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The Physician Philosopher Podcast

TPP 34: The Physician Should Come First (Not the Patient)

Today’s thought is that when physicians come first, our patients will receive the best care and the culture of medicine will change for the better.  How many times have you heard someone say that the patient comes first?  It is a mantra to 99% of us.  It has been engrained into us that the patient comes first no matter what.  What I am talking about today is that we, as doctors, should come first, not the patient!

Larry Keller

Who Should Come First in Any Business?

Most people that you ask that question to will automatically say the customer.  In a doctor’s world, this most times means the patient.  You may hear that the board or the administration should come first because if they aren’t happy nobody is.  What about the employees?  Costco has a long history of being a great place to work…do you know why? Because they put the employees first!  They have great benefits, free membership, and other employee perks geared towards keeping the employees happy. If the employees are happy to be there, the customers are treated well, the bottom line goes up, which makes the administration happy.  The employee is happy and so is everybody else!  So why can’t the same be true for physicians?

The Physician Should Come First

It is very rare that a physician is ever told to put himself/herself first. It is always to put the patient first. In reality it really isn’t JUST the patient who is put first. It is medicine, the hospital, the clinic, the charting, the insurance paperwork, the billing, the pre-authorizations, the online modules, the committee meetings, and everything else we are responsible for. Administrators think these things are more important than our lives as partners and parents. We are expected to stay late to help a late patient, open a room we don’t really have, and even fill scripts when we are done for the day…all to put the patient first. Then there are the metrics that we are asked to chase such as length of stay, patient bounce back metrics, patient satisfaction, turn over times in the operating room…if we put all these things before the physician, the physician is getting burned out! The physician should come first, not last! You can jump down my throat if you want to, but I am standing on this one.

If you are on an airplane, they tell you to put on your oxygen mask and then help other people. Why do they do that?  Because if you pass out from hypoxia, you can’t help anybody else! It is the same for physicians! If you aren’t getting the care you need, how can you help your patients how you should?  It is no surprise that physician turnover is high, and it isn’t a surprise it costs half a million to a million dollars to replace a physician, but we still can’t figure out how to create a system and culture that doesn’t make doctors want to leave and get burned out. 

How Do We Put Physicians First?

Each doctor is different, each institution is different, and each situation is different so each answer will be different, but it is all the same basic idea. The biggest problem is that physicians feel trapped. Trapped in their situation, trapped by financial obligations, trapped by insurance companies not covering procedures and medicines, trapped by administration, and trapped by unsustainable student loan debt. There are also non-competes and contracts that take a lot of money from the doctor who is already in debt if they decide to leave. Instead of making that doctor happy to work there and happy to stay, they threaten you if you want to leave. There is a lot of unnecessary things that physicians are required to do that don’t benefit the doctor, don’t benefit the patient, and are essentially a waste of time and energy. A few of these are online modules doing the same things we have done over and over again, maintenance of certification requirements, electronic medical records, and even hold backs for performance!  Hold backs could be completely changed by offering an incentive instead of withholding money if you don’t reach it. It is always a stick and never a carrot, and it drives me insane.

The biggest thing here is that doctors need to be free. They need to feel like they have true freedom instead of feeling trapped and feeling unappreciated, undervalued, and unheard. It is hard to feel this way, and very lonely. If you are feeling this way, don’t think that there is nothing you can do! We had a guest blog post a while ago titled The Hospital Will Not Love You Back, written by Vagabond MD.  Vagabond MD talks about how we pour everything into medicine and get nothing in return, and how the hospital will not love you back even if you give it everything. So, it is time to take matters into your own hands! It is time to empower doctors to practice medicine how they feel is right instead of leaving medicine all together. To do this you need to master your mindset, master your money, and master your ideal life like we discussed in episodes 30 and 31. 

My Hell Yes Policy

If you have been following me for a while you have heard of my Hell Yes Policy. This requires some deep reflection and answering some tough questions, diving into your mindset, and figuring out what matters most.  Most doctors who feel trapped feel like they don’t have a choice. Everything is a choice, and every time you say yes to something you are saying no to something that matters to you. Once you get clear on what matters most to you, you can put your time and energy into those things and say no to the things that don’t matter to you and find freedom.  When you know your value and your worth, you can have a hell yes policy and feel unapologetic about saying yes to the things that matter to you.

Put Yourself First

To put yourself first you need to focus on mindset, financial freedom, and your ideal life. Mindset is finding what matters most to you. Financial freedom is about knowing your monthly expenses and understanding your situation.  If your monthly expenses are high, this can make you feel trapped. Pay off debt and find a way to generate non-clinical income so that you aren’t completely dependent on your monthly paycheck in medicine. This is the goal! When you aren’t dependent on that paycheck you have all the freedom you need and can start building your ideal life.  

The next thing to focus on is boundaries. Put up boundaries for yourself. Know your value, know who you are, and stop saying yes to everything and being endlessly available. If you put yourself first the patient will be taken care of! Surround yourself with like-minded people because when you do, you can’t help but become like the people you are around the most.  

As a physician you do not have to keep doing the same things the same way. Start changing the ways for the current doctors and the future of medicine. If physicians are put first, patients are happy and better cared for, administrators are happy, benchmarks will be met, and doctors will be happier, will avoid burnout, and will stay in medicine instead of quitting! Change the culture of medicine for the better! Check out the blog post by Vagabond MD and episodes 30 and 31 for mastering your ideal life.  

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