I know I talk all big and scary about administrative types. But I want to be clear. Hospital and practice administration types are NOT physicians’ enemies. We see them that way, because they are the ones we are in direct contact (and conflict) with when any new regulation from lawmakers, CMS, or insurance payers comes down the pipe. They are the folks who in our eyes appear incredulously disconnected and uniformed when trying to explain the new hoop we have to jump through to get our patients taken care of and get paid (so we can pay off our student loans). But they didn’t come up with these asinine hoops. They are just trying to keep the team in compliance- and watch the bottom line. They may not always use the best strategies to encourage physician buy-in, but they are working (or can work) with and for us and our patients. These aren’t the greedy blood-sucking bottom-dwellers that sit in major insurance company CEO chairs. (OOPS, did I say that out loud?).
I recently attended a leadership conference where one of the directors seemed to have read my mind and knew what I needed to hear. He said (paraphrase here) “If we continue to be the helpless victims and make them the villains then we won’t move the conversation forward. We, physicians, have to learn the language and gain the tools necessary to sit at the table of conversation for change.” He’s right. I can’t go into any boardroom a screaming, self-righteous know-it-all physician demanding, threatening, and whining and expect to be taken seriously or effect any change. I may be right, I may know what is best for medicine, I may be the one with the real power since I’m the double board certified physician who actually sees patients, and I may have suffered injustice in the system as it stands… but there is a better way to make that known, if it is even relevant.
What is relevant? Taking care of our patients. Letting doctors be doctors. A common goal and vision for viable future of healthcare.
I believe an excellent first step to improving the practice of medicine is not to fight our admins, but rather to team up with them. We physicians do what we do well. Admins do what they do well. And we need each other. Yes, I can master an administrator’s education and skill set (faster than the 11 years my medical training took) and do their job and mine. But that is not most efficient or effective. And tossing that elitist attitude around doesn’t foster cooperation at all. We have a shortage of physicians, not administrators. Communication between our two sides can make the team more effective, in negotiating with insurance payers, in setting practice examples, in leading change. It’s called “the power of two.” Or if you want to sound fancy: Dyad Leadership in Healthcare. We are not the victims. They are not the villains. We are on the same team. We have to be to effect real change for the future of medicine in our country.
When I was in training, I thought “I just wanted to do medicine and let other folks handle everything else.” I didn’t realize how important it is that physicians understand the administrative details and reasoning and that administrators understand the medical nuances and reasoning. We can’t expect administrators to effect change on our behalf without understanding our viewpoint. And we can’t make a path forward to improve our system if we don’t better understand the system our administrators are working within. So we need to be friends- or at least know each other. We need to communicate…meaningfully, frequently, intentionally. We have to make time to see each other in our respective elements, spend time together understanding. Then we work together.
Some healthcare organizations already do this. Mayo is one. This is an accepted part of the culture there, and as physicians are employed, it is expected. But other organizations use the dyad model to successfully grow and improve their care simply on the idea of shared vision, shared goals, open communication through relationships that have been built over time to create an environment of trust. Not saying Mayo doesn’t do that too, just trying to head off any arguments against the whole teaming up idea based on “employed physician coercion.” I’m not saying this needs to happen in a formal spelled-out-in-an-organization-wide-email fashion. It can just be two folks talking. But, wouldn’t it be amazing to work where your administrators really felt like your partners in caring for patients? Where it felt like you both want the same thing for healthcare? Maybe you already do, but without the teamwork and communication, you don’t realize it. Or maybe, after teaming up, you realize you don’t have anything in common. So you start from scratch. You educate each other and learn from each other. You take time to build trust. Then you develop a shared vision that is patient centered yet advocates for the physicians doing the clinical work.
Last year I was skiing with my family. My 5 year old found himself stuck in new powder at the bottom of a steep stretch. He wailed and lamented his condition. He couldn’t unstrap his snowboard to walk out of the mess. He was stuck. He informed me he would just have to die there. This improved to the option of breaking his board in half and walking out. Then more weeping and gnashing of teeth. He was helpless. And it was all the fault of this beautiful new fallen snow. Stupid snow. Except that he needed snow for riding on his snowboard. But still. I (having just read Love and Logic) did not ski down to help him unstrap. Now before you think me a mean parent, or amazingly more determined than my child, know that I was more concerned about safely getting down said steep narrow stretch without plowing into him than I was about teaching him a life lesson. But mother nature would have that he learn his life lesson. When he realized I wasn’t coming to unstrap him, and he decided he wanted to keep riding (thus needing to avoid the board breaking option), he bent down and tried again. And again until he undid his binding and got a foot out. He solved his own problem and was so proud of himself (insert parenting moment here). But the point of the story is not problem solving. Physicians are great at that. The point of this story is if we want to keep practicing medicine in the way we feel is best, then we have to advocate for ourselves and our patients. We can’t stand still in the powder mess that is our current system and expect it to change. We can succumb to the snow and cold, we can break the snowboard and leave medicine behind; or we can work harder to find a solution.
Being the victim and pointing fingers at all the villains doesn’t help our patients or improve the longevity of our careers. It promotes negativity and a sense of helplessness which can lead to bitterness and “burnout.” If we want things to be different, we have to be a part of that solution. It’s not just as easy as that of course. If you are overwhelmed by the thought of simply completing your charting and finding your next meal/snack/peanut butter cup, then you aren’t ready for this step. You work on you and getting to a place where you can actually breathe and care about that bigger picture. I have been doing that for a minute myself (That’s southern speak for “a while now” – as in 2 years). That may take some time, and that’s ok. But some of us are ready. I think I am- that’s why I am writing on this blog. I’m dipping my toes in these waters because as unqualified as meek me would have me believe I am, confident me says that my passion is enough. And partnering with my administrative team means I don’t have to do it alone. Changing from the victim/villain mindset allows a synergistic relationship that can make a difference.
Next step, changing my tone above on the insurance CEO’s. It’s a lot easier to create a story around third party payers and their leaders that includes villainizing them than it is to see a way to communicate and gain perspective that helps our patients and the longevity of our ability to practice medicine. I’ve got work to do on my own mentality here. But I promise to keep working on my attitude and opportunities to open that conversation. For now, I’ll keep improving the open lines of communication I currently have with my practice and hospital administrators.