What they want is power, control, and to take all the credit. In short, they want what you have. Vision. Even more so, the ability to manifest a vison. Even more so, they want your energy. Your passion. “Candy Everybody Wants” by 10,000 Maniacs is an epic song. I know every word. Hey hey give ‘em what they want If lust and hate is the candy If blood and love taste so sweet Then we give ‘em what they want Hey hey give ‘em what they want It’s been ten very full years since I started what ended up being three years of constant work and pushing and convincing to get a pediatric weight management launched in my community, the final Stage in the Expert Committee Recommendations’ Staged Approach to Treatment. Three years of strategic partnerships, grant-writing to the tune of leveraging $100,000 to fund programs for Children’s, sharing patient stories and meetings, meetings, meetings. I worked with a health care finance consultant to create a 5-year pro-forma and operational plan for the clinic. It took me a year to write grants to obtain the necessary funding to support the health care finance consultant’s time. She and I worked together like a dream. I was a passionate visionary and expert full of stories about patients, their needs, and the community’s gaps. She was a strategic savant with the financial expertise and ability to know the exact next step to take. We even considered the two words corporate health care doesn’t want to say out loud, “contribution margin.” Referrals to specialists, procedures, special studies, lab mark-ups, facility fees, and most importantly, adolescent bariatric surgeries. Hey hey give ’em what they want. I played every game in their C-suite corporatized health care book. “Karla, you know the only reason the clinic is being funded is because of bariatric surgery.” “Offer bariatric surgery at the first visit.” Silly me. It makes me sick to my stomach that fellow visionary pediatricians are now back where I was ten years ago and are starting their hoop jumping and carrot chasing journeys. I’m on the AAP’s Section on Obesity Listserv. Amazing pediatricians are back where I was years ago, with their C-suite asking for business plans for the medical side of their adolescent bariatric surgery programs. The reality is corporate health care has infiltrated pediatric health systems, and the C-suite looks at the medical component as a necessary evil to drive adolescent bariatric surgeries. In fact, they are OK with medical treatment failing because it means more adolescent bariatric surgeries. The medical arm is what helps document six months of failed treatment which is a requirement for consideration for bariatric surgery. By the way, if your operational leaders rely on you as the physician to produce the business plan, stop there. This is what they do, and they can easily or should be able to create the business plan with your input. If there is a lack of operational infrastructure, that’s a huge red flag. I ignored this huge red flag right in front of me the whole time. When I started my non-profit, Teach a Kid to Fish (creating community solutions for children’s health to address childhood obesity), the love of my pediatric career, in 2007, my poor attorney must have been bashing his head against the wall before and after meeting with me. I would show up, and we would work through the monster 1023 form. What’s your mission statement? How many will be on your board of directors, and what is their role? What about officers? You need to develop your bylaws. After your Articles of Incorporation are approved, you can hold your first board meeting. In fact, you will need to. I remember putting a PowerPoint together called Traveling with Kids and holding my first official meeting at the family medicine program’s conference room down the street. I had a good turn-out and great feedback, besides one of my physician colleagues lectured me on having too many PowerPoint slides and too much text on each slide. Noted. While meeting with my very patient attorney, I wasn’t sure of much other than my vision and the fact that I would never start a pediatric weight management clinic. Famous last words. Over the years, I kept getting calls from school nurses about students who needed help. One story I remember was of a first grader who couldn’t walk down two steps without turning blue, and the nurse said, “I truly believe he’s going to die at school.” The need declared itself, and I remember thinking, “Here we go!” Everyone, including my Teach a Kid to Fish board, wanted a community clinic with all the health systems contributing. My problem was that neither of my community’s hospital systems supported my non-profit with funding. Despite many meetings and lots of promises and funding, the efforts of another physician-led non-profit had duplicated my mission. So, I focused on a strategic partnership with Children’s in Omaha, serving my community’s patients in Lincoln. During the strategic pitch meeting, “Who do you have at the table, Karla,” the COO asked. “YMCA, UNL Department of Psychology, Health department, Community partners, and local funders.” Hey hey give ’em what they want. Then I was shaking like a leaf when I got the COO’s call several weeks later: “Karla, I’m excited to tell you that I presented your vision at our retreat, and the executive team is going to support the expansion of HEROES (pediatric weight management program) in Lincoln. We would like for you to be the pediatrician for the clinic.” I sat the phone down, crying. It was happening. Then, nothing for months. Hey, hey give ’em what they want. More hoop jumping. “You’ll be an independent contractor.” “You’ll need to cover your own malpractice insurance.” “Teach a Kid to Fish will need to cover the costs of the group fitness program, the PhD psychology intern, and the program database.” Children’s didn’t provide us with a template for my contract. My attorney had to create my contract from scratch. The clinic launched in January 2015, and the ENERGY group fitness program launched at the Fallbrook YMCA in March 2015. I did it! But, at what cost? To me? To my family? Now, I know to call it moral injury. I didn’t have the words back then. If you’re a physician with a vision to build a community program to meet a need, then your role is to start here: Identify the need with data. How will you address the need? What are other models that will be helpful to highlight? Who are your community partners who share your vision? Make sure you are being additive, filling a gap, and utilizing best practice and evidence-based programming. Determine how you will measure outcomes utilizing a continuous QI lens. You will be successful and avoid moral injury if you keep these tips in mind: Be realistic. Even the best systems are only interested because of the marketing wins and bariatric surgeries. Never let anyone pitch your vision, even if it’s the COO. Fellow visionaries will want you in the room where it happens to pitch the vision yourself. Be willing to walk away if you’re not being funded for your time. Never allow the burden of sustainability to be fully placed on your shoulders. Sustainability is a shared effort. “So their eyes are growing hazy Cos they wanna turn it on So their minds are soft and lazy, well” “Who do you wanna blame?” If you don’t advocate for yourself, no one will. Source
