"Physician employers pull out of you only what
they need to make the most money from,
then throw the rest of you and
your incredible capabilities, skills
and expertise away."
Your value as an employee is manifested by the degree you kowtow to their system rules and by how much you subject your productive capabilities to their non-medical goals.
The classic example is what happened to me at the end of my second year as an employee of the Kaiser Permanente Clinic in California. My management and clinical focus on infertility patients while there led to the OBG department Chief ordering me to cease doing any kind of infertility work with patients or resign. I resigned.
You aren’t hired for your looks, personality, how much you know about medicine or even the medical skills you have. Jobs for medical doctors are available to those physicians who can see the most patients per day (earn the most money for the medical facility that employed them).
Why do you think that hospitals are so happy to buy local medical practices from
financially failing physicians?
I know that because of how the Kaiser Permanente and the hospital in Michigan where I had been employed (total = 8 years) measured an employed medical doctor’s usefulness to them by their productivity and profitability. (eg. the number of patients they are able to see and treat daily---measured by quotas they are expected to meet)
The criterion of measurement was almost entirely based on how many patients you saw each day compared to the other medical doctors.
When I left my position, the head nurse in the Women’s Clinic at the Michigan hospital was quick to point out that the medical doctor replacing me was able to see 60 patients a day, while I saw an average of only 25 patients per day. Quality of medical care given was not even mentioned because that wasn’t important enough. For myself… it was absolutely critical.
I could easily have seen 60 patients a day. Following that path would have violated every personal belief I had about quality of medical patient treatment and care.
Seeing a rapid flow of patients like that would have left me mentally frustrated, feeling neglectful of my responsibility to patients, and more than anything else, would have documented for me that I had fallen far short of being a good physician.
How do you go about rating the quality of doctor you are today?
"You have absolute control over but one thing---
your thought's. This divine prerogative is the sole
means by which you may control your destiny. If
you fail to control your mind , you will control
nothing else. Your mind is your spiritual estate.
What you hold in your mind today will shape
your experiences of tomorrow." ----Napoleon Hill
Many shortcomings related to employed doctors are...
- Your salary and compensation often stay nearly the same over the years. The only way that increases in salary occur is if you complain, threaten to quit, or somehow become considerably more useful to them… like take on another additional job responsibility (work harder... make more money for them). It’s not personal… it’s just good business… right?
In private practice, you can rather quickly adjust your income to a level you are comfortable with. You control the number of patients you prefer to care for. You essentially decrease your idea of quality of medical care you give out by increasing the number of patients you
see and treat.
It's what you are prevented from saying to patients in quick visits that is a great part of what is considered to be high quality of medical care.
- You are not in charge of your professional medical practice management activities. What you would like to do, beyond your required medical activities, has to be approved by another higher-level doctor or administrator, or both. If that medical practice treatment or procedure in any way interferes with your profitability in their view, you will not be allowed to do it.
This aggressive push to force physicians to increase their productivity is even more extensive in the present-day economy.
These healthcare facilities are only able to survive if they make enough money by persistently pushing their employees harder. The bottom line is always the profit motive... never
forget that.
For example, as a physician employee at Kaiser, I was forbidden to do what was necessary to carry out an appropriate infertility workup. I couldn’t keep my nurse (assigned to me) over time because of problem medical issues and because it cost Kaiser too much money.
For Kaiser doctors' appointments were rigid. Also, appointments were made and assigned to me without any choice by me whatsoever, and revisit appointments started three months from the date I instructed the patient to request a revisit at the front desk on the way out.
Fit in appointments was forbidden because it interfered with my rigid schedule for seeing patients and because all patients had to be seen by the time the clinic hours closed. Hour-long consult visits with patients were not possible. All visits at that time were 15-20 minutes in length maximum, no matter what.
Even when staff members who suddenly become ill during clinic hours, finding backup people to help became a chaotic affair.
Just think about that for a minute. The patient is brought to the exam room by the nurse. The patient gets into an examination gown. The patient has a full gyn examination or OB check. The patient is counseled by the doctor in the exam room. The doctor returns to his or her desk to make chart notes, or to enter the medical information into the computer records.
That enabled the patient to put on clothes, the nurse to clean the room and escort the next patient into that room, thus maximizing efficiency of the system.
How long does it take for you to manage all of your time in that effort? Have you actually time-tested your process?
Now assign a number of minutes to each of these actions. If you are any kind of conscientious practitioner, you probably will notice that the actual time with the patient, actually practicing real medicine is unacceptable for most gyn problems.
There is no accountability or time set aside for emergencies in the office. There was no attention given to unhappy patients who would like to slap you. There were no time intervals set aside for settling doctor-patient or medical staff disagreements.
- Hospitals present another set of problems for a physician employee, which is most often related to department conflicts, turf battles, and administrative dictatorial threats. Working in a hospital environment is primarily a team effort. That means you are subject to open criticism, intimidation, and very subtle threats at every turn…and, not just from your peers---that is if you want to keep your job.
Be aware that the concept of team management of health care being promoted today puts you in a position of compromise at every turn as well. It’s a concept that medical patients will be treated better, have better outcomes, and involve far fewer medical mistakes being made… which has not proven to be true.
For example, a few intolerable things that happened to me...
- I brought along the Ultrasound machine I had used for 8 years in my private medical practice business and used it during the first three months in my hospitalist position at the hospital Women’s clinic.
I was, suddenly without warning, forbidden to use it for any reason in my clinical practice, at risk of being fired. My first thought was, what did I do wrong? What rules did I break that no one told me about?
It happened because the radiology department wanted all ultrasounds done in their department only (by their sono tech), so they could earn the money. I had to wait for 3 to 4 days for their report to come back when I sent patients to them. I would have had the answer for myself in 10 minutes or less using my own Ultrasound machine.
That avoided a second visit to the clinic for the patient to be made aware of the report and then the treatment--and the hospital made the money from the visit instead of the radiologist department. Medicine is a business and it has to make money.
Obviously, it is easier to prevent me from using my ultrasound machine than to replace a radiologist who complained and might have quit over the incident.
Even more ridiculous was the fact that I, nor the women’s clinic, were billing for the ultrasounds I did on my patients. I used ultrasound for improving my diagnostic ability on the spot. I also was beginning to teach the Certified Nurse-Midwives how to use it for their own patients.
What a fantastic improvement in Gyn care would have resulted at the hospital, let alone the marketing and recruiting of new Gyn patients in much larger numbers form other hospitals in the area.
(Sidebar Info).....
I was the first OBGYN in my private practice in California to learn and use an ultrasound machine in my area. It enabled me to use the device to take pictures of the intrauterine embryo and baby and gave them to the mothers. Talk about a marketing explosion in the area, that I never expected---because I was marketing ignorant at the time.
The word spread like a wildfire that my patients had pictures of their babies. No other OB-Gyn doctors were doing that because none of them had taken the training yet.
(Continuation of discussion)
What the “decision-makers” were ignorant of, was the PR, publicity, and marketing that handing an ultrasound photo of a patient’s fetus to the mother does for the hospital’s bottom line over time. It fries my oysters to think of the money driven ignorance and lack of common sense that persists in the profession today among the administration
decision makers.
In addition, the ultrasounds I did for myself were never ones that I would have referred to the radiology dept. Besides, I wasn’t so dumb that I would avoid sending a complicated patient problem to the radiologists anyway.
The hospital Kalamazoo hadn’t a clue about the gold mine they had available to them in my ultrasound use and willingness to teach to my peers who had had no such training. I suspected that none of the 20 OBGs in the area had any training in ultrasound, nor the US devises either.
- I was involved in a hot discussion with an arrogant nurse in the clinic hallway one day when a supervisor nurse standing nearby immediately ordered me in a very loud voice (Yelling) to take the discussion into a side office.
By itself, it was a proper thing to do. However, she did it from down the hall in front of several staff members with an attitude I could not tolerate. My response was to forget the hot argument instantly walked down the hall to her face, and emphatically instructed her to never do that again in such a manner, emphatically.
She could have handled that professionally without offending anyone... and didn’t.
My actions were perceived by the physician administrator as insulting and threatening to the nurse and who then threatened me, and my job. I was never asked to present my side of the problem and they made the reaction only on the words of the Nurse.
I was ordered to apologize to the nurse and I didn’t speak to her for the next two years. Not because my anger persisted, but because I knew she was more important to the hospital than I was, and I was determined not to give her a chance to
test me again. The truth about this issue went much further.
- This hospital was at least ten years behind the medical services that the hospitals I had worked at in my private practice in California. I had already been doing advanced operative laparoscopic surgery procedures for over five years.
When I applied for privileges to continue these procedures, I discovered that the hospital had no Laparoscopic surgical procedures criteria for allowing me surgical privileges in advanced laparoscopic surgery. I gave them the ones my five previous hospitals had used for the same reason in California. The surgery committee granted me those privileges.
I scheduled a LAVH procedure and ran into problems immediately with the process. The OR supervisor had previously assured me they already had all the instruments needed to do the procedure... they didn’t--my lack of due diligence.
I was able to complete the procedure properly but with a few non-laparoscopic instruments, a prolonged procedure, and my decision to withdraw my privileges to do these cases.
The operating room staff, I discovered, had not been trained for this type of surgery, the necessary instruments hadn’t been purchased, and under these conditions, the risks were too high all the way around.
As it turned out I was never able to teach the other doctors what I knew about this kind of surgery (they could have learned a lot from me). They didn't have the necessary surgical equipment to even demonstrate to other doctors.
I felt disappointed that I had skills that would never be used again. And the medical staff made no attempt to improve their skills and capabilities for advanced surgical procedures for the five years I was there. That is an unbelievable example about how far behind physicians and hospitals were in that area at least in 1999 in the midwest area.
In private practice, you would replace the nurse immediately. In addition, you are treated with much more respect when you are paying your office staff salaries.
As an employed physician you are powerless to make those things happen. Why? Because it’s easier for the hospital to replace you than their own long-term employees.
I know that is true because of an event during my OBG residency. After an interchange of words with the Chief of Service’s secretary one day, the Chief told me in no uncertain terms that it would be “much easier to replace me” than it would be to replace his secretary of some 15 years. So, I apologized to her and avoided her for the rest of the time in my residency training.
- I brought along the Ultrasound machine I had used for 8 years in my private medical practice business and used it during the first three months in my hospitalist position at the hospital Women’s clinic.
"It's not what you achieve, it's what you overcome.
That's what defines your career."
----Carlton Fisk
Comment...
Remember that each doctor in an employed position is subject to many professional and personal rules that may not be tolerable. With the independence factor built into most medical doctors, every employed physician can expect to have their independence compromised in many ways.
Many physicians are adaptable to the compromises they must make, because of their personal, monetary, or personality reasons. However, there is truth to the fact that every doctor employee to some degree resents being told what to do, especially from non-physicians.
The aspects that trouble physician employees the most are how patients are being treated in mass-medicine facilities. Medical students develop a close rapport with their patients and have an inherent passion to treat them with respect and dignity. Every graduating doctor has their own well-established ideas about how they want to treat their patients.
Unfortunately, the reality of circumstances within the healthcare organization they work for inevitably chip away at those ideal patient treatment concepts. It continues until they have indoctrinated medical doctors into compromising almost everything they had learned and believed about how medicine should be practiced.
When employed doctors reach their ethical, moral and principled tolerance level, they quit their employment regardless of the consequences they will face after that. A professional can only be pushed so far.
In today’s world one slip-up, confrontation, or medical mistake while employed puts you on the list for possible termination of employment. It is quite evident that today in 2022 hospital and managed care employers are much more prone to terminate your employment because of the thousands of medical doctors waiting to take your job.
I’m talking about the 50% of graduating medical students that are headed for employed positions---about 10,000 per year in 174 of the accredited Medical Schools.
The advantages of an employed position today (with horrendous educational debt hanging over their heads) may not give large numbers of young doctors much choice in the matter.
“If you have a poor financial education,
you will always work for the rich.”
---Robert T. Kiyosaki
For the right doctor in the right circumstances and situation, some of those employment
advantages are...
- Practice schedules are usually 9 to 5, five days per week. Some medical doctors have night-call
but very infrequently.
- You are paid starting immediately and remain at that pay level for the length of your contract or you agree to take on a higher-level job with them. At Kaiser after 3 years you become a partner and share in profits they make, on top of your salary, unless they have changed their compensation system for doctors since then.
- You have much more time with your family.
- Your benefits are very good including health insurance, medical malpractice coverage, vacation time, medical meeting, and education coverage.
- You will have higher paid and experienced staff to work with.
- Once you have experienced an employed position, you will always have the option to leave
and go into private practice, often with an established private medical practice group.
Final considerations concerning employed physicians...
Because I have practiced a significant amount of time in both the private and employed sectors, it allows me to understand why doctors make the decisions they do regarding their medical
practice choices.
My strong belief is when you permit yourself to settle into an employed position practicing medicine, you are inevitably destroying a significant amount of the talent, skills and knowledge that you spent so much time and money to accomplish, then never use.
In doing so you have in a sense betrayed yourself by eliminating opportunities you would otherwise have to magnify your ultimate potential as a physician, to reach complete fulfillment, and to drive your skills and knowledge to the maximum you are capable of attaining. It seems sensible to me that if you have already spent all that time and money on such a desirable profession, that being able to advance your talents, skills, and knowledge to the limit, goes unsaid. Although employers claim you can do that, it is what they never told you that negates their claim.
The failure you should consider here, and happens here, is the result of the sequential series of choices you made along the way.
It’s not that you can’t fix it, but that most don’t make any attempt to step out of a less than satisfactory sticky situation for any of a thousand personal reasons.
“You cannot improve your future if you are not
willing to try something new and risk
making mistakes and learning from them.”
--- Robert Kiyosaki
The way I view physician employment may distress you. However, who in your medical life has ever pointed out to you what you are leaving behind in the process. I understand that you may not have a choice of how you spend your medical career, but you should understand clearly the compromises you are making as an employed physician.
The future of medical education is predictable. It's existed for a century with few basic changes. With the elimination of private medical practice in our country soon, it is quite obvious that medical education will need to be restructured to supply doctors who will fit into employed
positions rapidly.
Graduating physicians must be mentally trained to be satisfied with “managed care” medicine and are willing to tolerate a significant lack of professional independence. Any doctor who thinks that this authoritarian infrastructure of healthcare won’t happen in the rural areas doesn’t truly understand the extensive nature of the threat.
“Creativity, is letting go of certainties.”
Believe me, I left a lot of things behind during my physician employment years, which I regret to this day. A few examples of those I have told you above. But, there are many more and some even worse than those to think about.
----Professional Probe----
"Medical school amphitheatres remind us of how far we have come in the
art and science of medicine, but it's not far enough to even keep up with
what is seriously needed in healthcare in our nation even today
--a business education."
"If future physicians were introduced to economic reality,
the medical profession might cease to be part of
the cost problem and become part of the solution."
----John G. Freymann, MD
National Fund for Medical Education (Late 1900s)
----Professional Probe----
"There is no difference between the inherent talents,
skills, and intelligence of medical school students today
compared to a hundred years ago. But the one thing that
makes them seem to be better physicians than
older physicians is the expansion of medical technology."
Articles © 2013-2022/CGG INVESTMENTS LLC. All rights reserved. #45, 3-16-22
