Let's look at some of our local health institutions' mission and purpose statements starting with the shortest:
Some of these are short and directly to the point; others make an effort not just to talk about their purpose, but also some of the values and modus operandi important to them.
I also reflect on our own mission statement from time to time, which frankly looks like 75% of other general medical societies who modeled there's after the AMA's:
"The purposes of this Society are to promote the science and art of medicine, the protection of the public health, the betterment of the medical profession and to unite with similar organizations in other counties of the State of Idaho to form the Idaho Medical Association."
What is different about it than most healthcare organizations is the last phrase about "uniting with similar organizations" as a goal, not just a mode of operation. While it may be unique to being a "component society" of the state medical association, I also think there's an attitude of collaboration there that truly defines how we think here in the Treasure Valley.
To truly fulfill our missions, we must join with other like-minded people and organizations.
In fact, I wonder how it would change our healthcare institutions if they all added "with the greater medical community" to their mission statements and acted on it.
This fall, Mayo Clinic's Colin West, MD, MPH, a leading researcher on physician burnout, spoke in Boise at two separate back-to-back events. In the first, he very subtly threw down the gauntlet to physicians and administrators saying:
"I really believe that there's a gap that can be filled by those first adopter groups that actually reveal a competitive advantage when they successfully attack these issues (around physician burnout) … Nobody in the country is thinking about it that way systematically. So, there's a gap there and if somebody jumps into that breach, they're going to reap the benefit of that."*
Two days later, he led a workshop on actionable next steps physicians can take towards enhancing their workplaces. One of our hospital system execs stood up and threw down his own gauntlet saying, "I think we need to stake a claim that Idaho is NOT going to be the 50th state in provider wellness." (He was referring to Medscape's 2018 report that ranks Idaho #1 in physician burnout.)
These conversations raise the possibility from trying to address clinician distress at the micro level and aiming instead at the macro factors that drive it, and not just at the employer's level. To this end, ACMS is now gearing up to charter a coalition that would focus efforts across the medical community on tackling the largest contributors to burnout. We believe that by shooting at the same target together, we have a better chance at reshaping our community's medical culture in a way that supports the vitality of our caregivers for generations to come.
*Dr. Colin West's full statement in context: "I really believe that there's a gap that can be filled by those first adopter groups that actually reveal a competitive advantage when they successfully attack these issues (around physician burnout). You live in a beautiful part of the country and that gives some advantages (for recruiting.)…But the environment is really important to people as well. If people knew that Idaho has this emphasis on not just this beautiful place to live for your daily life, but actually takes care of their healthcare professionals, and recognize that is a good societal investment…Suddenly you've got something that attracts people.
"Nobody in the country is thinking about it that way systematically. So, there's a gap there and if somebody jumps into that breach, they're going to reap the benefit of that. But its going to take somebody to seeing this from a non-traditional way than the average hospital or clinical administrators' standpoint."
Not that long ago, one of the most creative entrepreneurs I know asked me, "What is a win for Ada County Medical Society?"
It was an outcome driven question that challenges lifetime non-profit leaders like me. We tend to be all squishy on data-driven metrics and balk at having to prove our value to our constituents. Sitting around a campfire and singing "kumbaya" actually isn't a bad idea to us.
However, as I reflect on what we truly aim to accomplish and the type of leaders we tend to attract to the board, there is something to be said about campfires. Our value statement is "We Connect the Docs of Ada and Elmore Counties." While we do have a longer formal mission statement (that looks just about like every other county medical society's), relationships are at the heart of our activities and efforts.
This board has prioritized the building of collegial relationships in our programming and making lots of time for doctors to get to know each other. In fact, at our annual meeting in October, we will be recognizing one of our local heroes as the ACMS Physician of the Year, due in part to his gregarious nature of tending to other physicians and helping lead ACMS in this direction during his board tenure this decade. If you've been to any of our events, Dr. Kyle Palmer, a newly retired orthopedist, has undoubtedly shook your hand and made you feel welcome.
While many associations keep scoreboards for membership totals, peer reviewed publication readers, legislative victories or even the more ethereal "member engagement," I personally am most gratified by when I see doctors connecting.
If you are feeling disconnected, I encourage you to take advantage of the three upcoming events ACMS will have this fall: Legislative Night Update, the Annual Meeting/BBQ Dinner, and Winter Garden Aglow. And if big events aren't your thing, give me a call and we’ll go have breakfast, lunch or coffee together instead.
As the Treasure Valley continues to grow at dizzying rates and more newcomers show up in our fair city, many are concerned about sustainability. How do we meet the increasing demands placed on all sorts of infrastructure: roads, schools, housing, and healthcare? If people are leaving "crazy-town" and coming to a slower paced and "nicer" place, how do we make sure they don't bring crazy with them? How do we help enculturate people to the area's values and heritage that make it special?
These are certainly questions that many communities face whenever there is a migratory influx. There may be plenty of "Welcome Refugees" bumper stickers emblazoned on tailgates, referring to foreigners fleeing violence and persecution. But on the other side of the bumper you might see it qualified by "Except Those Driving Up Housing Prices."
Speaking of driving, it reminds me of an ad that appeared years ago in my alma mater's alumni newsletter. It had a picture of a steering wheel and instead of the typical trumpet on the horn button, there was an icon of a man bent slightly at the waist, gesturing for somebody to go first. The headline said something to the effect of, "If everybody was a Cougar, perhaps our horns would announce, 'No please, after you.'" It's the kind of message I wish could be given to every new driver seeking an Idaho license.
It causes me to think about what kind of messaging and onboarding could or should happen with physicians coming to settle in Idaho. ACMS' membership has grown by 36% over the past six years, from 1229 members to 1766, mostly migratory and settling into large groups or hospital systems. That kind of rapid growth can quickly dilute important values – I've seen it happen when our charter school added 40% new seats one year. While I'm not a physician, here are a few pieces of the local medical zeitgeist I suggest we might want to project and protect:
Independence is Still Alive and Well
Part of the Mountain West states' pioneer ethic is a strong libertarianism, which believes in only minimal state intervention in the lives of citizens. While Boise itself leans politically towards a more moderate progressivism, statewide, these two tensions manifest themselves in many areas including healthcare. Whereas other large markets have almost entirely absorbed solo and independent practices, in the Treasure Valley there remains a thriving independent physician movement representing about half of all ACMS members.
Collaboration is King
Thankfully, the 2012-13 anti-trust lawsuit against St. Luke's Health System by Saint Alphonsus, the FTC and Idaho's Attorney General's did not put an end to the long-standing collaborative spirit in local healthcare. The frontier attitude of "we're all in this together" is slowly reemerging from the shadows in demonstrable grassroots ways between various departments and initiatives. For those arriving from cutthroat medical markets, it is important to help them understand what “Boise Nice" means and to assert that collaborative-competition ("co-orpative") is a viable alternative.
Some of the primary reasons people move to our city are to take advantage of nearby recreational opportunities, the family-friendly vibe, and relative affordability. Welcoming a new physician to town can include introducing them to your favorite non-profit or medical association, inviting them to help coach a kid's sports team, showing them the best biking trails, or tipping them off to the best craft beers or local wineries.
Self-Care: An Ethical Duty
This value may be more aspirational than the others, but there is a growing and emerging trend of tending to your own sustainability as a physician. The research is clear on this point: the better you take care of your own physical and mental health, the better prepared you are to give high-quality care to your patients. You can help acclimate new colleagues encouraging them to practice their humanity first and medicine second so that when they bump up against the inevitable occupational challenges of medicine, there's plenty of cushion to absorb it.