The Last Lecture / Work Ethic
27 August 2008
I am back and rested from my trip to Cancun. In reading the blogs Jim posted while I was away it makes me think I should take more vacation, his blogs are better when I am gone. Kidding aside, kudos to him for some insightful and great blogs.
While I was on vacation I caught up on my reading and finished 3 great books. Two were fiction thrillers and one was The Last Lecture. I suspect most everyone has heard of Carnegie Mellon Professor Randy Pausch’s inspiring story. If you haven’t you owe it to yourself to go to listen to it, (http://www.youtube.com/watch?v=ji5_MqicxSo ).
There are many great take aways from his book but one that particularly resonated with me was his perspective on work ethic. When his colleagues asked how he earned tenure a year earlier than normal he responded (I am paraphrasing), “Call me on Friday night at 10:00 in my office and I will tell you”. Hmmm, is he suggesting that hard work allowed him to achieve a goal sooner than his peers and not just being smarter or better connected?
Countless articles have been written on generational differences from Baby Boomers to Gen X to Gen Y and now Gen Z? Somewhere along the way work has become a 4 letter word. Somehow, having a strong work ethic now means you don’t have balance in your life.
Today’s physician recruitment climate is exacerbated by this very same issue. Physicians in days past worked long hours for big bucks. They called about opportunities wanting to know how much they could make and where it is located. Today’s, physicians want to get paid, yes, but they are generally not willing to trade quality of life for more money. This trend is changing the way hospitals do business. Because fewer and fewer physicians are willing to admit and follow their own patients hospitals have to recruit hospitalists. This keeps patients being admitted to the hospital and keeps the primary care base happy because they can focus on outpatient medicine and have a better quality of life. In addition to the “traditional” hospitalist there are now pediatric hospitalists, OB/GYN hospitalists and psychiatric hospitalists. Better patient care is also behind the hospitalist trend but don’t discount the influence that quality of life has on the trend.
I was fortunate to learn many valuable lessons from my dad when I was younger. One was how important a strong work ethic was. He said, “You can’t control if people you work with and for are smarter or more talented than you are but you can control if you work harder than they do.” Maybe that is why I never let my bosses get to work before me and I’d be damned if they were going to work later than me.
Based on the incestuous nature of the physician search business, most firms directly trace their roots back to companies that mandated late nights where you had to stay till 9pm making calls, mandatory Saturday mornings in the office, etc. With new FLSA laws, those practices have surely gone the way of the dinosaur, but everyone (hospitals, groups, Medicus Partners and our competitors) is looking for employees with a strong work ethic. Not just show up and do the minimum that is expected but the “old fashioned” do whatever it takes to be successful work ethic. I am a big fan of working smart but there are times that you have to roll up your sleeves and work hard also.
Success is relative. At Medicus Partners, we have a culture that old school work ethic and quality of life can co-exist and both enjoy success.
If you are ever feeling over-worked, under-appreciated and like you have gotten a raw deal, read the Greatest Generation by Tom Brokaw. After reading that, if you don’t feel thankful for every day in which you have the opportunity to work in this great country, nothing I write will matter.
Bob “Work Hard + Work Smart = Success” Collins
27 August 2008
Physician Compensation
22 August 2008
I always enjoy reading Gruntdoc’s posts. This one is essentially a link to an article by a physician that was in the USA Today, but I thought it was at least worth bringing to everyone’s attention.
What we’re paying physicians doesn’t drive up the cost of healthcare. As noted in the article, doctors only constitute 10% of overall healthcare spending in the US. Most physicians are paid relatively modestly when you consider the lengths they’ve gone to in order to be a physician, the risks they incur on a daily basis and the pressure they feel in being responsible for so many other lives. Out of the approximate total of 800,000 physicians in the US, there are about 100,000 internists, 80,000 FPs and 70,000 pediatricians who almost all make under $200,000 per year. I know a lot of pharmaceutical reps who make more than that working a couple of hours a day delivering donuts and mouse pads.
Speaking of the root of the problem, who’s with me on cutting direct-to-consumer (dtc) advertising by big pharmaceutical companies? I sure love it when I’m watching TV with my son and 15 viagra commercials come on talking about erections lasting longer than 4 hours. “Dad, what is an erection?”
I looked for a stat on how much big pharma spends on dtc advertising and the most recent figures I found were $2.5 BILLION and $2.8 BILLION from 2000 and 2002, respectively!!! In 1991, drug companies spent just $55 million on advertising. What’s shocking is that those same studies indicated that for every dollar they spend on dtc, they make another $2.20 in sales, which translates to another $2.20 in COST to you and I.
I found an article on the NEJM that said “Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. That tab is being picked up by all of us. We’re spending $2.5 trillion on healthcare in the US and they are spending $30 billion (12%) promoting drugs? I get that it is expensive to do all the R&D and testing and whatnot and I’m a capitalist at heart… I want them to make some money for what they are doing. If we could allow the doctors to pick the meds instead of the patient, perhaps we could lower the cost of meds, decrease people’s perception that they need to be medicated and put a little extra money in the pocket of healthcare consumers.
So, to recap, we pay the 800,000 doctors in the US who provide ALL care 10% of total spending and pharmaceutical companies spend the equivalent of 12% to promote drugs. For every dollar they spend, they make $2.20, which means that $66 BILLION dollars of our total expenditures are a result of their promotional and dtc spending, which is 26.4% of total healthcare spending, which is totally unnecessary.
Leave the doctors alone, they’ve got enough to worry about.
Jim
**Disclaimer- this post was very half-heartedly researched and probably includes factual errors and information that I’ve taken out of context, but you get my drift don’t you?
On Toughness
20 August 2008
Some readers know that I have a 6 year old son. Like most dad’s, I want him to be tough. Could phrases like “shake it off” and “rub some dirt on it” have originated with anyone BUT a dad? My son and I wrestle almost daily, and he’s getting to be a tough little guy. It used to be that anytime he got a little scrape he’d ball up in tears. Now, he’ll split his lip and just want to look at all the blood in the mirror. It’s probably part getting older, part conditioning and part pressure from me because I’m saying “shake it off” and “rub some dirt on it.”
It’s funny though; you can prepare for physical pain, but the pain of failing never seems to become easier to stomach. As many times as I’ve failed over the years, it still stings like you know what.
This spring I answered my phone and stumbled into an interrogation. The gentleman on the other line found our website online and wanted to talk with me and four other retained search firms, asking a series of questions and requesting very specific information from us. I provided that information and was informed later that we’d been chosen. When I asked why they chose us, he said “because you didn’t fill me full of a bunch of BS.” Based on their preference for straight talk, I was optimistic about being successful for this client in spite of their ultimate goal: To recruit an American born and trained internist to a traditional (in and out patient) setting in a town of 6,000 people.
Fast forward 3.5 months to this email: “I wanted to let you know that we have signed Dr *******, therefore you can suspend the search. I can honestly tell you that I am totally disappointed in your company… I have a real hard time feeling anything but a lot of anger toward your company at this point of time. You know if you would have gotten with the program and found us some candidates, we have another 8 searches we would have given you. Guess that is just the way it goes. Oh well you suckered some money out of us for no work, so guess you are happy.”
Devastation, panic, sorrow, fear, anger all at once.
How could something that started so well go so wrong? I needed to speak with this person directly. He stated very clearly that he felt that we had misled them, that we didn’t do any work on the search except cashing checks. Any time we have an upset client, we’ve done something wrong and this is no exception. Challenge is, what they think we did wrong isn’t actually what we did wrong. In the conversation, I heard about 10 minutes worth of his side and then asked if I could have a chance to inquire about a few things; he said I could. I asked the following questions:
Do you remember when you contacted us originally and chose us because we “didn’t fill you full of BS?”
Yes, I remember that. You were really slick.
Do you remember during the profile of the search, when we were getting started, that we shared with you that traditional internal medicine searches are very difficult, particularly when you must have American Born and Trained MD’s under age 45?
Yes, but if it was so hard, why did you take the search?
Do you remember when we shared with you that our average days to fill primary care searches was 175.33 in 2007?
No, I don’t recall anyone saying anything to me about that.
Lastly, the candidate that you hired, you remember that we spoke with that candidate a week after they had directly applied for your position and called you afterward to share information with you that we obtained, correct?
Yes, but getting there a week late isn’t what I paid you for. I think you guys were literally sitting there doing nothing on this search.
This gist of it is that he feels that we didn’t work hard on the search when we did. He feels that we didn’t prepare him that the search would take time to fill when we did.
What happened next was a surprise to me.
“____, I’m very sorry that you are unhappy with what we did. I’d like to first say that this is our fault and that I want to fix it. Second, I took the time to research your search before calling. In the 14 weeks we’ve been working on your search we have screened hundreds of physicians and presented your opportunity to 122 candidates (close to 10/week or 2/day).
Of those, we informed you of a DO who was interested as well as Dr **** who subsequently declined to interview and Dr **** who you didn’t think would be a fit. The balance of candidates was either not a fit based on your parameters or they weren’t interested based on your location, the set up or the offer. We sent you three written progress reports and spoke with you regularly on the phone about our progress. We also talked with the physician you hired who directly solicited you just before we reached them.
We were working diligently on the search, but we obviously did not meet your expectations of keeping you apprised of what we were doing. We also didn’t do an adequate job of preparing you for how long the search would take so that you weren’t surprised after three and a half months went by. That is our fault. I am very sorry and I want to do whatever I can to fix this. Please, share with me what I can do to make this right.”
“Nothing. You should have gotten it right the first time. You are the same as all the other big retained firms we’ve worked with. Take your money and don’t call on us anymore.” I ask repeatedly what I can do to make things right. I reiterate that I’m sorry again and that we will remain open to fixing this should they change their mind. I also let him know that we’ll do our best to try to learn from this to get better. I tell him that even one unhappy client is unacceptable to us.
And he doesn’t care about it and I can’t do anything to fix our mistake.
Failing sucks. I wish I didn’t care about this stuff. I wish my Dad were here to tell me to rub some dirt on it.
Jim
gar-uhn-tee
19 August 2008
guar·an·tee [gar-uh
n-tee] n.
- Something that assures a particular outcome or condition: Lack of interest is a guarantee of failure.
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- A promise or an assurance, especially one given in writing, that attests to the quality or durability of a product or service.
- A pledge that something will be performed in a specified manner.
- A guaranty by which one person assumes responsibility for paying another’s debts or fulfilling another’s responsibilities.
- A guaranty for the execution, completion, or existence of something.
- A guaranty by which one person assumes responsibility for paying another’s debts or fulfilling another’s responsibilities.
- A guaranty for the execution, completion, or existence of something.
Fat Doctor, a prolific physician blogger, recently posted about a surgeon who lost a patient in a simple, straight-forward surgery many years ago during her training. It was a bread and butter case he had done thousands of times and never lost a patient. The one time it happens, it crushes the surgeon. He can no longer guarantee an outcome.
I can’t imagine what it would feel like to lose a patient. To be there, in the OR or recovery room with the patient must be a helpless and frustrating feeling. To be a skilled, experienced surgeon and not be able to offer a guaranteed outcome of the case must be a challenge as well. Being at the mercy of chance is tough.
On a much different level, we are controlled by chance as well and yet we are asked to guarantee outcomes every day. Physician candidates want guarantees about how things are going to play out when they move. Our clients want guarantees about certain things associated with our performance or about how candidates will behave when they show up for work.
Like the surgeon in Fat Doctor’s post, we can guarantee only those things that we can control. What happens when things are happening is beyond our control… we can only govern our response.
Most of the time the guarantees we’re asked for by candidates revolve around referral patterns, and ultimately money. “So, if I take the job, are the XXX doctors going to refer to me? — If I show up there, will I be able to do 300 cases/year — Are you sure I can make $450/year in that town?” As much as we’d like to control all of those things, we just can’t. It’s human behavior we’re talking about. For those candidates seeking assurance, we can only share with them what we’ve learned from the clients we’re working with and what we’ve learned over the many years we’ve been recruiting. Most of the time it boils down to a basic level of trust and assumption that people are going to do what they say they will. Know that the hospital or group recruiting you is spending a lot of money to get you there and that it would be silly for them to do that if they didn’t fully anticipate your success.
Hospitals and physician groups routinely request all sorts of guarantees because most have been burned by search firms in the past. The most common request is a money-back guarantee if a candidate is not hired. As much as we’d like to do that, we just can’t. The money that we’re being paid throughout a search is being spent. It reimburses us for the resources we’re deploying to generate sourcing, screening, presentation, qualifying and vetting candidates. Does a hospital offer a money-back guarantee on their stays? On the outcomes of procedures done? When the hospital is paying an attorney to defend them or a CPA to prepare their taxes or an advertising firm to create a new campaign… the money is paid to do the work, not to guarantee a specific outcome. There are simply too many things at play for us to do that. Sometimes interviewing physicians sabotage searches, sometimes clients are inattentive and non-responsive and we lose candidates as a result, sometimes we have a blizzard in May in Tennessee that strands the physician candidate and gives them a horrible impression of the town, sometimes the candidate with impeccable references and pedigree gets off the plane for the interview drunk. Once again, we’re contending with human behavior and sometimes even mother nature.
Like the surgeon, the only thing we can govern for our clients is our effort, our skill/experience and our focus. At the end of the day, our job is to get the client’s opportunity in front of the candidates they seek, to pre-qualify and prepare that candidate for the opportunity and then to work with both parties through the process. No mind control, no strings, no ability to guarantee an outcome.
My job would be infinitely easier if I could guarantee outcomes. Some firms do it… it’s fool’s gold. Take the example I used before of the CPA, attorney or advertising firm. You are paying the firm for the work they are doing, right? So if the ad campaign doesn’t increase admissions, do you demand the money back? ‘Course not, becuase they were paying their designers and creative team to come up with the plan, right? The attorney who is defending you in the malpractice case bills by the hour for their time, correct? And if they lose they don’t pay that back because they have been working for you. So, if a physician search firm guarantees an outcome and is working for their keep only to have a local doctor make an offensive comment at dinner after a few belts, where do they get the money to pay you back? There are two choices. One, they didn’t do much work in the first place so the money wasn’t “spent” and they can easily give it back. Two, you employ some version of a Ponzi Scheme where you take enough money from the newest “clients” so that you can pay back the first ones.
We just want to do a good job. We work really hard for the people we work with, we try to stay ahead of the curve with our knowledge and skills and we try to be focused on helping our clients and physicians to be successful. Unfortunately we can’t offer more than that.
We’ve opened comments back up on the blog. We were getting literally thousands of spam comments, but have installed a new blocker so we’re hopeful that works. If anyone has thoughts about this, I hope you’ll weigh in.
Jim
Medicus Partners is #1
18 August 2008
When it comes to recreational basketball, nobody beats the Medicus Partners Ironmen. They successfully concluded their playoff run yesterday with a win at a local rec center. Rumors have swirled that the Olympics were scheduled to start on 8-8-8 to directly compete against the game, but the team didn’t let that bother them. They chose to make the lack of TV coverage a positive, allowing them to concentrate on their game without the critical eye of the media questioning their every move.
In the end, in front of a crowd in excess of 15, they came together as a team and made it happen.
Please join me in congratulating all of the Ironmen of Medicus Partners. Top row: From left to right Josh Stucky (in street clothes b/c he blew out his ACL in a game a few weeks ago), Justin Ballinger, Stan Galanos, Grant Alexander, Robert Clarke, Jarrod Alexander, Kevin Hardy and Travis Alexander. Bottom row: Team Mascot James Stone. Also, please join me in a special thanks to Grant Alexander for organizing the team.
Great job guys. James was star-struck that he got to sit on the bench with the team. He also wanted me to get everyone’s autograph after the game and he told Grant he thinks he should be on the olympic team.
Jim
ASPR
14 August 2008
Jim, Jeff and I just returned from the ASPR conference in Baltimore, MD. This was our 5th year to attend the conference and as usual it was a good time had by all. For us it is a chance to say “thank you” to many of our clients by being there and helping sponsor an organization that provides a great service to its members. It is also an opportunity to see our clients in person and let prospective clients know we don’t have 3 heads and fangs. We also enjoy catching up with many of the other vendors, some of which are direct competitors. Fortunately most of us realize there is plenty of work to go around and we are able to have good dialogue about industry trends, what searches are the most difficult, what challenges are they having growing their business, etc.
From this we get some very good feedback about what we are doing well and more importantly what we aren’t doing as well as we should. The “constructive criticism” (this term has always seemed like an oxymoron to me) we receive is not always easy to swallow but absolutely essential and appreciated.
It was great seeing those in attendance and I look forward to seeing everyone again next year.
I am off to Mexico for vacation for a couple of days so until then I leave the blog to Jim.
Bob
Open Minds
7 August 2008
I was recently interviewed by HealthLeaders (click here for the link) regarding the recruitment of IMGs. While the article does a nice job of addressing the importance of being open minded and looking past whatever prejudices one may have in recruiting IMGs, it doesn’t address how this has changed over the years. The most obvious is that today physicians who completed their medical school outside of the U.S. are called IMGs (International Medical Graduates) compared to FMGs (Foreign Medical Graduates) which is what they were called up until about 10 years ago when someone decided that Foreign Medical Graduates had a negative connotation? Either way they earn their medical degree abroad.
What the average person doesn’t realize is that 95% of all IMGs complete residency programs here in the U.S. In most cases, they have to do so to be board eligible/certified in their specialty and to get a license in most states. While there is still plenty of prejudice to go around, it feels like there is a greater acceptance and openness to IMGs today than ever before. I suspect the ever increasing imbalance of physician supply and demand has forced some “old school” administrators to accept IMGs physicians out of necessity. In most cases they realize a couple of things:
- They are driven and work as hard or harder than their U.S. trained counterparts
- They typically have better communication skills than expected
- Given a reasonable amount of time, the patients embrace them like any other new physician.
- All this, of course, leads to a greater willingness to be open to adding IMGs to their medical staff.
Bob “Keep an Open Mind” Collins
Is there life out there?
6 August 2008
In general, I believe that life is too short to be unhappy.
I advocate a positive outlook. I believe in doing your best to try to make your circumstances positive ones. And, if you fail in doing so, moving on to find positive circumstances.
Most of us spend 2/3rds or MORE of our waking hours at work during the week and many aren’t happy there.
Lots and lots of doctors are in that boat and it just doesn’t make sense. We’re entering into an unprecedented era during which we’re going to see physician shortages in every specialty in every community. The demand for physicians today is higher than it has ever been. In other words, your stock is about as high as it is going to get, so go find a situation that suits you.
Tired of your town? Can’t stand your partners? Want to radically change the style of your practice? Then take the plunge!
I found a great blog today that was featured in the LA Times recently. It’s called Ob/Gyn Kenobi. Everyone should check it out for a couple of reasons. For one thing, naming the blog Ob/Gyn Kenobi is pure greatness. For another, the posts are hilarious. She recently had a post on the subject of finding a new practice.
I agree with the wise Jedi OB. There is life out there. Go find a practice that makes you happy. If you need a little help or advice, I know of a great recruiting firm in Dallas that can help:-)
Jim
Shoot Straight
1 August 2008
“If time be of all things the most precious, wasting time must be the greatest prodigality”
After I looked up what prodigality means (extravagance), I decided that ol’ Benjamin Franklin was right.
I thought about wasted time today when I was reading a blog post at “Musings of a Dinosaur” which is written by a small town, solo family physician. His posts are hilarious and most of them time I agree with them. One of his more recent ones, however, struck me as one of the biggest wastes of time I’ve come across.
His receptionist fielded a call from a drug rep and said the Dinosaur is away and then he goes on to ruminate about how long he should say he’s out and summering at the Cape and whatnot.
Why not take the call and politely and quickly tell them you aren’t interested and that you don’t take calls from drug reps. When recruiters call, do the same thing. Or, have your office staff inform them that you don’t take solicitation calls and that no matter how many times they call they will be unsuccessful.
Think about how much time is wasted by avoiding the confrontation. The drug reps will keep calling and calling and calling. They will force your office staff to keep putting them off. Same goes for the financial consultants, equipment leasing companies, physician recruiters, etc. Instead of allowing those people to waste their time and yours, deal with the situation and tell them you don’t want to be called anymore.
This would save us a lot of money on phone bills and save us a lot of time.
Jim
