Late last night, I was in the office discussing with a patient how she could get her much-needed high blood pressure medication since the price was $225 a month and her insurance company hadn’t approved it. We had a very long conversation. I still needed to have 8 other conversations with patients that night to answer their medical questions. I looked around the office for any chocolate to keep myself energized so I could make the next series of phone calls. There was nothing around. No snacks. No chocolate. No caffeinated drinks. So I decided to go to our hospital cafeteria to grab a Coke. I know…you are probably thinking….”doctors shouldn’t be drinking soft drinks”….but I assure you, this was an exception. I asked the cashier if they had a Coke. Fabulous. They did. About 15 minutes later, they brought me a large to-go cup with the soda and then told me the price was $2.50. I mentioned that I had requested the smallest size cup. A manager looked at me and said….”So what? We only have large cups at this time. The price is $2.50. You can pay the $2.50 now or leave. Go to the vending machines. They are in the second building down the street and three flights down.” I counted all of my change and mustered up $2.00. I was short. I was humiliated. I did not bring my wallet or credit card. I was so exhausted, and it was getting late. I politely thanked her and left. As I was leaving, a patient with an eye patch glanced at me with his one seeing eye. He was able to discern the contrast between my beet-red face and my stark-white labcoat. He offered to pay for the soda. I thanked him politely and declined. He was a great man to notice with just one seeing eye that I was in a bind. I served this hospital for over a decade. I saw over a thousand patients free of charge for the hospital over the years. I worked weekends, missed family events, woke up at 2:00 AM and 3:00 AM night after night to make sure I took care of any emergency for which I was called. I never got paid by the hospital for my emergency work. Now, the hospital cafeteria felt that I was not worth a discounted soft drink. I realized that the Coke they poured for me would eventually go in the trash. What would have been better? Throwing it out, or letting a doctor who is dedicated to serving the hospital–at any cost–have a soda at a discount? So I went back to my office. No Coke in hand. 20 charts sitting on the table. I continued emailing, calling, filling out prior authorizations, documenting… and my work was periodically interrupted by moments of clarity about what this all meant. I know that being a physician does not make you entitled. Being a physician does not make you “superior” to anyone else. Before I became a doctor, I was a professional musician. As a clarinetist, I probably worked harder than I did in medical school with 6 hours a day of practicing, going to brutal auditions, enduring 5 hour rehearsals, performing in hundred degree venues, and facing the uncertainty of press reviews. Becoming a physician was a lot more predictable and less taxing. But having the hospital cafeteria manager yank the Coke out of my hand—a drink that was already dispensed in the to-go cup–and tell me to “leave”—gave me a big jolt. Why should any doctor ever be worth a discounted Coke? It made me think about the future of American Doctors. What’s Happening to Us Doctors? A couple months back I got a beautiful invitation to a holiday party celebrating the staff doctors at one of the hospitals. The “basic” ticket was $500 per person. I looked at the card more closely. “That fee is for sponsors, right?” I assumed. No. It was the ticket price for the staff doctors to simply attend their own hospital holiday party. Staff doctors had to foot an outrageous bill to come to this annual event? Two weeks ago, I went to go see some emergency patients to cover for a colleague of mine at a new hospital. I went to park in the doctors parking lot and there were no spaces and no attendant when I went. I went again…no parking spaces for the doctors….no attendant. I asked some of the doctors who were on staff what to do and they said that–for the last decade–the hospital did not offer enough parking for the doctors. So you just park in the middle of the lot, leave the key in your car, and cross your fingers when you go to round on patients that your car and belongings will still be there. All the doctors just accepted that “this is just how it is.” How could doctors blindly accept this? Hospitals are acquiring nearly every physician group with whom I have worked over the last decade. Doctors used to have the autonomy to run a practice the way they saw fit and to create their own office cultures. Now, the shape of their future employment is being determined by hospital administrators. A growing number of physicians are now at the mercy of quality scores, RVU metrics, efficiency scores, bounceback numbers, and patient satisfaction scores. Doctors are no longer calling the shots about how they would like to be treated at work. They are no longer making the decisions about creating a “work culture” that makes them feel valued. How Can We Make Things Better for Physicians? There are two key issues we need to address: 1. We need physicians to apply for leadership positions at our hospitals more than ever. If we don’t become the leaders, we need to find ways to get involved in recruiting and electing executives who value creating a “culture of appreciation” and respect for doctors. The Cleveland Clinic and Mayo Clinic are ranked the top two hospitals in the country. Both of these institutions have physician CEO’s and attract some of the nations most talented physicians to come work for these hospitals. We need more of our colleagues to become institutional decision makers. Physicians know from firsthand experience how to value and respect their fellow physicians. 2. Physicians need to emphasize to hospital leadership the importance of being “valued” by our hospitals and institutions and recommend positive ways to implement this. Hospitals want to acquire and retain physician practices more than ever. But, physicians must realize that if they are going to give up autonomy, they need to feel appreciated by the institution. Creating a “culture of appreciation” is not proportional to a numerical dollar amount spent by the institution to support physicians. It is often the little things that can enforce this positivity. Is there access to food for doctors stuck in the hospital late at night? Is there enough parking for the doctors? Do they have access to a free cup of coffee? Are there scheduled open forums for doctors to provide feedback to the hospital administration? According to a recent study of over 2,000 physicians conducted by Athenahealth, only 18% of hospital-based physicians feel that their hospital truly inspires them to go above and beyond what is required, and want to work at the same hospital in the next three years. Most tech startups that grow to become billion dollar successes all have one thing in common–they attract and retain exceptional talent by creating a culture of appreciation. Our medical institutions can do the same. When doctors feel “valued,” patient satisfaction scores will skyrocket and physicians won’t feel that they have traded autonomy for alienation from our nation’s hospitals. The only way physicians can succeed in our changing medical environment is for us to have the courage to become leaders at these great hospitals and to make creating a “culture of appreciation” for physicians a top priority. Source
