Since the physician is the senior member of a healthcare team, assuming the physician is always to blame makes a certain amount of sense. However, I was recently involved in a situation where there were clearly systemic issues in a healthcare system, but the system nevertheless more or less successfully shifted the blame to a physician.
The health system claimed the physician is always to blame.
A client of mine is a conscientious, experienced and caring physician who always treats the needs of the patient first.
A few months ago, she saw a pediatric patient for a routine checkup. Looking at the section in EPIC regarding vaccines, she noted that the child appeared to need several vaccines.
The father was with his child, but wanted to touch base with Mom before authorizing the vaccines. Mom approved, and shots were given.
When Dad and the patient went back to the waiting room, Dad explained to Grandma that several shots were given. At that point Grandma said that the patient had already received all required vaccines. Noting that the vaccines were not in the record, the physician asked a member of her staff to attempt to verify the vaccine status.
Sure enough, the child had received vaccines elsewhere, and whoever in the system received this information decided to stick this information in the form of a PDF into the “media” portion of EPIC.
Since the physician is always to blame, the health system was on the verge of implementing a corrective action plan
I’m not sure anyone would argue that there was a mistake made. The child should not have received those shots. But, since the physician is always to blame, the “obvious” solution was to school the physician on the proper use of vaccines.
As far as we know, nothing was done to correct the systemic failure of outside records being universally lumped into a “miscellaneous” category in the medical record. As with most things in healthcare today, the system is what it is, and the physician is expected to make it work.
Incredibly, however, the health system chose to counsel the physician, and was indicating that it was going to implement a corrective action plan to address this “deficiency” in care.
Since the physician is always to blame, what should a physician do?
This is where I would love to inform you that we spoke to the health system, they acknowledged it was their fault, and agreed to correct the issue in the ways medical records are maintained. If you have ever worked with administrative leadership, however, I’m sure you will not be surprised to learn that the system considered itself blameless.
The health system proposed an amendment to the physician’s employment agreement allowing it to terminate her on 30 days’ notice (instead of the 90 days in the current agreement). The physician wisely agreed to the amendment on the condition that she also be allowed to resign on 30 days’ notice, and promptly did so using the revised without cause termination language.
This was a classic “lose-lose” situation. The health system lost a respected and loved pediatrician, and the physician decided to move out of state to practice closer to her family. Incredibly, the health system proposed a separation agreement and a recommendation letter that indicated the physician was not compliant with the system’s vaccine policy. Any potential employer could reasonably assume from the initial language that the physician was an anti-vaxxer.
Happily, we were able to negotiate more reasonable (and accurate) language in the final separation agreement.
We have standard language we always request to avoid frivolous quality-based terminations of physicians. If you don’t have protective language in your agreement, you must obviously attempt to administratively convince the employer that maybe, just maybe, the physician is not always to blame.
My sense in this situation was that the health system was trying to protect itself from its poor record-keeping, and it didn’t seem possible to avoid a corrective action plan. A corrective action plan can be devastating to a physician’s career.
If you can’t win administratively, the best option may be to use the provision on without cause termination in your employment agreement. In this matter, and in several other similar matters, I have been able to convince administrations not to impose a corrective action plan once notice of termination has been given.
One expert's take on how to react to a system where the physician is always to blame
Shortly after negotiating a somewhat reasonable solution to this ridiculous situation, I had the pleasure of reading the latest book from my friend Dike Drummond, MD, Physicians Unchained: Retirement Mastery for Doctors. I can’t recommend this book enough to any physician who is anywhere near financial independence.
I couldn’t do the book justice in a short summary, but one take-away is that the US healthcare system is broken, and many physicians remain employed (and abused) because they are suffering from “survivor guilt.” If you are in a position of financial freedom, here is Dike’s advice (reprinted with permission):
Your boss will never hire new doctors or locums as long as three of you are seeing six doctors’ worth of patients. It’s a simple bean counter’s calculation: this “staffing ratio” maximizes profits. If they hire more staff, they’ll just make less money.
Ultimately, you are not personally responsible for caring for these patients. The responsibility to provide care lies with the insurance company that took their money and the healthcare delivery company that accepts the insurance payments in exchange for care.
Another source of input is to contemplate the Serenity Prayer.
Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
The only healthy thing to do is walk away. If you don’t do that now, things will quickly become much worse, and your resistance to walking away will only increase as additional partners and staff quit or go on disability leave from burnout.
I suspect the last thing you would want to do is to die in the saddle in a workplace that just doesn’t care about you. The writing is on the wall. Get out of there.
Survivor guilt is a current active factor in the physician retirement struggle. It freezes the best doctors in place with shame for what they feel is abandoning their patients and staff.
This struggle factor will only worsen as the US healthcare industry’s collapse continues.
Don’t be the last rat off a sinking ship.
