To practice or not to practice, that is the question. Among the other CMIOs I talk with regularly, it’s a nearly 50-50 split as to whether they continue to actively practice medicine or not.
For some of them, the decision was made based on factors related to medical specialty. Others gave up licensure when they pursued administrative work and found it too difficult to go back. Some chose informatics as a way to escape patient care. But it’s not always straightforward. It seems that those of us who are earlier in our careers are more apt to try to continue seeing patients, with those in the primary care disciplines hanging on longer than others.
I’ve been lucky because my EHR background has given me experience with multiple vendor systems. This allows me to work as a locum tenens physician and fill in for a week here or there in a traditional family medicine practice. Seeing how different practices function is interesting and I often get ideas for performance improvement projects or bring back tips and tricks that can help my providers.
I’ve also worked for the last several years in various emergency departments and urgent cares. Although I do a fair amount of “real” emergency medicine, it’s mostly the same kind of conditions that I’m used to handling in the family medicine office.
I try to work consistently, but it has been more and more difficult to find opportunities that will work with my ever-expanding CMIO work. My “day job” is full time and my hospital doesn’t provide much accommodation for my clinical work. Now that we’re in the throes of Meaningful Use and preparation for ICD-10, it seems like there isn’t enough time to do anything else.
During the last six to eight months, one of the hospitals where I worked has closed their fast track area in the emergency department. Another replaced all the part-time physicians with nurse practitioners and physician assistants. I took some time off while I was preparing for informatics boards and that impacted my seniority on the scheduling board at my remaining facility, which has made it harder to get back in the rotation.
Continuing clinical work doesn’t yield a lot of income compared to the cost of being an independent contractor. Although I don’t pay for professional liability insurance, there are many other costs: board recertification, maintenance of certification, state licensure, Drug Enforcement Agency registration, state drug enforcement registration, hospital medical staff dues, hospital recredentialing fees, and more. There’s also the cost of professional society memberships and continuing medical education.
Continuing education has been a thorn in my side the last couple of months. For emergency department work, I have to maintain certifications in basic, pediatric, advanced cardiac, and advanced trauma life support. They’re all due this spring, and trying to work them in with everything else that is going on has been enough to make me think twice about seeing patients. Thank goodness I finally got to stop maintaining the obstetric life support credential because I’m not entirely sure I’d be able to fit it in.
For most of the classes, I’ve been able to find programs that offer at least part of the course online, although all of them require a practical component. Some are sponsored by national organizations and others are modules that have been purchased by one hospital or another. I figured doing them online would give me more flexibility but I’m not sure it’s doing much good. The differences in quality are tremendous. When I compare it to what we’ve been trying to achieve with e-Learning for our EHR program, it’s even more striking. Some of the “e-Learning” is little more than written textbook sections punctuated by the occasional embedded video.
They vary greatly in the length of the modules and whether users can pause at any time or only at pre-defined points in the course. One of them was so restrictive that I might have been better off using a vacation day and attending an all-day course rather than trying to fit it in as time permitted. The cost of the courses is the same as what I have paid in the past for in-person courses except for the basic life support. It used to be free when our hospital education department offered it, but now that it’s offered online by a third party, we have to pay for it.
Despite being an attending physician, I couldn’t even register for the class until my check cleared. Rumor has it that employees have to sign up months in advance so a purchase order can be processed and a check delivered. Another negative is the lack of interaction with colleagues. I enjoyed meeting nurses, patient care techs, therapists, and other colleagues during the classes even if it was just for some chit-chat over lunch or a break. I know the hospital is saving money with the online classes because they require staff to complete them during non-working hours; previously, hourly staff members were paid for attending class.
I’m starting to feel like this might be the last time I do this. Although I enjoy seeing patients, it’s getting harder to manage. There are many things competing for what’s left of my free time after I leave the office. I’m thinking about exploring volunteer opportunities where I could use my healthcare skills but where there would be less overhead than I currently have trying to maintain half a dozen certifications.
I’d be interested to hear from other CMIOs whether they’ve hit this point in their careers and what they decided. Is there a right time to hang up the white coat? How do you know? Have any creative ideas for trying to do it all? Email me.
Email Dr. Jayne.