High Stakes

Administrators: Don’t Fear Your Physicians

Healthcare leaders are often afraid to have frank conversations with doctors about performance metrics. They shouldn’t be.

At almost every health system I’ve worked with, leaders face a management conundrum. On one hand, they need their employed physicians to meet performance metrics. On the other, they don’t want to tell physicians what to do or give the impression that the system cares more about money than patients.

But the truth is, most physicians not only can handle a frank conversation about metrics – they welcome it. What’s more, this type of discourse is increasingly necessary as hospitals purchase physician practices and need to communicate effectively with these new, critical colleagues.

Although employed physicians are a growing part of the healthcare workforce, administrators are often reluctant to refer to physicians as “employees.”  Hospitals employ more than 40% of physicians in the U.S., according to the Physicians Advisory Institute, up from 35,700 in 2012 to more than 80,000 in early 2018. But in many cases, something about the relationship isn’t working. Last year, the median operating loss on practices employed by integrated health systems ballooned to $243,918 per physician.

One of the ways healthcare leaders can course correct is by communicating clearly with employed physicians. And leaders who don’t shy away from discussing personal performance metrics can mitigate financial losses and engage their physicians at the same time.

How do you do that? Start by having a member of the health system leadership team conduct quarterly, one-on-one meetings with every employed physician. During those conversations, leaders should be candid. They should explain the state of the health system as a whole and the physician’s role in it. Then, though it may be uncomfortable, they need to talk personal performance metrics.

To help with the conversation, let’s dispel a few common physician communication myths.

Myth #1:  Physicians Don’t Want to Talk About Performance

Many administrators are hesitant to talk about performance metrics with physicians for fear that doctors would be offended by looking at data such as referral numbers.  But in reality, the vast majority of doctors want to know that information. Often, physicians don’t know what data hospital leaders consider critical. So if the system is tracking metrics such as referral patterns, for example, or annual wellness visits (AWVs) and colonoscopies for Medicare-eligible patients, then physicians want to know. This leads to Myth #2.

Myth #2: Every Decision Physicians Make is Intentional

It’s true that every clinical decision that physicians make is intentional. But many don’t keep close track of what they view as operational decisions. For example, most administrators are very interested in whether physicians refer patients to specialists inside or outside the system. But most physicians don’t track that. Typically, they’re so focused on caring for the patient in front of them they don’t have a great sense of the high-level stats about their patient panel.

Administrators can help. During these quarterly conversations, they can provide physicians with an overview of their practice. In my experience, doctors find this information both interesting and valuable.

Myth #3 Metrics are Just About Money

This myth manifests itself more on the physician side, and it’s important to dispel it during one-on-one conversations. That’s why – before diving into performance metrics – leaders should update physicians on the overall state of the system and explain how the physician is part of the greater whole. Physicians must see themselves as key voices shaping the vision for the system rather than cogs in a money-making machine.

Then, when the conversation turns to personal performance, leaders must clarify that they are tracking metrics for the overall financial health of the system as well as to maintain quality patient care.

Let’s take a scenario most leaders fear: When asked about referral habits, a physician mentions a preference to send patients outside of the system, due to a trust or quality problem. Though uncomfortable, leaders need to know that. And more often than not, physicians don’t realize how frequently they’re referring externally and are open to a conversation about it.

The conversation itself is actually the clearest benefit from one-on-one quarterly meetings. These meetings create a structure that fosters open lines of communication with physicians on the front lines; the collective results are incredibly valuable as a barometer for the health of the system.

Leaders of systems with employed physicians should start talking to them sooner rather than later. The further administrators get in their relationships with physicians before starting this work, the harder it is to implement. There’s nothing to fear and much to gain.

 

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