Finding Out Which Doc Wants to Play What Role

Professional Interactions – Best Practices Series
Finding Out Which Doc Wants to Play What Role

By Fred Corbus

This article first appeared in Round-up Magazine, official publication of the Maricopa County Medical Society.

Being a physician can be incredibly demanding on his or her personal life. Often this is not recognized until the damage is done, often manifesting itself as: underlying resentment, physician depression, or burnout.

Ultimately, a physician's role as a healthcare provider, no matter what the setting, will always be enhanced if that responsibility is assumed within the perspective of their values and goals. Practices depend on their only real asset: the providers themselves!

The Mother of All Assets

We tend to think of assets of any group of physicians in terms of collections, equipment, reputation, and obviously people. As a short-term definition, this is a good start. As a sustainable definition it misses the target by yards. The sobering fact is that the providers eventually create or destroy all the assets. If the right people are in the right slot at the right time, everything happens. If there are mismatches or voids, you suffer mediocrity. If there are too many mismatches or voids, everything dissipates.

Case Study

A few years ago, I was called in to a large, highly recognized specialty practice. The group’s reputation for the provision of specialty care had become widespread. Patient awareness had grown and confidence among a wide network of referring physicians for both clinic and inpatient care was at an all time high.

Life is good right? Answer: yes and no. Providing patient care that few groups can provide to a market with strong and growing demand is the “yes” part of the answer. And now for the “no part of the answer:

1. Physician administration had become very demanding.
2. Sub-specialties within the practice had to be consistently available.
3. More hospitals located in different geographical areas had to be covered.
4. Assignment of rotations and locations of practice had become personally impactful.
5. The value of outcomes research, publishing, and the assumption of leadership positions had increased.

To further complicate matters, provider demographics (and therefore personal values and goals) and desires varied widely:

1. Some physicians were unmarried, some were single parents, some were raising a family, and the rest were empty nesters.
2. The personally defined balance of the number of hours for practicing medicine (e.g. part-time versus full-time and number of call hours) versus the need for income varied widely.
3. People had strong preference or dislikes for certain clinics and hospitals, clinic versus hospital care, for research and publishing, teaching residents, and administration.

Now I recognize that you can’t “let the inmates run the prison,” and strong rules of group-endorsed government must be in place, nonetheless I was clear that we had to begin by understanding each person’s practice related personal goals and desires.

We used a form and a process similar to the following example. Interestingly, the process almost never fails! Who wants to play what role, for how long, and where, was formally discussed and recorded on a flip chart during a roundtable session with everyone present.

Plans were then drafted addressing each person’s role and responsibility. Both individual and roundtable sessions were held. In short, everyone felt heard and considered. While not everyone got what they wanted, everyone understood the process and everyone supported the end product.

Finding Out Which Physician Wants To Do What, Where, and For How Long

1. Informally (casual conversations) and formally (practice meetings) acknowledge the mounting pressures personally impacting the group, and the need to “get out in the open” everyone’s practice related personal goals and desires.

2. Distribute and explain the following simple questions and two examples. Have everyone fill out his or her answer before an already scheduled roundtable session.

3. During the roundtable, record each person’s answer on a flip chart after they have explained all of the important nuances. Have everyone’s answers typed on one page and distribute. Lean on the document for subsequent planning efforts that have impact on someone’s personal values and preferences.

Example

Do you want to specialize in a certain area or location? Are there program, teaching, administration, or clinical responsibilities you want to add or drop? Do you want to work for another 15 years, slow down, or retire in a few years? (Enter your responses/notes below)

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Typical Responses

Dr. Muller

1. Retire in three years
2. Cover downtown clinics and hospitals
3. Create more life balance
4. Expand my knowledge base in the areas of cardiology
5. Assume more administration
6. Be more proactive in educational programs for families

Dr. Batten

1. Drop code committee
2. Work another ten plus years
3. Maintain current level of income
4. Remain flexible to match my role with family needs
5. Work with physicians in providing excellent patient care through physician communication

“The development of documents such as these is an investment of time; requiring meetings where participants listen and understand. Giving a joyful environment within which to practice medicine makes it all worthwhile!”

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