While the presidential election captured most people's attention this week, there were a few healthcare-related ballot initiatives that passed as well. Michigan approved the use of medical marijuana, when approved by a physician, and voted to expand embryonic stem cell research in the state. In Washington, a proposal passed 59% to 41% making physician-assisted suicide legal.
Physicians and other eligible professionals who adopt and use qualified electronic prescribing systems to transmit prescriptions to pharmacies may earn an incentive payment of 2% of their total Medicare allowed charges during 2009, the Centers for Medicare and Medicaid Services have announced. This incentive is in addition to a 2% incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative, and both incentive payments are in addition to the 1.1% fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008, according to a CMS release. As a result, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1% pay boost for 2009.
Many of the trends within the physician workforce in recent years—a growing emphasis on work-life balance, a shift toward employment, a rejection of traditional ED call coverage models, and the growing shortage—are often attributed to generational differences and other consequences of a changing physician demographic.
But there's another, more sinister, force driving physician work habits: Physician burnout.
It's not just that some physicians are tired or overworked. In many cases, they are so chronically stressed that it affects their attitude about the healthcare system, their professional performance, and their personal lives.
And it's problematic at every level. The Annals of Internal Medicine recently published a study that found half of medical students are burned out, and 11% have considered suicide within the past year. Another recent study found widespread resident physician burnout and concluded that few interventions currently exist to remedy the problem.
With so many of today's physicians burned out by the time they make it out of training, who can blame them for emphasizing quality of life as much as compensation when looking for a practice opportunity? This is, in part, why we're seeing a renewed interest in employment and why specialties like dermatology, which offer both high pay and a stable work schedule, are among the most popular for new physicians.
Sure, there's the argument that such rigorous training helps thin the herd so that we emerge with the best and most dedicated physician workforce possible.
But medical school dropout is relatively low, and that becomes a moot argument when weighed against the many consequences of widespread burnout.
Studies have found a correlation between medical errors and burnout, as well as a decrease in levels of empathy toward patients. And physicians have traditionally had higher rates of divorce and suicide than the general public. It is a major problem, not just for physicians, but for the overall healthcare system that depends so heavily on their performance.
So is there any way to fix this problem?
Perhaps that's just the nature of the beast. Medicine is an intensive discipline, and stress is for the most part unavoidable, particularly when the overall healthcare system is strained by physician shortages and reimbursement cuts.
Yet, it doesn't bode well when doctors describe medical school as "the lowest point in terms of self esteem." There are ways to at least dampen the negative effects, and they begin with recognizing the seriousness of the problem.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
Effective teams are made up of individuals who take accountability for their behavior. Team members take action not because they should, but because they truly want to.
Such motivation is possible only in an environment in which employees feel valued and respected and, in turn, hold their colleagues, manager, and practice in the same esteem. If you struggle with getting your staff members to work in harmony, consider the following three critical steps:
1. Go for understanding. Sally Gardiner, CPC, RTC, a certified professional coach and trainer in Gladstone, OR, is frequently called on to help practices create more peaceful, productive relationships throughout the office. Much of her teaching is based in Choice Theory, a philosophy founded by William Glasser, MD, which is based on the premise that no one can control another person and that everything we do involves choice. Our behaviors are a result of the choices we make to get our needs met. If people understand the needs driving behaviors, they will begin to treat others differently.
According to Choice Theory, behavior is driven by one of five basic human needs: survival, love and belonging, freedom, power, and fun. "Everybody behaves to get those needs met," Gardiner says. For example, consider a workplace going through an uncertain time, perhaps with the possibility of layoffs or a buyout. "People's need for survival will rise to the surface because they're wondering if they're going to have a job," she says. "There will be a lot of behavior coming up that could be judged as disruptive and needing to be dealt with."
Rather than judge others based on their behavior, trying to understand the needs that are driving behavior will support more effective action. For managers, the best way to minimize fear-driven negative behavior is to listen to employees' concerns and arm them with as much information as possible to help them make sound decisions, Gardiner says.
2. Define and communicate expectations. It's never a good idea to ignore negative behavior. Beginning with the interview process, practice expectations should be made very clear to employees. "When we interview, I really describe the kind of person we're looking for. And when I do reference checks, I say, ‘Here's our environment. How's this person going to fit?' " says Paula M. Comm, MA, LCPC, CADC, administrator of Perakis, Resis, Woods & Associates Behavioral, LLC (PRA), a Chicago-area psychiatric practice. Upon hire, employees sign a confidentiality agreement and receive an employee handbook, which includes a page describing expected conduct and behavior.
Two of the main qualities PRA seeks in candidates are respectfulness and trust—the lack of which led to the walkout employee's demise. PRA has also saved several employees from a similar fate. For example, when one longtime employee started becoming rude with patients and showing other signs of being burned out from the front desk, Comm intervened several times and eventually suggested she take a position in the back office.
"It can be really hard to take the brunt of patients when they call in. It may be worse in our field [psychiatry]. After a certain amount of years, you just can't do it anymore," she says. "We thought if not faced with patients, she wouldn't be as agitated, and it worked."
3. Reward desired behavior. PRA employees are well-paid and receive generous annual—and sometimes impromptu—bonuses, Comm says. "I just gave each of them $100 last month in a surprise envelope, which made half of them cry, because we had a great month and wanted to have them all share in it. I think they have a passion for this practice because they know this practice's success is their success."
Although lower-budget rewards, such as a $5 gift card or employee of the month certificate, can also be motivating, the most effective reward system requires an investment of time, Cordes says. "A lot of PAHCOM members are ultimately motivated by their feelings for their patients, the work they do, and the people they work with," she says.
"People really want to feel like they connect, and if you give them the feeling that they are valued and connected and important, that is reward in itself. They become intrinsically motivated to do well," Comm says.
This article was adapted from one that originally ran in the November issue ofThe Doctor's Office, a HealthLeaders Media publication.
Joel J. Reich, MD, senior vice president for medical affairs at Eastern Connecticut Health Network, discusses the disconnect between physicians and hospital administrators when it comes to quality improvement efforts, and offers potential solutions for bridging that gap.
If you're a baseball fan in New York or Detroit, this has been an autumn of discontent. The New York Yankees, Detroit Tigers, and New York Mets spent gigantic amounts of money on player salaries—they are the top three spenders in the game, in fact—yet somehow failed to make the playoffs. Instead, they spent this fall watching the Tampa Bay Rays, with the second-lowest payroll in baseball, advance to the World Series.
The Rays' success is an example of how analyzing reams of complex data on players' performances and tendencies can improve a team tremendously at a bargain cost. Simply throwing money onto the field in the form of underachieving famous names seldom works.
Healthcare could learn something from our national pastime, according to a recent New York Times op-ed piece penned by an unlikely trio—former House Speaker Newt Gingrich, Sen. John Kerry (D-MA), and Oakland Athletics General Manager Billy Beane. The three men contend that the key to improving healthcare quality is following baseball's lead and adopting a similar evidence-based philosophy.
The authors' assessment of the state of healthcare quality is a blunt one. "Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures," Gingrich, Kerry, and Beane write. "Studies have shown that most healthcare is not based on clinical studies of what works best and what does not—be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition."
Later in the piece, the authors conclude: "To deliver better healthcare, we should learn from the successful teams that have adopted baseball's new evidence-based methods. The best way to start improving quality and lowering costs is to study the stats."
I want to believe this. It's a blueprint that works in many facets of our society. Study the information, formulate a course of action based on that information, and implement improvements. Simple.
Except that healthcare is not baseball.
Don't misunderstand—the idea that care should be based on concrete medical data is an important one. An evidence-based approach to healthcare delivery is a critical piece of the quality puzzle. And the Times piece offers a couple of examples of healthcare organizations achieving measurable success by emphasizing evidence-based care.
But upon further inspection, the healthcare-baseball analogy starts breaking down—and other issues beyond the notion of basing care delivery on data begin to emerge:
No matter what course of care the "evidence" dictates in a given situation, providers still must deal with a third party that often doesn't adequately compensate them for the cost of providing that care. If improving quality and cutting costs were as straightforward as studying the proper data, the industry wouldn't be in this mess.
And speaking of studying data . . . which data? Whose data? Studies drawing any number of conclusions about any number of topics emanate from provider organizations, pharmaceutical companies, managed care organizations, technology vendors, independent associations—you name it. All kinds of stakeholders with all kinds of agendas. All trying to demonstrate why this test or that therapy or this drug regimen is the most cost effective while delivering the best outcomes. Plenty of information is clearly less-than-objective, and I believe many caregivers can recognize that. But there's no singular All-Knowing Book of Medical Evidence.
Most physicians, I believe, are receptive to the possibility of medical data indicating that the way they've always practiced medicine could stand improvement in some way. But some are not. A purely evidence-based approach would not be without pushback.
A person's health is about more than the care provided by physicians and nurses. Environment, genetics, behaviors—all of these affect how well a patient responds to a course of treatment. The "evidence" is only part of the equation.
I know. I shouldn't be so negative. But if we don't train a critical eye on the real issues beneath the surface—and dedicate our best minds and technology and resources to resolving those issues—the ideal of better quality and lower costs will remain just that: an ideal tossed around in abstract op-ed pieces.
A little idealism is healthy. But healthcare, unfortunately, is no leisurely afternoon at the ballpark.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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An effort to freeze the assets of a former Chicago hospital operator is gaining worldwide traction, according to attorneys and court documents. Peter Rogan, 62, former chief executive of bankrupt Edgewater Medical Center, owes French bank Dexia Credit Local and the U.S. government tens of millions of dollars from civil penalties and settlements related to his involvement in a healthcare fraud scheme that led to the hospital's collapse. Rogan was charged this year with perjury and trying to obstruct the government's efforts to collect $64 million in civil penalties. But authorities in the U.S. and Canada and private attorneys for Dexia are winning court injunctions and other approvals they expect will lead to recouping money that has been held in property and in more than 60 financial institutions around the world.
The family of a 40-year-old woman who died following a cycle of experimental chemotherapy at the Dana-Farber Cancer Institute in Boston was awarded a total of $13.5 million. The jurors decided that her death could have been prevented if Dana-Farber doctors had investigated the cause of chronic diarrhea that surfaced during an unusual treatment protocol for a tumor behind her knee.
Healthcare played a big role in the presidential campaign, but the Obama administration will face a tough choice: try for a wide-ranging systematic overhaul or make do with piecemeal fixes. Overshadowing any effort to provide health insurance to millions of uninsured families is the huge deficit in Medicare and Medicaid.
While it definitely matters for healthcare who leads the White House and Congress, at this particular moment in history perhaps it matters less than you might think, says Sg2 Vice President Stephen Jenkins. He says that regardless of who was elected, a certain set of facts remain, including Medicare is in deep fiscal trouble and the national economy is swooning. These facts not only suck the political air away from other policy issues, but will be a persistent drag on tax revenues for years to come.
