Doctor morale shaky – improvements are possible.

An article by the American Medical News dated January 15, 2007 reports, “according to a new nationwide survey of physicians six (6) in ten (10) doctors have considered leaving medicine because they are discouraged by the health care system.”

As a result more and more physicians suffer from sagging morale, burnout and depression and the support from spouses and other family members is more important than every before.

Unfortunately, most physicians stress out more over circumstances where they have little or no influence such as low reimbursement rates, loss of autonomy and bureaucratic red tape just to mention a few.

What would happen if physicians only stressed out over circumstances they could change? How would our healthcare system and their life quality improve?

Reinhold Niebuhr says, “Grant me the courage to change what I can change, the strength to accept what I can’t, and the wisdom to tell the difference.”

Most of the times we focus too much on the things that we cannot change and bang our heads on the wall instead of focusing on things where we have the power to change and look for solutions.
But we cannot change our situation if we don’t change our mind and belief system first.

As Gregg Broffman, MD, medical director of Lifetime Health Medical Group in Buffalo, N.Y., said "No one ever said, 'Folks, the world is going to change professionally for you, not only technologically, but also in the way that business is done."

It is time to change and to improve if you don’t want to continue complaining about the same things year in and year out. So what can you do to include improvements in your life and boost your morale?

1. Control stress
This might sound trivial to you but if you feel too stressed in your life, you won’t be open for change, you won’t have the RAM capacity in your brain to process new information. Learning more effective ways of living and practicing medicine requires a calm and focused environment with a manageable amount of stress and pressure.
To learn ways to control stress, visit http://www.balancedphysician.com/a-stresscontrol.html

2. Step outside of your box
People who stay inside of their box get stuck. Insanity is doing the same things and expecting different results. So, step outside of your box, try different ways to accomplish a task, read a book that is outside of your usual genre, try out hobbies that you have never done before. Stepping outside of the box gives you a different perspective of your situation and challenges.

3. Learn from accomplished colleagues
Being a successful and fulfilled physician in today’s healthcare environment isn’t easy but also isn’t impossible. So many physicians have developed their own formula for professional success and personal well-being. Learn from them, get in contact with them. Ask them questions. And then develop your own formula.

4. Stop listening to the ‘naysayers’
Some people enjoy complaining. They sometimes get their energy from complaining. But listening to naysayers can be very draining and discouraging. People and their attitude either give us energy or take energy away from us. Naysayers can only complain but in general cannot provide solutions. Therefore the best approach is to stay away from them. Establish your boundaries by letting them know that you do not want to hear their complaints anymore. If they don’t honor your request, step away.

5. Take small actions
Improvements won’t happen without action. Therefore think of one little step that you can do each day that leads you to long-term improvement.

6. Get support from a mentor or coach
It can be challenging sometime to make major improvements by yourself and stay motivated along the way. Our success in life is proportionate to our ability to ask for help. Therefore, if you want to succeed with your action plan, consider working with a mentor or a physician coach. They can assist you in minimizing mistakes and maximizing your efforts. And you will have so much fun along the way.

Medicine has not only become a field with bigger limitations but also with new opportunities. It is up to you if you are open to seize them.

Lost Revenue in a Medical Practice

Last week a friend of mine told me the following story:

On Friday I went for my annual Echo Cardiogram. I was called on Monday to see if I had insurance. A recording called the house on Wednesday to remind me of my appointment saying, "This time has been set aside for you." And then a live person called on Thursday and asked me to call. Or course they call during the day while I'm at work and they're not in office when I get home. On Friday morning at 8.30 am I called to find out what they wanted and after 15 minutes on hold, someone just wanted to make sure I was coming at 10:00 am. I assured them I was.

Okay, I show up at 9:45 am - I'm always early for doctor appointments incase there is paperwork to fill out. As you many know, I'm not a patient person.
At 10:30 am I went to the window and told the receptionist that I was not going to wait any longer and said I'd call later to make another appointment. As I was walking to the door the woman got anxious and snapped to attention trying to get things done.

She managed to stop me and I returned to the window while she frantically looked up my appointment and who was to have done my Echo Cardiogram. She called around and started paging people go get some answers. Two minutes later, the woman who was suppose to do my Echo walked by. The receptionist called to her. "Judy, your appointment is here." As Judy walked out of site she said, "I'm about to get him." and continued to walk out of site.
At that point I told the receptionist, "I'm sorry, 'about to get him,' won't cut it."

As I turned and walk out of the office the counter lady went running after the Echo lady. I haven't felt that good in weeks. I also thinking of billing them for the parking.”

Now, isn’t it a shame that patients, who pay cash for their service – an $800 service – are treated like this? What has been the outcome of this event?
- The practice lost $800 in revenue for a service not performed.
- The practice spent valuable time on this patient that did not get paid at the end: making the appointment, confirming the appointment, registering the patient at the point of arrival
- The patient lost 2 hours of his time away from work.
- The patient feels so dissatisfied about this experience that he will not return to this medical practice.
- The patient told many of his friends and colleagues about this negative experience at this medical practice – I guarantee you that none of them will ever make a visit to them.
- This was a lose – lose situation; the patient lost and the practice lost.

And how many physicians or practice manages will ever hear about incidents happen in their practice and address them to the staff? Probably not many because many times patients wasted already too much of their time that they don’t want to spend more time by filing a complaint.

Being on time has something to do with respect.

Give the patient an option
- While on the telephone at 8.30 am could have said, “we are running behind on schedule.”
- Talk with the patient and inform them upon the arrival.
- Ask them if they would like to reschedule or give them a price break

So many times I hear practice manager complaining that a person would never negotiate the cell phone bill or the bill but patients always want to negotiate a doctors bill or don’t even want to pay a doctors bill.

If a doctor doesn’t respect my time or doesn’t treat me with a service that is worth the amount he / she bills me, then I must admit I have a hard time justifying paying the bill.

If a physician wants to be treated like all the other service providers – they also have to treat their patients like a valuable customer that they respect, care and honor.

Lack of Skills is the Reason for Dissatisfaction

A couple of days ago I read the following article.

Physician Compensation Survey Reveals "Disappointing" Income Levels - Career satisfaction decreases while overhead costs increase

BALTIMORE, Md. -- July 13, 2006 -- The average take home pay of physicians surveyed across all primary-care specialties is roughly $150,000 a year, and more than half of these doctors say they are "disappointed" with their income relative to their work efforts, according to the first annual Merritt Hawkins/Physicians Practice Physician Compensation Survey.

Doctors are not only forced to pay operating expenses out-of-pocket -- including overhead costs like staff salaries, benefits, telecommunications, and rent/lease costs. They're also forced to pay strict attention to the amount of patients they're bringing in to counterbalance the weight of practice expenses.

Most doctors surveyed expect overhead costs to get worse over the next five years. Twenty-two percent "are doubtful" of their ability to sustain operating expenses, while seven percent "will not be able" to within this timeframe. Today, overhead costs for a small minority of physicians actually exceed their income -- these doctors are losing money each year.

Among the survey results:

• Nearly 30 percent of physicians surveyed report they are already "too busy."
• More than 61 percent of internists surveyed are disappointed with their incomes, compared with 53 percent of pediatricians, and 49 percent of family physicians.
• Signs of a primary-care shortage abound; 26 percent of physicians report receiving recruitment calls four to six times a month.
• Only 37.6 percent of those surveyed would again choose primary care if they could start over, and 28.6 percent indicate they would not choose to go into medicine at all.
• Of the specialties surveyed, pediatricians claim the highest levels of career satisfaction. More than 28 percent are "very satisfied" with their careers, compared with 18.7 percent of internists, and 24.9 percent of family practitioners. Pediatricians feel this way even though they earn the lowest pay, and are in the least demand.

For complete survey results and analysis, visit

www.PhysicianPractice.com to access the July/August cover story, What's in Your Wallet?

Now there are some physicians – and I would bet the majority - who translate this news into grim news. I hear more and more physicians constantly complaining about the change of the healthcare industry environment. And yes – it is not as easy as it used to be to make lots of money as a physicians. The world is changing constantly and so is the healthcare industry.

But I see so many physicians standing here, throwing their hands over the head and keep complaining. And this is all they do.

What I have also been seeing is this:

- Physicians like to put themselves in a victim role. Many of them are crying, “I am already too busy”, “healthcare is a disappointing industry”, “we don’t get the respect we deserve.” etc. etc. I don’t say that this is all wrong but rather than putting themselves in this victim role maybe it is finally time to wake up and look at the physicians’ effectiveness and see where they need to upgrade their skills. And no, I don’t talk about clinical skills but rather self-management skills, interpersonal skills, and business knowledge.

- Physicians are striving to constantly improve and stay up-to-date with their clinical skills. But that is not the primary factor that makes a physician successful. Nowadays it is also required from a physician to watch their p/l statement, to constantly review practice expenses, and to fine-tune the business of the practice. Even though a physician might have a very good and reliable practice manager, a physician still has to understand the business concepts and the financial well-being of the practice.

- A successful business / practice is not only determined by the revenue it brings in each year but by the expenses it minimizes. When was the last time you or your practice manager talked with a representative of your telephone service provider to see if you could reduce your expenses? Does your merchant account provider charge you the appropriate fees? Are you getting the most bang for your buck with the health insurance benefits?
It is not the task of a physician to regularly check these rates, but the practice manager or administrative assistant need to have this on their to do list. Besides, there are companies out there such as Jeffry Finkel with Overhead Reduction Services who analyses your expenses for free and finds you the best deals. How much better can it get?

- One of the biggest expenses that any business has is employees with their salaries and benefits. Did you know that the replacement of an employee costs 1-1 ½ salaries of the leaving employee? Many physicians don’t recognize that their constant turnover is damaging their financial health. Many physicians take their hard working employees for granted. Instead, physicians need to invest in their employees in order to maximize their performance. Teamwork and performance are mainly determined by leadership and rather than only blaming a performance breakdown on the employees, a physician has to take responsibility for it as well.

- A medical practice is a business. Many physicians want to run it like in the 50’s. All a physician provides is medical care and he / she get paid for this very well. If you have this kind of belief, medicine won’t advance you much. Instead, as a physician in the 21st century, you need to have an entrepreneurial mindset. What additional income streams could you integrate in your practice? What kind of complementary services could you offer in your practice? Become creative and offer services / products that your patients need. At the end, you will be making money while enjoying a nice vacation. That’s why they call it passive income stream.

- If you are a physician who doesn’t want to make these kind of changes in your practice, then maybe my last tip might benefit you. If your income decreases, you don’t want to make changes in your business procedures or performance, then adjust your lifestyle. Too many physicians live on the edge of financial bankruptcy. Many live a lifestyle that they hardly can afford. So if you are not willing to make long-term strategic changes in your practice, then simplify your lifestyle and start having a life.

Disruptive Physician Behavior

When I speak with hospital administrators, many times the topic of disruptive physician behavior comes up.

Now that has some obvious reasons. Disruptive physician behavior can damage the hospitals reputation tremendously and it can cost the organization lots of money. It is actually estimated that unnecessary turnover rates alone costs health care organizations more than $150,000 per disruptive physician.

Additionally, a new survey about physician-nurse relationships uncovers a strikingly high prevalence of disruptive physician behavior that is affecting nurse retention.
It showed that disruptive behavior by physicians is contributing to fuel the nationwide nursing shortage, heavily impacting job satisfaction and morale for nurses.
The survey results also revealed the seriousness of the issue and highlight a lack of physician awareness, appreciation, value and respect for nurses.

As a result, disruptive physician behavior has a negative impact on patient quality care and increases the likelihood of medical errors. Now what is disruptive physician behavior? There are many definitions available, however, the American Medical Association sums it up succinctly by “defining disruptive behavior as a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care.”Obviously, disruptive behavior cannot be neglected and needs to be addressed at the organizational level. Of course every hospital has a process in place how they address those kind of interferences but unfortunately, the success rates are many times not as high as they envision them.

So what else can be done to reduce disruptive behavior?When you look at the incidences closely, you can see that disruptive physician behavior is the result of a lack of self-management, a lack of interpersonal skills or both.

No physicians gets up in the morning with the intention of cussing a nurse out, interrupting the success of their surgery by throwing instruments through the OR, or screaming at a hospital administrator. I don’t think that any physician has such bad intentions because then they would definitely not be suited for this profession and should look for a job where human interactions are non existent. Instead, I look at disruptive physician behavior as a sign that their self-management and interpersonal skills are underdeveloped.

At the end disruptive behavior is the symptom of an underlying cause, call it frustration with life, overwhelm with their professional responsibilities, inability to cope with the demands of life, incapability to effectively communicate with people.

Handing the physician a warning or having a conversations with the physician about repercussions will not cure the behavior but rather only band aid on it. In order to get to the source of the behavior, the conversations and the revelations have to go deeper and need to address topics such as:
- how to effectively control oneself in stressful situations
- how to resolve conflict with a win-win outcome
- how to communicate effectively in any kind of situation
- how to resolve frustrations and strive to create more harmony and balance in one’s life and many more.

As a result, rather than educating and lecturing physicians about the negative consequences of their behaviors, hospitals need to invest time and resources into preventative workshops that address those skills, performing self-assessments, increasing staff awareness of the issue, opening lines of communication and creating great collaboration among peers.

If hospitals don't do this, the problem will continue to grow and patients, nurses, and the financial situation of the organization will continue to needlessly suffer.

"An ounce of prevention is worth a pound of cure."
- Henry de Bracton, De Legibus in 1240

I look forward to your comments and hearing from you.

Iris Grimm

www.BalancedPhysician.com
Iris@BalancedPhysician.com