I’m intrigued by the number of articles written about the frustrations of medical practice. It makes for good reading, because it resonates with many physicians. From bloggers writing about maintainance of certification and regulations that are destroying medicine, to articles on KevinMD about burnout, physicians are not shy about complaining. But maybe it’s time to stop complaining and start leading.
If you stop in any hospital doctor’s lounge, you will certainly hear a lot more complaining. We complain about electronic medical records, complicated billing requirements, regulations, lawsuits, the difficulties of running a medical practice or working for a large institution.
Much of the complaining is warranted. But complaining without taking action is the characteristic of a victim. What we need in healthcare is leadership, not victimhood. And true leaders jump into action and skip the whining part completely.
Complaining Is Not Leading
What does complaining accomplish? For years, I’ve read surveys showing that physicians are unhappy. They’re planning to retire early. Physician numbers should be declining. They won’t recommend a career in medicine to their students or family. Fewer students will choose the medical profession.
But, I don’t see increasing numbers of physicians quitting. Retirement rates have not gone up. The number of medical schools has grown. So has the number of students applying to medical schools.
I’ll admit that physicians are unhappy. If you ask any physician what they don’t like, you’ll get a list of 10 or 20 things that are wrong with “medicine.”
My question is this: What are we going to do about it?
If you work for a large medical group or hospital system, you may be involved with recruiting physicians or negotiating employment agreements. It’s a set of skills worth learning because so many systems are on a recruiting binge. Salary levels have consistently grown at single digit rates for years. But the type and size of physician recruiting incentives have been more variable.
With the recent release of the Merritt Hawkins 2017 Review of Physicians and Advanced Practitioner Recruiting Incentives, I thought you might like a deeper review of that topic.
When recruiting physicians and advanced practitioners (physician assistants and nurse practitioners), the primary determinant of success in attracting good candidates depends on:
- Compensation offered;
- Quality of life (location, hours, cultural fit, etc.); and,
- Other recruiting incentives.
It’s time for the VITAL Physician Executive’s Monthly Leadership Favorites – June 2017 Edition. In this feature I share inspiring and enlightening advice from respected leaders, generally from outside of healthcare (but not always).
Leadership Favorites – June 2017 Edition
This month’s favorites follow…
How Leaders Kill Trust
In 16 Ways Leaders Kill Trust, Skip Prichard provides a guest post by his colleague Bruce Rhoades. Rhoades lists 16 things leaders commonly do that erode trust in team members, including:
- Publicly criticize
- Overreact to mistakes
As Rhoades writes: “When a leader exhibits any of these trust-killing behaviors, it not only undermines the trust of the team member directly involved but also threatens the trust of other team members. Even when not done in public, the word will spread among the team and damage the environment for trust.”
To see the complete list of bad behaviors, with examples, check out 16 Ways Leaders Kill Trust.
Modern Healthcare recently reported that Mercy Hospital Springfield and its affiliate clinic settled a case with the Department of Justice for allegedly submitting false claims to Medicare (Mercy pays $34 million to settle fraud, physician compensation claims). The case involved allegations of inflated physician compensation at an infusion center.
Modern Healthcare quoted the DOJ: “When physicians are rewarded financially for referring patients to hospitals or other healthcare providers, it can affect their medical judgment, resulting in a overutilization of services that drives up healthcare costs for everyone,” said acting assistant attorney general Chad Readler.
The hospital system acquired the infusion center from a group of oncologists. It was then able to charge hospital based fees and take advantage of 340(b) pricing for its medications. This is a common tactic used by hospitals to access favorable payments from CMS for hospital based services.
Inflated Physician Compensation
The DOJ alleged that the hospital paid the oncologists inflated amounts for management services following the transfer of ownership. This led to allegations of Stark Law and False Claims Act violations, ostensibly for exceeding fair market value and potentially encouraging referrals.
According to a National Law Review article regarding this case, the complaint alleged that “the compensation amount for the physician supervision work at the infusion center was approximately 500 percent of the wRVU for in-clinic work where the physician was actively involved in patient care… was not fair market value, nor was it commercially reasonable.”
Mercy agreed to pay $34 million to settle the lawsuit.
I addressed a similar issue in a popular post in 2016 (Physician Salaries and OIG Risk). I am re-publishing the content here for new readers. The previous article addresses inflated salaries. But the tactic of paying inflated management fees in order to maintain referral patterns has the same effect.
Pitfalls Involving Salary Surveys and OIG Allegations
I have been following news reports about recent OIG (Office of Inspector General) investigations related to physician compensation. These investigations have resulted in fines for alleged Stark Law and FCA (False Claims Act) violations. There seems to be more activity recently, including investigations in response to whistle-blower lawsuits.
Here is my take: Hospitals and health systems that use survey data (such as MGMA and AMGA) to set compensation levels for newly employed physicians are under intense scrutiny. This scrutiny results because:
- it appears that collections generated by the employed physicians do not support the salaries being provided, or
- salaries of newly employed physicians significantly exceed compensation previously generated in their independent practices.
Micromanagement can be defined as a management style that involves closely monitoring and/or controlling how employees do their jobs.
It’s a poor management technique that wastes time, fails to utilize our staff’s full potential, and causes resentment and frustration in those being controlled.
… the highway!
It is one of the 4 things that drive employees crazy, according to Dan Rockwell.
“How would you design a great hospital quality improvement program?”
A distinguished gentleman who looks to be in his 60s is asking the question. He and I are sitting across from each other at the end of a long, dark mahogany conference table.
I don’t remember how I came to be here. I probably look a bit confused.
“John. Tell me… How would you do that?”
I have previously devoted two posts to blogs written by physicians. I continue to identify new sites as I scour the web for news and reviews to share with my readers. With these newly discovered physician authored blogs, there are 73 for you to explore.
(I had 70 on my list, then realized I had forgotten to add The Productive Physician, a blogger I mentioned in my Monthly Leadership Favorites for March, Wealthy Doc and Smart Money MD).
You may recall that I posted my first list of 30 blogs with My Fascination with Physician-Authored Blogs. Then I added 20 more and published the list of 50 in Are You Intrigued or Entertained by These 50 Physician Authored Blogs? All 73 of them are included in the updated table below. The new ones are listed at the top.
In this list I have avoided blogs that are strictly clinical in nature (well, maybe one or two slipped in). However, some of them may have a mix of clinical AND philosophical or financial content. In fact, one of them (Sutured for a Living) has a mix of clinical and quilting content (you saw that right: quilting!).
It’s time for the VITAL Physician Executive’s Monthly Leadership Favorites May 2017 Edition. In this feature I share inspiring and enlightening advice from respected leaders, generally from outside of healthcare (but not always).
Leadership Favorites May 2017 Edition
This month’s favorites follow…
Leadership Through Coaching
Michael Hyatt provides some great advice in 3 Habits of Highly Effective Coaches. In this post, he mentions a book written by Michael Bungay Stanier: The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever.
Michael summarizes how leaders should use coaching to bring out the best in others:
- Give less advice;
- Ask questions instead; and,
- Ask better questions.
I feel that it’s time for me to reflect on where VITAL Physician Executive has been, where it’s going, and whether I am addressing the biggest challenges for the physician leader.
Update on This Blog
Last year when I started writing, I committed to myself to post twice a week. And I have stuck by that pretty well. Since June 2016, I have published 84 posts prior to this one.
But you may have noticed that I’ve slowed down over the past month. My recent posts have been longer than most of my previous posts. For example, the post just prior to this one (Creating a Wildly Effective Annual Management Plan) was well over 2,000 words, and the two prior to that ran around 1,000 words each.
When I read opinions about the ideal lengths of posts, I see recommendation of 500 to 700 words (Michael Hyatt), to 750 to 1,000 words (Mark Mason) to lengthy, in-depth mega-posts that may be 3,000+ words in length (Tim Ferriss).
My practice partner and I had been working together for about a year in our small family practice. A medical equipment salesperson approached us promoting a new device that would surely bring in additional practice revenue.
After considering the purchase, we decided to proceed. We signed a loan agreement and purchased the device. It would take 5 years to pay back the loan. We were convinced the device would generate procedures that would easily cover the loan payments.
Eighteen months later, we had only used the device about a dozen times, and we were stuck making that monthly payment with little revenue to offset the cost.
We had been overly optimistic in our assessment of the need for the device. And we had not considered what we would do if it failed to match the salesperson’s inflated return on investment.