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10 Tips for Staying Effective

Burnout is defined as emotional exhaustion, feelings of cynicism and detachment, and a sense of ineffectiveness at work. The inverse of burnout is engagement — a persistent, upbeat sense of fulfillment characterized by vigor, dedication, and absorption. I haven’t seen that doctor in the hospital lounge in a long time.

I am a neurologist practicing for 25 years in both academic and community hospital settings. I have a busy outpatient practice, take calls at two hospitals and serve a leadership role within our regional health care system.

I found I was becoming less enthusiastic about the practice of medicine. I was rushing to stay on time, to finish electronic records, complete inbox tasks of patient phone calls, emails, result notifications, disability forms, pre-authorizations for MRIs and medication, and pharmacy requests. Daily practice was becoming a grind; I was neither burnt out nor fired up.

The tipping point was the introduction of Press Ganey patient satisfaction scores. My initial scores were abysmal. Patients didn’t like the long wait times, delays in responding to calls, and they felt I wasn’t listening to their concerns. This was not the caring and engaged doctor I thought I saw in the mirror every day. For the first time, I began to consider other avenues such as an MBA, a full-time administrative role or locum tenens practice.

But here is my confession:

I love my job. At least most of the time. I love the sigh of relief when the patient hears the hand tremor isn’t Parkinson disease or poor memory may be due to depression and not dementia. I love the challenge of staying current on an ever-expanding knowledge base. I am grateful and honored to be in a respected and well-compensated profession.

I am a mostly happy doctor. Despite the frustrations of everyday practice, is there anything more fulfilling than caring for people? I had thought I was doing a good job, but my patients were telling me a different story. The body language of watching a computer is all wrong. Patients don’t believe I am listening if I’m glued to my screen. I needed to resolve the competing demands for documentation and the need to demonstrate presence to my patients’ concerns.

If you are one of the 60 percent of doctors who have experienced symptoms of burnout, here are ten changes I made that have helped reduce resentment and restore a sense of control, engagement and gratitude in clinical practice.

Ten simple changes to defeat physician burnout:

1. Patients complete a card with three questions for the doctor. I make sure we have addressed every issue on the card. No longer does the patient say, “one more thing” as my hand is on the doorknob because all issues have been addressed.

2. The two-minute rule. I spend the first two minutes with direct eye contact and try not to interrupt while asking the patient to tell me their story.

3. After a few minutes of listening, I ask permission to look away and take some notes on the screen.

4. I reassure that the patient is in the right place for their medical concern. I eliminate comments that suggest frustration with the EMR. I thank the patient for entrusting their care to me, offering email contact and regular follow-up and communication until the problem is resolved.

5. Optimize the EMR’s strengths. The EMR can gather data from other physicians, test results and can serve as an educational tool. Use the EMR to demonstrate images and reports to the patient, adding medical articles, online resources for exercise equipment, sleep hygiene courses, etc.

6. I end all encounters with the question: “Is there anything else I can help you with today?” Most of the time, the patient gratefully acknowledges that all questions have been answered.

7. Close the encounter before the patient leaves the room. The note, after visit summary (AVS), orders and letter to the referring provider are completed before the patient leaves the room. Avoid the temptation to complete records in bed or while on vacation.

8. I often finish with a request: “May I give you a hug?” While embracing, I will say a secular blessing, “Be well.” It is a simple act in the doctor-patient relationship that expresses empathy and support. There are caveats, especially in our current cultural awareness of sexual harassment: I always ask permission. An older female is generally safe; a younger female is embraced with caution or not at all, always with family in room; a male — generally not. A hug has the power to lighten the mood, to convey intimacy during a brief encounter and to share the burden of illness.

9. If the patient is smiling at the end of the encounter, I will encourage them to complete the survey. I may also request that they write a review on an online rating service.

10. I maintain resilience for the demands of practice with an intensive regimen of exercise. I became a group fitness instructor, teaching 3-4 classes a week of indoor cycling, including weightlifting and planks. In addition to the personal benefits, teaching has made me a more enthusiastic advocate for exercise with my patients.

What have I learned?

Since the electronic medical record and patient-driven quality metrics are unlikely to disappear soon, I have learned to use them to become a better doctor. The focus has become communication skills- demeanor, physical and emotional presence, listening and explanation of the evaluation and treatment plan. This has lead to a dramatic improvement in patient and physician satisfaction.

The physical contact has changed me more than my patients. I have moved from resentment to gratitude for a deeper relationship I thought wasn’t possible during a brief encounter.

Anticipating the offer of an embrace at the end prepares me to like the patient at the beginning. It opens me to want to know them personally, not simply collect data about their symptoms. Even though we may share hard truths about diagnosis, treatment, and necessary lifestyle changes, the patient may feel that we are in it together.

PSN Provider, Laurence Kinsella is a neurologist, and wrote this article for the KevinMD’s website.

Tips to Put a Stop to Early Aging

Dermatologists can’t stress it enough: How you treat your skin now will affect its future appearance. While it may seem silly to worry about wrinkles long before you have any, it’s true that preparation pays off.

According to dermatologists, more women in their twenties are asking for anti-aging tips. So, what can you do keep your skin looking young and healthy? Kiehl’s Since 1851, a company that specializes in skin and hair care formulas derived from natural ingredients, offers the following tips:

  • Rest up. There’s a reason “you look tired” and “you look great” aren’t synonymous. But did you know that the position in which you sleep can also affect your looks? If you sleep face-down, fluid can collect beneath your eyes. Try sleeping face-up with your head slightly elevated with pillows. If you do wake up with facial swelling, try tapping the skin beneath your eyes or applying a cold compress.
  • Apply vitamin C. Your skin contains more vitamin C than any other antioxidant, including the much-touted vitamin E. To keep vitamin C at an optimal level, make sure you are applying a skincare formula that contains plenty of vitamin C.
  • Reduce your sodium intake. You can make your doctor and your skin happy at the same time! When you eat too much sodium, you can cause your body to shift fluid into extracellular spaces, especially beneath your eyes. Avoid excess sodium intake to benefit both your health and your skin.

“Vitamin C helps keep skin even and bright, and it offers potent antioxidant protection from environmental stressors, such as pollution and sunlight,” said Dr. Adam Geyer, fellow of the American Academy of Dermatology, Instructor in Clinical Dermatology at Columbia University and Kiehl’s Brand Ambassador.

Two of Kiehl’s products, “Powerful-Strength Line-Reducing Concentrate” to improve tone and texture all over the face and “Line-Reducing Eye-Brightening Concentrate” formulated specifically for the eye area to boost radiance and minimize wrinkles, contain 10.5 percent vitamin C.

Unlike many retinol products, they won’t cause photosensitivity and irritation and are gentle enough for twice-daily use. Apply them after cleansing, both day and night to obtain the greatest results.

SOURCE: Kiehl’s

Top 10 Concerns Physicians Have When Considering Hospital Employment

Top 10 Concerns Physicians Have When Considering Hospital Employment

Hospitals and physicians increasingly are forming strategic alliances in an effort to help both parties position themselves in a manner that will help them survive an increasingly complex health care environment.

There are many reasons for such alliances, but along the way, both sides have to deal with important issues. Clinic administrators should understand a number of physicians’ common concerns. These are issues that, unless discussed transparently and productively, may prevent the parties from ever getting to the table, or if handled in such a manner to produce post-acquisition surprises, may scuttle the success of the alliance.

1. Staff Retention

For relatively small offices, employees can seem like family. Following acquisition, which of the employees will retain their jobs? It seems likely that nursing personnel and receptionists would have a good chance of working in the new practice arrangement, but what about billing and collections personnel? Initially hiring all employees just to seal the deal and later terminating them once the alliance is well under way could trigger deep resentment on the part of the physician and staff. If you have plans to downsize, be transparent.

2. Staff Compensation

Predictably, a physician will be concerned about his or her compensation after the deal, but it will be important to also address compensation levels for employees who transition with the acquired office. Will their salaries be brought into line with a hospitalwide compensation level based on job description and years of experience? If this will mean a significant change in compensation, this should be determined in advance so you will know who is likely to stay and who might resign over a salary decrease. Physicians often view departure of valued employees over unexpected compensation changes as incompetence on the part of clinic management.

3. Staff Benefits – Tenure

Consider what the staff currently receives in the way of employer-paid benefits, holidays, vacation, sick time or paid time off. This is easy to overlook, but with many small offices, various employees may have negotiated special time off in lieu of salary increases. If these benefits disappear, affected employees will expect some form of remuneration. Not addressing this effectively could appear as under-the-table sleight-of-hand to the employees, creating mistrust and resentment.

4. Voting Process to Add New Physicians

Physicians transitioning to a hospital alliance may be deeply concerned they will no longer exercise control over who their future practice partners are. What role will they be granted in selecting future physicians? One way to allay these concerns is to grant physicians a process of simple majority in the selection process. Established physicians who have skin in the game in the recruiting process are more likely to work through the communications diplomacy issues of helping to break in a new physician.

5. Restrictive Covenant & Unwind Clauses

Physicians coming out of private practice into hospital associations are loath to sign restrictive covenants, and for good reason. If they fear they have no recourse in the event the alliance goes badly for them, they may never sign. In response to this, some hospitals draft employment agreements that prohibit the acquired physician from leaving and aligning with other competing hospital systems, but not from returning to independent practice.

Hospital Employment

6. Production Incentives

Beyond gross charges or actual collections, many physicians don’t understand the mechanisms that are part of production incentive arrangements. It is worth the time to educate the physician candidate on what relative value units (RVUs) are—and more specifically, what work RVUs (wRVU) are. By obtaining a report of the physician’s historic CPT code utilization and listing the wRVUs to see what their production has been, a compensation arrangement based on wRVUs has a greater likelihood of being understood and trusted by the physician. Otherwise, wRVUs seem to many physicians to be a crudely carved-out aspect of their work, the domain of businesspeople, that is used by lay management to explain salary cuts.

7. Change in Overhead

Physicians who have experienced private practice usually have a fairly solid understanding of the basics of revenue and expenses and are usually considering hospital alliances due to shrinking profits. Many, however, have heard that by the time the physician’s direct expenses, along with their allocable share of administrative expenses are allocated to their profit center, the practice expense total is considerably more than it was when they were in private practice. The physician needs to be informed in advance what his or her overhead is likely to be following the transition to a hospital-owned practice. How much loss, if any, will be tolerated? If there is indeed an increase resulting in pressure on the physician to increase production just to help pay for additional overhead, the physician likely will view this as managerial incompetence.

8. Salary Guarantee Compared to Current Income

Physicians motivated to seek a hospital alliance will be interested in insulating their personal income from the erosive effects of shrinking reimbursements. In most cases, they will want a guarantee that their income will be no less than their most profitable year in the past three to five years; if their income has been on the decline in recent years, they may want a guarantee based on MGMA compensation averages (the 75th percentile for physicians of like specialty, for instance).

9. Credit for Midlevel Practitioner Income

Physicians who employed midlevel practitioners in private practice generally are accustomed to receiving credit for that production. While it’s true they pay the midlevel’s salary and benefits, the collections for these incremental costs usually create profits for the physician owner(s). Physicians supervising midlevels will want some sort of commensurate credit for this production.

10. Maintaining Professional Control

One final source of concern for physicians is that they and their associates or staff will be moved around and switched out with personnel from other locations. They usually have a strong desire to “keep the family together”; they don’t want to see partners switched to another office while a newly recruited doctor is brought in, nor do they want to see nursing personnel or office managers shuffled between locations.

While not all of these situations can be avoided, understanding the issues that cause concern for physicians can help prevent misunderstandings following the transition. Managing satisfaction and building and maintaining trust can be tricky, especially when physicians feel the economic changes in the health care business are forcing them to become part of a bigger system.