Physician Networking: Part Two

What Is Networking And Am I Doing It Right?

In one of my past posts, I talked about networking and building relationships as a physician. I wanted to get the idea across that networking should be fun and be to the benefit of both parties. 

As physicians, we don’t get the training to teach us about networking.  Therefore, we might not understand what it is or how to do it. I know I didn’t understand. It took me years to really get the fact that simply talking to others in a professional environment is networking. 

Some physicians come to me with the false impression that networking is manipulative or about asking for something and telling someone what they want to hear. Many of the physicians I work with have initial trepidations about social media outlets like Linked In. They may have heard that others on Linked In or on other forms of social media are just trying to use networking to sell their product. The idea that networking is about building professional relationships and that it can be a fun way to reach out to new people and learn new ideas seems unbelievable.

However, networking is also a part of business and there isn’t any shame in looking at it like that. Networking can build your business and help you sell your product and should be an essential component to your marketing strategy. Some of the people you network with for business you probably wouldn’t choose to be your personal friends.  

But how do you network, build your business or find a job in an authentic way? 

One of the best tips I ever got on networking is a simple tip and seems intuitive. It’s something everyone aspires to but is much easier said than done.  

Here it is:  Be liked in a social setting.  

Why?  As I’ve been saying, networking should be fun and that goes hand-in-hand with liking the person you are talking to. As far as networking for business goes, when it comes down to two similarly educated and experienced individuals, people do business with people they like.  I see it over and over in the business world.  It’s one reason why companies prefer to hire internally. Someone who is already a member of the team is already known and liked by others at the company. It’s the reason certain vendors and consultants get repeat and new business within companies that “know” them.

So how do you ensure you are a likeable person? What if you are an introvert by nature? What if you don’t think you are any good at “small talk”? How can you be successful even if you don’t naturally attract others through your (self-proclaimed) undeniable charisma?

Here’s a tip that’s worked for many individuals, including myself: Find out what the other person is interested in outside of work.  

There are a number of ways you can do this. Ask questions because people love talking about themselves. Be interested enough in what the other person has to say that you can find something interesting or different in those things they say. Someone will usually reveal a personal interest or passion in the first few minutes of a conversation. 

For example, say you are meeting with a guy named Bob to talk about doing business with his company. Perhaps Bob likes running. He’s run two 10K’s and is currently training for a half marathon. Before work each day, he’s up at 5 AM and out running a 5-mile tempo run. He will likely reveal this fact after a few minutes of talking with you because he’s proud of himself and his legs are possibly a little sore. This is your chance to ask Bob about his training or his past races – even if you’ve never run more than 4 miles or you hate running.   You could even mention your own past (perhaps failed) attempts at running. Before you know it, you and Bob are smiling and have built camaraderie. When you follow up with Bob the next day, it’s easy to include an article you saw in that day’s newspaper, comparing sports drinks to gels and goo while training. 

Two weeks later, you may be shaking hands with Bob because you have agreed on a way to work together in an opportunity within his company.

Remember, people do business with people they like.

The Disappearing Independent Physician

In a recent post I noted the trend among physicians to sell their practices to hospitals.

The recession coupled with the passage of the healthcare reform initiatives has pushed many physicians into simply throwing in the towel and walking away from the independent practice model.

This month in Smart Money is an article entitled Say Farewell to the Family Doctor.  It's an interesting read.

The articles continues the discussion about physicians becoming employees of hospitals and describes the impact this change is having on the physicians, patients, and the economics of medicine.  

I enjoyed the article, but the last paragraph really gripped me. Here it is:

Still, Mikell acknowledges, "doctors don't want follow-the-directions, cookbook medicine." And for many physicians, the idea of following new rules triggers a much larger unease at giving up their independence—a feeling of loss, both for the businesses they built and for their patients. Back in Bozeman, Blair Erb, the sole cardiologist in town, is a picture of resignation as he prepares to sign a contract with Deaconess. "I feel defeated," Erb says, looking around at the office furniture he and his wife, Liz, chose from a catalog years ago. The weathered ranchers and bundled-up women that come through his door mostly express disbelief when they hear that this frank-talking Tennessee native will sell his practice. His staffers say they're not looking forward to the questions the hospital's medical records system will soon prompt them to ask patients. (Do you wear a bike helmet regularly? Do you have a smoke detector?) "We'll try to retain as much professional independence as possible," Erb says, gazing at the hospital building, whose bulk he can see through his window. "But the fact of the matter is, we'll have a new master."

This paragraph was especially poignant to me since Dr. Erb is a former president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.  

Regardless of one's stance on all the healthcare reform initiatives, it is difficult to watch this generation of physicians enter the twilight of their careers with frustration and disappointment. These men and women-- and their loyal patients-- deserve better, and our society will soon feel the impact of the loss when they and  their practices are gone.  

Update on Apr 15, 7:42 AM by Greg Bledsoe MD

Note:  I wanted the readers to be aware of a correction to this post.  The Dr. Blair Erb who is mentioned in the Smart Money article is the son of the Dr. Blair Erb who was the president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.

Understanding The HITECH Act: HIPAA On Steroids

By Jeffrey Segal MD JD & Michael J. Sacopulos JD

Understanding the law before you send your patients any e-mail.

Snail mail is becoming less popular as the calendar pages turn. E-mail and social media networks have changed how we communicate. Before clicking the send button in an e-mail template, healthcare professionals should better understand that HIPAA violations have also entered a new era. More cases are prosecuted with assessment of both statutory civil fines and criminal penalties.

A little background: Even though HIPAA passed in 1996, little prosecution followed when patient privacy was violated. Since the law took effect in 2003, nearly 45,000 complaints were filed with the Health and Human Services (HHS) Office for Civil Rights. Of these complaints, only 775 cases were referred to the Department of Justice or the Centers for Medicare and Medicaid Services for investigation. None resulted in direct civil monetary penalties.

Then, in 2009 the HITECH Act (“HIPAA on steroids”) was enacted. This act intended to increase HIPAA confidentiality protections of Electronic Protected Heath Information(ePHI), instill tough civil and criminal penalties for violations, mandate notification of breaches of HIPAA protected heath information, and extend the definition of covered entities to include business associates. A tall order indeed.

For example under the tougher HITECH Act, in April 2010 a former employee of a hospital was sentenced to four months in prison for accessing the medical records of his coworkers and various celebrities. He had no “valid” reason for accessing these records.

According to the Health and Human Services (HHS), penalties have increased. Prior to the HITECH Act, the HHS Secretary could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. Section 13410(d) of the HITECH Act strengthened the civil money penalty scheme by establishing tiered ranges of increasing penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision.

Just how "high tech" are physicians when it comes to communicating with patients?

A survey by the health information firm Manhattan Research in 2009 found that 42 percent of physicians had some online communication with patients.

The American Academy of Family Physicians reported in a 2009 survey that just 6 percent of responding members had performed a Web-based consultation - that number was more than double the 2.6 percent who had done so in 2008.

But is all of this electronic communication legal?

The HITECH Act requires that all communications involving ePHI be encrypted.  HHS recently adopted National Institute of Standards and Technology guidelines for encryption.  This means that if a physician wants to consult, refer, or prescribe for a patient by e-mail, the e-mail had better be encrypted.  Of course most patients do not have software to decrypt.  So what alternatives do healthcare providers have? And, more importantly, how can this be made easy and pragmatic. Email was designed to simplify, not complicate.

Healthcare providers may seek their patient's consent to communicating via unencrypted e-mail.  While HHS does not provide a standard form for securing patient consent, basic "informed consent" strategies should apply.  First, get the patient's consent in writing.  The patient should not be given just a binary choice – but a menu of choices.  For example, a patient may wish to electronically receive information on appointment dates but not test results.  The consent document – as is standard with most routine HIPAA forms -should also note that the patient may withdraw his or her consent at a later time. This can be part of an expanded HIPAA form the patient signs when first seeing you in the office.

Here are some more recommendations when communicating with patients electronically:

1) A physician may be held responsible for a delay when responding to a patient's e-mail. Solution: A physician that wishes to accept e-mail from patients should use an auto response feature that informs the patient that a) the physician typically responds to e-mail within XXX number of hours/days; b) if the patient requires immediate attention, the patient should telephone the physician's office or contact an emergency healthcare provider.  

2) If a patient initiates an e-mail with a physician, Rachel Seeger of HHS Office for Civil Rights says that it is assumed that the patient consents to unencrypted communication.  "If this situation occurs, the healthcare provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual”.

3) If a physician does end up sending a patient an e-mail, double check the recipients’ e-mail address before clicking the send button. This is to prevent the e-mail from being sent to the wrong person, therefore sharing private information to an unintended party. Good advice also in the non-healthcare world.

4) Add any e-mail a patient sends (and any response) to the patient's chart.

5) In the HITECH Act code 170.210 section B states that the date, time, patient identification and user identification must be recorded when electronic health information is created, modified, deleted, or printed; and an indication of which actions occurred must also be recorded. This means if you send an email to a patient with protected health information – and delete it – you will need a record of what was deleted and when. This is not dissimilar to crossing out a line in a paper medical record- updating the record – with a date of the update.

6) Since communicating with patients via e-mail is becoming stricter, more physician offices and hospitals are using portals as a means of communication. This allows the patient to sign in with a secure username and password to view their records and communicate with their physicians. The security rule allows for Electronic Protected Heath Information (e-PHI) to be sent over an electronics open network, as long as it is adequately protected.  Of course, this is more complicated than using Outlook or gmail.

The HITECH Act has ushered in a new era of technology requirements and standards that must be met by physicians.  Given HHS's recent enforcement efforts, physicians should use caution when electronically communicating with patients.  By working within the boundaries of the six points above, physicians should comply with the HITECH Act. 

Jeffrey Segal MD JD and Michael J. Sacopulos JD are with Medical Justice, a Medical Spa MD Select Partner that protects physicians from frivilous lawsuits.

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How To Open A Travel Medicine Franchise?

Here on Freelance MD we often discuss unique business opportunities for the medically inclined or interesting clinical practice models.

One of the interesting opportunities that I've come across is the possibility of opening a travel medicine clinic through a franchise model with the company Passport Health.

Headquartered in Baltimore, Maryland, Passport Health allows owners to buy into their franchise model and "own" a specific geographic region for development.  They currently have over 160 locations and their website mentions opportunities for the entrepreneurially-minded:

If you are a health care professional or entrepreneur with appropriate connections, we can help you achieve your dreams. Passport Health is an excellent business opportunity for the right individual. Passport Health is a simple, low-overhead service company, which provides immunizations to those about to travel to a foreign country. Basically, we are in the immunization business; we offer on-site services such as Flu and Hepatitis clinics. However, we also specialize in safety and security travel information. We are already a household name in many areas across the country, but there are plenty of great territories remaining.

A follow-up email from the company provided more specific information about their franchise opportunity:

We generally sell large territories, including a city and the surrounding counties, with the owner expected to open multiple offices over time.  Our franchise fee is $35,000.00, and it includes training (5 business days), videos, materials and the use of our exclusive software, Passageware.  There is no build-out and very limited start-up expenses. Owners consist of doctors, nurses, and entrepreneurs, with one hospital (Sentara in Norfolk) and one university system (University of Rochester School of Nursing).  Due to the hard work of the individual owners and our marketing team, we are constantly adding corporate accounts and our business model is ever expanding to include all areas of vaccines.

Besides being an interesting field, Travel Medicine is open to healthcare providers from a variety of backgrounds.  While many Travel Medicine providers are trained in Infectious Disease, I know physicians with many different backgrounds involved in Travel Medicine.  

For those interested in Travel Medicine and desiring increased training in this area, our ExpedMed courses are an excellent way to be exposed to this niche.  Two Executive Board members from the International Society of Travel Medicine, Dr. Alan Magill and Dr. David Shlim, will be speaking this year at our Expedition Medicine National Conference that will be held September 16-18, 2011 at the Omni Shoreham hotel in Washington, DC. A prior post here on Freelance MD described other, multi-month programs in Tropical Medicine that are also available for those with increased desire and more time to invest.

The Value Proposition For Health Care: A Challenge For Physician Leadership

In health care there is nothing more complex than the simple.

In a recent New England Journal of Medicine article, What is Value in Health Care?,  Michael Porter, a Harvard trained PhD in business economics, makes a compelling case for defining, measuring and rewarding value in health care. By shifting our focus on value, simply defined as quality divided by cost, we can lower costs and improve quality.

The elegantly written article shows that value is what drives consumers.

Not quality. Most of us wouldn't shell out $100,000 for a  new automobile, regardless of its quality.

Not cost. We wouldn't buy a new car for $5,000 if we were convinced it would spend most of its time in the repair shop. Honda and Toyota have been kicking Detroit's butt because of value. Most of us see Honda or Toyota automobiles as providing high quality and low cost. It's time we move health care in the direction of value.

The value proposition is easy to understand, but its implementation will be complex.

There are three complexity challenges that will require effective physician leadership:  

1. Defining and measuring quality outcomes
2. Identifying and understanding the true costs involved in delivering care
3. Shifting the paradigm of our health care culture from a physician-centric to a patient-centric one

Dr. Porter outlines some of the challenges in defining and measuring quality outcomes. These include the fragmented and insufficient state of medical informatics, the length of time needed to track outcomes, and the dynamic nature of quality outcomes.

He explores the difficulties in measuring costs (not charges) across a continuum of care. Dr. Porter also recognizes that to properly measure value, one needs to identify the proper consumer. In health care the proper consumer is the patient, not the physician. The culture therefore needs to be patient-centric.

As an economist, Dr. Porter presents a well nuanced analysis of the first two hurdles in achieving value in health care: measuring quality outcomes and tracking costs acurately. He may, however, have underestimated the challenge involved in the third: moving from a physician-centric to a patient-centric culture.

Our physician-centric health care culture has deep roots. It is planted in the elitist soil of medical school selection, fertilized by the academic docents of physician indoctrination, and nurtured by the competition skewed by a physician friendly supply-demand curve with further nutritional supplements supplied by a perverse payment incentive system.

The future culture of patient-centric healthcare will not take root in today's American health care soil unless the current physician-centric culture is uprooted. No one should underestimate this task's importance nor its challenges.

Uprooting the current physician-centric culture before it uproots the foundation of the American health care system is the biggest challenge facing our physician leaders. This task will require effective physician leadership in academic medical centers, in hospitals, in outpatient clinics, and in our medical societies. It's time to develop and support effective medical leaders by teaching them the leadership skills required for success.  

Writing An Introduction Or Chapter 1: What To Say & How To Say It?

Are you writing--or thinking of writing--a book or article for the general public? Have you thought about how to begin?

One of the biggest mistakes I see in the first draft of a nonfiction / how-to book is that writers often either start out by providing too much background to readers or they don't provide enough--and just launch into advice. What your readers really want to know is whether you can help them with their problems. And they want to feel they can trust you.

Whether you are writing a book or an article, your initial words offer an opportunity for you to forge a connection with your readers and present yourself as an authority on your subject.

A successful introduction motivates your readers to read on and provides a sense of what readers can expect from the rest of your book or article. If you feel overwhelmed by how you can provide all that in your introduction, don’t worry—if you think like your reader, you should find the job much easier to accomplish.

In the introduction your reader is trying to find out:

1. “Will this book help me solve my particular problem, challenge or goal?”
2. “What kind of results can I expect to get by reading this article, self-help book or how-to book?” Or “What kind of experience might I expect in reading this piece?”
3. “Does the author have some kind of system to help me and is it something I can easily learn, use and incorporate into my life?”
4. “Will this article or book be enjoyable to read? Is it entertaining? Moving? Approachable and informational?”

Your reader also wants to know about you:

1. “Has this author helped many people? And what are his/her credentials?”
2. “ What kinds of results have other people gotten with the author’s system or work?”
3. “Do I like this author? Do I relate to him or her?”
4.  “Most importantly: Do I trust this author?”

Your introduction should:

1. Motivate your readers to invest their time (and perhaps money) in the article or book
2. Inspire your readers to envision what they might get out of the piece
3. Begin to develop a relationship between you and your readers
4. Help readers understand how the book or article will help them
5. Tell readers how to get the most out of the book (less necessary in an article)

Starting on page one, you want your writing to come alive for readers: show your readers through by providing details and actions that help readers draw conclusions. When you tell (“He wasn’t taking well to treatment.” “Jane loves her doctor.” “The side-effects bothered her.”), you’re not making your story real for your reader. You are blandly telling information. This format makes the article or book two dimensional. When you use the five senses to show your reader, the information pops off the page. Be sure to fill your introduction with plenty of stories that make your points and your readers will become engaged.

While I talk about an introduction for a book, you may prefer to skip the introduction and start with chapter 1. After all, some readers skip introductions because they expect the meat of the book starting with the first chapter. So, feel free to start your book at chapter 1 if you have such concerns.

Leave a comment and let’s hear from you:

• Have any questions on writing an engaging introduction or first chapter?
• Any tips you’d offer others on writing an introduction?
• Want to share something you did with your article or book’s first chapter?
• Or a writing challenge you’re experiencing right now?

Healthcare Reform & Voting With Your Feet As A Physician

How will physicians vote with their feet in response to the changes that have occurred?

When I was a kid-- I'm not exactly sure when-- I remember a teacher in school telling me that to get to the bottom of any current event, you simply need to watch and see how people vote with their feet.

For instance, whenever a dictator in some distant land would wax eloquent about the utopia he had created, the truth was easily found by watching how the citizens in his jurisdiction were "voting."  Were they risking their lives to flee this "paradise" to begin a new life elsewhere? If so, you could guarantee that all rhetoric aside, living under this dictator's rule was anything but pleasant.

How might this idea of "foot voting" apply to modern day American life?

Well, I recently read an article in the Washington Times written by a physician named Dr. Milton Wolf .  Dr. Wolf is a Radiologist who also happens to be a distant cousin of President Obama.  His article details a very interesting footnote to the whole healthcare reform debate and whether the changes made were for the better or worse.

In his article, Dr. Wolf notes that it appears that many friends of the President-- those who supported and pushed for the new healthcare reforms-- have received waivers protecting them from the obvious and dramatic increases in healthcare insurance costs that those who were against the reform package argued would occur if the measure passed.  In other words, recipients of the White House waivers-- over 700 thus far-- helped push a bill onto the American public that they themselves believe is too onerous to live under.  Their rhetoric says they love this new bill, but their feet are voting against it-- or at least voting against paying the price for it.

Another area where I've found individuals voting with their feet is within the realm of clinical medicine.  Physicians, especially primary-care physicians, are fed up with the ridiculousness of modern-day clinical medicine and are leaving it in droves.  The new healthcare regulations seem to add fuel to the fire, with one poll reporting that 40% of clinical physicians will leave clinical medicine or significantly reduce their practice hours over the next three years as the reform mandates are phased in.  This is in spite of the gleeful assurances from the American Medical Association that physicians in America were and are strongly behind these new initiatives.  It appears that the AMA is learning that controlling the behavior of America's physicians is a little more difficult than distorting their voice.

Which brings me to one last example of individuals voting with their feet.

In a recent article in Worth magazine, individuals of high net worth (ie- rich), were being given advice about the pros and cons of moving outside the United States and relinquishing American citizenship.  Here's an excerpt:

It used to be difficult for me to offer advice to people who emigrate from the United States about the tax rules that apply to them. As the son of an immigrant—my father came to this country by ship from Russia in the 1920s—I couldn’t understand why an American would relinquish his benefits and protections as a citizen of the country with the greatest liberty and highest standard of living the world has ever known.

Until recently, anyway. The sad truth is that the business environment in our country was in decline even before the recent economic crisis. Federal and state governments, through encroaching regulation and selective enforcement, appear hostile to both entrepreneurs and big business. Deficits will plague our country for decades, and without the political backbone to tackle entitlements, the only alternative is increasing taxes on the “wealthy.”

Regardless of where you stand politically, this sort of exodus is concerning.  Furthermore, until recently, it was simply unfathomable. 

The facts are very simple:  human beings are not automatons that can be easily controlled by distant bureaucratic rulers.  People respond to incentives, and when they no longer have an incentive to work hard or stay or be productive or take risks, they simply modify their behavior.  

I am reminded of a quote by a physician character in Ayn Rand's novel, Atlas Shrugged.  When asked why he stopped practicing medicine, this fictional physcian replied:

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t.”

The fuzzy-headed policy wonks in our federal government need to keep in mind a few simple realities as they attempt to micro-manage our lives and clinical practices in between sips of Starbucks expresso:

• you cannot force someone to become a physician
• you cannot force a physician to practice clinical medicine
• you cannot force a healthcare system to function, when it destroys the healthcare providers necessary to support the system

While the talking heads continue their verbose debates on television and throughout the halls of Congress, my attention will be focused not on what's said over the next few years, but who's moved.  My prediction is that we will soon begin seeing some very obvious "foot voting" that will cut through much of the bluster and posturing.

Over the next few years I'll be watching to see how physicians, small businesses, and other mainstays of American society vote with their feet in response to the changes that have occurred.

I believe these votes will be dramatic and significant.

I'm already hearing footsteps...