Guest Blog By: Kevin Mosser, MD
37 years ago, in 1982, I completed my residency training in the specialty then called Family Practice. As part of my residency, I was comprehensively educated on how to start my own practice. Everything from billing, scheduling, collections, staffing and human resources to supply orders and obtaining a facility by lease or buy was covered. The curriculum even included time in the third year that was dedicated to setting up your practice. Solo practice was still popular and was attractive for its autonomy and independence.
Fast forward to today. Graduating physicians often choose to be employed by a health system, a large specialty practice, or a for-profit healthcare company. High levels of debt from education, a desire for “work-life balance,” a surge in the complexity of the business end of medical practice and a growing gap between compensation opportunity from professional fees alone and pay opportunity through employment all contribute to this shift.
Unlike the old preparation for self-employment, however, nothing in today’s training of physicians prepares them for life inside a large, complex organization. Often, physicians struggle to find a place and a voice within the organization. If the physician feels disconnected, unrecognized, and powerless, risk for burnout becomes significantly higher as satisfaction and joy of work fall precipitously.
Related– Physician Burnout: 6 Leaders Making a Difference
Why do physicians experience such difficulty existing within an organization? The answer is complex and multifactorial, but a few of the causes are critical to understand in order to optimize organizational synergy. These are best viewed by the physician as tensions rather than correct or incorrect views. Here are just three of many to illustrate how this dissonance occurs.
The needs of the patients always come first. Everything else is secondary. Organizational leadership, while dedicated and concerned about the patients they serve, is required to balance fiscal realities, needs of a wide variety of employees and long-term strategic positioning. This leads to a tension where physicians feel as though the organization puts money ahead of patients, and they question the allocation of resources to anything other than patient care. If this tension is not acknowledged and addressed, the employer sees the physicians as demanding and irresponsible, while the physicians can too easily dismiss all management as corporate overhead that diverts resources from patient care.
Given the complexity and pace of modern practice, the physician has her / his hands full simply managing the day. They understandably see the world from the lens of the microculture and situation in their practice location. Organizations take a very macro view, spending much time on industry trends, consumer priorities and external measurement and reimbursement. Access initiatives are a perfect example. Organizations know that patients as consumers increasingly demand same day access. They also see the strategic imperative to capture as many patients as possible. Initiatives are created and enacted to increase same day appointments, emphasize practice growth, and optimize the ease of making an appointment. The busy physician, however, may only see the full schedule and wonder how in the world they could see another patient. This tension of micro- and macro-viewpoints leads to physicians feeling as though the organization keeps adding one more needless thing to an already impossible daily existence. The organization, in turn, sees the physicians as resistant to change.
Caring for patients is a stressful, high risk endeavor. Error can have severe consequences, both for the patient and doctor. The pace is fast and hectic, and physicians need to have the freedom to build workflows and routines which reduce error and help them avoid mistakes. Change perceived as externally driven increases risk of error, yet the consequences of that error on a personal level are borne largely by the physician. The organizational mindset, however, is one of minimizing variation, centralizing services to improve efficiency and cost and standardizing the patient experience wherever they touch the organization. Tension arises when the physician comes to see every standardization as equally risky and disruptive, or when the organizational lack of understanding of the stress of practice creates insensitivity to the impact of stepping too far into the realm of patient care, and the consequence of inserting the company into the patient care space.
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These issues arise from good people operating in two worlds that simply have only recently collided. Neither world truly understands how the other operates, and thus easily devalues the needs and thinking of the other. These three issues, and a myriad of others, are best viewed as polarities to be managed rather than a contest to be won. In an environment where physicians are experiencing high rates of burnout symptoms impacting their health, patient care, and system financial performance, aligning our physicians and their organizations should be a singular priority.
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