Increasing pressures in the outpatient surgery setting — ranging from regulations and quality measures to issues surrounding payors and reimbursement — can make physicians feel less engaged in the practice of medicine, according to Bob Uslander, MD, an entrepreneur and the founder of Doctors On Purpose, an organization dedicated to coaching and mentoring professionals to achieve balance in their careers and lives. "It puts a different emphasis on what doctors are doing," he says. "They are being told that they have to satisfy everybody, and satisfying patients doesn't always relate to providing them the right care." This can lead to physicians feeling disconnected from the practice of medicine and from the surgery center environment, he says.
Dr. Uslander discusses three common signs of physician disengagement, and how to address these physicians collaboratively and effectively.
What are the signs of physician disengagement?
1. Physicians complain more often. Physicians who are feeling disengaged from the center tend to feel trapped and, as a result, may adopt a "victim" mentality, Dr. Usland says. "They tend to complain about a lot of the things that are happening, and the complaining is a sign of not feeling like they have the power to change anything," he says. "They complain to anybody who will listen, but typically not to patients, because they don't want to give them that burden."
Physicians may complain about the competence of the staff, for example, or about patients being difficult and unreasonable. "They might say that the primary care doctors are not getting them the medical clearance that they need, or that the lab is not getting them what they need in time, or that electronic medical records are difficult to deal with," says Dr. Usland. "They tend to complain about all of the processes in the system instead of trying to be the solution or engage in meaningful discussion."
2. Physicians receive more patient complaints. Disengaged physicians will often start receiving more patient complaints about them, says Dr. Uslander. "The patients feel like there is not a connection and that the doctors don't care, and they tend to be quicker to complain about the experience they have," he says.
If a patient experiences a long wait to see a physician, for example, a disengaged physician may not acknowledge or apologize for the wait time. "They don't make a human connection, and the patients just feel like nobody cares. They feel as though their time is valuable, but nobody respects that," Dr. Uslander says.
3. Physicians are less enthusiastic about collaboration and teamwork. The staff members working with the disengaged physician will often perceive that something is "off" about his or her behavior. The physician may consistently arrive late to work, show signs of not prioritizing their work, complain, or repeatedly make excuses for not completing tasks. "The staff that they work with will know it," says Mr. Uslander. "It will be clear that the physician is not being part of an effective team."
How can disengaged physicians be reengaged?
1. Designate a committee to talk to the physician. Every surgery center should identify individuals or groups in the organization who can engage the disengaged physician in a discussion, says Dr. Uslander. "It's all based around having a system of communication and not allowing issues to go on without some action," he says.
If a surgery center is part of a hospital, there may already be an existing wellness committee that can facilitate the discussion. Independent surgery centers should create a committee that consists of the operations director and several others who hold leadership positions at the center and are committed to creating a collaborative, cohesive culture, says Dr. Uslander.
2. Ask open-ended questions that focus on improvement. Conversations with a disengaged physician must be focused on helping him or her as opposed to assigning blame, says Dr. Uslander. "The first question that will open things up is, 'How can we as an organization best support you?'" he says, adding that a fairly broad opening question shows that the surgery center is looking to help create an atmosphere of success while allowing the physician to identify areas for improvement. According to Dr. Uslander, an appropriate follow-up question would be: What do you think you can do to best serve the needs of the organization? What can you do differently?
3. Prioritize collaborative, sensitive communication. "The real goal of an organization is to have everybody moving forward with shared values," says Dr. Uslander. "There should be an environment where everybody is honored for their individual things to give, where there isn't a big hierarchy, and where each person feels that they have an important role." If this message is emphasized, he says, then the pressure to make and execute all decisions — which can often lead to feeling overwhelmed and disengaged — will be removed from the physician.
"Physicians are not the ones who are supposed to be answering all of the questions," he says. "They want to be an important part of the team, but they don't have all the answers."
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Dr. Uslander discusses three common signs of physician disengagement, and how to address these physicians collaboratively and effectively.
What are the signs of physician disengagement?
1. Physicians complain more often. Physicians who are feeling disengaged from the center tend to feel trapped and, as a result, may adopt a "victim" mentality, Dr. Usland says. "They tend to complain about a lot of the things that are happening, and the complaining is a sign of not feeling like they have the power to change anything," he says. "They complain to anybody who will listen, but typically not to patients, because they don't want to give them that burden."
Physicians may complain about the competence of the staff, for example, or about patients being difficult and unreasonable. "They might say that the primary care doctors are not getting them the medical clearance that they need, or that the lab is not getting them what they need in time, or that electronic medical records are difficult to deal with," says Dr. Usland. "They tend to complain about all of the processes in the system instead of trying to be the solution or engage in meaningful discussion."
2. Physicians receive more patient complaints. Disengaged physicians will often start receiving more patient complaints about them, says Dr. Uslander. "The patients feel like there is not a connection and that the doctors don't care, and they tend to be quicker to complain about the experience they have," he says.
If a patient experiences a long wait to see a physician, for example, a disengaged physician may not acknowledge or apologize for the wait time. "They don't make a human connection, and the patients just feel like nobody cares. They feel as though their time is valuable, but nobody respects that," Dr. Uslander says.
3. Physicians are less enthusiastic about collaboration and teamwork. The staff members working with the disengaged physician will often perceive that something is "off" about his or her behavior. The physician may consistently arrive late to work, show signs of not prioritizing their work, complain, or repeatedly make excuses for not completing tasks. "The staff that they work with will know it," says Mr. Uslander. "It will be clear that the physician is not being part of an effective team."
How can disengaged physicians be reengaged?
1. Designate a committee to talk to the physician. Every surgery center should identify individuals or groups in the organization who can engage the disengaged physician in a discussion, says Dr. Uslander. "It's all based around having a system of communication and not allowing issues to go on without some action," he says.
If a surgery center is part of a hospital, there may already be an existing wellness committee that can facilitate the discussion. Independent surgery centers should create a committee that consists of the operations director and several others who hold leadership positions at the center and are committed to creating a collaborative, cohesive culture, says Dr. Uslander.
2. Ask open-ended questions that focus on improvement. Conversations with a disengaged physician must be focused on helping him or her as opposed to assigning blame, says Dr. Uslander. "The first question that will open things up is, 'How can we as an organization best support you?'" he says, adding that a fairly broad opening question shows that the surgery center is looking to help create an atmosphere of success while allowing the physician to identify areas for improvement. According to Dr. Uslander, an appropriate follow-up question would be: What do you think you can do to best serve the needs of the organization? What can you do differently?
3. Prioritize collaborative, sensitive communication. "The real goal of an organization is to have everybody moving forward with shared values," says Dr. Uslander. "There should be an environment where everybody is honored for their individual things to give, where there isn't a big hierarchy, and where each person feels that they have an important role." If this message is emphasized, he says, then the pressure to make and execute all decisions — which can often lead to feeling overwhelmed and disengaged — will be removed from the physician.
"Physicians are not the ones who are supposed to be answering all of the questions," he says. "They want to be an important part of the team, but they don't have all the answers."
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