Transforming Practice to Improve Professional Satisfaction

H. Clifton "Clif" Knight, MD; Robert Eidus, MD, MBA, FAAFP; Emily Briggs, MD, MPH, FAAFP


October 23, 2017

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The AAFP Physician Health First portal provides numerous online resources to support physician well-being

H. Clifton "Clif" Knight, MD, FAAFP: Hi. My name is Clif Knight. I'm the senior vice president for Education at the American Academy of Family Physicians. I'm in San Antonio for the Family Medicine Experience. Joining me today are two family physicians.

Robert Eidus, MD, MBA, FAAFP: My name is Bob Eidus. I am in independent practice in northern New Jersey, and have been practicing there for the last 15 years.

Emily Briggs, MD, MPH, FAAFP: I'm Emily Briggs. I'm a family physician in New Braunfels, Texas, in a small independent practice providing full scope, including obstetrics.

Dr Knight: Bob, Emily, thank you so much for joining me today for this discussion. What we really want to talk about today is how you transform your practice to improve your professional satisfaction. One of the concerns we have is that there is a lot of burnout in the physician population and a lot of unhappiness.

We understand that much of what needs to be changed is at the big-system level. So many burdens are thrust upon us from the big system. I think folks understand that we have to fix the system: the payment system, the burden of regulations, documentation requirements. We also know that we want to help individuals with their personal resilience by giving them different tools and techniques they can use for their own sense of well-being and relaxation.

For our discussion, let's focus on some things at the practice level that folks may find frustrating. Things that if they could improve or transform in their practice situation in some way would improve their well-being.

Ups and Downs of the Practice Environment

Dr Knight: Bob, how do you think the practice environment affects a physician's sense of well-being and professional satisfaction?

Dr Eidus: I think there are two opposite poles. On one side, you have the exhilaration of seeing that patient who comes in and says, "Doc, since the last time I saw you, I've improved my life expectancy by 9 years through lifestyle change. Thank you so much." On the other hand, you have the interruptions, the pile of refills, the prior authorizations, and the frustrations.

The doctor who views the world with a cup half-full is going to look at the former example for their fulfillment. The one that looks at it half-empty might ignore that positive and just focus on the things that are distressing for all of us.

Dr Knight: Emily, what is your perspective? What are some ways that the practice environment, where folks practice on a day-to-day basis, affects well-being and professional satisfaction?

Dr Briggs: We have physicians in all stages and practice types. Some are in groups where staff can do very many things for them, whereas others may be in a smaller practice where they have one or two staff members. We have members that are in direct primary care all the way to members that are fully employed.

It really is about finding that perspective. If somebody's focus is on the individual struggles of the day—the prior authorizations, the paperwork, the frustrating patient—by the end of the day, they will look at that as being just the worst day. They will wonder, "Why I am I doing this day after day? Why am I running through the rat race of patient after patient if it's not bringing me joy?"

If they can transition that focus to positive meaningful interactions with patients and colleagues and to national networking opportunities where they see friends they have not connected with since the last conference, then by the end of the day, they know that they have the best job in the world.

Resources to Improve the Practice Environment

Dr Knight: Bob, you are in more of an urban setting, and Emily, you are in a mid-sized city but you serve a rural area. There are different resources available. What are some of the things that folks can do in their practices that may help if they are frustrated about inefficiencies or have issues that negatively affect their day-to-day experience with seeing patients?

Dr Eidus: I've found that the creative and empowered physician can be incredibly impactful on their practice environment. I'll give you a few examples. When I attend the Institute for Healthcare Improvement (IHI) Summit on primary care, I find a wealth of ideas to bring back. They were not "cookie cutter," but ones I could modify and implement in our practice setting to make life better.

One idea about 10 years ago was integrating behavioral health into our practice. Another one was using advanced scheduling theory to improve access and open access scheduling to unburden long waiting lines to get in. Yet a third, not from IHI but from other areas, is the whole concept of operations management, which is theory that comes from manufacturing. More recently, people in the healthcare area are finding that these principles can be applied to the primary care setting, allowing us to see patients more effectively and efficiently and lessening the burden on the physician.

[T]he creative and empowered physician can be incredibly impactful on their practice environment.

Dr Knight: Emily, how about from your perspective?

Dr Briggs: I keep connections with colleagues I went through residency and medical school with. Many of them are in their younger/newer years into practice. Many of them are employed physicians. Being an independent physician, I cannot connect with all of those parts. But many of my employed colleagues feel a disconnect with their ability to make those changes.

Not having control over your situation begets dissatisfaction. If you continue to live in an uncontrolled (at least not personally controlled) environment, it's hard to maintain that satisfaction. I especially encourage some of my younger colleagues to get involved at their facility level. I encourage involvement not only at the state and national level for family medicine advocacy, but also on a local level, to become a leader within their organization. They can then feel empowered to help that system make changes, not only for their individual clinic but also for all family medicine clinics within that organization.

How to Become Empowered

Dr Knight: What would you say to somebody who says, "I'm just a physician. I don't have business skills. Nobody really taught me leadership skills. I just focus on taking care of patients." What would you say to them as far as how to become more empowered?

Dr Briggs: Family physicians are very good at undervaluing ourselves. We are amazing family physicians, amazing physicians, and an amazing component of the team. Quite honestly, we are the lead of the team even when there are other physician specialties. We have been trained to use that comprehensive approach not only with patient care but also at a systems-based level.

We were trained in residency by default in how to lead that team. I bring up that point with these colleagues that, no, in fact, they are the right person. They are the exact person who should be leading these teams in their changes.

Dr Eidus: I think Emily brings up a great point. In taking care of an individual patient, we do not think of the heart, the lungs, or the brain. We do not divorce one from the other. We take a whole-systems approach to the patient. You use that systems approach in your office and say, "Why did I just get five refills of medications that I filled 2 weeks ago? What happened? What was the root cause of that?" Talk to others and figure out how to fix that root cause, and then you assume a sense of control. We know that when anyone has a sense of control, their stress goes down and their joy goes up.

Family physicians sell themselves short because we were told that we were not as valuable when we were in medical school. It's absolutely not true. In fact, it's the opposite. As we get into value-based payment, we are not going to be at the bottom of the pyramid. We are going to be at the top. We should train ourselves and learn not to be defined by relative value unit (RVU) productivity.

Dr Knight: That is a great point. People feel a sense of frustration because they are told that the most important thing is providing high-quality care, but they are measured and reported on RVUs. It's just such a mismatch.

Find and Do What Makes Your 'Soul Sing'

Dr Knight: What advice would you have for somebody watching this video who is feeling stuck in their practice or who is deciding whether they even want to continue practicing medicine because they are frustrated with their practice?

Dr Briggs: Find that part of your day that makes your soul sing. Find that part that you enjoy, whether that is direct patient interaction or a component of administration (there are some of those in the world!). If there is one part of the day that you know time after time gives you joy, expand on it. That is the opportunity to bring in staff to help you in all those other components—the prior authorizations, the medication refills. If you enjoy patient encounters, bring in telehealth so you are able to communicate with your patients in nontraditional settings. That brings patient satisfaction too. Focus on that joyful part, and really optimize that in your day.

Dr Eidus: That is great advice. Network. Find out who your support systems are and latch onto them. Find out who has had similar issues and how they dealt with them and how they solved some of the operational problems. Learn. Develop some leadership skills that maybe you do not have now. Do not be afraid to fail. Do not sell yourself short. You do have the ability to change your practice environment a lot more than you think you do.

Dr Knight: Great advice. Is it safe to say that sometimes folks are in a mismatch with the organization they are with or the practice, and that sometimes they just need to find a different place to practice? Hopefully, a message that people hear is that there are really successful examples of making transitions from one practice to another.

Dr Eidus: I agree. The litmus test I always have when I look in the mirror is: Do I look forward to Mondays, or I do look forward to Fridays? I've been blessed in over 40 years of being a family doctor that in all but one of those years, I always looked forward to Mondays. The one time I did not, I looked in the mirror and said, "I'm not going to allow myself to be in this TGIF mind frame. I have to reinvent myself." And I did. My next step was going into solo private practice. That was actually the best thing for me in my career.

Find that part of your day that makes your soul sing.

Dr Briggs: It's important for American Academy of Family Physicians members to know that we have resources through our academy. If you are interested in reinventing yourself, continuing medical education activities can help you to identify that business side or other opportunities you might have. You are not in it alone. Other family docs have already invented the wheel, so just use theirs.

Dr Knight: Bob, Emily, thanks so much. I really appreciate you sharing your perspectives and your experience. Best of luck to each of you, and continued success. Thanks for your leadership, and do continue to be leaders to help move our healthcare system forward.


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