Here’s what doctors really think about where they work

Maybe 10 to 15 years ago, my medical center at the time invited a prominent former resident to give grand rounds. He had become the statistical director for what was a large regional insurer absorbed by a national insurer shortly after that. He spoke very little about the prevalence of disease among his company’s beneficiaries but extensively about how his company assessed the performance of physicians. He also related how they measured what their insureds and participating physicians thought about their interactions with his company. While time blurs much of the detail, what I remember most vividly is the design of each survey to predict about 10 percent negative opinions so as to make the rest of the survey valid. They do not want a lot of cheerleaders scoring them a “5” on each question, nor do they want a lot of curmudgeons rating them in the basement either. They valued accuracy, either in the performance of the providers or in the perception of the company.

Since then, the world in which many of us work has transformed, with fewer of us masters of our own cottage and many more of us toiling away in a variety of institutions, some very collegial and some closer to medical sweatshops. If you have hundreds of solo or small group physicians in a community, they probably function primarily as colleagues. If you have three or five very large organizations where the physicians have banded together, the element of organizational competitiveness with each other takes on more meaning. It is in the enlightened self-interest of these organizations to have their physicians using the computers to care for patients and not to seek new job opportunities, so a mini-industry has emerged in which the hospital hires an independent survey organization to have employees rate their experience in multiple facets over which senior management has some element of control.

This past month I filled out the latest incarnation of this effort, a safety and satisfaction survey created by a leader in health care assessments. I also attended a focus group of physicians to discuss the composite opinions tabulated on last year’s questionnaire. A few things struck me about the results conveyed to us. First, the composite score for pretty much every question reviewed was about 3.7, none much higher, none much lower. The fraction of respondents giving a strikingly low score to any question hovered at 17 percent, virtually none more than a percentage point above or below that with a sample size of about 140 physician respondents.

So as a group we seemed pretty consistent, though knowing that my own responses to individual questions varied widely, there were ample others who thought differently on pretty much any issue being explored. Assuming that Press-Ganey and the like have sufficient experience creating and tabulating questions in a way that expose one’s inner thoughts, the analysts of the data can figure out whether the status quo keeps us engaged in the flow of our hospital’s pageant or whether we hold our medical chieftains in reverence or contempt. While turnover might be a better metric than questionnaire response, it takes a lot longer to assess that.

While a survey can reveal what we conclude about our individual and composite experiences, it cannot expose the reasoning or incidents that created the results. For that, you need feedback. If you don’t really care about the feedback, and undoubtedly there are management mindsets of “we can do no wrong,” there is no point suspending patient activity for two hours for thirty docs and feeding them lunch.

Ours took a different view, inviting us to a conference room with a plate full of wrap sandwiches, cookies and soda, to hear whether the scores we gave met our expectation and, more importantly, why. Our surgical staff is the smallest of the medical center’s three subdivisions, but 100 percent of them were verbally irritated by learning from a memo about the new anesthesiology group’s appointment and its plans to reschedule OR time — something akin to taxation without representation.

And when the scores of relations with senior management were subdivided by specialty, the surgeons rated that lower than medical physicians did. We spoke of reputation enhancement for our medical center, like some ingrained irritations from patients that are conveyed to us most days in our exam rooms that managers could fix if they knew about it, our appreciation for being part of an organization small enough that we know all the people of title, our mixed reviews of our parent company headquartered just a two-hour plane ride away. None of this would be actionable were physicians not invited to express what we experience.

So does anyone take notice in the absence of excessive numbers of resignations? I have to think that they do. While my wishes as an individual doc do not create policy or alter existing policy, having those thoughts tabulated as a group almost creates the reality of a virtual union. Our medical center cannot meet its mission unless the docs bring it to its mission. Knowing that we, as a group, have reasonable alignment with where our medical center is trying to go and that most of us are reasonably engaged in the journey to serve our patients expertly and each other collegially gives us a significant advantage over other places that may have more infighting or more ambiguity of purpose. As others have noted, our thoughts create our destiny. They are dismissed at the organization’s peril.

Richard Plotzker is an endocrinologist.

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