Your Opinion Matters, Doctor

What is the value of a physician’s mind? I will provide a perspective through typical examples in healthcare and give you, the MD, strength and resolve to trust yourself and have faith in your profession and continue to care for your patient with clarity and comfort.

If you have limited time, go right to the end for the 10 points to success.

You are taking care of patients in the hospital and notice some problems with the protocols being implemented and make some recommendations to the administration. Over time, you end up on a committee that evaluates the very problems you encounter and feel fulfilled that your opinion matters.

‘My voice is being heard and I matter!’

You meet like-minded individuals that are on the same wavelength and share ideas for improvement and together you band together to help your patients and feel satisfied. You spend several hours of your time thinking, evaluating and then discussing in monthly or quarterly meetings and sometimes even presenting a new vision of success as well as a thoughtful business case. Problems get identified and solutions seem to be offered and you feel the momentum of change. You are making a difference.

At the same time, you notice that some issues get left behind. You realize that the corporate machine of change moves slowly. There are subcommittees upon committees and then oversight committees to review others followed by higher level executive meetings that carry forward relevance to administration eventually leading all the way to the top, the CEO. Yay! Decisions are made, budgets are cut and funding is reduced and changes do not happen. Yet, quality improvement scores somehow magically shift and everyone pats themselves on the back about the successful ‘moments’ they have achieved. However, in the real trenches of health, patient care is not better. Patient satisfaction is not optimal. Why? you ask?

Points get raised to administration again. 'We need to formulate a plan'. An outside agency is then hired, a rosy consulting company, primarily made up of non-MDs and MBA graduates that learned all about workflow and process and economic shift and revenue modeling on white boards, not examination rooms. Hundreds of thousands of dollars are spent on consulting, in some cases millions. Another hundreds of thousands to millions are spent upon equipment, remodeling, the hiring of new staff, new project construction – a whole new workflow and newly revised dream of progress with the CEO stamp of approval. The CEO gets a raise and a bonus.

Did I tell you that most of those MDs on those committees were unpaid volunteers? These champions of change are rarely acknowledged through compensation. The exception is for Exec level positions and the CMO and a few that receive reimbursement for their time as Director or Medical Director. Otherwise, all volunteers. Not paid consultants. Not employees. Now, let’s examine this for a moment because it is basically our fault as physicians to have placed ourselves in this position of weakness yet we presume it is our strength because we put patients first. It is an honor to serve on a board or a committee. It is my duty. Ok, then why does the CEO not volunteer? It should be an honor to run a hospital dedicated to caring for patients. Let the CEO take an oath of office and manage a hospital for free.

We are so concerned about patient well-being that we essentially allow ourselves to be mentally raped by hospital administration, universities and companies. How many times have you as a physician been asked for an opinion on how to improve things or make a product better. A rep for a billion dollar company in the room asks an innocent question, ‘how do you like that, doc?’. Of course, if you are, like most MDs a little naïve, you proudly give your opinion and state how you would do something differently. You were taught to be competitive and always have an answer – that’s how you passed the boards, you never attended an economic forum. The rep then asks, ‘oh, really, that is cool doc, can you tell me more?’. And then you do. Stop this now.

What is your billable rate as an MD? Do you even know what the value of your opinion is? If you do not, then we need to chat. Even a county hospital pays their CEO to run it. Just because you want to take care of those in need, does not mean you should squander your time while paid employees sit back and relax.

How many people, including business graduates, have gone through 4 years of undergrad, 4 years of professional (medical) school and 3-7 years of post-professional residency and 1-3 years of post-post-professional fellowship before they start working? Zero. Do you not think that you have learned a lot in those previous 12-18 years? Of course, you have. You definitely know something that you probably take for granted all the time. Do you know what that is? How to solve problems. Of course, that is the correct answer. Of course, that is the optimal approach for my patient. Of course, that is the ideal placement for that jig on that contraption to improve that gizmo. Your ability to grasp complex problems in a matter of minutes and develop and formulate a solution through an efficient cost-effective manner is not to be taken lightly – it is a leap that hospital administrators are not trained to do. It is because you care and you are the one who needs the solution. Your need, your patients. You have something that nobody else has. The ability to think fast and quickly and offer a solution in split-seconds because that is what you were trained to do. Right now, I want you to slow down and read.

You trained under intense pressure and scrutiny and developed a mental toughness that compares to few other professions out there. You cannot deliberate only between 9am and 5pm and then reschedule a deadline because someone is out sick and your patient is bleeding to death. You do not get paid for billable hours in the middle of the night when they show up with a surgical abdomen on Medi-Cal. You do not have the luxury of a business luncheon and a boardroom of time to decide when to clamp the aorta. You cannot have a blended scotch while reviewing a case file a few weeks before a big litigation when the baby is crowning. You definitely can not structure your time with your children by working from home on your laptop while cutting out a tumour. If you screw up, patients die, patients feel pain, patients are hurt, patients suffer, patients get depressed, patients feel neglected. Your absence matters.

How do you gauge the value of a trillion dollar loss to a venture capital company versus a patient’s life? Money lost can never replace a life, period. We, the people, need doctors because our lives matter. We need our health. We need to live and breathe and enjoy life. You as an MD matter in this world and your mind is more valuable than all the venture capitalist companies combined. Do not get frustrated, my friends. I know this is a difficult time for us, physicians. You are a strong individual with the mind of a mega supercomputer in your hippocampus. Yes, you will fatigue. Yes, you may suffer. Yes, you may miss your children. Yes, you need a vacation. Yes, you need more freedom to be yourself and have time to simply be. Do not feel betrayed by our healthcare system. It is, after all, ours. Remember that.

The first step to realizing your value as a physician is to understand that, in any other profession, an opinion is a billable event and every bit of time is calculated. That may seem obvious to some and many of you may already do consulting on the side and may even work for corporations or litigators. However, do you really understand the value of who you are as a physician? Do you realize that a pharmaceutical company could not complete a single clinical trial without having an MD on their payroll? Do you realize that not a single insurance company could deny a single claim without having an MD peer review each case? Do you know that not a single device company in the world could get through the FDA regulations without having an MD analyze their data?

The CEO, COO and the CFO are paid very well to run and manage the hospital. The CMO may or may not be well paid at a hospital but typically is in Big Pharma. The hospital hires people and pays their employees to meet with doctors and take notes and sit on committees to listen to the doctor’s voices, your voice. Administrators are being paid to get your advice and make changes based on what the physician’s needs are which is a direct reflection of patient care needs - your needs are being counted for free. You are giving advice a gratis to a profitable company that has hired managers, directors, administrators, and executives to run the hospital. Why should you give them advice without payment? Oh yeah, Stark laws. However, that is where consulting positions or managed care models have surfaced. Utilize them. Otherwise, you are being raped out of your mind without appropriate consent. Your patients will get the care they deserve because you, the MD are there. But we must all, MDs, join together in this to help improve our lives. Nobody else is going to do it, not any national organizations or regional. You must behold yourself to your title and embrace your value to be truly heard. I have heard NPs and PAs enjoy being called doctors. They are not.

There are billion-dollar companies out there that could not exist without your mind. You, as a physician, are so valuable that you could quit practicing today and would be picked up like a lollipop by any pharmaceutical giant immediately. There are scavengers of litigators and insurance companies searching for disgruntled and frustrated MDs, like you out there who want a better lifestyle and job where time is considered important. I worked for FDA and I have worked at Big Pharma and have seen the other side. It is far removed from direct patient engagement. Taking care of patients is incredibly satisfying because no matter what the FDA does and no matter what the device or pharmaceutical company makes or approves, your license is essential in order to prescribe it all. The entire healthcare industry depends on those 2 puny letters – MD. Do not kid yourself and believe that you are forsaken in healthcare. You, the MD are the single biggest player in the entire healthcare environment and you are letting yourself be a pawn in a charade of shotgun poker.

You do not have to believe me. All you have to do is believe in yourself and your training. Remember all those hours as an intern dis-impacting a constipated patient and then to be scolded by a nurse for the mess you made? Recall all those years as a resident running to a code and then immediately back to the ER, then up to ICU, exhausted only to prepare for rounds that morning? Remember the time in fellowship when you first glimpsed the light at the end of the tunnel? Feel the goosebumps and sweat on your skin again when you greeted your first patient in practice. Remember that feeling of confidence. Now, recount how much you owe in student loans. Nobody and I literally mean nobody is more valuable in healthcare than you, the physician. You took the Hippocratic Oath. You are the only one who can prescribe controlled substances. If every MD in the world quit today, a million more nurse practitioners and physician assistants could not handle your load – they are not trained like you.

You, the MD, are the key to health. You are the savior of patient-kind.

You matter and this is how you will make a difference in your career:

1. Value your time.

2. Take care of your patients like they are your family.

3. Be Available, Affable and Affordable.

4. Maintain your ability.

5. Write down your fee structure.

6. Provide your fee structure to anyone who asks for your professional opinion. A free dinner at a fancy restaurant is not appropriate compensation for your thoughts.

7. Do not sit on any committees unless you are reimbursed equitably according to your fee structure and do not violate any ethical or conflict of interest laws even though Senators and other Bureaucrats do it all the time.

8. Do not give free advice except to family and friends that matter.

9. Answer Reps questions in the following manner, “I have some ideas if you are interested to know how I would improve this” and then when they say ‘yes’ because they will, you provide your consulting schedule and your fee structure. Say nothing otherwise.

10. Smile often. Laugh more. Enjoy patient care.

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