By Dr. Dike Drummond, Guest Writer, CEO of The HappyMD.com
For the vast majority of physicians, your practice is your No. 1 source of income. It is the Golden Goose whose paycheck “eggs” allow you to build toward financial freedom. If you or your practice struggle, your path to financial freedom can be damaged or even taken completely offline.
Tough times call for new strategies.
Conditions in the healthcare industry since the start of the COVID pandemic—and trends we see taking hold in 2023—mean it is time to actively protect your practice and its income. If you simply put your head down and grinded out the RVUs when the going got tough in the last 18 months, we have seen many practices collapse, get bought out, or simply disappear. This market churn has left a number of our clients without a position, needing to rebuild their practice and its income from a standing start.
Don’t let this happen to you. Here are some active measures to protect you, your practice, and your income in the year ahead.
The Top 3 Physician Wellness Tools for 2023
#1 The Team Huddle
2023 is shaping up to be the year of the Team Huddle. The reasons are simple.
Short staffing will continue. There is no end in sight. When you don’t have the staff you need, you must do two things:
1) Maximize Your Teamwork and Performance Each Day
When the makeup of your team is not predictable, the Team Huddle is the simplest and most powerful way to coordinate the activities of your shifting lineup. Every day you do not huddle, you get home later than you have to. Never convince yourself you are too busy for a team huddle.
2) Take Really Good Care of Your People
Make sure the people you work with enjoy playing on your team and stick with you for the long run. Grab your inner circle—your own personal patient care team— and hold them tight. This is the place where your leadership can have the most impact. Your culture can become the glue that holds you together through the winter and beyond (see “tripledemic” below).
#1b Huddle Protocol
As I describe this process for an outpatient practice, if that is not you, don’t just say, “Huddles don’t work in my practice,” and dismiss the concept. Huddles help in ALL situations and EVERY TIME you run one well. Use your creativity (and you can even ask your team) to figure out how you CAN huddle in your situation.
1) Just Do It
Grab your team and the schedule if you have one. This is a stand-up meeting. Circle up. Make it happen. Just do it—every day!
2) Clear the Group
“Hey everyone, thanks for making it to the huddle. Let’s all start by taking a deep breath (take a breath for yourself), and as you exhale, let go of anything that does not need to be here right now (exhale and flutter lips if you wish, shake it out even).” Huddles work best when everyone is outside their personal whirlwind.
3) Take Stock
What is the state of the ward/wing/service as you come on? Review missing personnel, supplies, inpatient beds available, equipment shortages . . . whatever is relevant for your team. What and who is missing or out of services? What are you short on?
4) Troubleshoot Your Shift
What does your shift look like going forward? Review the schedule if you have one. How will you have to change your routine today to accommodate today’s circumstances? Put out fires before they happen.
5) Make the Team Connection
Say hello. Ask everyone how they are doing. Make eye contact. Remind them of the difference they all make to each other, the patients, and their families. Thank them early and often for their hard work.
6) Bond and Launch into the Day
Put your hands in (like a basketball team at the end of a timeout). “Support on three. One . . . Two . . . Three . . . SUPPORT! Let’s have a great day!”
With this structure set, remember you can do a Huddle in the middle of the day any time you need one. Just get their attention, make the “T” with your hands, and shout, “Timeout everyone. Let’s huddle up.”
- Make sure you Huddle every shift—twice a day if you have an AM and a PM slate of patients.
- Have a very low threshold to call a timeout any time things even start to go off the rails.
More information here:
#2 Stay Proactive: The Best Year Yet Worksheet
When conditions in the healthcare industry are set for struggle, it is critically important you remain positive and focused on a positive vision for your career. No matter what is going on around you, stay focused on what you want your job/practice/career/life to look and feel like in an ideal world.
The beginning of the new year is a natural time to refocus your VISION. Creating and building your ideal job/practice/career/life takes just a few simple steps:
1) Step Out of Your Whirlwind
Block off some time to yourself as the new year begins. Most people use a quiet hour or two on a weekend. Step out and away from the whirlwind of your busy workdays and look back on all four levels—Job / Practice / Career / Life—from this viewpoint outside the busyness.
2) Ask Yourself Some High-Quality Questions
For six years now, we've given out our Best Year Yet Worksheet during the holidays. Thousands of physicians use this process to: gather all the learning and note all the gratitude for the events of the year gone past (2022); and to set their sights on the important people, relationships, and goals in the year ahead (2023) in both their career and their larger life. As the worksheet name says, the goal is to focus on making 2023 Your Best Year Yet.
Here's what to do:
- Download and print the worksheet.
- Grab your favorite cup of tea and a pen.
- Put about 30 minutes into answering the questions.
- Then tuck the worksheet pages away in a safe place so you can pull them out and review them over the course of the year.
We also recommend you consider printing extra copies and doing the worksheet with your significant other/partner/spouse or your work team or partners.
More information here:
#3 Stay Nimble and Ready to Move
In other words, educate yourself on career alternatives.
Make 2023 a year of studying alternative revenue models to the Fee For Service (FFS) employee grind. It is important for all physicians to understand alternatives to employee status and the FFS revenue model if they plan to continue a career in patient care. If you are looking for an off-ramp to seeing patients, taking time to create, or ramping up your side gig, here are some alternate clinician career examples.
Learn all you can about entrepreneurship; non-clinical careers; private practice (especially Direct Primary Care (DPC) or concierge medicine); Full Risk/Capitated workplaces such as Medicare Advantage (ChenMed, Oak Street, One Medical) and other practice models that are NOT the grinding combination of both Employee and FFS.
Plus, make sure to:
Shadow Early and Often
If you see a practice or a side gig that seems interesting, shadow that person immediately. Do not wait. Call them up and ask from your heart to shadow them during a workday to learn more about what they do.
Always Be Interviewing
If you are not perfectly satisfied with your current position, always be interviewing. Physician shortages make this a seller's market for sure. The retirement cliff means the market for good doctors gets better and better going forward.
If you have any qualms about your current job, set up three interviews in the next three months. Set them up now. This is the only way you can stay up to date on your job market and get a taste of how a change of setting and leadership teams can make all the difference.
When interviewing, it is critically important to ask quality questions to separate yourself from the usual disgruntled and burned-out job search candidates. You are looking for your ideal practice, not just jumping ship. We highly recommend Our Ideal Physician Job Search Formula Training. It was developed and tested for just this Ideal Job Search situation.
If you are in a situation where your practice is collapsing around you—your partners are quitting or the administration is closing your location or you are acquired by a big out-of-state company—do not be the last rat off a sinking ship. Use your market knowledge, your recent interviews, and the tools in the IPJSF to find a new and better job.
More information here:
4 Reasons Your Wellness Will Be at a Premium in 2023
#1 Support Staff Shortages
Short staffing in all support roles is everywhere, forcing everyone on deck to work significantly harder to get through each shift.
This was a key stressor in 2022 with no end in sight. The most affected specialty was probably Emergency Medicine, where nursing shortages are not allowing the hospitals to open all wings. Patients are routinely backed up into ER waiting rooms with dozens treated in back hallways every day in many locations. Outpatient physicians are also struggling without MAs and receptionists, rooming patients on their own and being hounded to keep up with RVU quotas.
#2 Boomer Docs and Nurses Retirement Cliff
The retirement cliff gets closer every day, as 45% of physicians are 55 and over. A survey of nurses in 2022 found the median age of RNs was 52 years old with nurses aged 65 years or older accounting for 19% of the RN workforce. Both the physician and nurse workforce will be dramatically downsized in the years between now and 2030.
#3 COVID + Influenza + RSV = the Tripledemic
The TripleDemic is taking hold in many areas across the lower 48, adding patient volume and disease severity to the stresses on our understaffed providers. The simultaneous crest of COVID, influenza, and RSV is filling those same ERs and ICUs. Mask mandates are again—and appropriately—being considered.
#4 Physician Reimbursement Cuts
Revenue continues to drop with the 4.5% Medicare Physician Fee Schedule (MPFS) payment cut kicking in on Jan. 1, 2023. In response, the AMA organized two letters to leaders of the House and Senate asking to prevent the cut from taking place. The first letter was signed by all 50 state medical associations. A separate letter, also organized by the AMA, was signed by more than 100 national specialty societies. The main signatories were hoping for a reprieve from the lame-duck Congress.
Before I sign off, a quick reminder of the power of context. These stressors above bite differently depending on the context in which you practice medicine.
These stresses are most severe if you are an employee physician inside an FFS revenue model. Unfortunately, this is a large majority of US doctors. Your employee status will often rob you of control over your schedule, your pay, and the hiring/firing/management of your staff. It is the ultimate “loss of autonomy.”
The FFS revenue model is built to drive profit over everything else. FFS ensures you will be expected to produce the maximum in RVUs with the minimum of support. It also tends to rob your leaders of empathy for the doctors and staff. If you don’t hit your numbers, they find it hard to empathize with or acknowledge your struggle. (See STAY NIMBLE AND BE READY TO MOVE, as shown above.)
There will be many challenges to your practice and its Golden Goose skillset in the year ahead. Your eyes are now open to what is coming and some of the active measures you can take to protect yourself, your family, and your net worth.
Circle your wagons and take care of your practice team. Huddle every day and take timeouts early and often. Have a proactive vision for the year ahead—with our Best Year Yet Worksheet. Stay nimble and light on your feet. Study alternative practice models and build or accelerate your side gig. Always be interviewing. Never be the last rat off a sinking ship.
Here’s to your success in 2023.
How do you plan to make sure your mental wellness is in check for 2023? Did you make changes in the years prior to combat burnout? What worked well for you? Comment below!
We know you visit The White Coat Investor to learn about investment strategies and planning, and we’ve always strived to teach financial literacy to physicians, high earners, and anybody else who finds their way here. But the COVID pandemic has also shined a light on physician burnout and its dangers. That’s why we feel compelled to run articles and columns like the one you just read—to make sure white coat investors stay mentally healthy. We know mental wellness is what leads to a long, fruitful financial life, and we’ll continue to run pieces like this because combatting burnout has become such an important part of everybody’s financial journey.