The last couple of weeks have been quite challenging at my job. As you know, I have the privilege to see patient 60% of the time. The rest of my time is committed to an administrative role, working with multiple internal medicine practices in aligning goals, improving efficiencies, and sharing best practices. It is a job that I also consider a privilege. It would be an understatement to say that healthcare is in transition currently. For the last seven years, we've been trying to understand Obamacare and adjust to its regulations. Now, with the changing political establishment, we have no idea what to expect. The bottom line is that the way we have always practiced medicine is changing. And, I believe it needs to change. In short, we need to see more patients, with fewer resources, more efficiently and produce better outcomes of care. And, of course, we need to be always placing patients first in their experience with healthcare. This concept of balancing patient experience, quality and cost is know as the "triple aim." Many leaders in healthcare turn this triangle into a pyramid with the 4th point being provider well-being. This is because the balancing act has created the sensation of burnout in many of my colleagues. On Friday, yet another publication came across my desk that indicated burnout has increased between 2011 and 2014 (45% in 2011 go 54% in 2014). No surprise there. Furthermore, those experiencing burnout are not those physicians on the fringes. Many of our most engaged physicians (over 47%), who are trying to navigate and to lead through this tumultuous time, say they are burned out.
Several interactions in my administrative role over the last two weeks have reminded me of this fact. I came up on the elevator with one of my partners recently who was simply distraught. My partner said we had "lost our mojo," and it felt like we were like gerbils on a wheel. The conversation made me sad but rang true with the comments I have been hearing from so many of my colleagues. Through the course of the conversation, I had the opportunity to remind my partner that this job is still the highest calling. We can implement the truths of evidence-based medicine around managing certain conditions without compromising the sacred interaction between a patient and provider. A recent email said a provider was exhausted with the "Viking raids" of administrative forces pulling resources out of our practices in the name of centralization and efficiency. Indeed, we are experiencing change to our care delivery models that feel like our offices have been violated. I reminded that partner that healthcare is certainly changing and we do have to practice medicine differently than we did in the past. I also reminded that partner that some areas of centralization, such as virtual behavioral health resources in the practices, have greatly improved the experience of patients and providers. Some changes we will get right. Others, we may have to rethink. I then attended a meeting with a practice that was struggling with maximizing the number of patients seen without compromising the care of complicated patients. I reminded that practice that we need to empower each member of our healthcare teams to work at the top of licensure, dividing and conquering tasks according to skill level.
Many of these conversations have not been fun. I've lost sleep, and I've been on my knees in prayer, asking for wisdom and guidance and how to best serve my partners.
Friday, however, allowed me to hit the pause button and remind me that this administrative aspect of my job, even with the ethical dilemmas and difficult conversations, is part of my calling as well. I was asked to speak at career day at my sons' elementary school. When I arrived at the school, I realized that instead of volunteering in my children's second grade classrooms, I was slated to speak to the combined fourth and fifth grade classes. I was initially bummed as I was not going to be with my kids. But, God had something else in mind. Each of the session speakers was given 5 to 6 minutes to share why they chose their career and how they used various subjects in it every day. As I quickly told my story of backing into a career in medicine, after attending graduate school in counseling and seeking premedicine classes post my graduate degree, I heard myself gushing with excitement about all the ways my job uses the things I've learned and experienced, starting in elementary school. I get to use math as I calculate doses of medicines or kidney function. I get to use English as I compose clinical documentation and letters to patients on a daily basis. I get to use Biology, Chemistry, and Physics as I am constantly researching how the body is fearfully and wonderfully made. I get to travel, as the skills of a doctor are a valuable asset on the mission field. And, I get to use counseling and discernment as I listen and provide guidance to my patients and to the providers I'm trying to serve and lead.
At the end of the session, children had an opportunity to ask questions. One asked me the most difficult part of my job. I initially responded that giving a patient bad news about an unexpected diagnosis, such as cancer, was difficult. I was then asked what was the one thing I did not like about my job. I actually had to pause. I had a hard time thinking of anything.
And, I realized that I love it. I love all of it. Even the difficult conversations with patients and with colleagues around the changing healthcare environment. Why? Because I know that God has called me to it. The words "work" or "toil" appear 480 times in the Bible. God considers work to be an important aspect of our lives. I am very blessed that my job coincides with my calling. But, I don't think that has to be the case. I think God considers work to be important. And whatever we do, He doesn't promise it will be easy. But, He expects us to do it for Him.
"Whatever you do, work at it with all of your heart, as working for the Lord, not for men." (Colossians 3:23)
"Commit your work to the Lord, and then your plans will succeed." (Proverbs 16:3).
I know that the work ahead of me as a healthcare administrator will be a roller coaster over the next months and years.
But, I am rejuvenated and excited that I have the privilege to be a doctor and to lead other doctors through this season of change. And, I am claiming the encouragement of 2 Chronicles 15:7:
"But as for you, be strong and do not give up, for your work will be rewarded."
May you find that same joy in your work as well.
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I'm busy working on my blog posts. Watch this space!