Thursday, October 20, 2011

Greed- and Your Reputation in the Medical Community

Those of us involved in the healthcare industry love to share the tidbits and gossip of what's going on in the practices in our community.  While there may be hundreds of practices in our particular demographic area, word spreads like wildfire when a physician practice does not work or play well with others.  A practice may find itself literally blackballed when it comes to referrals from colleagues when business models are based on the Gordon Geko philosophy of "greed is good."

There is a world of difference between a healthy attitude of ambition and a toxic desire for money that allows certain physicians to ignore the rules of healthy partnerships and collaborations.

In our current climate of reimbursement reductions, physicians are using their imagination and resources to create marketing programs and lease space arrangements that should benefit all parties involved.  Many practices have enjoyed great success as a result of these collaborations, however, certain parties cannot find satisfaction unless they take much more than their mutual agreement called for, or worse, find a way to constantly renegotiate their business deals to their own advantage.  It may take a while for the manhandled party to realize they are on the short end of the deal, but sooner or later the deal falls apart and the reputation of the physician who did not keep his promises often cannot be repaired.  

We have seen a societal change in our country where fair play and hard work is downplayed in favor of winning at any price.  Pride in a job well done has been replaced by the sole desire for material reward.  Indeed, it becomes increasingly difficult to find employees or even professional staff who operate with kindness and consideration both for patients and colleagues alike.   All of us have born witness to those barracuda physicians who operate as if they were the only game in town.  Partnerships are broken, employees become disgruntled and burn out, and fellow physicians stay as far away from the practice as possible.

Often, these "bad press" practices initially enjoyed moderate success and were well respected in their communities.  Over time, however, they failed to acknowledge some basic truths.  The first and most important rule that is disregarded is that every business eventually reaches the "glass ceiling of cash."
There are only so many patients that can be effectively treated in a business day.  You may have taken your practice into the millions of dollars range, but eventually you will reach a level of reimbursement that is appropriate for your specialty and the number of physicians that you employ.  The expectation of a "no limit" cash flow year after year, is unrealistic and the physicians who deny this basic tenant will go over and above the rules of fair business practices.  

A second and perhaps more grievous error is the hiring of multi-specialty physicians outside of your specialty before due diligence is performed.   Practices who deal in this behavior are constantly in a revolving door situation where physicians come and go, often at great expense and legal consequences.  These physicians do not make an adequate study of whether or not the incoming physician will be a good fit for their patient demographics and they may not realize that they are now paying for a physician in the same specialty as those doctors in their community who provided them with referrals.  They ignore the warning signs for the sake of "empire building" and may lose the possibility of future practice growth.  Many of these business deals end up in disaster, especially when the physicians who join the group do not meet their expected financial goals.  The comings and goings of these doctors have serious implications for the hiring practice and the unhappy physician who ends up leaving the practice will eventually voice his complaints loud and clearly in the community at large.

A medical practice cannot exist in a vacuum.  Those in our community will not experience our level of skill or caring attitude in the exam room.  We will be judged by our fair and equitable business practices and once our reputation is damaged, repair may not be possible.






Wednesday, October 19, 2011

Finding Your Fit

For those of us who have worked hard and successfully in the health care industry, opportunity often allows us to move forward up the chain of command.   Some navigate these changes and find a home in their new position, while others may end up feeling adrift and realize that their new job is just not the right fit.  Sometimes, we are motivated by the money, sometimes just the flattery that accompanies advancement is enough to induce us to move forward in our careers.  What should motivate us, make us stay in our new jobs, or admit that moving on was a mistake? 

The biggest falsehood in any career move is believing the adage that what one man can do - another can do just as well.  The fact that we have been noticed and appreciated for our work ethic does not necessarily mean that we can make a smooth and happy transition to any job description.  In order to assess our chances for satisfaction, it is necessary to make an honest appraisal of our skills and to understand where our motivation lies when it comes to career choices.

Many individuals report to work each and every day for no other reason than their weekly paycheck.  There is noting wrong with having the sole motivation to satisfy our financial obligations, and indeed how many of us would continue the grind of the work week if we suddenly won Lotto?  If you find that this describes your attitude toward work, then as long as you do your best each day, you should accept that climbing the ladder of success may not be for you. 

First and foremost, all of us should take an honest appraisal of our skills.  If paperwork drives you absolutely mad and sitting behind a desk for eight hours is akin to water torture, you probably should not think about taking an administrative position.  The money may be great and initially your ego may be flattered, but eventually you will find yourself bogged down by your responsibilities and your job satisfaction will continue to decline.  This is especially true if you have spent a large portion of your career at the bedside or engaging in some form of direct patient care.  Although difficult, many health care professionals who have moved into administration find that they pine for the days of one to one contact with patients.

Secondly, you should always consider your training before you accept any position.  What skills have you honed in your career?  Are your skills transferable to a new role in health care?  What is the learning curve?  

Most of us expect that we will have a mentor to aid us in our new roles, but without essential skills in place we may still flounder.  Our mentors may also be struggling, especially since health care is ever changing the way we process information and patients, so daily access to those who can make our transitions smoother may not be readily available.  Successful transitions involve the ability to customize our new positions so that they reflect our strengths.  Trying to make an exact fit into the existing job description will not allow for growth and positive change.   Claim the playing field as your own and use your essential skills to individualize your position, so that you and your new opportunity will be seen and appreciated as one entity. 
 


Wednesday, October 12, 2011

Help in the USA ? Not Anymore

There was a recent news story about the construction of a house made strictly from materials made in the USA.  Every single product from nails to bathroom fixtures was a product produced here.   The builder compiled a list of each product and their associated costs to forward to construction companies throughout this country.  His best estimate showed that new construction comprised of only American produced products would result in the creation of over 200,000 new jobs.

I couldn't help but wonder when we decided that American labor, which once led the world in innovation, was suddenly no longer a desirable work force.  One need to merely go online and search for something as arbitrary as American made sweaters to find how few goods are available with the Made in the USA label.

We have become a nation where the rewards of our consumption are reaped overseas and many of our citizens are barely making it from paycheck to paycheck.

It's difficult to understand why our nation allows corporations the luxury of selling their goods in this country while denying its citizens the opportunity to produce them for a livable wage.  The American public has been duped into believing that the demands of organized labor are just too extreme to keep our jobs at home, but in order to live at home, in this country, we cannot afford to work for the wages paid in China or Indonesia or wherever else the production of our goods and services have gone. Indeed, for most American families the cost of living is what may no longer be the greatest nation in the world is now a hardship rather than a privilege.

We have paid and continue to pay the incredible high cost of premiums for our homes and cars and to provide health care for our families.  The insurance companies who provide this protection consistently show staggering profits while Americans are struggling to put food on the table week to week.  Our out of pocket co-payment and prescription costs are rising, while our government makes an effort to keep testing and services farther from the reaches of those that support it.  To add insult to injury, the same companies that we continue to make richer are farming their customer support bases away from the United States, further denying us the opportunity to profit from the billions of dollars they make year to year.

Anyone who has worked in a medical office and has had to call customer service for claims or insurance verification knows what it is like to speak to someone who is virtually impossible to understand.  My billing department used to pray each time that they dialed United Health Care, hoping to be connected to an American representative rather than someone in India who could neither be heard or understood.  Does United Health Care insure citizens in Bombay?  Highly doubtful!  Why then should jobs for an American company be done on foreign soil?    What incentives are we giving these giant profit making machines to keep jobs here?   Further, what penalties are we imposing for those who take jobs out of the hands of our citizens while collecting their money?  It's truly pathetic and even worse when the money that they claim to save by using foreign labor never seems to translate into lower costs for their goods and services!

In order for us to solve our current financial dilemma, we had better stop pandering to multi-billion dollar companies who take jobs from American hands.  Who do they think they are fooling?








Tuesday, October 11, 2011

Treating Our Patients To Addiction

Like many Americans and indeed people throughout the world, I have been following the trial of Dr. Conrad Murray, the physician who treated Michael Jackson and is now charged with involuntary manslaughter in his death.   Jackson died from Propofol intoxication, Propofol being a drug administered in hospitals or ambulatory surgical centers as an anesthetic.  In the case of Dr. Murray, propofol was used in order to assist Michael Jackson get a good nights sleep- administered in his bedroom, through an IV, which is amazing in and of itself.  Why he agreed to use this anesthetic in the first place is even more amazing.

Having first hand experience with Propofol, during a colonoscopy/ endoscopy, I can tell you that waking up from this drug is akin to spending a week in the Bahamas, without the tan.  You feel as if you have taken the best nap of your life and your mood is one of sheer elation.  This feeling is common to almost everyone who has had an experience with Propofol and I must admit that you do have a quickly fleeting desire to purchase a six pack of the drug to take home.   The fact is that drugs are addictive, aside from the physical component, simply because they make you feel good long before they make you feel awful.

Now the case of Dr. Murray certainly seems bizarre, but physicians all over the world can become enchanted with their patients, even though they may not be "The King of Pop."  Doctors want to alleviate not only pain, but also an entire host of other patient complaints that give their patients less than an optimum lifestyle.  Insomnia, headache, menstrual cramps, muscle aches - treated with a swipe of pen on script pad.  Creating in many instances a whole garden of future addicts.

Put quite simply, the drugs exist, so why not use them?

There are, of course, those drug seeking patients who travel from physician to physician to obtain the medications that they now need for their daily survival.  Many patients, however, present to their patients with acute and chronic pain, unaware that abuse of medication to treat this pain will eventually become a way of life.  In many cases, physicians simply do not take the time to adequately explain how the medications that they prescribe can lead to overuse or addiction.  They treat the symptoms with drugs to alleviate pain, without realizing that the majority of patients are not aware of the implications of these drugs.  Pain relief equals pills and pills lead to more pills and so on and so on.  In addition the courting of physicians by the pharmaceutical companies tend to minimize the side effects of their products and gear their efforts to make their medications as appealing as possible.  You merely need to watch the commercials for some of the new drugs brought to market and if you are not shaking your head at the list of side-effects, you are certainly in the minority.

Perhaps patients and doctors alike need to realize that not every physical pain needs immediate treatment.    Physicians need to make sure that they take the time to assess the patient's lifestyle, diet and exercise regime before writing a script to deal with a symptom that could be addressed with simple lifestyle changes.  There needs to be a larger learning curve where physicians are better informed in the use of natural and herbal supplements that may work just as well as prescription medications.  Acupuncture and chiropractic treatments may also provide relief for acute and chronic pain as well as physical therapy.
We need to begin to align ourselves with modalities and lose the fear of having our patients seek alternative therapies.

As our largest population group continues to age, we must be mindful of using drugs that are often rushed to market with catastrophic consequences.   Continuing education in our various specialties should always include embracing less invasive techniques.