Stop Being An Emergency
I recently read a story written by a friend and business coach about a time when she volunteered at an event. During the event, she had given away all her food to support others. Now she was hungry, the event was not over, and there was no place to get more food for herself. Instead of being praised (as she had expected) by one of the more senior volunteers, she was told “If you don’t take care of yourself you can become an emergency someone else needs to tend to.”
That’s what has happened to our healthcare system.
It’s become an emergency that someone else has to tend to.
Physicians have been so consumed with doing the ever-increasing amount of tasks, like the added roles of stenographer, online order placer, consult caller, electronic prescription writer, operating room or day surgery case requestor (including all the instruments needed for the case), the caller of the equipment representative to make sure the stock and instruments will be there as well, discharge summary producer, PCP caller, quality metric generator, coder, authorization obtainer.
The EMR has vastly shifted work toward doctors and away from support staff. All without giving the physicians additional time to do it. What are a few hundred extra clicks for someone who’s already clicking up a storm?
Physicians have accepted all these new job mandates because they need to be done. They need to be done right. They need to be done now.
Also, they dread being thought unhelpful, lazy, or incompetent. They fear being told they’re not pulling their weight when all their colleagues fall in line without complaint. These potential appellations strike at the heart of the physician’s self-image.
Healthcare systems have figured out that physicians will simply do more work. They will see more patients. They will not walk off and leave things unfinished because they are fundamentally concerned about the delivery of care. They have an innate sense of duty. And a desire to provide their patients with the best possible service.
And because they’ve been taught that being a good physician means attending to your patients' needs before your own.
Physicians will respond to statistics about how they compare with their peers, due to their natural competitiveness. They will be self-motivated to bring up their scores, increase the number of patients they see, and RVUs they generate.
It’s time for physicians to understand that they’re being distracted by all the things that need to be done for the healthcare delivery system, rather than for their patients or themselves.
Meanwhile, all the power about HOW it gets done has been slowly but surely eroded, just like their incomes have been hijacked to pay for all the other staff that hospitals and practices now deem necessary to be competitive in the current application and administration of the healthcare industrial complex.
“If you don’t have a seat at the table, you’re probably on the menu.” (Often credited to Elizabeth Warren, although she says she didn’t originate it.) Physicians and patients are both on the menu in health care.
Not only that, but physicians are the ones doing the shopping, preparing the food, serving at the table, and eating themselves only if there are leftovers.
Who’s got the power really matters, and it’s time to take it back.
Because NONE of these healthcare activities can happen without physicians. We have more power than we’re able to exercise because we are too busy giving away our lives to do the work. And the work seems too important.
It’s time to stop giving away all your provisions to others who appear to need them. Stop eating last and only if there are leftovers. Stop giving away what is precious and vital to you.
It’s time to take care of yourself.
This is not selfish, because it’s necessary to continue to be of service in sustainable practice.
Start pushing back on all the added jobs without added time or pay. Demand the non-patient-care time you need to accomplish your work. Delegate tasks to members of your team.
Figure out what time, EMR support, and support staff you need to work efficiently. What schedule will support your needs and the needs of your patients?
At some point, I realized I tended to order more knee MRIs in the late afternoon clinic spots. Patients actually preferred that to a long discussion about how Physical Therapy was most likely what they needed (good for patient satisfaction scores!).
But that’s not the best medicine. So I moved all new knee patients to earlier in the day when I would be better able to serve their healthcare needs.
This is the only way to stop being the emergency that someone else has to tend to, most likely in a way that is a bandaid rather than a solution.
I know many physicians who have helped redesign their EMR, their clinic schedule, and their clinic flow, gotten admin time to complete tasks and notes, become more efficient in their daily work, and/or fundamentally changed their schedules or clinical roles.
There are many options for you to explore, rather than just keep doing the same things and expecting different results.
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