My 20-year medical school reunion was a time to reflect: Have we aged more gracefully than medicine? The Class of 1999 carried books and wore pagers while scrambling to gather paper charts for rounds. Residency did not prepare us for the explosion of managed care, EHRs, health systems, and allied health providers. What do I wish I knew then? The hardest part of medicine isn’t becoming a doctor; it’s staying a doctor.
System issues trample the care I want to provide, and interactions with colleagues and administrators are often more complicated than dealing with patients on the medical floor. Like most doctors, I perfected the art of medicine through countless patient interactions and a personal health crisis, but I became a better doctor when I learned how to survive medicine.
Webinars on burnout and compassion fatigue stress the importance of self-care. Yes, self-care is part of the survival kit, but a yoga class or vacation day here or there will not sustain a career. If a plant is wilting, you don’t blame the plant. You troubleshoot the environment. Does it need better soil? More light? Less water? The health care system is broken, but we plant ourselves here anyway because our profession is all we ever wanted to do, and it’s important.
Even the healthiest plant needs strong roots; for me to feel grounded. I needed to learn the leadership and business skills that I didn’t get exposed to in medical school. Leadership classes are vital and the best use of your CME funds, even if you aren’t gunning for the C-suite or an MBA after your name. When you more fully understand the realities, you can reset your expectations and learn how to interact with the administrators who have the power to make your practice environment better.
Even if better is impossible, someone needs to advocate to protect the physician-patient relationship. Leadership, physician management, and MBA programs aren’t just about finances and economics. Classes include topics such as communication, conflict resolution, negotiation, and meta-leadership. Here are my takeaways from the Pennsylvania Medical Society’s year-long physician leadership academy:
Learn to disappoint people. Medicine attracts perfectionists; there is so little room for error. Radically accept that real-life practice is not a textbook. Be kind to yourself as you can’t be perfect in an imperfect system. You’ve performed well on tests for years, but great doctors can earn low scores on patient satisfaction surveys; in fact, those numbers could mean you’re doing your job. You can be hardworking and dedicated without being selfless; it’s OK to set some limits on what is being asked of you. Saying no to a task may offer an opportunity for someone else to develop leadership skills and give more depth to the medical team.
Communicate your needs in a productive way. I suspect many physicians don’t want to learn more about the business of medicine, as it sounds so hopeless. But guess who knows a lot about the business side? The administrators who set your clinic schedule or RVU scale and the insurance carriers that determine best practices for value-based care. When I learned the lingo of business, terms like silos and BATNA, I was more confident in speaking up in meetings. I knew how to gather data on what my team needed as an emotional plea without numbers to back it up won’t get very far with administration. I crafted a clear ask and felt heard, even when the outcome was not what I hoped for.
Negotiate like you are fighting for someone else. Doctors don’t love talking money as we worry we will appear more concerned for ourselves than patients. Being smart about money isn’t the same as being money-driven. I learned to work smarter, not harder, so I could continue to enjoy my practice and still have a little left in the tank when I returned home to my family. Every time I’ve set limits on my time, I’ve made more money. When reimbursed appropriately for your time and effort, your work feels different. This satisfaction carries over to patient interactions. Physicians are great advocates for patients and colleagues; use that fire to stick up for yourself.
Following these three points as a mantra, I’m less frustrated with what medicine has become, and I am more available for my patients. When I used my leadership skills and business knowledge to practice like I wanted to stay a doctor, I became a better doctor—a doctor with a chance at another 20 years. Medicine is better with you in it. What do you need to stay?
Candace Good is a psychiatrist who blogs at How to Shrink a Shrink.
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