Monday, February 23, 2015

0.7 + 0.1 = 1.0

I've been looking carefully at my weekly schedule to make sure I'm not committing to projects that I don't have time for. There just don't seem to be enough hours in the day to get things done, and while I know that's a common sentiment, as a part-time worker I'm not sure anyone will empathize with me.

I currently have two employed positions; I work 0.7 FTE with a residency program and 0.1 FTE with a medical journal. I intentionally left 1 day a week open for my writing and volunteer projects; it also definitely de-stresses my marriage for one of us to have a little wiggle room in the week to take care of all of those sniggly domestic tasks that always crop up.

While examining how I've been spending my time, though, I discovered the phenomenon of "schedule creep." 0.7 FTE should leave 1.5 days a week free; 0.1 FTE should only take up 0.5 of one of those days. But I've been working 32-40 hours a week at my 0.7 FTE position; the 0.1 FTE is pretty close to 4-5 hours a week. That adds up to 36-44 hours per week of work, or 0.9-1.1 FTE. Add to that the sniggly domestic tasks that fall to me, and no wonder I'm not writing or volunteering nearly as much as I would like.

Of course, few full-time physicians work 40-hour weeks, and 32-36 hours is close to 70% of the average physician workweek. My husband is a 1.0 FTE physician, and he is regularly clocking 50-60 hour workweeks (which is why I don't begrudge doing my fair share of those sniggly domestic tasks). But seeing just how much time I am spending makes me feel a little better about the non-work activities that haven't been getting done as much as I would like.

That said, I have no regrets about being part-time. Although our dream to have a family hasn't panned out, it still works well for us as a two-physician household to have a release valve in our weekly schedule. I am certainly not getting 8 hours a week (my supposedly leftover 0.2 FTE) to spend on writing and volunteering, but at least I don't feel guilty about the time I do spend on non-work activities.

For right now, it works, and that's good enough for me.

Monday, January 19, 2015

How much should my employer get to know about my activity?

As is true with an increasing number of employers, my new organization provided me with a free fitness tracking device. I sync it daily, and I'm earning incentives (mostly cash) based on my level of activity. If I track what I eat and engage in online health challenges, I can earn even more.

I have to admit that I find this little device (more accurately, a Virgin Pulse Max) motivating. Every morning, my Max greets me with a "Good morning, Jennifer" and a heart symbol on its screen. It's neat to accumulate activity badges and see my Max smile at me when I achieve my goal steps for the day. It's not cumbersome to use, and the cash incentives are nice.

While the jury is still out on the cost savings related to these worker incentive programs, they are becoming increasingly popular. I like the idea of being rewarded for making healthy choices, and it makes sense on a lot of levels for companies to promote health and wellness among their employees.

And yet.

I admit to some hesitancy, at times, with my Max. Adding another item to my daily "to do" list gets annoying; I have to clip Max on my waistband every morning and unclip it at night. It's a small device and easy to misplace (or for a cat to bat off my bedside table). I have to remember to sync Max regularly to earn my incentives. And, I have concerns about who might be doing what with my data. Who, precisely, is getting to see the data I upload? How much should my employer get to know about my activity? What I eat? How much I'm sleeping?

I also wonder how fair it is for companies to be able to punish employees for not engaging in wellness programs. Although some companies only reward desirable behaviors, some also have financial penalties for employees who refuse to participate and/or have unhealthy behaviors (tobacco being the most common). I worry that some employees may feel financially coerced to participate; they may not feel that they can afford to leave incentive money on the table (or pay penalties).

So, these are the issues I wrestle with when I attach Max to my waistband every morning. I enjoy the motivation, I think companies should promote employee wellness, but I'm bothered by privacy and fairness concerns.

I already know, though, that tomorrow morning I'll clip Max on again.

Wednesday, January 14, 2015

Healthcare costs should matter (even to business-adverse docs)

This morning, I had the privilege of attending a grand rounds lecture across town given by Dr. Chris Moriates titled "First Do No Harm: High Value Care From the Front Lines." Dr. Moriates is among the team at Costs of Care dedicated to "transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills."

Confession time: when I start hearing about finances in medicine, part of my brain tends to shut down. I usually find most everything "business" oriented dull and difficult to comprehend. I have no interest in getting an M.B.A. or even ever being an office medical director; budgets and dollars and numbers are simply not my forte. But bear with me, because even this cost- and budget-adverse physician found Dr. Moriates' presentation highly compelling and actionable.

His lecture centered on these key premises:

1. Tests or treatments that physicians order that do not help their patients' health contribute mightily to wasteful healthcare spending, on the order of around 210 billion U.S. $ a year. This spending not only hurts our country as a whole but hurts our individual patients.

2. Although there are many issues regarding health care costs that physicians don't have direct control over, we can choose to not order tests or treatments that the evidence base clearly tells us are not helpful or even harmful.

3. Just telling doctors what to do (or not) and showing them the evidence base to back it up, however, is insufficient to create meaningful change. Cultures and systems of care have to make it easier for us to choose the right thing than it is to choose the wrong (or even less-right) thing.

I often feel overwhelmed and powerless when it comes to the problems with health-care costs, especially as someone who is not naturally gifted at understanding business and finance. What can I, as just one individual doc, do to play my part in making this gargantuan problem better? Thankfully, a great resource exists to help me play my small part: the Choosing Wisely campaign.

The Choosing Wisely website provides lists of "Things Providers and Patients Should Question," which are divided by specialty. Each specialty has a list of 5 common practices that have a strong evidence base behind them that physicians should adopt in most circumstances.* You can find the list for Family Medicine here.

By incorporating the 5 Choosing Wisely recommendations for Family Medicine into my practice, I can help prevent patient harm and unnecessary healthcare spending. It feels good to know that I do have the power to make a difference after all! I appreciated how Dr. Moriates distilled these complex issues into simple, straightforward concepts that I can apply, both a family doc and a residency educator.


* of course, there are exceptions to every rule. Choosing Wisely isn't, as far as I can tell, advocating "cookie-cutter medicine." Hence the lists are things we should "question," not hard and fast rules. But, most of the time, our decisions should probably fall in line with the evidence base.