This year (like last) I have made A List Preferred Status on Southwest Airlines. As I write, I’m actually sitting at DCA on a weekend night having left my family waiting for a flight to head out on another business trip. When I finished medical school over 25 years ago, achieving airline preferred status wasn’t really on the radar. I was worried about finishing residency, paying back student loans, starting a family and finding the right job.
As I progressed in my career I learned to balance clinical care at the bedside with the business side of medicine. My partners and I learned early that if we were going to be successful as a practice we would need to be successful as a business. Some may find that odd or potentially offensive but I found it exciting and challenging to balance the care we provide to our patients with successfully building a business in medicine.
Now, as a Regional President for US Acute Care Solutions (USACS), my job is to support over 500 physicians, nurse practitioners, physician assistants, and support staff in treating over 1 million patients a year at 25 hospitals on the east coast. I take that job incredibly seriously and try to support my colleagues while balancing the needs of our hospital partners as we care for those patients every day. I consider my most important role to be to allocate appropriate resources to our amazing people so they can better care for patients. What exactly does that mean, allocate resources?
As a company, our most precious resource is our people – period. And, with 3-4 open job opportunities for every one practicing emergency physician and increasing competition for high quality advanced practice providers, there is an ongoing war for that most precious resource.
We must constantly balance how much we ask our people to do. What’s the right patient/hour, RVU/hour and mix of APP to physician staff? How do we continue to attract the best to our company? When do we add scribe coverage so our clinicians do not feel as if they are an entry-level data tech? When do we bring in our internal consulting team to assess patient flow and make it more efficient? When do we send providers (or bring onsite) to a patient/provider experience seminar to both improve the patient experience and lessen the chance of burnout? What resources can be dedicated to internal leadership development training and who do we select for that program?
Some people may look at a large physicians group allocating resources and think that it’s just about the dollars. It’s not that simple. Medical care in this country has always been both about the care and about the dollars.
In a smaller practice, it’s about seeing patients and managing overhead to make sure you can cover your expenses and have enough left over to make a decent living for the sacrifices you, and your family, have made. How much do you invest in your practice? Are you ready to put some of your payments at risk for programs like MIPS and MACRA? What about billing and collections, especially in this increasing era of high deductible health plans? How about negotiating with insurance plans so you can get fairly compensated for the work being done? When do you go ‘at risk’ for outcomes? It’s no wonder the majority of physicians coming out of training today choose to become an employee of a health system – they at least can avoid thinking about many of these business challenges.
I’ve chosen to continue to walk a different path. Our company is dedicated to physician ownership and all that it entails. It’s not always pretty, but preserving the ability for us physicians to control our own destiny means that we must constantly devote attention to balancing the forces in the marketplace with ensuring those resources are directed toward our mission as clinicians to care for patients. This is very different than it was 20 years ago when I helped form a founding partner of USACS, an organization that shared the same values, and the belief that a group committed to physician ownership was the best model for caring for patients. Over time, the consolidation of hospitals and insurance payers required us to change in order to thrive. Joining USACS was the right decision and I am proud to be part of a company dedicated to continuing those shared values.
While I still practice emergency medicine I do less and less of it. It’s an odd feeling to have to choose between picking up an extra shift or scheduling that trip to visit hospital leaders who want to discuss issues they are facing in the marketplace. I take comfort in knowing that we have some gifted clinicians in our company and my role is now different.
Some people will point their finger and say I’ve changed. Fair enough, I will take that criticism. I’ve seen tens of thousands of patients in my career at over 10 emergency departments in several states. I take comfort in the fact that I continue to bring to each shift a belief that we are here to care for patients, meet them where they are and make them better, a simple goal that has its innumerable challenges.
As I get ready to board my flight, to continue the discussion of allocating and balancing resources, I keep in the forefront of my mind the 500 colleagues and the million patients in my region that they serve. In truth, I never forget that duty to serve them. I consider it an honor and will continue to do so as long as I am able.