Have You Checked Your Own CVP Lately?

Most physicians are familiar with the acronym CVP, which stands for Central Venous Pressure. As an emergency physician I can’t actually remember the last time I measured a patient’s CVP. Unless you’re dealing with seriously ill patients in the ICU, most other physicians aren’t measuring the CVP either.

In my physician coaching practice I try to measure a different kind of CVP. This CVP stands for Clarity, Vision and Purpose. A low CVP results from living with lack of clarity, limited vision and an unclear purpose in life, which leads to a life of struggle, being a “victim of circumstances” and lack of fulfillment.

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Patients Who Bill Their Doctors For Being Late

Meet Elaine.

We lost touch for a while, but caught up with each other recently.

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.

Elaine shared: ”If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”

Wow! I had to hear more.

Elaine scheduled her physical as the first appointment slot of the day. She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

Elaine values herself and her time.

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

I was intrigued. Who pays for waiting?

Cab drivers charge hourly for waiting. Restaurants may provide a discounted meal for the inconvenience. Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity? Or when physicians are so emotionally, physically or financially distraught by their profession?

Patients suffer. And their wait times increase.

So what’s a doc to do?

1. Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.
2. Functional clinics attract functional patients. Patients fall to the level of dysfuntion within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.
3. Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

My opinion. Share yours:

Find Out What You Love As A Physician

Freelance MD is about finding out what you love as a physician outside of clinical practice, and then going there.

Here's what Steve Jobs had to say about it where you should be.

You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do.... Don't settle...

...Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma--which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

Steve Jobs - Commencement address, Stanford University, June 12, 2005

If you feel that you're not following the path that you want, it is possible to cut a new path and find the career and lifestyle that you want. But you have to start.

If you're looking to understand your options outside of clinical practice and get some personal face-time with others who are where you want to be, come to Medical Fusion. Not only will you get a fantasitc understanding or what's available out there, but you'll have mucho face-to-face access to every speaker (and other attendees) during breaks and accellerator sessions. (Take a look at who's speaking at Medical Fusion.) I hope to see you there.

The Medical Fusion Conference - November 11-13, Las Vegas

The Best Way To Find And Choose A Good Career Coach?

Are You A Physician Who Needs Help With Your Non-clinical Career Search?  

Have you been thinking about transitioning for a while and are you considering hiring a coach to help you?

Here’s some advice for choosing the right person to help you.

Know who’s giving the advice: Make sure the person you’re hiring is the actual person doing the coaching rather than a salesperson who has staff doing the actual coaching.   By the same token, stay away from resume mills that have staff do all the client work.

It is often better to work with someone who has experience:  Consider that “certified” coaches often have very little actual experience helping people find jobs. Many have tried to break into coaching/resume work by taking an inexpensive certification class that gives them “magic” initials after their name.  The certification isn’t the problem, it’s that these people have little prior job search or coaching experience.  

Choosing a physician versus a non-physician: A coach with a physician background has the unique perspective of what works for another physician and usually understands the challenges unique to a non-clinical transition.  Most physician coaches do a good job helping other physicians translate their CV’s to good non-clinical resumes.  If the prospective coach is not a doctor, make sure he or she has worked with doctors before and has successfully helped them find the particular jobs and companies that work well with doctors.

Understand what “success rate” means: Success is often defined by job placement but a coach is not responsible for placing someone into a job.  A coach should be guiding and leading you towards the right job and situation and connecting you with people who may further help you in your goals.  Remember that you are ultimately responsible for your success, even if you are working with a recruiter who does place individuals into jobs.  Instead of evaluating a coach on job placement, talk to the prospective coach about his or her past experience with others.  Asking for references is another good way to help you determine how a coach works with other clients. 

Make sure this person “gets” you: Explain your career issues, past work, individual work/life balance needs and geographic restrictions during an initial call. Ask questions of your prospective coach to understand how he or she will help you overcome your specific barriers and work within your situation to fulfill your needs.

Remember that cheap isn’t always quality: Quality coaches charge more.  Coaching is a personal service, and you get what you pay for here.   A good rule of thumb is to plan on spending more than a few thousand dollars but less than $10,000 on coaching.  Remember that physician career transition is very difficult (otherwise, why would you be hiring someone to help you in the first place?) so paying this sort of money is usually justified.

At some point, you’ve got to just make a decision:  As you weed through opposing opinions, remember that if you ask ten people about your resume, you’ll get ten different opinions, often conflicting. Open your mind to alternative approaches and determine which opinion seems right for your specific situation. 

Ultimately, it’s important to remember to go with your gut: Your gut is usually a pretty good judge.  Make sure you feel comfortable with this person from the onset.   Usually you’ll get a sense of that from the initial phone call and e-mails as you ask this person questions about their services.

In the recent years, "coaching" has become a fad.  That's unfortunate because it gives coaching somewhat of a trendy feel and can be seen from a slimy/slick perspective by others.   I appreciate that Atul Gawande, such a master of words and communication, has given the world a thoughtful view of coaching.  His article can be viewed here: http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande

A word of disclosure – I’ve served as a coach for physicians looking to transition to a non-clinical career for the past eight years.  However, I’m not the only one on FreelanceMD who provides this valuable service.  In addition, there are others out there (physicians and otherwise) who also coach doctors looking to make a transition.

Doctors Underestimate Their Options

By Franz Weisbauer MD

Most of us who studied medicine went into medical school thinking that they were going into the coolest profession that was ever invented. It’s exciting, it’s intellectually stimulating, it’s well respected, it’s well paid etc. etc.

Many of us started to work as physicians after medschool and realized that there were parts to our work that we did not like that much: the long hours, death, grief, paperwork, administrators, bad pay (but everyone told us that doctors were rich?).

Some of us did not get over these undesirable aspects of the physician life, they are unhappy with what they are doing but unable to quit….after all, this is supposed to be the coolest profession (remember?). Plus, what would my friends, parents, grandparents, …. (fill in blank) think of me?

Very few of us jump in at the deep end and either don’t start to work in medicine or quit this highly respected profession to do whatever feels best to them. Many of those who are stuck, who don’t dare to exit think that there is really nothing else they can do. Think twice. You are highly educated, smart, creative, eloquent, analytical. Otherwise you would have never made it into medical school.

There are tons of jobs out there waiting for you: be it as a medical writer, entrepreneur, public health expert, medical advisor to the industry, teacher, speaker, blogger, coach, psychotherapist, angel investor etc. etc. etc. If you are one of those people who think that you are not creative enough to come up with alternatives to your current job, this video is for you….Enjoy!

By the way, we highly recommend Derek‘s book “Anything You Want”. It describes his lessons learned from founding, running and selling cdbaby an online platform for indie music. Derek can serve as a role model for all of us.

About: Dr. Franz Wiesbauer is a founder of Medcrunch

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Making Choices As A Physician In Management

Physicians in management and leadership roles can use a strategic choice framework to improve the quality of their decisions.    

Problem solving and decision-making are important skills for all physicians, in business and in life. Problem-solving often involves decision-making, and decision-making is especially important for management and leadership. There are processes and techniques to improve decision-making and the quality of decisions. Decision-making may be more natural for some personalities, so these physicians should focus more on improving the quality of their decisions. Physicians that are less natural decision-makers are often able to make quality assessments, but then need to be more decisive in acting upon the assessments made. 

Too often, the process of making a decision is cumbersome and unfocused.  

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Finding Your Lifesytle Niche As An MD

ZDoggMD (AKA Zubin Damania MD) is a hospitalist who's kickin'it his own way.

ZDogg's interview with TechCrunch TV discussing finding your niche and being happy as a physician.

ZDogg is a genuine doctor who uses YouTube as a creativity outlet to teach people about things like safe sex, delivering bad news, stayin’ healthy on vacation and hemorrhoids. When Hsieh asked how the world of being a doctor was going for him, ZDogg answered that he loved it but was frustrated with the fact that he couldn’t be himself. He told Tony that he’d love an outlet to share the raps he composes with a wider audience, hopefully to give people a good laugh but also to teach them a medical thing or two. Tony, being the zen like guy that he is, responded, “Why don’t you do it then?”. And so he did. The results are in the links above.