All the things they don‘t teach you in med school (and why they should)

Intentionate’s Stu Schaff was interviewed on a recent episode of the Healthcare Financial Management Association (HFMA)’s Voices in Healthcare Finance podcast alongside Dr. Glenn Hardesty of Texas Health Resources.

In the interview, which begins at 6:15 of the episode, Stu explains why it is critical for healthcare organizations to set clear expectations for physicians and how it relates to their compensation.

You can listen to the podcast or read a transcript of the interview below. If you have any questions or would like to discuss how Intentionate can help your organization with provider compensation, please contact us.

Interview Transcript

Erika Grotto, HFMA: 

In April of this year, Senior Editor Nick Hut reported on a Medscape survey of more than 12,000 physicians. They found 42% of respondents felt burned out during the second half of 2020. That’s not a big surprise given the stresses of the COVID-19 pandemic. However, the survey also found that the most frequent cited source of burnout was,” too many bureaucratic tasks”. Those tasks are what we’re talking about today, and I have two guests who will be sharing their perspective. Dr. Glenn Hardesty is the system consultant for medical staff services and Medical Director for the physician leadership development program at Texas Health. He’s also a practicing emergency physician, so he spends time in both the clinical and administrative worlds. Stu Schaff is founder and principal at Intentionate Healthcare Advisors. If you’re an HFM reader, you might have seen his article in the June issue about physician compensation which we will get into a little bit today. According to both of them, the problem starts in med school. We’ll start with my conversation with Dr. Hardesty.

What do you think are the biggest things that surprise and frustrate physicians when they come into the job, or maybe when they’ve been in it for a while, and they realize that they have to learn about the business piece of health care? What do you think are the biggest knowledge gaps and how can we start to address those gaps?

Dr. Glenn Hardesty, Texas Health Resources:

Well, the knowledge gap comes from med school. We never learned anything about leadership. We never learned anything about business. We learned about science. When I graduated from residency, I knew a lot about disease, but I didn’t know anything about medicine. To your point, what we need to bring into the curriculum is the business and leadership aspects of medicine because both of them are going to intersect you. You’re going to have to learn that medicine isn’t an individual sport. It’s a team sport. And we were never taught how to play as a team in medical school. It was all as individuals.

From the business perspective, there are several ways you can go about doing that. There are some programs that HMFA has, that we haven’t incorporated into our leadership development program yet or we can go all the way to the extreme of going to business school. There’s a continuum that physicians need to understand: the business of medicine, learning the numbers, and understanding how other people are looking at medicine. You may think of yourself as a great doctor, but if it turns out that you’re not cost effective, you’re not efficient. In fact, you’re not a great doctor because most of the cost is being shifted back to the patients who really do care about what things cost, not just “is my doctor the best”. So, you must look out for all those things as well because the financial aspect has a lot to do with the patient’s well-being.

Ms. Grotto:

After hearing Dr. Hardesty’s take on what physicians should be thinking about, I wanted to find some ways that physicians can be supported by their employers. This is where I brought in Stu Schaff.

How can provider organizations get this right? Is it training? Is it education? Is it taking some of these responsibilities away, or simply being clearer about expectations when a physician comes into the organization?

Stu Schaff, Intentionate Healthcare Advisors:

Expectations are very important. And we’ll come back to that in just a second, but I want to start by talking about where we are today. I do extensive work around physician compensation design. Many hospitals, health systems and other organizations, have tried to address these kinds of things and address the levers in their business through physician compensation. There’s a lot of talk about incentive compensation and aligning incentives through compensation. In a fee-for-service system, if you want to make more revenue as an organization, you must do more, and so, we incentivize physicians to do more, right? That’s just an overly simplified example. But what we ended up doing as a healthcare system, broadly, is that we’ve gone to a place where we try to manage physicians through compensation, instead of managing them through management, like any other kind of employee. What I think we need to do as a system, as an industry, is to start looking at physicians and other health care providers like any other employee. Now, they’re certainly not just any other employee, but we need to start treating them more like we treat our other employees, and there’s a few examples of that.

Number one, we need to set clear expectations for what physicians need to be doing, and that may be many things, right? We expect them to do coding on their patients and have great documentation in EMRs. We expect them to be involved in care coordination. We expect them to show up to clinics as scheduled. Those things sound quite simple and straightforward. Frankly, the right things will sound simple and straightforward. So, we must set those expectations and then frequently telling them how they’re doing; scorecards are huge. We want to keep things as straightforward as possible, but we want to be timely in our feedback. Number 2, help them understand the why of what we’re asking of them. What we’re talking about here is actually managing positions and you may want to have physicians in those roles, or at least involved in that management. Physician leadership is particularly important. Number 3, taking things off their plate, and then getting out of their way so that they can practice good medicine. Number 4, giving them time and space to do the things that we ask of them. So, if you are in fact, piling on more responsibility, does that mean that you’re going to be asking them to work after hours? Or does that mean maybe we need to call off a clinic? Number 5, asking them how they might need help. That sounds broad, but it’s something that we often don’t stop to do.

Ms. Grotto:

Of course, I asked Dr. Hardesty about this issue as well.

 When you have a physician coming into an organization and realizes the job is different than they expected; that physician has to somehow be set up for success to be educated and supported. Here’s what you he had to say about that.

Dr. Hardesty:

When you look at well-being, we’ve transitioned the word burnout to well-being, focusing on the positive rather than then than the negative. EMR is an electronic medical record that is a stressor on well-being. One of the greatest stressors on well-being is additional documentation. We have several EMRs available and none that seems to really have the end user in mind. I think at some point when it comes to physician productivity and burnout, people really must begin to believe and understand that there is a relationship between wellbeing and patient outcomes that is undeniable in the literature; then we’ll be able to start to address some of the ways EMR can be more efficient for the end user. There was one study that showed that there was an emergency department physician with over 5000 clicks in a shift. It’s kind of unfathomable. So, I think advancing of the software, advancing the platforms and looking at things as the end user, will help with that at some point when we get there. Other than that, we need to prepare physicians better to come into the world that they’re going to come into. It’s not just about knowing how many cranial nerves and what they do, but rather, how that relates to a patient as a whole and how that relates to the whole medical ecosystem. That comes into knowing the business aspects of medicine and the leadership that is required. It’s much easier to fly with the wind than it is against the wind.

Ms. Grotto:

One way Texas Health works to support it to physicians is through its physician leadership development program. Dr. Hardesty mentioned earlier that leadership development isn’t a big part of physician training. This program aims to close that gap and put physicians into the mindset of medicine as a team sport.

Dr. Hardesty:

Texas Health has made a commitment to physician leadership development, knowing that it’s a huge gap in our training. We were never trained to be leaders, yet when a physician is in a committee or is in a group of non-physicians, they’re by default, the leader, whether they realize that or not, whether it’s immediately or whether it’s a subject matter expert leader, they are a leader of some kind. We’ve all been trained by bad leaders, and I say that because the people that trained us were never taught leadership skills. So, we’ve made a commitment to have a yearlong leadership development program and we are starting our seventh cohort tomorrow morning. So, we have trained over 300 physicians in our year long program, to focus on getting to know themselves, taking several psychometric instruments, getting to understand who you are, and learning about others, who they are and putting those together to lead with exceptional results. I know how that sounds, are what that sounds like, but it’s what we’re it’s what we’re doing. We’re finding that the physicians that come out from this, now have the tools and skill sets to lead in places where they were previously untrained. The physicians that come out of this program are now more aligned with a system they understand. They also meet people from across the system, and it builds a better medical staff. It builds a better collegial environment. We focus a lot on collegial environment. We focus a lot on their action. This not just about the informational download from the speakers that we bring in.

Ms. Grotto:

This is a big topic, and the conversation can go in any number of directions. But the thing that really struck me was what Dr. Hardesty said about well-being. As he mentioned, he doesn’t like to use the word burnout; he prefers to focus on the positive and that feels like a powerful thing. We know burnout is bad but the absence of it doesn’t necessarily mean things are great. So, finding ways to support physicians, setting clear expectations, and giving them the tools, the training, and the time they need to do their jobs well is something to always work toward. So, if your organization has a great program in place, or is having good conversations about this and is including physicians in those conversations, let us know at podcast is hfma.org. I would love to hear your stories.