Hi, everyone, this is Dr. Incorporated helping doctors maximize their personal and professional satisfaction. I want to thank you for everything you’ve done today. When you look around your home, I hope you see a wife, children, friends, companions, roommates, extended sources of relationships that you’re making happy that you are influencing for the better; that you are making a difference in their lives not just because of what you do for them medically, because of who you are. And because of the security and the provisions that you provide in their world because really, your life and your income and really what you do as a person. You are highly valued. And I know you don’t always hear that from your employer, I know you don’t always hear that from your patients. And I know, you may not even hear that from your family members. But I want you to know, today you are highly valued.
This brings me to today’s truth. Today’s truth is that you must prove your worth to your employer. You must prove your worth to your employer. This is a subject that took me a little while to get my mind wrapped around as a physician with 25 years of employment experience. I’ve always been driven by really an internal monitor that I knew that I was doing my best, I knew that I was making patients better and making them happy and satisfied with my care. And I knew that I was practicing good medicine efficiently and productively. And for many years, I felt like I could just sort of ignore all the stuff going on around me in terms of what my employer expected from me. Because, frankly, I wasn’t too concerned about it, I knew I was a good doctor. And I knew that being a good doctor the outcomes would be good in regards to my patients. But as time has gone on over the years, one of the things that have begun to eat away at me is just a sense that I have to prove my worth every month.
I don’t know about you, but we have these practice council meetings that are monthly in our office and have quarterly business meetings for our physician employment group. And each one of those meetings, we go over the myriad of numbers that have to do with our productivity and the economic forces that flow out of us and through us when it comes to the care of patients. We review our patient satisfaction scores, our safety and quality scores, and a host of other things that are scorecards that sometimes influence how much we’re paid. But sometimes they’re just sort of a scorecard or report card that gives us feedback about how we’re doing. And one of the great challenges of those meetings for me is, first of all, because I’m in primary care, our practice sites are often basically losing money. And it’s been a source of confusion to me for many years. Because I keep thinking to myself, how can I be working so hard and seeing so many patients, taking care of so many people, yet this practice is losing money?
As most of you have realized by now it’s because, as an employed doctor, you have given up the huge amount of downstream income that would have been contained in your office but has now been allocated to other sites within your healthcare employers organization. So your practice is set up quite honestly to most of the time, lose money.
It’s not about how much money you are making. It’s about how much money you’re losing.
Every organization wants to mitigate the amount of money that each one of its physician groups is losing in the outpatient environment. But that’s made up for the downstream revenue, because at the end of the day, most of those employers have chosen you as an employee, a physician employee in particular, because of the downstream revenue that you create for their organization. Not within the office, but outside of the office.
It’s amazing to me that the average physician generates about $2.5 million in downstream revenue per year, which is exactly why so many healthcare employers are working hard to employ more and more doctors because they realize that their downstream revenue is something worthy of capturing. That’s why they like you, quite honestly. I know for me in my practice, because I’m a traditional family doctor who does obstetrics, through surgeries, including c sections, and so forth, I provide about $5 million in income in my downstream to my organization. And you can bet your bottom dollar that they kind of like me, because of that. I do garner some respect within the organization. Because of that, I don’t get off the hook in terms of my accountability and my need to prove my worth to them every month, but yet, they are aware of what I produce and how much I provide to them.
I hope you’re aware of the downstream revenue that you provide for your organization. If they’re not providing those to you, those monthly reports or quarterly reports, I encourage you to reach out to your administrator and ask them for one of those reports that provide how much downstream revenue you’re providing for your employer.
I also know that many employers encourage accountability when it comes to corporate citizenship. Corporate citizenship can look like a lot of things when it comes to your loyalty to the organization, whether it’s diminishing the leakage of referrals that you’re making to doctors and organizations outside of your employer, or perhaps it has to do with how many times you’re volunteering to serve on committees, or perhaps how many times you’re speaking in a community environment or the number of medical students and residents that you’re hosting with you. There are just several things that are involved in corporate citizenship, that many organizations value, but they frankly hold you accountable and make you prove your worth by proving that you are a worthy corporate citizen.
I can tell you that I again found this a little bit strange because I enjoy doing things to help people and I enjoy doing everything I can to improve the quality and benefit of my community and help those who are interested in going and healthcare. But I never thought of it as sort of a ledger, that I kept track of, that put notches on my belt when I did that. But for each one of you, you probably know very well that some employ you who are watching over those elements for you. Then there’s the quality work element.
I know that I am doing good quality work with my patients. And the frustrating part of that process is I can know that I’m doing good quality work, that patients can know I’m doing good quality work, and even my staff that are working with me to support and transcribe my notes can know I’m doing good, quality work. But if it’s not in a mindful location on the patient’s EMR, or the insurance or third party is not able to gather that information of what I’ve done or not done in terms of my medical decision making and communication, then they act like I never did it. Which is so frustrating when it comes to quality of care. I know for many of you doctors, this is one of those things, just a thorn in your side. I know it is for me because I am very aware of my quality of care and I believe is as good as anybody else in the country. Yet, I get these reports back within the organization that just kind of makes me feel like I’ve forgotten to do things, whether it be the diabetic whose foot exam wasn’t done, although it was done – it just wasn’t documented in the right place to prove that it was done, or whether it be the patient who needed a mammogram and I ordered it when they left the office but the patient failed to show up to get the mammogram and I get dinged in a report because the patient didn’t follow through with what I recommended.
There are all these elements of quality of care that we’re measured by as physicians that quite honestly are so beyond our control and so frustrating at times, yet I know as employed physicians, you are constantly having people beat you down when it comes to this stuff. You have to prove your worth to those employers when it comes to the quality of care that you provide. And then, of course, there’s the whole EMR proficiency thing, which is just absolutely absurd that we are asked to waste our time populating EMR records with minimal data when we could be using our time so much more efficiently. That’s why I’m a big fan of team care, our scribed model of care for physicians because I think it’s only wise to have physicians use their brains and their resources to really provide patient care and to make medical decisions, to do the right things medically for the patient and let others help you with that documentation process. So that it is placed in the right place, in the right location, and documented in the right way.
I think there is a lot of good about EMRs, but man, there’s a whole lot of bad. And if there’s one huge physician dissatisfier that continues to come up year after a year, it’s the EMR and we all know that. Unfortunately, we have to prove our worth to our organizations and they expect us to be proficient with the EMR population and note-taking. They don’t care if we have to get our notes done at lunchtime, before the office or after the office or at nighttime, or on the weekends. They just know it needs to be done and they expect it to come.
If I’ve heard one administrator say it to me once, I’ve heard it 1,000 times- “Well, that’s just one more click. That’s just one more click here. One more click there.” And what they don’t realize is that those “one-more-clicks” taken are compounded by the scores of hundreds and thousands, really equate to another 10, 15, 20, even 30 minutes of extra time in my day, that lead to me getting home later for supper that leads to physician burnout and physician exhaustion and physician dissatisfaction. But this is the world that we live in. We have to prove our worth to our employers, that we can be proficient with EMRs, and get all the work done that they expect us to prove that we can make the money they need us to make.
So, employed doctors, I know there’s a lot of good about what we have going on. And there are many qualities to that, that that come along with that predictable paycheck that we love. These are a few of the things that are a little bit behind the scenes that we all know of. I invite you as followers on this journey with me to chime in. What are some of your frustrations or challenges or unique things that you’ve learned from having to prove your worth to your employer?
