to his/her free time. Some practices strictly limit "on-duty" commitments to demands imposed by clinical care and the unavoidable non-clinical responsibilities related to the practice. Some groups accept selected outside activities because they are seen to contribute to the practice in some way, whereas other groups have a liberal attitude. Having an up-front understanding of the spectrum of activities and interests that the practice will accept within its duty time is essential. If your career vision includes commitment and growth through participation outside of the direct practice responsibilities, be ready to discuss it in the interviewing process. Conflicts between practice priorities and individuals' interests often occur, and can be destructive to collegiality.

What are some potential professionally-related activities in this category?

•  Local community activity. Because neonatology deals with infant and perinatal survival (and mortality), colleagues often are asked to participate in community public health efforts (eg, Fetal-Infant Mortality Review), state public health task forces or committees, or in related activities in local professional organizations. Periodic or sporadic attendances at such meetings often are incorporated into the administrative or educational fractions of practice activity. But, if attendance at regular meetings or acceptance of leadership roles add significant time and inflexibility to that participation,buy-in from the practice as a whole is constructive.

• Professional organizational activity. Practices should recognize that the AAP and its Section on Perinatal Pediatrics comprise the organizational "home" for neonatology. Often this recognition supports attendance at Section or AAP educational offerings, but this participation may be limited to the educational allowances of time and/or money included in practice benefits. Thus, organizational participation often falls under educational benefits, and competes with other offerings. Individuals with interests in expanded participation in leadership, Section committees, or other endeavors beyond CME meeting attendance (such as the Neonatal Resuscitation Program, editorial boards, or meeting planning committees) should determine the degree to which the practice accepts the commitment within its time frame and compensates for the time you commit.

• International Health. Neonatologists from many practices are active in international health programs, and international programs are among the priorities of the AAP and of the Section. Types of participation vary: some are directly clinical (eg, relief for Haiti's earthquake victims); others may be primarily educational (eg, Neonatal Resuscitation Program, Helping Babies Breathe, World Health Organization, Non-governmental organizations). Time for these endeavors requires the ability to "take off" specified blocks from the practice, during which time others' opportunities for leave may be limited. Again, if you have interest in or experience in international health that you wish to continue or to pursue, introduce the idea relatively early in your dialogue with a practice site.

• Non-neonatal education. Through the educational process leading to completion of fellowship, some colleagues will have pursued other disciplines they wish to include in their career planning. Degrees in Public Health, Ethics and Philosophy, Business Administration, Education or Educational Leadership often lead to future career interests in teaching or scholarly endeavors. In academia, these may fall well into the scholarly expectations for rank or tenure. If a private practice is your choice for neonatology and you wish to continue other scholarly interests, be sure that you are ready to bring this into the discussion of your personal and professional goals. Flexibility in practice time allotment and interest in personal growth of colleagues should not be limited to academic environments!

All the above activities and others you may consider may be aggregated under the category of "citizenship." From a diverse group of practice colleagues, citizenship may consume considerable time. One academic practice did a detailed analysis of desired and actual time commitments. Overall, this category used about 7% of total practice work time, exactly the percentage the group thought should be allocated; individual's times ranged from 0% up to 15%. That group is lucky—lucky that they did the analysis so now it is transparent; lucky it came out as it did! Practices need to determine the amounts of time allocated to these activities that can be considered "on the job." In that reimbursement in these areas often may not exceed actual expenses, allotment of time for citizenship is a contribution of the practice to the community and to the profession as a whole. Having a citizenship commitment also fosters diversity in interests among practice members, allowing all colleagues time to pursue their specific passions.

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