The unwieldy name of the resolution was "Lessening the Stigma and Potential for Negative Professional Consequences to Physicians Seeking Mental Health Care Services." It sailed through the Idaho Medical Association House of Delegates without comment on Friday July 21 during the first session. But when it came time to vote on Sunday morning, the reference committee requested more input from delegates. Suddenly what sounded like a no-brainer to most physicians became the most contested resolution at the IMA's Annual Meeting, hosted this year in Sun Valley.
The resolution sought to promote an atmosphere where physicians are able to freely seek mental health care without being afraid of losing their job, their license or their professional standing when they admit it. (See recent University of Michigan study on this issue.)
Take this example, shared on a national residency faculty listserv:
"Talk about shame and stigma - one of our residents is currently applying for his full license in another state (moving there for a new job after graduation). Apparently, the application asked about mental health disorders and he checked 'yes' for his hx of MDD (stable, no relapses x years, on same dose of meds x years and wouldn't know it unless he told you about it). He now has to pay for a forensic psych eval (about $1800 at least, out of pocket), arrange for his PCP to speak to the BOM-contracted psychologist, do drug-testing and then wait to hear if he will be able to move forward, have to enter a monitoring program, or be denied his license (unlikely I think)."
I have to trust the doctors I know personally who have served on Idaho's Board of Medicine. To their credit, they claim that IBOM always treated physicians in situations like these reasonably quickly and fairly. Unfortunately, I've heard one too many blood-curdling instances in-state where peer-review processes by employers and groups meant to improve patient care have been weaponized against physicians.
Unquestionably, public and patient safety has to be maintained and that is the primary goal of application and review processes. But I contend when those processes are not fair or transparent and doctors are forced to run blind-folded through an administrative gauntlet, this burdens them with an additional layer of avoidable trauma and fear that is too much for some. Whether the above examples were warranted and repeated or not, word travels fast among physicians that can have a chilling effect on healthy disclosure and that is not in the best interest of patient safety.
Doctors forced to run blind-folded through an administrative gauntlet burdens them with an additional layer of avoidable trauma and fear.
The direction I hope all Idaho employers, licensors and credentialing boards start moving in is to provide the positive message that "if you are a medical provider, we encourage you, we want you, maybe even expect you to seek mental health care preventively. It's good for you and it's good for your patients. And unless there is a real impairment, we're not going to be punitive when you tell us about it. In fact, to encourage you to do so we're going to be very open about our review process."
I believe that the employers, hospitals, practices and states which are the most transparent, whose medical cultures allow for doctors to remain human, are the ones where doctors will gravitate to as the burnout epidemic takes its toll.
Eventually, the House of Delegates resolution was referred to the IMA Board of Directors for further study. Clearly, this was no simple matter to be debated in short order while trying to finish up HOD business. As ACMS continues to advocate for physicians, I invite you to share stories that would help various institutions understand what it feels like to sit on the other side of the desk.
There are probably dozens of people who have told you to network more. They have pointed out that in the past, physicians were part of the wider community: leaders in Rotary clubs, presidents of school boards, and even elders or deacons in their church. Not only that, but they also contend it would be better for you to spend your lunch hour face-to-face with a person - especially a colleague - rather than eating a sandwich while catching up on your charting so you can go home on time.
Well, as much as they would like to convince you that you need a LinkedIn profile or should consider joining Toastmasters, I think they are completely off base. Here are a few reasons to put in your back-pocket next time you feel bullied into more networking.
You Already Feel Secure About Your Job
One of the reasons people talk about networking is to build a buffer in case their job suddenly comes to an end. And once again, this isn't a problem for most doctors, especially in Idaho where we have a shortage of physicians. More money is being spent on health care every year so there really is no reason for you to think that things could suddenly shift. Those employed by a large system should feel doubly secure:
a) You know that your employer has your best interests at heart and you have a contract you can rely on to protect you
b) Even if they had to let a few people go because they bought up too many specialists or family doctors, with so many on hand, you are the least likely to get axed.
Independent practitioners should feel even more secure because despite all the changes in the medical industry, you are the masters of your own destiny.
Employed Physicians Already Have a Big Network
Job security is not the only thing you get by being an employed doctor, and I am not just talking about the complete elimination of HR, IT, and ICD-10 headaches. With hundreds of other physicians on the payroll next to you, you already spend your lunch hours hanging out in the physician lounge eating, consulting with each other, and bearing one another's struggles. There is pretty much no good reason to leave the campus to pursue a wider set of relationships. Everybody at your job is working enough hard to fulfill the Triple Aim and you do not want to be the slacker who isn't.
You Thoroughly Understand Your Trade
Ninety percent or more of what you do is pretty routine: you see the patient, assess the situation, prescribe a treatment. The other 10% that leaves you scratching your head really doesn't amount to much, leaving you plenty of time to dive into the journals sitting on the corner of your desk and researching in the well-resourced library. Why would anybody want to be so inefficient as to build relationships with other physicians in the off-chance that they might know the answer to a problem which has not even come up yet?
Doing Tasks is More Fun
If you are like me, checking boxes on forms is as fun as popping bubble wrap. With 100+ clicks per patient that you see, that can make for a really fun day. Let's see: 100 X 24 patients. That's like 2,400 times your brain is getting an endorphin hit for doing something right! And by golly, if there is something you are compelled to do, it is to comply with all the regulations required of you. Taking time to focus on developing relationships is going to cause you to fall behind on the most important part of the job: doing the paperwork in order to get paid!
Nobody Refers to Actual Physicians Anymore
Still others might try to convince you that building relationships with other physicians or community members will help build a referral pipeline. They say by getting to know a physician's personality and strengths that trust is engendered. Pffft! Nobody refers to actual physicians who might do the best job anymore - you can only refer to people who are covered by the patient's insurance. And frankly - you don't even do referrals if you work in a big setting. You have a whole department that coordinates patient care so you don't have to. The added bonus is that by keeping these referrals in your health system, you are actually helping saving the patient save money by avoiding duplication of services.
I hope by now you are convinced that there is NO bigger time suck for physicians than to prioritize networking with people. Building relationships with others – especially outside of your specialty or with competitors across town – is risky, with no guaranteed outcomes and it simply cuts in on doing your fulfilling work. I hope the next time somebody invites you to get away from your desk that you will remind them how all the relational time spent with your patients is more than enough for you.
*In case you don't know what I really stand for or take things super literally, the preceding piece is completely satirical.
April showers bring May flowers, but what do Mayflowers bring?
Well, pilgrims of course.
After you think about that one for a while (and groan), it may do you well to ask yourself if have lost your sense of creativity (and humor) thanks to your perpetual steeping in logical problem solving, evidenced based medicine, and science.
As Albert Einstein has famously said, "We cannot solve our problems with the same thinking we used when we created them." Unfortunately, in our modern world of medicine the systems that drive medical treatment – mainly those who pay for and administrate it – have worked to eliminate most efforts that color outside of the lines. It stifles innovation and herds the majority of healthcare into pre-determined channels in the name of maximizing efficiency, increasing patient safety and minimizing loss and risk – all laudable goals, and yet…
This is nothing to be surprised by since so much of our healthcare in the U.S. is paid for by Federal and State governments whose goal is to create stability and predictability. But what is shocking is how many physicians are "taking it lying down," knowing full well that more harm has been done to the sacred physician-patient relationship because of these pressures. Many physicians – especially those graduating with huge medical school bills – are forced to be more interested in financial and professional security than they are with the professional autonomy and creativity that their predecessors enjoyed.
After a recent meeting of a physician wellness committee, one of the doctors said, "Boy I wish we had more research about that to find out what kind of interventions there might be to do with that problem." I snapped my fingers – almost as if breaking a hypnotic spell – and said "Mary! (name changed to protect the innocent) you and I know well enough by gut instinct what the solutions are and we don't need research to start on interventions!" She and another doctor said "Omigosh! You're right, we've been so conditioned to think that way. It paralyzes us."
Don't get me wrong: I am so grateful for the peer-reviewed research that goes into making medicine more reliable and have no desire to return to snake-oil salesmen hawking their "creations" to anyone who will buy them. However, when it comes to the problems facing healthcare itself, we have to encourage each other to scribble outside the lines a little more. Individually, this is hard to get away with, but collectively enough doctors can make a big enough stink that "the system" is forced to listen and change.
I hope you'll join me in our podcast this month (after taking April off) as we talk with some some creative local thinkers in medicine.
What do you do to remain creative as a physician? Please comment below.