Jul 2, 2013

4 complaints of physician employees and 1 solution to fix them

by Dike Drummond, MD

Originally published KevinMD.com, June 30, 2013. Reprinted with permission of publisher and author.

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These gripes are basically a cry for effective physician leadership.

Although the numbers are not exact, these days about half of doctors are employed physicians, either by a hospital, a medical group or a larger healthcare system. That number is rising pretty rapidly as the industry consolidates to grab the bonus pools soon available to groups large enough to qualify as ACOs.

This move to become employed physicians is so popular, I have even seen articles lamenting the death of private practice and killing Marcus Welby.

Here is what Medscape identified as the four things employed doctors dislike the most and my suggestion of the best way to avoid these in your organization.

1. Being bossed around by less educated administrators.  As an employee, you no longer have the final say in the decisions affecting the logistics of your practice. The person actually in charge is often not a physician. They work for the institution, not you. They report to the heads of the administration, not you. They can literally tell you what will and will not be done. You are treated just like any other employee.

The article uses the term “loss of autonomy” over and over again.

You do retain most of your autonomy over clinical decisions in the exam room (notice I said “most”) and lose the decision making power over the way the office/hospital is run.

2. Not being able to make decisions about staff and personnel. That is because you are no longer their boss. You are not the leader/manager/person responsible for any of these decisions in the org chart.  If you had an office manager in your private practice, you probably lost them in the transition. Your medical assistant and receptionists are hired and fired by a middle manager, sometimes without your input, consent or awareness.

3. Having less authority over billing and charge coding. In many cases your employer has a remote and centralized billing office that takes over billing on day one. They may not have much experience with your specialty or outpatient medicine in general. They will require documentation in enough detail to survive an audit. You may not have been as thorough in your private practice as you are required to be now. It can sometimes feel like you have to learn documentation and coding all over again.

4. Being forced to use new equipment and technology. Your employer has their own equipment, EMR, supply chains and procedures. You will now comply with their systems, just like any other employee – systems you did not choose, request or approve along the way.

If a copier breaks down in your office you will have to go through the bureaucracy and policies and procedures to get a new one. That is much more difficult than handing your office manager the credit card and sending them down to the local office supply store to pick up a new one.

In some cases there are reports of groups “telling employed surgeons which kinds of joint implants to use, and according to a New York Times article, even whether to implant defibrillators in Medicaid patients.”

What don’t employed doctors complain about?

Turns out Medscape’s answer is practice guidelines. The reason is simple. Most groups don’t enforce them, yet. Many organizations have established guidelines, they can even be built into the meat of the EMR, however few are strictly enforcing them at this time. As ACOs grow and shoot for quality bonuses, you can certainly expect that to change.

Physician leadership is the answer to these concerns

Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees? The key is a strong physician leadership structure on the clinical side of the business.

Doctors must step up and play a leadership role within the organization. Don’t fight and object and resist. Dive in and lead. Without strong physician leadership in your organization, you have little or no influence on the administration and in the board room.

It is equally important that you allow your physician leaders to lead. You must allow them to represent you and provide solid input from our clinical side of the house to all the decision making committees in the organization.

Without physician leadership, the gripes will continue and the feeling of powerlessness will not change.

There is a famous quote, “Lead, follow or get out of the way.” My encouragement is that these gripes be addressed by a wave of effective physician leadership that accompanies your move to become an employee. Just because you are not in private practice, does not mean leadership stops. It is perhaps even more important when you are inside MegaHealthCorp than when  you were in private practice.

The two biggest challenges to employed physicians taking this leadership role are:

1. Bandwidth. Where do you find the time for the committee work to represent the doctor’s interests in your busy practice?  Does your organization respect these leadership activities enough to compensate you fairly for them?

2. Learning how to lead inside a large and established bureaucracy. The rules of influence here are very different than in your smaller, physician lead private practice.  It is a whole different ballgame.

The bottom line is some group of physicians in the organization must step powerfully into this new style of leadership. It is the only way the doctors as a group can hope to maintain any influence or autonomy as members of a large group of employed physicians in a much larger organization.

There is an alternative that might become viable in the near future. I will only mention it here. That option is for physicians to unionize.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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