PookieMD's Blog: Where Physicians Learn About the Business of Medicine

It’s hiring season at my compnay, ExtraMD, a “local locums.”  My group of doctors has too much work to cover, so it’s time to add to the stable.  I finally realize that I need to have more doctors that I think I need.

But how to find good, caring doctors that want to enjoy medicine, life, and a balance in between? How to find physicians that put integity as a core value?  How to find physicians that do what they say they are going to do?

Here’s what I have tried so far, and accompanying results:

Craigslist.org: best response from this.  Two physicians interested, will be interviewing one on Friday.

Linkedin: no response

Sermo: no response

Bounty offered for referral: two responses, no interviews.

Mass emails to my friends and acquaintences: no responses.

On the docket for more recruiting: a post card mailing, advertisement on the Colorado Medical Society site, placing ad on medical job websites.  My best results have come from referrals from my friends, but that well seems to be dry.  Any thoughts on how you have successfully recruited the right doctor for your practice?

I just finished Drive-the surprising truth about what motivates us, by Daniel Pink. A good read, and helpful when looking at why we do what we do.  Recently, I blogged on burnout, and the very next day our “lunch’n'learn” was about physician burnout.  A lot of physicians I know are burned out, and it crosses specialties and matters little whether a physician is clinic or hospital based.

Pink states that we are motivated to do our best when we have autonomy, mastery and purpose. 

Relating to the physician job, lots of us became physicians because we want to be the captain of our own ship.  We like to run the show, and enjoy the stress and mind candy that comes along with doing just that. However, over the past several decades, physician autonomy has shrunk.  We feel controlled by insurance companies, coding requirements, “best practices”, and patient demands. Control of our times feels as if it has gone the way of  tie dye and mood rings.  The very way we do our daily tasks has changed–now we must deal with an EMR that may force us into a new way of thinking that is not our own.  One hospital where I work forces physicians to write notes in a APSO format–with the assessment and plan first then the subjective/objective portions.  Physicians had not choice–they were told that this would make the notes easier to read on the computer.

Mastery should have come through our training during  medical school and residency.  Actually this was just the beginning.  We now realize we can hardly keep up with the speed of change and the increasing fragmentation of specialists. We try to maintain our corner of the medical garden.  Motivation comes with the attempt toward mastery–and it’s hard to improve our skills and knowledge base if we are just trying to keep up with patient flow, learning the *&%@! new EMR and filling out the right insurance forms. As students, we loved the human body, now we rarely allow ourselves to think of the majesty of how the body works and the joy we once had it helping a person toward health!

Purpose has gotten lost along with autonomy.  When was the last time we really felt we were healing, caring and improving?Currently, it may feels as if we just prolong the inevitable! I became a physician with single purpose of “helping people”–really, that’s why!  Too many of us have forgotten that very real reason for why we endured the years of training–because there is nothing more amazing than the mysteries of the human body.

So how do we regain our motivation–so dependent on autonomy, mastery and purpose?  The answers given at our lunch and learn were trite, and not to be repeated here.  I will need to think more about this and invite you to send me your thoughts.

Take a breath, have a sip of coffee, and celebrate all that you have accomplished!

As I pull myself out of my post holiday over fed stupor, I have a bunch of random items floating in my head.  Most of them have to do with my business, ExtraMD, but quite a few have to do with the process of practicing medicine.

Okay, that’s clear as mud.  I’m such a ruminator it’s amazing I don’t have a cud.  What I’m trying to say, is that I frequently review events and try to figure out what I can do in the future.  It’s a more constructive form of worrying, which I have down pat.  Here are some questions I am pondering, along with questions that have been asked of me:

• How can an EMR mimic work flow?  More specifically, why do most of us still think better on paper, and what can be done about it?  (Quite a few docs have asked said, “You know, I do a note on the EMR, and then can’t even remember what I wrote.”)  I don’t know if this is because we all trained on paper–leave out the puppy training/paper analogy! Perhaps the physicians currently in training that grow up with an EMR won’t have this problem.  Thoughts?
• How can I build more loyalty from the physicians that work for my company?  The last two months have been filled with prima donna behavior from them that has left me cringing and apologizing to our clients.  All from some of my best doctors that usually give me no problems at all!
• How can I recruit more physicians into my company that will help my company grow?  Entrepereneur magazine suggests I ask the potential candidate for his/her vision of their role in my company.  I really like that, as I think most candidates would not have a vision beyond the paycheck.  I’m not cynical, I just know that I have  not been rigorous enough in shaping and sharing a vision.
• Why do some consulting physicians intimidate me? And how can I muster up?   
• How can I find the time to do the things I want to do both professionally and personally?

I’ll be thinking about answers to these questions and post on them.  I’d appreciate your insights as well!

Christmas is a great time.  For me it represents a possibility of what ifs.  What if Santa could bring me everything I wanted?  Here’s what I would wish for, for my company, ExtraMD,  and for myself professionally (and a few personal items thrown in!):

• A second office.  Now that Dear Hubby is entrenched in the upstairs office doing his job search I have moved to the basement, which is cold and dark.
• Another desk top computer.  I have an Acer Aspire which I love, but I still miss the big screen that’s in the upstairs office.
• A cell phone plan that doesn’t drop calls every 10 feet. I have AT&T, and it’s making me nuts.  I don’t have an iPhone,  so I’m not wedded to the plan.  Do I want an iPhone?
• A teenager to come load my mp3 player.  I still can’t remember (did I ever learn?)  how to use the dang thing!
• An assistant like Miss Moneypenny.  No, I don’t want the fawning adoration, just the efficiency and dedication.
• Time.  I want to time to spend with patients, thinking about patients, talking about patients and helping patients.  I also want time to work ON my business, not just in it.  I want time to read, read, read, and think, think, think, and then plan, plan, plan.  I want time to enjoy the journey, not just rushing to the next destination.
• A waterproof watch that is actually water proof.  Simple hand washing has dusted my last 3 Timex ironman watches! Seriously!
• A guarantee that my knees will be okay if I keep running.  Someday, I would like to do a marathon, but received a stern lecture from my local orthopod–”People like you keep people like me in business!”
• A chance to be an expedition doctor. 
• A belief that what I do truly matters.  Isn’t this really what we all are striving for?

What’s on your list?

Photo

It was a challenging week last week. Tweenager Daughter, of broken arm fame, is depressed and moping, and has decided that being a honor roll student isn’t all it is cracked up to be, and Hubby is still not gainfully employed.  (Month seven, not that I am counting!) I am still working to much, eating bad for me food, and exercising too little.  Last night my dog, a hyper Vizsla, tore up the trash, frustrated that I haven’t been walking her enough.

A wake up call came in the form of a Christmas card.  It was one of those pictures of the family in front of a beautiful location cards.  This card had a picture of a doctor, her stay at home husband, and their two children posed in front of half dome, in Yosemite.  What struck me was the fact that the doctor was decidedly overweight, next to her trim husband.  The second wake up call came in the form of an article in Entrepreneur magazine–about a 30-something corporate type from Denver that had an MI.  It had some advice on how to “get a life.”

I will summarize, but encourage you to read the whole article.  We doctors are the masters of over commitment, under self care.

• Control your calendar.  Learn to say no. For me that means saying no to taking  more shifts and regretting it later. 
• Lower stress.  I know that when I go to the gym, I feel better. I need to schedule this in to my day.
• Set aside “me time.”  Around the holidays, this gets really hard. For me, I get me time when I get up early and read.  I love to read, and it centers me for the rest of the day. 
• Define work/life balance.  I define this as time with my family, away from pagers and phones, with time to help Tweenager Daughter with her home work. What is decidedly out of whack–time with Hubby.  More later when I get a handle on this.
• Hire somebody.  I found someone to send out holiday cards for my business and take on some projects. 

I’m off to walk the dog.  What are you doing to create balance?

photo

Lots of you may have guessed that I am a wannabe mountaineer, and have secretly lusted after being an Everest base camp doctor, just so I can look up at the highest mountain in the world at least once in my life.  I also harbor visions of helping others and leaving a legacy, and I try to convince myself that being a Girl Scout leader may be sufficient.

Meet Dr. Geoff Tabin, National Geographic Hall of Fame Member.  He has stood on the top of the so called seven summits–the highest peak on each continent, is a practicing physician, and goes on missions to remove cataracts from the near blind in countries like Ethiopia, Nepal, Tibet and North Korea.  He is married, and has 5 kids. I’m exhausted thinking about it.

He ain’t no Girl Scout leader.  Instead, he travels to places with abject poverty, operates on over 82 patients in one day, drinks tons of coffee, and apparently, does it all quite cheerfully.  And in his spare time, he plays tennis  (he arranged a match with one of Ethiopia’s top players while he was there), and meets with the Dalai Lama.  Dr. Tabin organized and runs the Himalayan Cataract Project.  And oh by the way, when he met with the Dalai Lama, Dr. Tabin was given the 2009 Unsung Heroes of Compassion Award.

I challenge all of you: what are you doing to make the world a better place?  We can’t all be Dr. Tabin, but we all can climb our own summits and support our own causes.  What’s yours?

To start the karma flowing, here is the link for Himalayan Cataract Project.

If you are interested in Girl Scouts, here is the Girl Scout website.

I have been a Girl Scout leader for a long time, and this past weekend my troop went for a mountain bike ride.  (Hey, it’s Colorado–it’s what we do!) I am part of “Troop Xtreme” –a bunch of girls that have together since 1st grade that like to push life to the limits and do go deeds at the same time. Not a bad gig, really!

I was reflecting on why I am still a leader after 7 years, and realized that so much of what I do in life, and believe about life, can be summed up the Girl Scout laws.  Here’s the law, and following it, is how I try to live it.

“I will do my best to be
     honest and fair,
     friendly and helpful,
     considerate and caring,
     courageous and strong, and
     responsible for what I say and do,
and to
     respect myself and others,
     respect authority,
     use resources wisely,
     make the world a better place, and
     be a sister to every Girl Scout.”

Honest and Fair: just this past week, a patient asked me not to tell his wife his diagnosis.  I was torn, but, I told the patient that I couldn’t lie–I had to tell the truth, and if she asked me, I would tell her the truth.

Friendly and Helpful/Considerate and Caring: isn’t that why we all became doctors?

Courageous and Strong: I think we are required to be strong, especially in the face of crises.  No one wants a shrinking violet running a code!

Responsible for what I say and do: I have to say that one of my most basic core values of all is responsibility.  I don’t think we can be physicians unless we are willing and able to shoulder responsibility for not just the small things, but major ones–like some one’s life.  Sometimes, I have to admit, the weight of patient care seems overwhelming, however.

Respect for myself and others: as a physician, this has been my greatest area of growth over the last 5 years.  Now that I am more comfortable in my own skin, I can see other’s view points, and finally recognize that my way is not the only way.  This learning process especially is relevant when I have  different view points than patients.  I remind myself that what they believe is as equally relevant and important as my beliefs.

Use resources wisely:I’m better at recycling because of this law, but we all could use our medical resources more wisely!  I think this is the reason health care reform is so important–we are not using our health care resources wisely–for many reasons.  (E.g.: malpractice, tort reform, the public’s unrealistic expectations, etc…)

Make the world a better place: time will tell if I’ve left a mark.  I have to say that sometimes, it doesn’t feel that way.  I thought, back when I was 5 and thought I would save the world as a physician, that it would be much easier! I hope I am giving back.

A sister to every Girl Scout: this is one of the best things about being a Girl Scout–everywhere I go I meet leaders and former Girl Scouts.  It’s a great sorority to belong to! 

I’d love to hear about how Girl or Boy Scouting shaped your life–I’m a big believer in it!!!

As you know, I have been been working a lot of extra shifts since Hubby got his pink slip.  I knew I was burning out in mid September after taking about 5 extra shifts per month.  Here are my warning signs, and my anti-burn out plan. 

• Dread of going in to work that would start on my days off.
• Shortness with nurses on the phone.
• Excess whining at work on my part.
• My daughter asking, “do you really have to go to work today?  I haven’t seen you in FOREVER.”
• Over reliance on coffee.
• Hoping that someone else would get to the “Code Blue” first so I wouldn’t have to run it.
• Looking longingly at patients’ beds, wishing I could just sleep.
• Wishing I would catch H1N1 so I could stay home, but no, my iron clad immune system is too strong!
• Yelling at hubby to “get a job, dammit!”
• Regretting instantly how b—-y I have been to just about every one in my life.

Anti burn out plan:

• Over the top self care.  I got two 20 minute neck massages at WholeFoods before I went in to work.
• Reducing the amount of shifts I am willing to work.  I cut down by a couple each month, starting in December.  (That’s the soonest I could change my schedule.)
• Bring in good lunches/dinners to work.  No more high fat, high calorie doctor’s lounge junk!
• Getting out side.  It’s beautiful out here in Colorado.  Getting out for a walk with my hyper dog (a vizsla, if anyone wants to know) helps her and me!
• Saving the notes my daughter puts in to my lunch box.
• Reminding myself that this too, shall pass, although it sure feels like a kidney stone right now!

And what do you do to avoid flame out?

PS: there is a nice summary of an article from JAMA on reducing physician burnout over at KevinMD.

I love watching Letterman and his top ten lists.  So, in hopes to provide some inspiration, I offer up mistakes I’ve made in my career as physician entreprenuer:

10. Hired someone when my got screamed not to.

9. Stayed in a job too long.  (I was a prison doctor at a women’s prison.  It wasn’t until I quit that I realized how bad it was!)

8.  Walked away from the first urgent care opened in Denver with out asking for a stake in the business.  (Still recovering from that one!)

7. Calling someone too late when I really wanted a job.  I called too late, and the job went to someone else.

6.  Not embracing technology sooner.

5. Underpricing/underpaying myself.  An ongoing problems.  My forehead is flat from smacking it every time I underprice myself!   Arggh!

6.  Listening to nay sayers,  Sadly, members of my family are huge negativists.  If it had been up to some of them, we would never have gotten to the moon because it “can’t be done.”

5. Being scared to take risks.  See note above about forehead smacking and negative family members.

4. Being intimidated by those smarter, cuter, richer, sleeker, older, more experienced…what ever.

3.  Spending too much time IN my business rather than ON my business.

2.  Not taking coding seriously when I first finished residency.

And my top mistake is:

1. Not believing in myself.

Hopefully you will not make these mistakes, but if you do, and you want to share how you over came them–comment at will!

I have decided to change the tone of the blog slightly–I want to post on where I’m going as a physician and a person.  The last four months have been especially challenging for me on a personal and professional level.  My husband, a high tech electrical engineer type, was laid off in May, and still doesn’t have a job.  I have taken extra shifts as a hospitalist and a primary care physician to try and make up the difference.

The result? A stressed, frazzled, and crabby PookieMD who misses her family and her time outdoors. Hubby and I had always chosen a simpler life–we have two cars with with over 100,000 miles on each, live in a very middle class neighborhood, and have consciously elected family time over money (and extra shifts!)  Our greatest pleasures have been bashing down black diamond ski slopes with our daughter and clinging to rock faces.  We have always chosen to earn less in favor of more time with each other and Tweenager Daughter.

So how did I end up working 50+ hour a week?

Fear.

Fear that Hubby would not find a job, fear that things would get worse, fear that we wouldn’t make it.

Well, I’m done with that.  I want myself back. So as I try to bring my life back in to balance, I will explore wins and losses with you, and continue to blog on the business of medicine.  So to that end, PookieMD’s blog will now be about managing your practice and your life.

I hope you will chime in frequently with suggestions, tips and criticisms as I bring my life back in to balance.