Before we get to the interview, I must mention that my NEW focused mentoring program, called Become CMO in a Year, is the sponsor for today's episode.

In this program, you’ll launch your career as a hospital or medical group Chief Medical Officer. Then, over three to four weeks, we develop a plan together to get the necessary experience you need to become irresistible to recruiters and health system CEOs.

To learn more about the program, visit vitalpe.net/cmomentor.

OK, let’s get to today’s interview.

Career Transformation with Dr. Michelle Mudge-Riley

Dr. Michelle Mudge-Riley is a physician career coach, consultant, and entrepreneur. She was my guest on Episode 010 of the podcast.

She has spent the last ten years coaching physicians and creating helpful resources for those seeking career change. She’s come on the podcast to explain the 5 Stages of Career Transformation that she has come to recognize during her long career.

Photo by Suzanne D. Williams on Unsplash

For each step, she describes the common emotions you feel and actions to take to move through the stage.

She also describes where you might get stuck, and how to overcome the obstacles you may meet during each stage. She notes that some physicians reaching Stage 5 may need to circle back and re-engage at an earlier stage once or twice during the process.

And, she reminds us that the greatest mistake you can make is doubting your ability to navigate this process successfully.

Click here to download a TRANSCRIPT of today's episode.

Physicians Helping Physicians 2.0

At the end of our conversation, Michelle provides us a glimpse into her latest resource for physicians. It’s a membership site at Physicians Helping Physicians with a complete explanation of the 5 Stages and how to progress through them. And, it offers 30 videos that you can work through at your own pace, as well as other resources that she described during our conversation.

If you’d like to check out Physician Helping Physicians 2.0 simply go to vitalpe.net/php2. Use this link to access this wonderful resource AND receive a 25% discount.*

Physicians Helping Physicians 2.0*

Thanks again for listening. I hope to see you next time on Physician NonClinical Careers.

As always, I welcome your comments and feedback.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Disclaimer:

The opinions expressed herein are those of me, and my guest. And, while the information published is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed herein will lead to success in your career, life or business.

The opinions are my own, and my guest's, and not those of any organization(s) that I'm a member of, or affiliated with. The information presented on this blog and related podcast is for entertainment and/or informational purposes only. They should not be construed as advice, such a medical, legal, tax, emotional or other types of advice.

If you take action on any information provided on the blog or podcast, it is at your own risk. Always consult a professional, e.g., attorney, accountant, career counsellor, etc., before making any major decisions related to the subject matter of the blog and podcast.

*As an affiliate for this program, I may receive a stipend in exchange for helping to promote it. This will not affect the price of the program.

Right click here and “Save As” to download this podcast episode to your computer.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher

The post How to Survive the 5 Stages of Career Transformation with Michelle Mudge-Riley – 055 appeared first on NonClinical Physicians.

Today’s episode will be a short one, just hitting on a few issues related to nonclinical career transition. That’s because I’m leaving for a 7-day fishing trip in northern Minnesota and I’m a bit short on time.

Vermilion River flowing into Crane Lake in Minnesota

I want to provide you a little more incentive for taking action on your career pivot. For those that are new to the podcast, I'd like to provide suggestions for blog posts and podcasts to “consume.”

This episode will have a lot of links to follow.

My Primary Goal Today

Today I’m attempting to encourage action. If you’ve been unhappy and unfulfilled in your career but you’ve been struggling to take that first one or two steps, here are some ideas to get things rolling.

Nonclinical Careers

First read these blog posts. All of them can be found on Vital Physician Executive (vitalpe.net}:

• Is It Time for a Nonclinical Career?
• Options for a Nonclinical Career
• Unorthodox Career Advice

That last one, in particular, will help you to understand how to stack new skills. Those skills will then help you develop your unique skills profile.

Then listen to these podcast episodes that address mindset and other foundational issues:

• The Proper Way to Pivot
• Engage a Mentor
• Create Your LinkedIn Profile
• Address Your Mindset

Rainbow on Crane Lake

Management Careers

For those of you considering a hospital or medical group management career, start with these blog posts:

• Five Steps for the Budding Physician Executive
• The Three Domains of the Physician Executive

Then check out these podcast episodes:

• 10 Reasons to Pursue a Hospital Management Career (020)
• The Ultimate Resource for the Physician Leader (024)

Once you’ve read or listened to that articles posts and podcast episodes, you’ll find even more information about specific careers among the interviews. You can scan through quickly by going to PNC Podcasts for a complete list that you can pick and choose from.

At that point, you should be feeling fairly optimistic. You should accept that you deserve a career that brings you joy. And you will begin to understand that there are thousands of potential jobs out there for you.

But you need to take those first few steps.

Inspiration and Support

Unless you've already gotten deep into your career search, here are some things you can do to stimulate movement and get some inspiration.

1. Read Michael McLaughlin's book Do You Feel Like You Wasted All That Training?: Answers About Transitioning to Non-Clinical Careers for Physicians. It describes Michael’s journey. It's in Q & A format, so it's a quick read.
2. If you're not already a member, join the Physician Nonclinical Career Hunters Facebook Group. This is a closed group, so you will need to ask to join AND you will be asked to answer three questions to verify that you're a physician. After applying, drop me a note in the Comments Section of the show notes at Episode 42 and let me know you applied. That way, I can be looking for your request.
3. Set up a free LinkedIn Account if you don't already have one. Then do the following:
   • Request to connect with me – I'm at John V. Jurica, MD, MPH, CPE – and mention that you're a podcast listener.
   • Join the following LinkedIn Groups: Non-Clinical Careers for Physicians, and Doxodus – A Social Network of Doctors with Nonclinical Careers.

Unfortunately, many of us don't know exactly what career we want to pursue. We're not sure about our strengths and weaknesses, and we don't know the full universe of possible careers to consider.

Let’s do some more foundational work.

Quiet evening on Crane Lake

Next Address Your Mindset

First, it's best that you address burnout and other issues pushing you away from clinical medicine. Many of us feel trapped in our jobs. We don't think that we can change our environment, so we seek something “better.”

It's best to address those feelings before you leave your current job. The grass always looks greener, but it almost never is. And you run the risk of bringing that baggage and bad attitude to any new job you pursue.

You can get some useful advice on this issue from two of the coaches I’ve interviewed by listening to the following podcast episodes.

1. The first is with Dike Drummond in Episode 028. He is the guru of physician burnout. He has coached many burned out physicians. And the vast majority (over 90%?) decide to stay in clinical medicine after completing his program.
2. The second bit of advice comes from Katrina Ubell in Episode 035. She believes it’s important that your burnout be addressed before leaving your current job/career. And you should make the move primarily to pursue a higher calling.

Personality Inventory

Once that's settled, you should spend some time thinking about your own strengths, weaknesses, and personality, and the kind of job you might be suited for.

You might take an on-line personality inventory such as 16Personalities. It looks like it’s based on the Myers Briggs Inventory. It will provoke some ideas around the type of job you might like. Are you an introvert or extrovert? Feeling or thinking? Analytical or creative? Then match those traits to a career after using the resources that follow.

The next step is to create a list of possible career options.

Free Lists of Career Options

I know of two blogs that provide specific nonclinical career descriptions.

The most recent one I've read is on the blog Look for Zebras. This post links to descriptions of 19 specific nonclinical careers. It can be found at lookforzebras.com/nonclinical-careers.

If you find them to be useful, do me a favor and please leave a comment stating something like this: “I'm so glad that John Jurica at PNC Podcast told me about your blog. This information is awesome!”

Another site that lists possible career choices is Nonclinical Doctors by Heidi Moawad, MD. There is a page that lists dozens of nonclinical careers. She provides specific details and physician success stories for many of the career options that she lists.

There is also  a free guide that you may already have received if you signed up for my newsletter. It's called 5 Nonclinical Careers You Can Pursue Today that has information about five nonclinical careers. If you don't already have the guide, you can go to Free 5 Career Guide to download it.

Don't forget to network widely and develop mentors.

Deer outside our cabin door each morning.

Paid Help for Career Change

Sometimes, however, it's necessary to invest a little money to overcome the inertia in your career pursuit.

A Very Useful Book

The first suggestion is very reasonably priced. It's the book Physicians’ Pathways to Non-Traditional Careers and Leadership Opportunities.

It sells for about $60.00 new, but you can find a used copy in good shape for about $28.00 on Amazon.com. At 385 pages, it's a very comprehensive look at “non-traditional” careers. It describes dozens of career options in 25 chapters categorized by broad career types.

It also addresses other topics related to physician career transition.

Physician Career Coaching

But probably the most proactive way to expedite your career pivot is to engage a physician career coach. Many such coaches are physicians who have completed their own coaching, then trained to become coaches themselves.

The costs vary. I don't have scientific survey results to reference. Anecdotally, I expect costs to range from $150 to $400 per hour, depending on the experience and training of the coach. For comparison, executive coaching for C-Suite executives generally runs $250 to $500 per hour or more.

But everyone I’ve ever talked to has found coaching to be well worth the cost, whether its executive, life or career coaching.

The benefits of coaching are numerous. Coaching opens our minds to new possibilities, helps us overcome self-limiting beliefs, maintains accountability, and accelerates progress towards progressive positive goals.

Coaches I've Interviewed

I've had the pleasure of interviewing the following life and/or career coaches: Kernan Manion, Charlotte Weeks, Michelle Mudge-Riley, Heather Fork, Dike Drummond, Katrina Ubell and Maiysha Clairborne.

They’ve all had great success with their clients and high demand for their services. Some of them may not be taking new clients, but will generally refer you to an alternate if you reach out to them.

Michelle Mudge-Riley has created a site called Physicians Helping Physicians that has three levels of paid services. I have not used them personally, but I'm a big fan of coaching.

There are hundreds of trained physician career coaches out there. With the proper vetting, usually with a free consultation and speaking with references, coaching may be the best way to jump-start your career search.

Take Action and Overcome the Inertia

I think I’ll end it there.

To Summarize

Start by addressing your attitude. Then discover as many career options as you can. Reflect and assess your personality, strengths and weaknesses.

If you’re stuck, check out one of the listed coaches, or do your own coaching research. Then start with a few sessions. The coach may be able to provide insights into your personality, strengths and weaknesses, and help you to identify a career or two that’ll be a good fit.

If you enjoyed today’s episode share it on Twitter and Facebook, and leave a review on iTunes.

And join me next week, for another episode of Physician Nonclinical Careers.

Right click here and “Save As” to download this podcast episode to your computer.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher

The post How to Overcome the Inertia in Your Career Search – 042 appeared first on NonClinical Physicians.

However, committing to an MBA is a serious decision, not to be taken lightly.

Sure, there are some good reasons for pursuing one. But it’s time-consuming and potentially very expensive. So, we don’t want to jump into a one- to two-year commitment that keeps us from pursuing our ultimate career choice.

Completing an Executive MBA

For this episode, I wanted to talk to someone with intimate knowledge of an MBA program, especially someone who has worked with physicians.

Luckily, I was already introduced to such a program by one of my previous podcast guests. I interviewed Atish Jaiswal in the third episode of this podcast called Seeking an MBA. When the interview was published, he was about 2/3 of the way through his physician executive MBA program at the University of Tennessee.

Photo by Marcos Luiz Photograph on Unsplash

Then, while I was attending the SEAK Nonclinical Careers Conference last fall, I met the Executive Director of the Program. After some correspondence, she was kind enough to agree to join me on the podcast.

Introducing Dr. Kate Atchley

Kate Atchley, Ph.D., is the Executive Director of the Executive Programs in the Department of Graduate and Executive Education at the James A. Haslam College of Business. During our conversation she explains more about how the physician executive MBA program fits in with what they do there.

You’ll hear that the program has graduated more than 650 physician executives. So, other than the individual physicians completing the degree, nobody knows more about the impact of an MBA on a physician’s career than Kate Atchley.

You’ll find that there’s much to learn about an MBA program before jumping in. But for some of you, if the timing is right, it might be just the thing to boost your career trajectory.

What Did We Learn?

Some of the  topics we cover are:

• Kate's background and 18-year career at the U. of Tennessee College of Business;
• The history of its physician executive MBA program;
• The difference between a traditional MBA, an executive MBA, a physician executive MBA, and how different programs use “distance learning”;
• Why physicians might consider an executive MBA and how it would enhance their careers;
• The answer to the question: Is it true that getting an MBA will open doors for me and help me to figure out what I want to do?;
• How to evaluate different MBA programs that you might be considering;
• The typical curriculum, and why certain courses are important to the physician manager or executive;
• Examples of the work that previous graduates are now doing; and,
• The cost of an MBA.

Coming Up

I have one more bit of news to share today. I’m putting the finishing touches on a Free Guide that I’m calling “Five Nonclinical Careers You Can Pursue TODAY.” As soon as it’s completed, I’ll let you know, so you can get a copy.

As mentioned in previous podcast episodes, I am promoting a fantastic online course produced by the White Coat Investor, Dr. James Dahle, called Fire Your Financial Advisor. It is the best and most convenient way for high-income professionals to learn about: handling student loan debt; creating budgets and financial plans; selecting the right disability, life and housing insurance; investing for retirement; asset protection; creating an investment portfolio; estate planning and much more. To learn more and to purchase with a money-back guarantee, go to vitalpe.net/money. All physician leaders should look at the course materials. As an affiliate promoter, I do receive a small stipend that does NOT affect your cost, if you purchase through my link.

In Closing

I really enjoyed this conversation. Kate provided so much useful information and encouragement. You should visit the website or contact their office if you're considering the pursuit of an MBA.

You can send inquiries to Dr. Atchley's office by email at pemba@utk.edu.

You can visit the web site at Physician Executive MBA at University of Tennessee at Knoxville.

Let’s end today’s episode with this quote:

Next Time

Next week, I’ll be presenting a review of my first 25 podcast episodes and what I’ve learned from them. I’ll be distilling much of the wisdom from my thirteen guests into this one episode, so don’t miss it.

Finally, be sure to subscribe to my newsletter using the form below.

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The post Boost Your Career Trajectory by Completing an Executive MBA with Dr. Kate Atchley – 025 appeared first on NonClinical Physicians.

In this podcast episode, I speak with Dr. Stephanie Pearson, a disability expert and physician advocate. A work-related injury forced Stephanie to leave her specialty of obstetrics and gynecology. Next, she found her disability insurance carrier unwilling to cover her injury. This put her family at risk. Yet, she overcame these challenges, becoming a disability expert and physician advocate along the way.

Not every physician who is struggling to find a new career leaves medicine because of burnout, or a desire for something better.

Sometimes, we’re forced to leave our profession due to circumstances beyond our control. Then, we must decide: Can I overcome such events? Can I build a new career that brings me joy? Can I rediscover a career that inspires me like medicine did?

From Career Loss to Physician Advocate

Stephanie Pearson was a successful obstetrician/gynecologist who loved her practice. And, she had every intention of retiring after years of successful practice as an OB/Gyn.

However, an unfortunate injury, sustained while caring for a patient, ended her career.

To make matters worse, her disability insurance excluded work-related injuries from coverage. And, as the primary breadwinner, this put her family in a difficult position. And, there was no physician advocate to help her.

Stephanie explains in this interview how she responded to this challenge. Unable to return to her profession, she created a fulfilling new career for herself. And, she explains how she became a physician advocate in disability and life insurance.

Today, she’s made it her mission to educate and empower her peers about the importance of protecting their most valuable asset — the ability to earn an income. Respectful of physicians’ time and needs, she’s an expert on the basics and nuances of disability insurance for doctors. She now works full-time as a Physician Disability Insurance Broker and Physician Advocate.

Stephanie’s story is very inspiring. In addition to helping us understand how she overcame her setbacks, she provides practical advice for pursuing a career as a disability broker.

Educating Physicians

That’s an area that I didn’t know much about. But, Stephanie is committed to educating physicians and involving more of them in this field. She describes her journey excellently and shows us how we might pursue a similar nonclinical career.

In Closing

You can contact Stephanie Pearson at PearsonRavitz.

In my next episode, I present a conversation with Dian Ginsberg, the Director for Career Services at the American Association for Physician Leadership. She provides an excellent overview of the services provided by the AAPL and how it might help in your quest for a nonclinical career.

Here are the resources mentioned in this episode:

[table id=20 /]

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The post The Journey From Career Loss to Physician Advocate with Dr. Stephanie Pearson – 023 appeared first on NonClinical Physicians.

After working clinically, she transitioned to working full-time in medical writing. She has experience as a freelancer and a full-time employed writer. She currently serves as a Medical Director for HealthLoop and continues freelance medical writing at Armitage Medical.

I've been interested in writing myself. It's one of  the reasons I started this blog. But Mandy is very serious about writing and describes what she did to make this her full-time career.

Mandy is also passionate about helping others to pursue a career in medical writing. During our conversation, she describes her transition from practicing physician to full-time writer, including resources that she used to develop her writing skills. She also defines the various categories of medical writing.

Here is some of her advice for transitioning to a writing career:

• Join the American Medical Writers Association;
• Enroll in a writing course;
• Identify and engage a writing mentor; and
• Use LinkedIn to advance your writing career.

She goes into some detail about each of these resources.

Although we did not spend much time discussing her freelance activities, Mandy still provides writing services through her own company, Armitage Medical. Some of the content she produces includes abstracts, CME and CE materials, treatment guidelines, journal articles, literature reviews, news stories and feature articles.

As mentioned in the podcast, I am still promoting a fantastic online course produced by the White Coat Investor, Dr. James Dahle, called Fire Your Financial Advisor. It is the best and most affordable way for high-income professionals to learn about reducing student loan debt; creating budgets and financial plans; selecting the right disability, life and housing insurance; investing for retirement; asset protection; the right way to approach housing; creating an investment portfolio; estate planning and much more. To learn more and to purchase with a money-back guarantee, go to vitalpe.net/money.

In Closing

You can contact Mandy Armitage using her contact form at Armitage Medical. You can also reach her on LinkedIn.

Let’s end today’s episode with this quote:

Next Time

In my next podcast episode, I'll present a conversation with a physician who transitioned out of medicine because of an injury. Although she loved her chosen career, she could no longer practice her specialty because of it. She tells us how she came to grips with that, and leveraged her experiences to create a new career as a physician advocate.

Be sure to subscribe to my newsletter so you don't miss it, using the form below.

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Here is a list of resources mentioned in this episode:

[table id=19 /]

If you liked today’s episode please tell your friends about it and SHARE it on Facebook, Twitter and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

The post How to Become a Medical Writer with Dr. Mandy Armitage – 022 appeared first on NonClinical Physicians.

Besides, numerous surveys of, and interviews with, successful business leaders and entrepreneurs report the importance of following one's passion. 

But there are two serious statistical concepts at play that place such advice on shaky ground.

Bad Advice

The first is that correlation does not equal causation. To the contrary, it's quite possible that success fosters passion. It's perfectly logical to become passionate about a career that has brought fame and fortune.

The second is survivorship bias. Yes, a high percentage of successful persons declare that passion was responsible for their success. But for every successful business owner, there are often many unsuccessful business owners.

About 60% of new restaurants fail within 3 years. Most of the founders were probably passionate about starting a restaurant. But if they were all passionate when they started (including the failures), then the correlation with success is zero at best.

Yet we never hear from the unsuccessful business founders or career seekers. Who would interview someone about being a failure?

So, the presence of passion itself probably does not correlate with success, just as the TV show American Idol has demonstrated that passion for singing does not correlate with the ability to sing well.

This particular example was mentioned by Ben Horowitz  when he spoke at some length about passion while presenting the commencement address to the class of 2015 at Columbia University .

He described why passion is probably overrated as a reason to follow a career path or create a business:

1. You probably have several passions, so which do you choose?
2. Passions change over time.
3. Your passion does not always correlate with your abilities.
4. Following your passion is too self-centered.

Horowitz’s advice was to “follow your contribution.”

Lessons From “Dirty Jobs”

Mike Rowe of Dirty Jobs fame, seems to agree with Horowitz. Based on his talking with dozens of people doing “dirty jobs,” he's found that his hosts often developed a love for a particular job after they had done it for a while and become reasonably good at it. He clearly advises against following your passion.

He recommends following opportunity to select a job. Look for what's needed in a market, get good at the job, and prosper by being good at it. The excitement and passion follow because the job has become so prosperous. He also agrees that passion and ability often do NOT correlate, so pursuing a career based on passion, but lacking in ability, can be a terrible waste of time.

Unexpected Findings

Several years ago, I was reviewing the results of our recent Top 100 Hospital designation. At the time, there were nine categories that hospitals and health systems were ranked on. These nine compromised a pretty good balanced scorecard and we had put several specific programs in place to address the Top 100 measures.

As I looked over our results for each of the nine categories, I was surprised by the following observation. We had performed slightly below average to somewhat above average on most of the measures. There were only two in which we had performed significantly above average.

Yet, here we were, one of the top performing hospitals in the country based on this basket of quality, financial and satisfaction measures. And we were certainly not top ranked in most of them.

I found that it was more important to rank average to above average across the board, than to perform exceptionally well in one or two measures. Apparently, most hospitals have difficulty performing average to slightly above average in all measures, even though they may be spectacular in one or two, because very few hospitals are able to achieve a Top 100 rating even once.

By consistently pushing on all of the important domains, from mortality rate, to length of stay, profit margin and patient satisfaction, we were able to outperform most of the other hospitals in the country in terms of overall performance.

That was an eye-opening realization for me.

Unorthodox Career Advice

The second bit of advice concerning preparation for a career change has to do with those who have not yet decided exactly which career to follow. Especially if you're early in your clinical career and uncertain of which direction to go, the tactics for finding a new career, in addition to forgetting about your passion, may be to abandon goals and start acquiring skills.

Just as the top healthcare organizations don't have to be the best in every major hospital performance measure, the most successful leaders may not need to be experts in every leadership skill.

In his book How to Fail at Almost Everything and Still Win Big, Scott Adams describes how he came to be a nationally recognized, award-winning writer of the Dilbert cartoon.

He explains that it wasn’t his passion or intense study of humor or drawing. It wasn’t his having spent 10,000 or 20,000 hours learning his craft.

It resulted from his being mediocre to reasonably good in several, apparently disparate, fields:

1. Drawing
2. Business
3. Writing
4. Early adopter of technology (the Internet)
5. Sense of humor

He writes that combining his mediocre skills in each of these areas enabled him to achieve outstanding success in the area of writing a funny comic strip about characters in an imaginary work setting. And he had no idea that these skills would come together to make him wildly successful. He also suggests that his success contributed to his eventual passion for writing Dilbert.

Increase Your Odds of Success

His rough estimate is that each additional skill doubles our chance of success. Here is the list of skills that Adams recommends everyone become reasonably good at:

• Public speaking
• Psychology
• Business writing
• Accounting
• Design (the basics)
• Conversation
• Overcoming shyness
• Second language
• Golf
• Proper grammar
• Persuasion
• Technology (hobby level)
• Proper voice technique

To reiterate, Adams is a proponent of “stacking average skill sets” until a combination of skills creates an above average mix.

My Take On Choosing Skills to Stack

I don’t completely agree with Adam's list, especially for physicians looking to move into a new (nonclinical) career. I would probably make some adjustments, dropping golf and combining some items to come up with my starting list:

• Writing (includes, spelling and grammar skills)
• Public speaking (includes “voice technique”)
• Second language
• Accounting (and finance)
• Psychology and persuasion (includes negotiating skills)

I'm assuming that most clinicians have already developed a set of skills that serve them well and are already in play:

• Leadership
• Composure (ability to work under pressure)
• Strong work ethic
• Communication (one on one)
• Logical thinking and a working understanding of the scientific method
• Human physiology and biochemistry
• Focus/Concentration

Then stacking additional skills would open the possibilities for other career choices:

• Legal concepts and resistance to criticism, to be an expert witness
• Healthcare finances, running meetings, project management and writing, for hospital or medical group management
• Case management and conflict resolution, to be a medical advisor
• Basic or applied research, writing, and statistics and epidemiology, to be a medical writer

In reality, many of these careers share certain skill sets, as shown in the following graphic.

Final Take-aways

When considering a career in management, or any other nonclinical field, I recommend this unorthodox career advice:

1. Don't spend too much time worrying about finding your passion. Ultimately, your passion may find you, or develop along the way.
2. Identify and develop useful skills that will compliment those you've already acquired during years of education and training.
3. Focus on acquiring additional skill sets (quantity) rather than on perfecting a smaller set of such skills (quality or mastery).

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Can you think of times when adding new skills was more important that honing established ones?

Was there a time when following your passion was a waste of time, or even harmful?

Next Steps

Please add you're thoughts in the Comments.

SHARE this post, SUBSCRIBE Here and complete a SURVEY .

Email me: at johnjurica@nonclinical.buzzmybrand.net or record a voice message.

Until next time.

The post Effective But Unorthodox Career Advice appeared first on NonClinical Physicians.

On several occasions, I recall feeling totally unprepared to inform an elderly woman that her spouse did not survive the cardiopulmonary arrest that occurred while I was on call. Or the fact that the chest X-ray demonstrated a likely lung cancer in a patient admitted with a cough and bloody  sputum.

Admittedly, I probably should not have been the one having those conversations, but it just worked out that way.

Over the years, I became more comfortable with delivering bad news. I watched others do it. I read about it. But I never did receive any formal training on how to do it.

Several decades later, I was asked by the Director of Graduate Medical Education at my hospital to present a series of lectures to the residents. This past month, I presented one of those lectures devoted to the topic of delivering bad news to patients. It gave me an opportunity to review the subject.

I developed my method of delivering bad news by observing my instructors as I completed medical school and family medicine residency training. I don’t recall being taught a consistent method or process to follow.

As I reviewed the subject matter and integrated what I learned with the approach that I had come to follow, I was pleased to find out that there has been an effort to study the subject and several processes have been described and tested.

I think my readers will find this review of the process I taught to the residents to be a useful model to share with colleagues or use themselves in delicate conversations of this nature.

Definition

Let’s define the term “bad news” using Robert Buckman’s definition: “any information likely to alter drastically a patient's view of his or her future.”

Think of these examples:

• A young, pregnant woman is told that she has experienced a fetal demise, her fantasy of a healthy, happy newborn crushed in an instant;
• A middle-aged man with arm pain for several months, discovers he has metastatic prostate cancer causing his pain;
• An elderly woman with “indigestion” and weight loss is found to have pancreatic cancer.

These are life-altering conditions with implications for ensuing disability, loss of autonomy and premature death. Learning of these ailments causes intense emotional responses in most patients, which can interfere with their ability to fully grasp what you're telling them.

Why is This So Important?

The reality is this: patients want to know the truth. They expect the truth from their doctors. They don't want to be lied to, or misled.

Patients want to know what their life is going to be like, the constraints that an illness is going to place on their activities and how long they might have to live.

They need to get their affairs in order. And they're legally entitled to know what's happening to them because they cannot make informed decisions unless they have all the facts about their medical condition.

Barriers to Conveying Bad News Effectively

There are three major challenges to completing an effective conversation about news such as this:

1. Time constraints

This conversation cannot be completed during a five-minute visit or while rounding briefly on a hospitalized patient. It will require an extended meeting to allow the patient to absorb what is being said, ask questions and reflect. Most physicians are not prepared to take 30 minute break to sit down with their patient and talk this through unexpectedly, so it is a conversation that must be planned and scheduled.

2. Physician Fears and Misgivings

There was a time when physicians believed that patients should be sheltered from the truth about a terminal or disabling illness, believing it will destroy hope and impede healing.

Consider this quote published in the American Medical Association’s Code of Medical Ethics in 1847: “The life of a sick person can be shortened… by the words or manner of a physician… avoid all things which have a tendency to discourage the patient and depress his spirit.”

We've certainly dropped this idea that giving bad news should be avoided in order to protect patients. But physicians still have fears about the emotional outpouring that might ensue, fear of being blamed for the bad news, or of having failed the patient in some way.

3. Lack of Instruction

Most of us in medical practice learned how to deliver bad news by watching others do it. We’ve not received formal training. If we had sensitive, empathetic mentors, that might have been good enough.

But, if our instructors were impatient, or not naturally good listeners, or cursed with a low emotional intelligence level, we may have learned some bad habits during our training. Good leaders will be certain that members of their organization present bad news in a measured, empathetic and humane way.

Hospital and medical group leaders need to ensure that our colleagues, department heads, and others have the tools needed to communicate effectively. We should develop educational programs that include much of the information that follows. Taking this a step further, it would be ideal if groups of caregivers, including physicians, could get together and do some role-playing in order to practice having such conversations.

The S-P-I-K-E-S Protocol to Deliver Bad News

So what are the steps? I'm going to outline the steps following the SPIKES protocol. Each letter in the word SPIKES represents one step of the process:

1. Setting
2. Perception
3. Invitation
4. Knowledge
5. Emotional response
6. Strategy and Summary

There have been other approaches developed for delivering bad news. For example, the ABCDE method was described by Rabow and McPhee. But they generally follow a similar approach.

Let me go through each step individually.

Setting

There are several components we should address under this preparation phase. We should go through a mental rehearsal of the conversation we hope to have with the patient. We should plan to have this conversation in a private setting where we can sit down face-to-face with the patient and have good eye contact.

This setting must be free of distractions so we should leave our telephone and pager outside the room or put them on “do not disturb” mode. We should be prepared to have sufficient time to have this conversation. This is not a conversation that will occur in five minutes during rounds or in a semi-private room with another patient in the room in the hospital setting.

Perception

The next step is to assess the perception that the patient has about her illness and the pending conversation. You could say we should “ask before we tell.” Ask the patient, “What is your understanding of your medical situation?”

If you've had a conversation with the patient about testing that was going to be done or the consultation that was going to be arranged, and you explained what the expected outcomes of that test or consultation would be, then the patient should have a pretty good understanding of the potential implications.

But if you're a hospitalist encountering a patient for the first time, or an emergency room physician who has no personal relationship with the patient, it's going to be a little different. You'll need to determine the perception by the patient of their situation.

Do they know that they might have a terminal illness or one which is going to seriously affect their long-term living situation? Did they know that coming into this meeting today you were going to provide them the results of the testing and explain any bad news that might be coming?

Invitation

The next step is to understand whether the patient is ready to proceed, and how they want to proceed. Do they want every detail, or a short summary of the illness, with a focus on the treatment? You're seeking an invitation to provide the information and answer questions. You want to be sure that the patient is prepared to do so. If your patient says that they really aren't prepared emotionally to hear the results, then you might need to stop and regroup later.

The patient might want to have a family member present with them. Or he might not have been aware of what was coming. And, is the patient ready to receive both the medical knowledge and the plans for dealing with the bad news going forward?

Knowledge

The fourth step is imparting the knowledge or the information. The most important advice here is to take… your… time.

Do not rush through this conversation.

This is the most lengthy part of the interaction, explaining in layman's terms exactly what is going on. Is this a terminal illness? Is this an illness that is going to severely impair the patient's daily activities, ability to work, ability to travel?

This part of the conversation should start with a warning, something like, “I'm sorry but I've got bad news for you today.” Be sure to use non-technical terms. Provide the information in small bites. Pause frequently, and assess the patient's response.

And don’t use euphemisms, like referring to a “growth”, when you should use the term “cancer.” Use terms like “very serious,” limited “life expectancy” and “death,” if necessary. But be gentle and patient at the same time.

Is the information sinking in? Are they grasping what you're saying? Be sure to provide reassurance as you go. Tell the patient, “Yes, this is a serious condition, but we're going to be here to help you along the way. We're not going to abandon you.”

Emotion

The fifth step is the emotion phase. How is the patient responding to the news? Observe the patient. See what emotions have been elicited. Is the patient sad, angry, or in denial? Acknowledge that there has been a strong emotional response, and try to reflect back what that emotional response is. Use terms like, “I see you're very sad” or “I can see you're very upset” or “You seem to be angry.”

Then try to connect the emotional response to the underlying reasons. It may seem obvious that since they received bad news, they should be angry or upset. But it's the interpretation of the news that drives the emotional response. Find out, if you can, what fear is driving the emotion. Then help the patient connect meaning to the emotion.

Consider using observations such as, “You look angry. What is it about this news that makes you so angry? Tell me more.”

The patient may state that they had plans coming up for a trip and they're angry because now they won't have a chance to travel.

They may be more worried and upset about the impact of this news on other members of their family, rather than the direct effects on themselves. Or, perhaps the patient has lived through a loved one’s illness and are fearful about the effects of treatment (hair loss, other side effects) or uncontrolled pain.

Link the Emotion to the Meaning

It's important that you identify both the emotional response and the meaning that’s driving it. Then acknowledge both. Be empathetic, acknowledge their concerns and their emotions, pausing frequently to allow them to vent.

At this stage, they must get their emotions under some level of control before we can proceed to the next step of the process. If someone is completely distraught, and crying uncontrollably, they're not going to hear what you have to say.

Give them a few moments. Wait to see if they can compose themselves enough to answer your questions. Verify that they understand what you've said, and move forward with the conversation, answering questions slowly and deliberately.

Be sure to validate their emotions and their concerns as you go. But, again, do not downplay their condition. Don’t say “Don’t worry, everything will be OK” in a way that whitewashes what is going on.

Once they seem to have accepted the reality of the situation, and are composed enough to proceed, move to the final phase of the discussion.

Strategy and Summary

This final step is designed to verify that they've heard the information. You might ask them, “What is your understanding of what we've just talked about?” Are they able to clearly articulate what you've conveyed? Are they using euphemisms that you may have used like, “I have a tumor”? Or are they being realistic and accurate with their assessment?

Be sure that if this is a terminal illness, that is understood. Be prepared to describe what is known about the course of the illness. You can explain that the condition may result in their death at some point, but you're going to be there to help them and not let them be suffer needlessly. Describe some of the support that will be available to them.

Provide a brief overview of the steps that will be taken to address their diagnosis. Then ask them to reiterate the plans that you have discussed. Explain decisions that might need to be made. Once they've heard about them, give them a chance to express their initial thoughts. But a final course of action should be discussed later, after they have fully digested the information that has been provided.

You might ask. “Is there a direction that you'd prefer to follow, or would you like to come back later and discuss the treatment options again in more detail?”

If the patient is too distraught to finish this part of the process, then it's best to stop, circle back to the beginning of the SPIKES protocol and reiterate some of the information.

If necessary, stop completely and reconvene later in the day or the next day with the patient, perhaps with a family member present. Then reiterate the plan, including when you're going to meet next.

Recap

Let's quickly recap the six steps of the SPIKES protocol.

First, you're going to address the SETTING. In setting up, you're going to rehearse mentally, make sure you have a private setting where you'll be sitting eye-to-eye with the patient, and that distractions are going to be eliminated.

Second, you're going to assess the patient's PERCEPTION of what's going on and any recall of previous conversations leading up to this meeting.

In the third step, you're going to look for an INVITATION by the patient to proceed. That means they're ready to proceed and they've told you how much detail they want to have during this conversation.

The fourth step is imparting the KNOWLEDGE that needs to be delivered, starting with, “I'm sorry to tell you that I have bad news” and avoid using jargon. Give the information in small bites, pause frequently and reassure as you go.

During the fifth step, you must address the EMOTIONS evoked in response to the news. You should observe the patient, acknowledge their emotions, clarify them, connect them to the meaning that the news has to that patient, and validate them.

The sixth and final step is to elicit their SUMMARY of what has been discussed and outline the STRATEGY for moving forward while reassuring them. Then set a particular time and place when you're going to follow-up with them.

This process seems to be a little bit too “cookbook” for some. But after using it a few times, it becomes second nature. The six seemingly discrete steps start to blend into one another, so that this conversation can be done in a very responsible and effective manner. This will enable you to convey the news to the patient and prepare them for the next steps in their treatment.

Final Suggestions

You may find it useful to watch some videos, demonstrating poor examples of giving bad news and more effective examples. Below are two such videos:

• Poor approach to delivering bad news.
• Good example of delivering bad news.

Questions

Does this approach seem useful? Does it generally follow the process you've developed to convey bad news?

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Next Steps

Please add you're thoughts in the Comments. I will respond to them all.

Don't forget to SHARE this post, SUBSCRIBE Here and complete a SURVEY .

Contact me: johnjurica@nonclinical.buzzmybrand.net

Thanks for joining me.

Until next time.

The post Use This Proven 6-Step Process to Deliver Bad News appeared first on NonClinical Physicians.

I am re-posting the material from my previous article. However, I am adding 6 additional benefits completing a business degree provides.

More physician leaders have recently acquired an MBA, MHA, MMM or MPH (an MPH is not actually a business degree, but a significant number of physician executives have one). A business or management degree is definitely not a requirement for a career as a physician executive.

There are many successful physician leaders without such a degree. There are numerous physician CEOs, working in hospitals, insurance companies, medical groups and nonprofit organizations who don't have one.

However, if you have not already graduated from one of the 65 joint MD/MBA programs, then you will likely consider obtaining it or a similar degree after completing residency. Pursuing such a degree is a big commitment. The costs will run into the tens of thousands of dollars. It will require hundreds of hours of study and up to a three-year commitment to complete.

In spite of that, I believe you should seriously consider pursuing a business degree.

Top 10 reasons to Pursue a Business Degree.

1. Differentiate Yourself

You may have taken a leadership role and handled several projects. You demonstrated your ability to lead and manage. Now you are interviewing for a position as a full-time administrator. Frequently, you will find yourself competing with several other qualified candidates.

All things being equal (experience, expertise, communication skills, etc.), the candidate with the degree is more likely to be hired.

2. A Business Degree May Be Required

Sometimes the prospective employer will only list a preference for candidates with a master's degree in business or healthcare administration.

However, there are systems that require applicants to have a management degree. (In fact, I've even seen a few postings list a CPE (Certified Physician Executive) as a preferred qualification.)

3. Different Perspective and Enhanced Skills

This is really the most important issue. Sure, you may have participated in educational offerings (through specialty societies, the American Association for Physician Leadership, the Advisory Board, the American Hospital Association, or the American College of Healthcare Executives).

But participation and immersion in a management degree program will provide:

• more in-depth study,
• ongoing exposure to faculty,
• development of new skills, and
• more practice working in teams.

I have witnessed a transformation in colleagues who have completed a business degree. They have better mastery of the business aspects of healthcare. Consequently, they are better managers and leaders. And they display more confidence.

They have learned how to write a business plan and create a pro forma, to understand accounting, finance, marketing, and managing staff. These and other skills will benefit a physician in any enterprise, from the private solo practice, to a large organization.

4. Demonstrate Commitment

When making a shift to a new career, it is sometimes necessary to demonstrate that it is not a passing whim.

This is especially true if you are trying to obtain an administrative position at your home hospital, or in your home town at a new organization. Unfortunately, your peers and prospective employer may need evidence that your interests and skills have evolved in order to take you seriously.

5. New Mastermind Group

Working on an MBA or an MMM will help you develop a network of colleagues with similar goals and interests. These colleagues will often become friends and an ongoing resource for advice and counsel. Some may morph into an ongoing mastermind group of advisors and coaches.

6. Intellectually Stimulating and Inspirational

It's intellectually challenging and exciting. Engaging in an intense learning environment often rekindles passion for your career. A colleague of mine was inspired to address an important issue in his practice while nearing completion of his MBA, as described in this Medical Economics article.

7. Project Management

Perhaps I could have included under #3. There is definitely a process for organizing and managing a project that is not learned in medical school or residency. However, the ability to execute a project, from business plan (if needed) to specific milestones and metrics is an important skill. The course work involved in pursuing a business degree should deliver this new ability.

8. Strategic Planning

Very few physicians having any idea how to create a strategic plan. It is a critical skill needed to run any sizable organization. A full-blown strategic plan may not be needed for a small physician practice. But any large group or hospital needs regular strategic planning.

Granted, the CMO may not be the one leading it. Sometimes, an outside consultant might be employed to help run a formal strategic plan.

But strategic planning for your own division, or spending time thoughtfully considering strategic issues, is an important part of being a physician executive. A SWOT Analysis (described in When to Use a SWOT Analysis and From SWOT Analysis to Inspired Goal Setting) is often a vital part of preparing a strategic plan and is generally taught in business school.

9. Career Flexibility

Physicians already have a secure career path. They often have multiple clinical jobs available to them if they're looking. Obtaining a business degrees provides even more career opportunities, with the ability to seek jobs with a combination of clinical and/or management duties.

10. Compensation

I believe this is the least important reason to pursue an advanced business degree. Granted, seeking an MBA is an investment, so it should have a financial and personal return.

All things being equal, the respected physician with an MBA will earn about $50,000 more per year than without it. Of course, there are exceptions to that, including well-compensated hospital CEOs without a business degree or the physician MBA running a struggling practice receiving poor compensation.

But most primary care physicians who leave clinical medicine and move into a management or executive position will do better financially. The same may not be true for a high volume cardiologist or neurosurgeon moving into full-time administration. Senior level executives at most healthcare organizations are well paid.

Summary

You can readily obtain management experience through certain jobs. You can access CME to obtain additional training in business related disciplines. And you can certainly move into a management position without getting an MBA, MMM or MHA.

However, pursuing an advanced business degree is challenging and rewarding. The intense study enhances the lifelong learning to which we're all committed. And it provides an opportunity for creating meaningful lifelong relationships.

You should strongly consider pursuing a business degree.

I am very interested in your experiences with this issue.

• Have you completed a degree program during your quest to pivot from clinical to administrative work?
• If so, has it been worthwhile?

Comment below or email me at johnjurica@nonclinical.buzzmybrand.net.

The post Physician Leaders: Top 10 Reasons to Pursue a Business Degree appeared first on NonClinical Physicians.

A distinguished gentleman who looks to be in his 60s is asking the question. He and I are sitting across from each other at the end of a long, dark mahogany conference table.

I don’t remember how I came to be here. I probably look a bit confused.

“John. Tell me… How would you do that?”

Now I remember. I’m interviewing for the position of Chief Quality Officer (CQO). I’m ten minutes into an interview with the Chair of the Board of Directors. His name is Samuel.

That’s quite a broad question, Sam.

Clarify the question for me. You want me to describe how I would build an ideal quality improvement program? For a hospital like this? Are there any financial constraints?

“I’d just like to hear your opinion on what a really good program looks like. Let’s not worry too much about budgets. But keep it within the realm of possibility.”

A Great Hospital Quality Improvement Program

OK. I’ll tell you what I think. And I’ll try to keep it brief and fairly high level.

I’m making the following assumptions:

• We’re talking about the quality program at a stand alone general full-service hospital.
• I am going to include patient safety as part of overall quality program.
• I’m assuming that this program will need to meet all of the required reporting demands of CMS and other regulatory bodies.

“That sounds good,” Sam replies.

OK, then let me start with the basics.

First, I’ll define what I mean by quality improvement.

We’re talking about a program designed to support the hospital’s efforts to deliver medical care to patients that is:

• Undeniably effective and evidence-based,
• Timely, and
• Error free.

I’ll describe my design of a basic quality program. However, in the real world, the design process would be collaborative. It would involve multiple conversations with stakeholders from the local community, and possibly some outside experts.

Culture

The underpinnings of the program will start with the culture of the organization. Quality and safety must be built into the fabric of the culture of the hospital.

That means that the hospital mission addresses quality and safety. And the values of the organization will also include a commitment to quality.

Furthermore, the QI program itself would have its mission, values and vision. They would be defined by the hospital leadership, with input from all stakeholders, including patient representatives.

The Board of Directors will approve them. And everyone working at the hospital will need to acknowledge and sign off on the mission, vision and values. That includes the employees and non-employed medical staff members and independent contractors working at the facility.

The cultural aspects must include evidence that teamwork and effective communication are valued. We will implement the list of Safe Practices from the National Quality Forum.

Credentialing

Next, we will ensure that team members believe in quality and continuous learning. Hiring will involve an assessment of the commitment of potential hires to quality and safety.

Of course, all necessary licensing and credentialing will be followed.  An excellent quality program starts by involving motivated and engaged team members. Whether it's environmental services, phlebotomists, CNAs, lab and imaging technologists, nurses, pharmacists, or physicians, we will ensure that they all have the best credentials and a demonstrated ability to provide excellent care.

That sets the stage for building a great program.

Metrics

A great hospital quality improvement program has the ability to measure, report and improve important measures of quality and safety. So, next, I would define for the organization how quality is going to be quantified. 

We will need to implement tools to monitor our performance. In order to clearly define the tools we need, the expertise we need, and the structure to put this program in place, we need to define the metrics that will demonstrate our success or failure.

Ideally, we will track every outcome and process measure that experts agree define quality in the hospital setting. Off the top of my head, the following are generally recognized as important outcomes to track and report:

• Overall mortality rate, expressed as mortality index.
• Mortality rate for high volume conditions like heart failure, COPD and pneumonia. The top 20 by volume would be a good start.
• Complication rates for the top 20 procedures (by volume), such as total joints and other inpatient procedures.
• 30-day readmission rates for the top 20 medical, and top 20 surgical, diagnoses.
• Compliance rates for process measures (such as CMS core measures and other important lead measures).
• Selected patient safety measures (including Sentinel Events and Never Events).
• Selected AHRQ Inpatient Quality Measures.
• Length of Stay (overall, and for specific high volume diagnoses).
• Medication Errors.
• Additional measures, as indicated by comparing the Leapfrog National Measures Crosswalk and other published guidelines to what is already in place.

Measurement Tools

Given the list of measures that we must monitor, I will lead a team to identify the best measurement tools. If there are tools that can integrate with our EMR, I will focus on those. Otherwise, I will find tools(s) that will provide as much of the needed data as possible. The tools will need to provide risk-adjusted outcomes and rates for process measures. It will need to be as affordable as possible.

Such tools might include those provided by The Advisory Board, Premier, Quantros and others. Without automation of these measurements, they become very difficult to follow and compare to benchmarks.

People

In addition to leadership by the CMO or CQO, we will need an experienced, knowledgeable, clinical expert to lead the quality and safety department or division. He or she will have the appropriate attitude, experience and training to ensure success in this position.

Other expertise needed within the department will include:

• Regulatory (CMS, TJC or DNV, and state regulatory departments);
• Quality processes, including process improvement, quality improvement, and patient safety;
• Sentinel events and root cause analysis;
• Infection prevention;
• Medication safety;
• Data analysis, decision support and statistical analysis;
• Continuing medical education;
• Super-user for any measurement tools installed; and,
• Coding and documentation as it relates to quality and safety reporting.

Structure

We will need to assign the activities to the appropriate teams and create a REPORTING structure. We can start with a structure that looks like this, and adjust it to suit our needs:

In a small facility, one person might handle multiple duties. As the organization gets larger, the duties will need to be managed by a larger team.

I will place management of continuing medical education as part of the QI division. In this way, the majority of educational content for physicians will be designed to address gaps in care or patient safety.

Process

The Quality Committee, which is a subcommittee of the Board, will oversee all of the activities. So, there will need to be several scorecards that the board can review in order to easily monitor our performance.

The membership of the committee will include select board members, the CEO, COO, CQO, CMO, QI & PS Director, Pharmacy Director, Nursing Director, representatives from CME and  Infection Prevention, and members of the medical staff from each of the large departments (e.g., medicine, surgery, etc.).

Several subcommittees will report directly to the QI Committee:

• CME
• P & T/Medication Safety
• Readmissions
• Quality Team (tracking mortality, complications, core measures)
• Patient Safety
• Infection Prevention
• Code of Conduct

Each of these subcommittees will be monitoring outcomes and creating teams to address specific gaps in performance. The subcommittees might need specific teams for certain projects or for certain high risk units.

Here is how the COMMITTEE structure might look:

Reporting

Each SUBCOMMITTEE and TEAM will develop its own scorecards for reporting the ongoing performance being addressed. Minutes of each meeting and scorecards for each TEAM will be sent to its SUBCOMMITTEE. Each SUBCOMMITTEE, in turn, will report to the Quality and Safety Committee.

The CQO will present quarterly quality and safety reports to the senior executive team and the Board of Directors.

That structure ensures accountability of the organization to the community, via the Board.

Peer Review

Notice, Sam, that this model has not addressed the formal physician peer review process. But that must be included as part of the re-credentialing process for physicians.

My recommendation is that medical staff peer review be done by a multidisciplinary committee, with members from each medical staff department appointed by the chair. Cases will be reviewed, based on screening criteria for each department. Also, cases can be referred to the peer review committee as needed.

Some of those cases will also be reviewed through the sentinel event or QI process as well. The physicians will be invited to participate when their case is being discussed.

So, Sam, that’s what I consider to be a starting point for a good program.

In addition to the what I've already mentioned, we will:

• address new opportunities as they arise,
• focus on continually improving the quality of the care,
• take a multidisciplinary approach,
• integrate education into the process, and
• evaluate the culture through regular cultural surveys.

Wrapping Up a Great Hospital Quality Improvement Program

Sam replies, “That sound like a really sound plan. Thanks for taking the time to describe it.

“I think we’re out of time, so I’ll bring you to your next interview. Best of luck and thanks for coming in to meet with us today.”

I'm walking toward the door when, suddenly, I hear a distant ringing. The ringing becomes louder and louder.

Where is it coming from?

I open my eyes. The alarm on my cell phone is ringing. And I’m in my pajamas, in bed. I'm so preoccupied with my upcoming job search that I was dreaming about an interview!

Some of those ideas about a quality program were pretty good, though.

I jump out of bed to find a pen and paper to jot the ideas down!

Next Steps

What have I forgotten in my dream-induced quality plan? Let me know in the Comments.

Please share this if you found it useful – just use the links below to share on Facebook, Twitter or LinkedIn.

The post Building a Great Hospital Quality Improvement Program appeared first on NonClinical Physicians.

My usual optimism was gone. I did not become overtly suicidal, but I began to have thoughts about what it would be like if I was no longer “around.”

After wallowing around in that state for a while, I took some steps to extricate myself…

• Engaged a psychotherapist and began weekly counselling;
• Started a regular practice of mindfulness;
• Spent more time with some of my closest friends, parents and siblings;
• Began exercising regularly;
• Took up some new hobbies: rock climbing, downhill skiing, and scuba diving.

Gradually, I was able to claw my way back to a life with passion, energy and hope.

I was reminded of those times during a conversation about resiliency at the recent American Association for Physician Leadership Spring Institute in New York City.

Welcome Back

It has been about four years since I last attended a formal AAPL conference. Hence, I was really looking forward to this one.

Being in Manhattan with my wife, just a short walk from Times Square, was a great start. We enjoy being in a diverse, exciting city that never sleeps, even though my wife and I were back to our room by 9:00 PM most nights.

Home to the future stars of stage and screen at Ellen's Stardust Diner

Since we were staying at the Sheraton Times Square, it was a short walk to Ellen's Stardust Diner, where your servers and the entertainment are one and the same. There was some great talent there!

My wife enjoys the attention of a very talented crooner.

Pursuing Resilient Physician Leadership

The conference started April 19 with an all day workshop on Resilient Physician Leadership. This workshop was led by Rebeka Apple and Mamta Gautam.

This seems to be a very popular general business topic. Resilience has been taken up by the AAPL as an important subject for physician leaders themselves and for the physicians in their organizations.

This may be in response to the apparent increase in physician burnout. Burnout is an issue that threatens many health systems and, while not a disease per se, has been associated with depression and suicide.

All of the registrants for the course completed the CPI 260 prior to arriving. This tool is one of several California Psychological Inventory instruments that can “help people gain a clearer picture of their personal and work-related characteristics, motivations, and thinking styles.”

Dr. Apple brought the Client Feedback Reports for each of us to review. So we spent time talking about the sections of the report that related to resiliency.

And we discussed useful skills needed to maintain resiliency:

• coping strategies for stress;
• the ability to maintain focus, optimism and composure; and,
• strategies for recovery when excess stress or burnout occur.

An awesome musical five minutes from our hotel. Highly recommended!

Enhancing Resilience

The second part of the workshop was led by Dr. Gautam. She started with a story.

As a young psychiatrist, she was asked to assist a few struggling physicians early in her career. This rapidly became a large part of her practice as she assisted professionals distressed by the circumstances of their challenging lives.

She came to devote much of her time to improving physician wellness. She spent years increasing awareness of physician health issues, treating colleagues, and creating a network of resources for physicians in distress. Now she devotes time to coaching physicians to learn strategies to keep well. Many can be used to enhance resilient physician leadership.

Here are the danger signs of increasing stress that she described:

• More frequent physical ailments and illness
• More problems in relationships
• Increasing frequency of negative thoughts
• Accumulation of bad habits
• Exhaustion

Additional Skills

She presented her approach to enhancing personal and professional resilience and described the FIVE C’s of RESILIENCE:

• Control – not of our circumstances, but of our perceptions about our circumstances
• Commitment – remembering our values and prioritizing them
• Connections – using our personal and workplace support systems
• Calmness –  self-regulation, meditation, and mindfulness
• Care for Self – through exercise, nutrition, sleep and time alone

I found the workshop to be quite interesting and applicable to my life. Fortunately, I had already implemented many of the suggestions, but there are several that I don't use as much as I should:

• I spend less time with my parents and extended family than I would like.
• Time with close friends is very limited. For example, I recently wrote about a friend that passed away, and my regret for not having spent more time with him.

Finally, in addition to time for learning, there was plenty of time to network and meet new colleagues. I was impressed again by the breadth of backgrounds of the participants. Hearing about their varied experiences was very inspiring.

My Conclusions

I have been severely stressed at certain times in my life. And I wish that I had a better mastery of the skills presented in this workshop earlier in my career.

Resiliency is a leadership topic that will be increasingly important, and one that should be taught to our physician colleagues.

Next Steps

• Read more about resilient leadership. You can start by reviewing Harvard Business Review the article mentioned above, and this interview with Eric Greitans.
• Join the AAPL if you're not already a member and attend a live course or access one of its online courses.
• Subscribe here.
• Take a short survey:  Survey Page

Recent Interview by Future Proof MD

FPMD was kind enough to post a written interview with me at Future Proof Docs – The Vital Physician Executive. Check it out and look around his site for useful financial information.

Feel free to email me directly at john.jurica.md@gmail.com

If you like this post, please share on your social media using the SHARE buttons below.

See you in the next post!

The post Pursuing Resilient Physician Leadership appeared first on NonClinical Physicians.