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EPtalk by Dr. Jayne 3/23/17

March 23, 2017 Dr. Jayne 1 Comment

I get a lot of junk mail in my Dr. Jayne account. Most of it is marketing and public relations related, with varying degrees of personalization.

My favorite ones are those that attempt to sound all chummy and personal, but make it clear that the writer has never read HIStalk. “I was looking at your website that mentioned a mental health topic and am curious if you’d be open to me writing some unique content for your audience on the subject?” shows no grasp of your marketing audience. Of course, it’s easy to hit delete, but sometimes they’re just so bad you have to read them and laugh.

I’ve also recently been inundated with survey requests from HIMSS Analytics. Half the time I can barely make it through the fresh items in my inbox, so I’m not likely to be induced to finish a survey of questionable merit.

Hot topic in the physician lounge this week: the looming physician shortage. These reports come out nearly every year and always predict a shortage, although with variable numbers. Our local paper ran an especially Chicken Little version of the story, promising long wait times for appointments, but failing to interview anyone from the multiple medical schools and training programs we have in town.

As a former primary care physician, I’m not sure how much of a shortage we really have vs. how much of an incentive misalignment problem we have. I’d consider going back to primary care at some point if it wouldn’t mean working far more hours and taking a significant pay cut. Until then, I’ll stick with the wild and crazy world of urgent care and healthcare IT.

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I’m already tired of everyone’s marketing tie-ins to March Madness. The MGMA ad featuring “insane savings” was a little tasteless – as a health professional, I don’t typically find insanity funny. I do still like (and highly recommend) my urologist friend’s March Madness promotion. His practice figures there are a lot of men doing a fair amount of sitting and watching basketball during the tournament, so he offers complimentary pizza delivery for patients scheduling their procedures in that time frame. It’s a significant business booster and he’s been doing it for more than a decade, so it must be effective.

Maybe it’s just the blogs I read or the people I follow in Twitter, but I’ve seen a spike in discussion of physician burnout. There are many stories about physicians retiring from medicine in their 40s (often to choose another career entirely) or going part time as soon as their loans are paid off. A recent study looks at another consequence of burnout – the loss of the sense of medicine as a calling.

The study defines “sense of calling” as, “committing one’s life to personally meaningful work that serves a pro-social purpose” and surveyed over 2.200 US physicians across all specialties. The study had a 63 percent response rate, with 28.5 percent reporting some degree of burnout as measured by responses to six true/false statements:

  • I find my work rewarding.
  • My work is one of the most important things in my life.
  • My work makes the world a better place.
  • I enjoy talking about my work to others.
  • I would choose my current work life again if I had the opportunity.
  • If I were financially secure, I would continue with my current line of work even if I were no longer paid.

According to the authors, physicians who don’t see medicine as a calling see it more as a means to learn a living. That’s what most of us call “having a job” or “earning a paycheck.” Physicians who are burned out are less socially motivated as well.

The authors go on to note that physicians who don’t see practicing medicine as either personally meaningful or as a service to society may see performance impacts, including negatively impacted quality of care. They also interestingly note that monetary bonuses to improve performance may backfire, as they undermine professional autonomy and physicians’ sense of competence.

Due to the study’s construction, it’s not clear whether burnout itself reduces that sense of calling or whether physicians with a higher calling are somehow protected from burnout. More research is needed.

I did some anecdotal research myself, asking physicians if they would stay in practice if they inherited a large sum of money or won the lottery. The only ones who said they would stay in practice would move to a cash-only model and/or work only part time. There were several comments about dreaming of the opportunity to tell Medicare and commercial payers which parts of the posterior anatomy they can kiss.

My friends who happen to be physicians have a variety of strategies for trying to avoid burnout, although some ultimately do leave practice and that’s a shame. Every day there are articles about the catastrophic events that happen to physicians and other healthcare providers: sleep deprivation-related accidents; pre-term labor and birth; stress and anger management issues; and suicide. We lean on our families and friends to try to help us cope or to find a little slice of ‘normal’ among the chaos.

Several of my physician colleagues have taken up traditional handicrafts to try to relax. Two guys I went to medical school with do crochet – I sometimes see them at conferences with their projects. I have three friends who make soap. There are a couple of woodworkers (not surprisingly, neither are surgeons). At least if there’s a collapse of the world’s infrastructure, I know who I can barter with for socks, furniture, and toiletries.

As for me, my knitting skills are marginal, but I wield a mean cast iron skillet, so you’ll find me in the outdoor kitchen if the dystopian future arrives. Until then, I leave you with a recent revision of the Hippocratic Oath for today,courtesy of Paul Simmons, MD:


I swear by Epic, by eClinicalWorks, by Allscripts, by Athenahealth, and by all the coders and accountants, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my mouse in this art equal to my own hand; to make it right-click as well as left-click; when my ACO is in need of money to share an “at-risk” portion of mine with it; to consider Joint Commission inspectors as my own brothers, and to answer their questions, no matter how obscure, without hesitation or resentment; to impart coding, billing, quality measures, and all other vital instruction to my own sons and daughters, the sons and daughters of my teacher, and to indentured employees who have taken the physician’s oath, but to nobody else competing with my health system.

I will use mouse clicks to help the sick according to my ability and judgment, but never trusting my own judgment over that of guidelines, directives, policies or best practices. Neither will I administer a poison to anybody when asked to do so, unless the poison is properly linked to a diagnostic code and reconciled in the medication list.

Similarly, I will not give to a woman a pessary to cause abortion, especially if the pessaries aren’t covered by her insurance plan. But I will keep pure and holy both my problem list and my billing codes. I will not use the knife unless credentialed by a committee, not even, verily, on sufferers from the stone, but I will give place to such as are craftsmen therein, and will do my best to decode their two-sentence notes should they choose to leave one.

Into whatsoever houses I enter, I will enter to help the sick, without expectation of payment because no one pays for house calls. I will abstain from all intentional down- or up-coding and premature closing of encounters, especially from abusing the computers on which I labor, for they are my true patients. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets, but mainly because HIPAA says so, and that comes with monetary fines and jail time.

Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my mad abilities to click boxes and buff the chart; but if I transgress it and forswear myself, may the opposite befall me, and may I be banished to a Third World nation where I might labor in obscurity to help truly sick people with my medical skills.

Email Dr. Jayne.

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Currently there is "1 comment" on this Article:

  1. Quite a juxtaposition to discuss physician shortages– especially in primary care, whether or real or artifact, matters little to patients who can not get appointments–with a specialist trying to get patients by offering pizzas.

    What is wrong with this picture?







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