Curbside Consult with Dr. Jayne 12/9/24

It’s definitely a slow time in the healthcare technology universe. The HLTH conference is in the rearview mirror and HIMSS is still a couple of months away.

CES will happen in January, although on the healthcare side, I see more entrepreneurs there than I do those who work for hospitals and health systems. I’m looking forward to seeing cool consumer products and wearables announced at CES, although I have low expectations for anything that will truly transform healthcare. Even if there’s something useful for patients, cost is still a barrier for the majority of patients I interact with. Many of them struggle to afford their medications, can’t afford to take time off work for a physician visit, and aren’t going to pay hundreds of dollars for devices that may or may not improve their health.

One physician I spoke with recently is working extra hours trying to fit in patients who want to proceed with non-urgent procedures because they’ve met their deductibles for the year and can now afford them even though they couldn’t do so earlier in the year. He’s been in practice for a while and this isn’t a new phenomenon for him, so he avoids scheduling family vacations during November and December so that he can accommodate the needs of his patients. It creates a bit of a burden on his office staff because he has to limit their ability to take vacations as well, but that’s not an unusual situation for staff members working in a small private practice.

Several of my physician colleagues are planning to cut back on their working hours in 2025. I’m happy for them because at least one of them is experiencing severe burnout and it’s been difficult to see all that she’s gone through in the last couple of years. Depending on how physician employment agreements are structured, many physicians don’t take enough time off to allow themselves to recharge from drain caused by physical and psychological stressors on a daily basis. Some physicians don’t take time off because they don’t have appropriate coverage for patient care tasks. Others take the time off but end up working because they don’t have coverage for inbox messages or other patient care needs, and therefore don’t get a real break.

Lack of adequate coverage for physician time off is a pervasive issue and causes enough issues that the AMA recently released a module under their STEPS Forward series to address it. The webinar reviews various barriers to physicians taking time off and strategies for organizations to address them. Some of the strategies are straightforward, like making it easy for employees to track their time off and understand how much they have used versus how much remains. Especially if your organization has a use it or lose it policy for time off, this is important. Another strategy is to block physician time off well in advance so that it’s not a surprise. I’d go one step farther with that one and recommend that when the physician schedule is blocked, the scheduling team creates buffers around those blocks so that physicians can manage last-minute issues before their time out of office as well as to have additional capacity available for their return.

Other strategies are more subtle but might be more challenging, like having physician leadership model expected behavior. That might be easier said than done depending on the organization. Another example is ensuring that leadership isn’t celebrating the fact that team members are working while they’re supposed to be off. If your organization wholeheartedly endorses hustle culture, it’s unlikely that they will be making that change. Another significant change called out in the module is making it the organization’s responsibility to find coverage for clinical matters while a physician is out instead of making the physician find their own coverage, which can be a disincentive to taking time away.

The module also addresses physician compensation programs and how they might be adding to the pressures that make physicians less likely to take time off. They recommend that organizations construct productivity models to reflect appropriate time off including holidays, educational time, and sick time. As someone who has managed a consulting team, I know how important this is, because if you calculate productivity expectations based on 40 hours a week for 52 weeks per year, you’re going to make your team crazy with unrealistic expectations. In addition to time away from work, you also need to consider productivity losses for mandatory training (fraud, waste, and abuse, anyone?) as well as office and hospital closures due to holidays.

The module also challenges organizations to look at how physicians are taking time off as part of their organizational scorecard. New research has shown that physicians who have adequate time off are less likely to leave an organization, so it would make sense to look at that data in conjunction with turnover data. Especially for larger organizations that are using human resources systems to track time off, looking at this data should be fairly easy. For those of us on the administrative side, many EHR/practice management systems have stock reports that let you look at scheduled clinic hours and blocked hours, and if you’re a physician leader and you don’t have access to that data for your team, I’d recommend you track it down – you just might see some interesting trends.

As far as my colleagues who plan to cut back their working hours in the coming year, it will be interesting to see how their organizations support them in those efforts. I know of a number of physicians who are supposed to be working at 75 or 80% of their previous full time schedules, but who end up working nearly as much as they did previously due to the same kinds of organizational barriers that keep people from taking adequate time off. At least a couple of them have gone back to full time work so that they at least get full time compensation for their efforts. It’s something to think about for those looking to reduce hours.

What are your plans for time off in the coming weeks? Will your workplace be a dead zone as everyone struggles to use up their vacation time? Leave a comment or email me.

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