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Dear Friend,
A disruptive physician can lead to the death of your medical group.
As humans, we’re primed by evolutionary forces to fear the loss of something much more than we value an equivalent gain.
That’s why many medical group leaders are concerned that market and other pressures will have a significantly negative impact on their group. From competition from hospital-aligned physicians, to the failure of the hospital, to increasing pressure from far better capitalized, venture backed practices, these and other concerns actually do keep you up at night.
But while medical group leaders are keenly focused on the dangers from the outside, there are dangers lurking inside groups, as well, just as dangerous, or maybe even more so.
You recruit Dr. Stacy because of the sterling CV and other credentials. College in Cambridge, medical school in Cambridge (the other one), and trained at an even more famous place at the elbow of a Nobel laureate.
And then six months later, you learn that Stacy might just be a pathological a-hole. Stacy badmouths your group to the hospital CEO. Stacy questions your leadership abilities in the cafeteria, but never in a conference room with you present. Stacy works with your competitor to undermine your group. Stacy screams at nurses. Stacy might even throw scalpels, not as a hobby at children’s birthday parties, but in the actual operating room. Yes, these are all real-life examples of real-life Stacy, an amalgam of Stacies, of course.
It’s important to distinguish your Stacy, the poster child for disruptive physicians, from a simple nonconformist. Nonconformists aren’t trying to take your group down. Nonconformists aren’t conspiring against your leadership or the group’s future. As they say, they simply march to the beat of a different drummer – they didn’t pop out of the same mold as the rest of the group. Nonconformists can easily be contained and even harnessed to the group’s benefit.
But there’s no pH strip or imaging procedure that definitively diagnoses the difference. (Some from former Eastern Bloc countries have hinted that there may be a highly invasive procedure, but that’s another story.)
Fortunately, disruptive physicians leave snail-like trails. Before jumping to the conclusion that your Stacy is a disruptor, pause and question motives at the same time that you’re examining evidence. Is it truly disruptive action that should lead to, perhaps, one warning and then termination, or is it, instead, nonconformity that can be made to be beneficial to your group’s success.
Because wrongful termination claims are far more common than thrown scalpels, it also pays to get legal advice in connection with the determination and, certainly, before any actual termination.
The worst thing you can do is to do nothing. Lopping off a gangrenous toe, after an attempt to resolve it less drastically, is better than letting the patient (or your medical group) die.
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| | Tuesday - Success in Motion Video: Busy vs. Business
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | I want to talk with you today about busy vs. business.
I’m about to drive through a construction zone, where for about a month they’ve had signs up saying “Construction - Expect Delays.” At one point in time, there were large orange cones laid out on the street. But then workers came and took the orange cones away.
Now I see some cones up ahead, but they used to be on the right and now they’re on the left. What’s going on? Has there been any actual construction?
No, not really. There’s just been a bunch of busyness.
In a way, it's similar to the usual response you get when you ask somebody engaged in almost any business, “how’s it going?” They say, "oh, I’m busy.”
But does that mean that they’re really devoting any time, any effort to business? Is there any business?
Now for many medical groups there’s lots of busyness. There’s probably lots of business, too. Sure it might not all be profitable, but there’s a lot of stuff going on.
But query this: Is much of that stuff just the stuff that you have to do? In other words, the day-in, day-out patient care functions of being a physician, of providing patient care services within your medical group.
How much of that time is actually spent on your group’s business, that is, on its future? On your marketing, on ways of bringing in more cash, on generating better opportunities for your business, and so on?
It’s like the woman driving the Honda that I just passed. She was busy driving down the street, but she was looking at her cell phone and texting with an interior light on, and when she turned the corner, she was going about four miles an hour.
Maybe she’s busy, but hey, she’s not really doing any business. Same thing in your group?
Think about it.
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| | | Wednesday - Medical Group Minute Video: Another Medical Staff Moves to Fire the Hospital CEO
Watch the video here, or just keep reading below for a slightly polished transcript:
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| I can’t be sure that anyone on the medical staff at St. Mary’s Medical Center in Long Beach, California read my 2017 post, What You Need To Know About The Flea That (Metaphorically) Killed The Medical Center CEO, but they appear to be following the same strategy in an attempt to eject a hospital CEO, Carolyn Caldwell, in whose leadership ability they have no confidence.
In that 2017 post, I recounted the story of the “no confidence” action by no more than 37 medical staff members that brought down the CEO of Ohio State University’s Wexner Medical Center, Sheldon Retchin, M.D.
I analogized the action of the few handfuls of physicians to guerrilla warfare as described in the seminal work by Robert Taber, The War of The Flea. Taber wrote about how a small band of guerrilla fighters could emerge victorious in a conflict with a larger, well organized enemy
“Analogically, the guerrilla fights the war of the flea, and his military enemy suffers the dog’s disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to come to grips with.”
In the “Battle of Long Beach,” the opening salvo was fired in February this year when the Medical Executive Committee sent a letter to all members of the medical staff that they were initiating a dispute resolution process with the medical center’s administration centering around what appears to have been their learning, through the “grapevine,” that St.Mary’s was about to end very long-standing contractual relationships with the anesthesiology and radiology groups covering the facility.
In that letter dated February 6, 2019, the MEC stated their contentions that the administration had violated both Joint Commission requirements and California law pertaining to a medical staff’s rights of self-governance, (1) by refusing to discuss with medical staff leaders who will be providing contracted clinical services, (2) by initiating steps to terminate existing clinical services contracts and to award alternative contracts in retaliation for medical staff leaders’ advocacy for improved patient protection and peer review policies, and (3) by taking steps to terminate contractual arrangements with the Vice Chief of Staff so as to interfere with the medical staff’s right to select its leadership.
Although it’s unclear what, if anything, happened to the radiology group providing services at Saint Mary’s, the hospital initially granted an extension to the current anesthesia group, Long Beach Anesthesiology, which had held the contract since the 1990s. Then, in mid-May 2019, the hospital announced that it would no longer deal with Long Beach Anesthesiology and that it was awarding the contract to Somnia Anesthesiology beginning September 1, 2019.
The warm war then became hot, with the MEC calling a meeting of the full medical staff on May 21, 2019, at which there were no votes in favor of CEO Carolyn Caldwell’s leadership abilities. 58 physicians added their names to the no-confidence letter delivered to the hospital, with others, according to Chief of Staff, afraid to sign-on publicly due to fear of retaliation from the administration.
So far, CommonSpirit, the system that runs St. Mary’s, has refused to cave in to what is essentially the Medical Staff’s demand that Ms. Caldwell be terminated.
What does this mean for your organization and for you, personally?
From the organizational perspective, as in a guerrilla war, change within the organization, as well as within a domain in which the organization interacts, can occur as a result of agitation, even by a vocal minority. Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
What you think is permanent is only temporary. How temporary is the question.
What you do, and how you do it, within your organization, and how you project it to essential third parties (e.g., hospital-based medical group to hospital) is all-important in maintaining relationships, contracts, and even existence. That’s the flea collar.
And, just the same, from the perspective of the individual, the small, the “out group,” the “flea,” a steadfast, vocal, and somewhat intransigent minority, can kill the dog. The large group can be made irrelevant. The hospital CEO can be forced out. The small organization can ingest the larger. Yes, the dog bites back. No win is guaranteed.
In the Ohio State/Dr. Retchin situation, just 3 letters signed by, at the most, 3% of the medical staff, were unable to unseat the king. Chalk up one for the flea.
Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin’s and Wexner’s world, it’s flea-kills-dog as well.
In the St. Mary’s situation, it appears as if 100% of the medical staff wants to unseat the queen, but the administration is pushing back. Perhaps it’s chalk up one for the dog.
But only time will tell. And, unlike at a state-owned academic medical center with hundreds of employed physicians, at a community hospital like St. Mary’s the huge majority of the staff have the ability to refer their patients elsewhere. Ms. Caldwell may indeed remain queen, but perhaps as the queen of a ghost ship. So, perhaps it will end up as chalk another one up for the flea.
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| | Thursday - Podcast: Why It’s Easy To Be Knocked Off Course |
| Listen to the podcast here, or just keep reading for the transcript
They say that a journey of 1,000 miles starts with a single step.
Note that the saying doesn’t discriminate between heading in the right direction or the wrong direction.
This is certainly true of the steps taken a connection with a medical group’s relationship with payors, hospitals, referral sources and patients. Each movement along the business road involves small decisions. A few small missteps don’t deter from reaching an ultimate desired destination – as long as you quickly realize that they are steps in the wrong direction and then make corrections.
But allowed to continue unchecked, small, discrete errors have a multiplier effect, quickly taking you off your course to, say, business San Francisco, sending you to business San Marcos.
Check your compass often, taking stock of the direction you’re headed in. You might believe, for instance, that the only important provision in a payor agreement is the rate, only to be surprised a year later when you’re not being paid, the effect of which multiplies to the inability to retain staff.
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy here.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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