How to Motivate Them Docs


I got tipped off to this nugget in an email from a loyal reader:

Hey Dr Doug,
I thought you might enjoy learning some more about how the Badministrators are “training” physicians to be “more motivated.”

Steve R Deputy, MD, FAAP

First, here, for your enjoyment, is the title of the piece:

Executive Leaders Key to Physician Engagement with New Healthcare Structures

If you have been reading this blog you just know how I love the newest buzz word “engagement”. Well, there it is again.  Let me highlight the rest of the article for you.  My comments are in parenthesis:

  • In a recent article published by the Harvard Business Review, Thomas H. Lee and Toby Cosgrove examine the new challenges confronting healthcare leaders when faced with motivating physicians to react positively to newly emerging innovations in healthcare.  (We are like children and should be motivated as such.  In fact, there should be an animated movie called “How to Train Your Doctor”)
  • Many organizations attempt to appease their doctors by giving them leadership positions and creating financial incentives based on performance. To get physicians on board with new processes and procedures, however, hospital systems must focus on providing a solid foundation on which their teams can build. “Just employing physicians and providing them with a compensation package with bonus incentives will not achieve the level of quality outcomes as a high-performing organization,” says Robert Kuramoto, MD, a managing partner at Quick Leonard Kieffer. “A culture of collaborative patient-centric care must be developed and continuously grown to face healthcare’s challenges. The appropriate executive leadership and experience is needed to make this transformation, and many hospital-owned physician groups will not be successful because this culture of shared purpose and teamwork has not been realized.” (I have no idea what any of that means, do you?)
  • According to “Engaging Doctors in the Health Care Revolution,” there are four motivations that drive social action: shared purpose, self-interest, respect and tradition. These motivations will be paramount in creating a positive atmosphere in which new systems in healthcare can be implemented. (You see, Dr. Pavlov and his peers would be proud.  But let’s make sure they give us some free cheese as a reward as well.)
  • …administration used these levers to help their doctors adjust to a new “full disclosure” policy, while clinicians at Brigham and Women’s Hospital used the motivational tools to improve the care patients receive in the emergency departments. Although these initiatives were met with resistance by staff at first, both hospitals were able to get their physicians to comply and attained successful outcomes. (levers? tools? comply?  What the hell is going on here.  Are we not human?)

I hope you enjoy what we doctors have now become.  Experimental rats. We are in a huge maze created and rearranged continuously by administrators.  They feel they can train us, change us and motivate us.  If we don’t like it, then they will replace us.  It’s time for us to rebel.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “How to Motivate Them Docs

  1. Jeff
    July 11, 2014 at 8:18 pm

    Toby Cosgrove is a cardio thoracic surgeon / administrator at the Cleveland clinic. A quick search shows his base salary in 2012 to be $2 million!

  2. Michael G. Perera M.D.
    July 10, 2014 at 7:14 pm

    “Just employing physicians and providing them with a compensation package with bonus incentives will not achieve the level of quality outcomes as a high-performing organization,”

    Why the those who know everything do this at the VA ???

  3. Michael Gorback
    July 8, 2014 at 4:55 pm

    Hey let’s write a book on how to do this!

    Chapter 1. Welcoming your doctor to his new home

    Your new doctor will be anxious at being separated from his former litter mates. You can help him make the transition by giving him some familiar objects from his previous practice – an old stethoscope or a chair that smells like his last office. You should allow him to hang up his diploma in his cubicle.

    Your new doctor may tend to wander off to use the lavatory instead of staying on his hamster wheel, er, in his exam room. You may find that you have to “crate” him by locking the clinic door when he is seeing patients so he can learn to control his bladder.

    • Kurt
      July 11, 2014 at 1:45 pm

      Let me make this perfectly clear, “Nothing is going to change.” I educate patients ad nauseum and they are not obligated to follow any physician’s advice period.

      Until patients are held to some sort of standard, nothing is going to change. I try to steer as many med students away from primary care that I can in hopes that they don’t screw up their lives. Those who are financially trapped into doing pri-care due to subsidies panic and I advise to get out while they can, even if they have to go into debt. With a higher paying vocation, they can pay off any debt sooner instead of the $170K they want to force all the FP’s into.

  4. Michael Gorback
    July 8, 2014 at 4:17 pm

    I draw the line at being “crated”.

  5. Pat
    July 6, 2014 at 1:33 pm

    (Oops) …is the opposite of my self-interest.
    3. “Tradition” – that was surrendered long ago, and only counts now when some administrator exhorts a physician to do more by claiming “you took an oath!” It’s meaningless.
    4. And my favorite… Respect ! – What we did not surrender was taken from us. The only token of respect in this field that has any meaning left for me is a document with my employer’s signature in the lower left corner, and the words “Pay to…” above. That’s it. Shove your respect, you academic vermin.

  6. Pat
    July 6, 2014 at 1:27 pm

    Doug, the first bullet of gobbledygook that you could not interpret is merely a doublespeak, obtuse way to say “paying the docs more isn’t the answer, therefore we have a built-in rationale to ultimately not pay them more”.

    As for the “four motivations” these academic jerkoffs propose, they are absolute lies:

    1. “Shared purpose” – earlier they called for “collaborative patient-centric”, which means the patient is in charge and the docs will bend over and take it. So ‘shared purpose’ means ‘get on board and follow orders’.
    2. “Self-interest”? – Are you freaking kidding? The entire raison d’être and result of the health care revolution is to minimize the self-interest of those who actually do the work of providing care. This is tragically laughable. All of the worsening load of Medicare/CMS/ACA/JCHAO/WHO et al rules and directives involve telling me what to do and controlling my income. That i

  7. July 6, 2014 at 10:52 am

    There is an amazing book by Viktor Klemperer on the language of the Third Reich. He offers in his thoughts the powerful suggestion that certain key words, which are cynically machined and altered for the purposes of usefulness in propaganda, will inevitably condition those who use the words.
    I offer the word “Islamofascism,” which was thrown around liberally about the Iraq/Afghanistan business during the 2000’s. It never had a rational definition, of course – but what a power word for propaganda purposes!

  8. July 6, 2014 at 10:45 am

    “motivating physicians to react positively to newly emerging innovations in healthcare”
    “to comply and attained successful outcomes”
    “creating a positive atmosphere in which new systems in healthcare can be implemented”
    “many hospital-owned physician groups will not be successful because this culture of shared purpose and teamwork has not been realized”
    There is an amazing book by Viktor Klemperer on the language of the Third Reich, and his thoughts that language which is selected for the purposes of propaganda conditions those who speak it.
    The Sapir-Whorf hypothesis is a more gentle proposition that the manner of thought is guided by the nature of the language; Klemperer is the philosopher where Orwell is the novelist.
    It is too obvious to state Skinnerian programming to a subject – we will inflict punishment on your unwanted actions, and reward those which the Organization desires.
    It is better to introduce a restricted and toxic language subset on a community – and then let the community take it where it will! One need only to state “doctors hate teamwork” and let it percolate it around the community. Apply the gentle carrot-and-stick to the use of this language, and the culture will enforce it themselves!
    For example, Klemperer’s family descended from Austrian Jews, but his branch had practiced Christianity. His wife’s branch had descended from Northern Germany. Often, during the War, when he was living (tenuously) in Germany, he was complimented – often – on what a prince of a husband that he must be, as his (Nordic) wife remained married to his (inferior) blood-roots. And these were his friends!
    Propaganda is an amazing skill. It is necessary to sweep away the opposition in the culture now – and the propaganda is being nicely laid down, nicely indeed.

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