By: David Kashmer MD MBA FACS (@DavidKashmer)
What’s dangerous is not to evolve. –Jeff Bezos
Once upon a time, a young man went to work every day providing an invaluable service for his local community. The work was considered essential, in fact, to help make sure people were safe and were able to get done what they needed to get done in order to live their lives. Now, that position no longer exists in our society. The job: lamplighter. It could’ve been milkman or a host of others.
Oh, did you think I was leading up to a job in Healthcare? No problem! Insert radiology file room clerk (not many around since the dawn of the electronic medical record and PACS integration). Colleagues, here’s the point: if you think of Healthcare as static, well…stop! The story I share above about lamplighters could easily be another role in the hospital or perhaps, some say, an entire medical specialty.
I invite you to think of Healthcare, and your role in it, as more like navigating an ocean instead of walking a beaten path. And in oceans, my friends, things happen. Unexpected weather, accidents at sea, and moments of amazing calm are each represented in different measures at different times.
Let’s talk about the tumultuous state of Healthcare. Like me, you’ve seen:
- increasing numbers of employed physicians and declining numbers of private practices
- significant time spent (more than 20% of our days in many reports) on documentation in electronic health records.
- increasing focus on defensive medicine owing to many factors including the modern climate of tort law
Now, let me be clear: I’m not commenting on whether this is bad or good…I’m only saying that this just is.
Ok, now let’s get to where we’re going: in order to navigate the highly complex ocean of Healthcare, physicians need tools. And, unfortunately, we often weren’t given these tools in medical school. Now, I agree that medical school should help us understand disease & its treatment. We should focus on the basics of baking the cake of how to deliver excellent, compassionate care to people. Much of the rest is icing. We may even learn how to be lifelong learners…but what then?
Nowadays, we have needs that medical school didn’t directly address: we need a different mental model because times in healthcare have changed. Why? Because the only constant thing is change. The Affordable Care Act, the ongoing transition from a system focused on volume of services delivered to one centered on value of care delivered, and a swell of other influencers have made the practical side of what it means to provide care very different than what the tools we took from medical school were designed to address.
So what about these situations where the waves surge so high that our boat is threatened? What about situations where we have no map or compass?
Tools for the ever-changing landscape, ones that build strategies, teach us how to maintain the financial viability of our practice, or otherwise guide us in this often-challenging ocean…well, those tools are not included in our medical textbooks. Those tools, ones that enable us to provide high quality care, create a new practice of our own, or to allow us to practice at a higher level as an employed physician…those tools are more typically found in business textbooks.
How exactly is a Relative Value Unit (RVU) defined? What exactly is an acid test ratio, and what does it tell me about my practice? How can I create a system in my hospital as an employed physician that helps me provide routine, excellent care? These questions, and others, are answered by a toolset that we’ve often seen little of in Healthcare. These are more commonly found in the business world and those are the ones that help us navigate amidst an uncertain future.
So, once upon a time, an entire job disappeared. Don’t be the next lamplighter and wind up snuffed out by a towering wave of disruption. Build a better map to navigate what are sometimes treacherous waters–waters which will likely become only more challenging to traverse in the years to come.