Physician Stakeholders

Nurses Strike!!! Why Not Doctors???

Trigger alert. The URL you are about to be sent to contains an article written by a resident physician and published in Left Voice. If you are ready to chow that down, click here.

Key points that you will read. The American medical system is broken. Yup! WHO ranks it 37^thin the world, despite our huge per capita spend on healthcare. Wow! Etc.

So, what does this budding young physician think doctors should do about this? Organize! Strike! Not for better pay or better hours, but for the kinds of patient care improvements that nurses in NYC and other locales have been striking for.

Bottom Line. I buy the author’s premise that physicians should be far more vocal than they have been about healthcare issues. And I buy the notion that they need to get more “organized” to get their voices heard. But frankly, the image of doctors walking picket lines doesn’t thrill me.

Has it really come to that?

Stop Money Shaming Physicians!!!

Here’s a little piece that caught my attention. Why? Because when I got into healthcare marketing research over 40 years ago, it was well recognized that physicians made a lot of money. Many of them drove Cadillacs, which was about as fancy a car you could get “back then,” i.e. before foreign cars became the in thing for cognoscenti with money. I remember a Pharmaceutical Sales Representative in South Carolina telling me years ago that one of the physicians in his territory specifically warned him that the Rep was NOT to drive a Cadillac. Why? Because it was a “Doctor Car.”

More recently, as this post points out, it has become verboten to talk about money in medicine. Not even what drugs are going to cost a patient, let alone how much physicians make. Or how they invest. Or how some doctors want to be able to practice medicine simply for the good of their patients, rather than because they are dependent on revenues from their practices to support their lifestyles.

Bottom Line. I am guessing that like with so many things, there must be a happy medium here. Maybe it is inappropriate for a particular brand of luxury car to be “reserved” for physicians, but it is probably okay to realize that most physicians are not willing to practice medicine without appropriate remuneration. Little things like huge student loans make doing so not only silly, but impossible as well.

AND. It is increasingly being recognized that physicians, who have long been seen as “whales waiting to be harpooned” by ersatz financial advisors, need to become more financially sophisticated.

In any event, I believe “The White Coat Investor” is probably quite correct. It IS time to stop money shaming doctors!

Meditations On The Term “Provider”

We have touched on this topic before, so I will be brief. Check this out. In previous posts, we have shared the emotions of some blogging physicians who get ticked off when they are referred to as “Providers.” This time around, Dr. Jennifer Weiss brings greater clarity to why physicians should fight actively against being referred to by this term. She offers several good reasons, including:

The fact that the term was originally conjured up by Federal Law, which uses it to lump physicians in with all kinds of other “professions,” many of which have nothing to do with the practice of medicine. Many of which don’t require a license. Etc.

The perspective that physicians are not the only ones that should be offended by this terminology schema. How would you like to be referred to as a “Mid-Level Provider?” Midway between what and what???

The very troublesome historical allusion that as the Nazi’s began to close the loop around the neck of Germany’s Jewish population, one of the first things that they did was to deny a Jewish doctor the right to hold himself out as Ein Arzt, a physician. The mandated substitution term was “Behandler” which translates loosely as, you guessed it, “provider.”

Bottom Line. Yup. I am with Dr. Weiss. Words matter. AND. American physicians are currently under enough stress that they don’t need their profession to be traded down by being referred to with a generic, make that offensive, term.

BUT. Here’s the really ironic part. There has been a widespread movement afoot in the pharmaceutical industry over the past few years. Toward what? Toward substituting the term “Health Care Provider,” or even “HCP,” for when we used to use the term “Doctor.” Why? To avoid offending NP’s, PA’s, etc.

We thought we were being politically correct. Are we?

Physician Leadership in a Digital World

Check this out. What you will see is the WEB presence of a physician/entrepreneur who assists physicians in developing their “profitable brands on line.” Just let your eyes roam across the site to get a feel for what she is up to. As usual, all of this got me to thinking…

More specifically, I thought about the fact that here on Hilton Head Island, SC, PCP’s are in amazingly high demand and short supply. When one thinks of “underserved” areas, I tend to think stereotypically of places like Appalachia, not well-to-do resort golf destinations with lots of senior citizens like HHI. BUT. Many of my friends scour the area to find a PCP that will take them into the practice. “First Appointments” are often six months out, if you can get one. Too few doctors, with many who have already “Gone Concierge,” seem to be accounting for this state of affairs.

My point? PCP’s here don’t seem to need much of a sophisticated digital presence. Word of mouth seems to do just fine in filling up waiting rooms.

Bottom Line. All of which brings me to the thought question for the day. What physicians DO need a sophisticated digital marketing strategy? Does it vary by Specialty, Geography, Side-Gig interests? Probably all of the above! And some other things as well.

Understanding the answer to such questions could help us to understand yet another important aspect of our physician customers in 2019 and beyond!

Bullying In The Medical Profession???

This post follows up on my most recent offering, in which I described the legal travails a Neurologist had with her (former) group practice. Today’s post is actually a related one, and describers the multifarious, non-physical ways in which senior physicians, a.k.a. those in “power,” can kick around their junior colleagues. Little things, like hellacious schedule assignments, failure to provide needed psychological support, etc.

Bottom Line. I would like to promise you that I will be off this run of dark posts soon, but I am not sure that is a promise that I can deliver on. See, the more I read, the more I am convinced that medical professionals, who are our customers AND our care providers for heaven’s sake, are increasingly in a bad way. Maybe it is just disgruntled physicians who are writing all of these troubled posts I am reading, but I don’t think so.

I don’t believe that any of this is good for the medical profession, and I do believe that anything that is bad for doctors is bad for our business.

Anybody have any ideas as to what we should be doing here?

WOW!!!

I don’t know what else to say about this case. Check this out. What you will see is an article describing the legal travails of Dr. Diana Blum, the Neurologist pictured here. Blum joined a medical group in CA, and over time became horrified by their optimization of profit at the expense of patients. Mandated use of generic drugs, refusal to distribute drug samples, unwillingness to refer out of network.

To her credit, she spoke up about her concerns to her colleagues. Heatedly. Repeatedly. Eventually, she was asked to stifle her comments or leave the practice. Her contract was terminated. And she sued the group. For $10 Million!!!

Eventually, a jury awarded her all of $28,415. But the story doesn’t end there. The medical group is suing her for $1.4 Million in legal fees!!!

Bottom Line. Good grief. I frequently express my concerns about physician well-being in terms of burnout, suicide, etc. But I hadn’t really thought much about the stress that this kind of acrimony could cause on the physicians involved, and on the practice of medicine in general.

Sad!!!

What Family Practice Should Look Like

Check this out. Usually when I do a riff on Pamela Wible, M.D., it focuses on her work in understanding and preventing physician burnout and suicide. This article is the flip side of Pamela. The side that, following her own near suicide, focused on developing an ideal family practice setting. Based on ideas contributed by her patients. No outside funding was necessary. $280 per month rent, $1,200 per year malpractice insurance and NO staff! Read the description of the practice carefully. Picture, with me, the smile on Dr. Wible’s face as she bicycles to and from the office. She works part time, but on a schedule that doesn’t require patients to miss work.

Bottom Line. Yup, the see-a-patient-every-ten-minutes model of Family Practice almost killed this caring doc. What you are looking at here is the “after” picture. After she decided to take control of her practice. And her life.

Heart-warming stuff! Can other physicians be helped to see the light? Dr. Wible is trying to help them do just that, by providing a template for creating a practice like hers.

Should we help her to help?

When Is A Surgeon Too Old To Operate???

The FAA requires that airline pilots retire at age 65. Should there be a similar rule for surgeons? Check this out. What you will learn is that there is no simple answer to this question.

Data on the topic are equivocal. Some studies show better outcomes for patients operated on by older surgeons, some show worse.

What do we know? We know that cognition and other abilities decrease with age, but that variability on these dimensions actually increaseswith age. Thus, some older (?) doctors are still good to operate, others not so much.

We know that performing some simple procedures might be fine for older surgeons, while longer/more complex surgeries might tax their stamina to a breaking point.

We know that some hospitals are setting up special programs to evaluate the competency of older surgeons. And that such programs are being met with significant resistance on the part of, you guessed it, older surgeons!

Bottom Line. SO. This NYT article clearly indicates that the answer to the question of when a surgeon is too old to operate is complicated and multifactorial. My hope and bet is that the surgeon himself is the best judge of his own ability, and that no doctor is going to knowingly put a scalpel to a case that he believes is beyond that ability.

AND. My fear is that, like in so many areas in medicine in 2019, well- intentioned concern about older physicians will cause some august body to establish testing requirementsfor older surgeons that might not have appropriate levels of validity.

I sincerely hope not!

Doctors Need To Shut Up More, Says This Doctor!!!

Check this out. What you will see is a thought-provoking article by a physician who is also a freelance writer. In it, he questions the topics on which physicians and medical societies should be broadcasting their opinions. Should the AMA, he ponders out loud, have lent its name and gravitas to an article on nuclear disarmament? Having expertise in human anatomy and physiology, this article holds forth, is not the same thing as having expertise in “human safety.”

Funny thing. Doctors are sort of like celebrities are in the media. Everybody is certainly entitled to have an opinion on virtually any topic, but does the MD after one’s name, or being a movie star or sports figure, really legitimate the extra credibility ascribed to their comments?

Bottom Line. So, here’s the question, folks. Pure and simple. What is the doctor’s appropriate “lane,” and how closely should they stick to it? Think about it!

Death By Patient Satisfaction

I’ve done riffs on the craziness of evaluating and compensating physicians based on patient satisfaction before. But you will find new, and humorous, insights on the topic by going here. In brief, the blogging ER doc that penned this piece makes it extremely clear that, maybe especially in the ER, it is difficult to view the concept of patient satisfaction as being a reasonable measure of the quality of the medical care being delivered.

This is really sort of a fascinating siren song. It seems so reasonable in the abstraction to be fretting over, and measuring, patient satisfaction. But as the examples posted here rather clearly indicate, considering patient satisfaction as an important parameter to use in gauging the quality of care being delivered is, well, just silly.

But wait. It is even worse than that. As my colleague Dr. Neale Martin points out in his seminal book, Habit, there is basically no correlation between customer satisfaction and repurchase behavior. In any area of commerce! Why? As Neale explains, customer satisfaction research taps into our Executive Minds, that have to be engaged to answer marketing research questions. BUT. Most purchase decisions are made based on habits that reside in the Habitual Mind, an unconscious level unreachable through questionnaires.

Bottom Line. Maybe it is time for everyone to stop fielding those annoying “customer satisfaction” questionnaires. I don’t know about you, but no matter how satisfied I am with a product or service, I can become dissatisfied rather quickly if you ask me a bunch of annoying “satisfaction” questions. AND, as Neale explains, our answers don’t matter anyway!!!

Category: Physician Stakeholders