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Curbside Consult with Dr. Jayne 1/27/14

January 27, 2014 Dr. Jayne 6 Comments

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.

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Currently there are "6 comments" on this Article:

  1. ” 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. ”

    If you think times are difficult for CIO’s and CMIO’s are now, the move to ICD-10 will certainly ratchet up the stress level for the entire healthcare spectrum seeking some time to learn ICD-10! Only by using the appropriate learning tools will that stress level head lower.

  2. Knowing DrJ was an FP, figured it was only a matter of a short time until this would be one of her topics. It is a tough world out there. The expectations for physicians– especially primary care in the trenches– is approaching the unreasonable. Practice v. not practice has always been a contentious issue for those of us in academia and management–IT is just one more arena where clinicians are needed for their input but hard to pull off in an increasingly complex environment.

  3. I wound up in the “not practicing” track purely through circumstance and not by choice, but I never really understood the notion that we had to practice to maintain credibility as I never really had a problem with that despite not seeing patients actively. In my experience, if you still at least understand what the MDs are going through and what their problem areas were going to be, which is frankly pretty easy after practicing for quite a while (it’s not like you forget your past life that much), then they seem to not really care.

    The only person who told me I didn’t “get it” also said the chair of his department didn’t get it. The same chair who had practiced virtually full-time for ~45 years and still attended half-time. I figured I was in good company.

  4. It’s a shame, and somewhat ironic, that we have not yet reached the point where HIT makes life easier for doctors (and better for patients)… I think many doctors who moved into the CMIO role over the past 5-20 years have all thought that this vision was just “5 years away”, and they would be the ones to help make it happen. And maybe, after the job was done cleaning things up, they’d be able to go back to practicing full time, but in a world where HIT truly did improve the efficiency and effectiveness of their practice so they would not feel burned out. But let’s face it, that vision is not close yet…. but maybe some day, some day…

  5. I’ve recently found myself reluctantly giving up practice, 11 years out of my IM subspecialty fellowship. Last summer I left my hospital system CMIO job (where I cross-covered for another doc in my specialty about 10-15% of my time) for a role with a vendor. I’m enjoying the new job quite a bit, and my management is OK with me practicing occasionally — however, there’s no easy avenue to practice or moonlight (especially in my unique specialty — I’m too rusty to go back to IM/urgent care). I suppose I could go find a locums opportunity somewhere far away, but there are only so many hours in the week, and my wife and family are happy I’m spending more time with them and less working. I’m still reading the journals, though, and keeping up with CME, just in case…

  6. When a family-based shift from West to East landed on me, I left my CIO position in a large primary care practice for work in industry. While the practice position afforded and favored keeping some clinic time, the industry job did not. Subsequently, I have pieced together my clinical work, along the lines of Dr. Jayne. Locums work was a bit too irregular, so I joined the pediatric hospitalist team, with set shifts, on weekends and Holidays, which could be scheduled in around business travel.

    Several ironies attend. As I seek and qualify for more executive responsibility, I am also getting older, so 2 AM admits are heavier than they used to be. But that same seniority gives me tools and perspective that the house staff, students and nursing staff seem to value. I add a measure of health system payment innovation to my non-clinical work, which results in me standing amid pathology, and systems, and resource utilization, marveling at the mix of functionality and dysfunction.

    It is interesting to note your ability to move between settings because of a facility with IT systems. The loss of liquidity in transferring skill from one place to another because of IT systems isn’t discussed much, but is a reality which will change the organic scale for organizing physician work.

    “Maintenance of Certification” for the Boards is an interesting process, which while likely appropriate, requires an multiple investments. Add my late start on a family, and something has to give.

    Too bad: I think am actually good at doctoring, but I think we face a similar state of compromise. That being said, weep not for me: it is a “chocolate or vanilla” choice, which many would love to have.

    Good luck in navigating the way ahead.

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