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  • q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    #222742 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2047
    Joined: 01/15/2017

    Yes.

    #222744 Reply
    Avatar Peds 
    Moderator
    Status: Physician
    Posts: 4424
    Joined: 01/08/2016

    yea was a good article.

    i wish i got 15m per pt….

    also this “Imagine a plumber or a lawyer doing 30 percent more work without billing for it”

    also also …..

    #222746 Reply
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1836
    Joined: 02/11/2019

    The only thing that is new here is they are lumping nurses in with physicians now.

    “Never let your sense of morals prevent you from doing what is right.”

    #222747 Reply
    Liked by Tim
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3512
    Joined: 01/14/2017

    Disagree that all efficiencies have been exploited or that some (entire professions even) clock out at end of shift. But the broader point I agree with – we are too nice when it comes to pushing back.

    #222754 Reply
    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 1138
    Joined: 01/12/2016

    Thanks for the article. As I’m leaving my current job, I have come to realize that at least for me, there was more room to ask for things that I needed, than I realized. I’m not leaving because I’m unhappy, and I would gladly and happily return to my position. But if I did, I would ask for more time for charting and responding to MyChart messages and time built in to my schedule to meet with the therapists in the clinic so we could consult together on difficult patients. I believe admin would allow this as they offered this and pretty much anything else I wanted after I told them I was leaving. I just didn’t know what I needed or what to ask for, fresh out of residency but now I do. I think as physicians we need to ask for what we need to succeed at work and we might be surprised at what we get. I’d like to see this happen on a structural level rather than individually, but we have to start somewhere. It’s not even about pushing back, it’s about recognizing we are only human, we have limits and how can we offer the best care within those limits.

    #222777 Reply
    Liked by hatton1, SLC OB
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6184
    Joined: 01/12/2016

    Also disagree banking on physicians and nurses moral goodness as a source of free work isnt baked into the equation. It absolutely is. They play that card at negotiation often because it works most of the time.

    Lithium Lithium 
    Participant
    Status: Physician
    Posts: 1176
    Joined: 02/15/2016

    I work in a group where everyone is treated equally and transparently.  This is great for morale in many ways but does make it harder to individually negotiate.  Every time I have asked for more I’ve hit a brick wall, even when I’ve argued to administration that some of their policies make little sense economically and everyone loses from their intransigence.  Prime example is how little they seem to value physician retention considering how much they spend on the costs of turnover.  Sometimes I think the C Suite is run about as inefficiently as the DMV.

    #222800 Reply
    Avatar SLC OB 
    Participant
    Status: Physician
    Posts: 562
    Joined: 06/23/2018

    Great thread…

    As I try to balance the work in my organization, I recently proposed a “Physician Quality Bonus” be structured for certain meeting attendance and participation in committees. Thought this would improve engagement, improve buy-in to new projects, increase collaboration between nursing leadership and physicians, while showing physicians that we value their time and opinion.

    I am getting some push back from a c-suite member that it is not a “quality” measure however I think with improved engagement comes reduced burnout, improved quality through new initiatives and education. They want me to add back in “patient satisfaction scores” which I am looking into to see if the same docs continue to get the bonus based on good scores and the same docs continue to not bonus, due to bad scores…. just not sure this bonus really moves the needle. Thoughts? Do you think tying the bonus to patient satisfaction actually improves the interaction between patient/doc?

    How else would you want your Quality Bonus earned? This is not a huge chunk of money but it is an additional $15K/physician (different from production bonuses).

    #222833 Reply
    Avatar ZZZ 
    Participant
    Status: Spouse
    Posts: 702
    Joined: 06/18/2018
    Splash Refinancing Bonus

    “Do you think tying the bonus to patient satisfaction actually improves the interaction between patient/doc?”
    -No.

    “How else would you want your Quality Bonus earned?”
    – Trick question. I’d rather not jump through some silly hoops chosen arbitrarily by some stuffed suit to earn a token carrot. All the dumb targets and measures and metrics like that, most of which are completely divorced from good medicine or are entirely beyond the control of an individual physician, are significant contributors to burnout and job dissatisfaction.

    Goodhart’s law, when a measure becomes a target, it ceases to be a good measure

    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2837
    Joined: 01/03/2017
    I am getting some push back from a c-suite member that it is not a “quality” measure however I think with improved engagement comes reduced burnout, improved quality through new initiatives and education. They want me to add back in “patient satisfaction scores” which I am looking into to see if the same docs continue to get the bonus based on good scores and the same docs continue to not bonus, due to bad scores…. just not sure this bonus really moves the needle. Thoughts? Do you think tying the bonus to patient satisfaction actually improves the interaction between patient/doc? How else would you want your Quality Bonus earned? This is not a huge chunk of money but it is an additional $15K/physician (different from production bonuses).

    Click to expand…

    Patient satisfaction scores isn’t a quality measure. Sure, it may be a metric that will give the administrators a bonus, which I’m guessing is why they want to tie physician bonus compensation to it. If anything, attaching a bonus to patient satisfaction scores will encourage bad medicine including unnecessary tests, unnecessary antibiotics, unnecessary pain medications, etc. It’s no secret high patient satisfaction scores do not equal good medicine. I would prefer any quality bonus to be given to me in my base compensation but if I didn’t have a choice, I’d prefer my quality bonus to come from something that actually measures quality.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #222849 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3473
    Joined: 01/21/2016

    This is a great article. I have followed Dr. Ofri’s work for years, and she hit it out of the park with this one. I strongly suggest reading the comments, too. There are some great pearls in that section including some admin types who own up to the premise of the piece.

    I believe the article will impact future negotiations between physicians and the administrative side, too. We have all read the article (docs AND the dark side alike), and the next time one of our colleagues feel like he or she is getting the short end, the topic of exploitation should naturally roll off the tongue (immediately followed by that obnoxious graph showing the growth of admins over the years).

    As for the issue of burnout, it is far too textured to be simply solved by getting admins off of our backs, but anything that gives us more control and less interference will stack the chips in our favor.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #222858 Reply
    Liked by ZZZ, snowcanyon
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 464
    Joined: 05/12/2016

    Reminds me of the mandatory “how to reduce physician burnout” lectures that we were required to attend at 630 pm… always felt I would be just a tad bit less burned out by just being able to go home and hang out with my kids.

    Another vote for the dislike box for all those stupid quality metrics and for any doc that pushes that on other docs (unless it’s not at-risk money which it rarely is)…

    #222860 Reply
    Liked by Zaphod, CM, ZZZ, Tim, ENT Doc, Hank, and 1 othersHank
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 401
    Joined: 07/07/2017

    10 admins per doc seems low….

    #223003 Reply
    Liked by childay
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3047
    Joined: 09/18/2018

    The problem with metrics is their design and use has been turned into a “weapon”, rather than a “tool”.
    Sometimes it simply “measures “ but fails to identify the cause. . If the metric was a “tool”, a provider would have data. Self improvement and system improvements are the goal. Would a physician want to attend a meeting that would greatly increase his/her productivity? If patient feedback was relevant, not one physician would resist adjusting.
    Patient surveys: is each score adjusted for the context of the encounter, the quality of the medical care and the source of the discontent? Nope! No wonder a physician doesn’t “buy in”. Responsibility without authority and a huge volume. It’s not worth a physician’s effort for $15k.
    Now if you have data and actionable feedback, that’s a metric that would help, a tool.

    #223026 Reply

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