Philip McGraw built a career by asking, “How’s that working for you?” He learned early that no matter how hard you try, only outcomes matter.
“You can’t eat intentions, only results.”
“I suppose that’s how I came up with one of my favorite questions: “How’s that working for you?” When I ask that, I genuinely mean it. How is what you’re doing working for you? Are you getting what you really want and need?“
Dr. Phil might ask doctors, How’s this working for you?
Did you ever imagine spending your spare time fighting government?
Doctors’ Response to Cuts
Doctors at the lowest end of the fee scale and those with the biggest cuts react first. They are marginal customers, those most sensitive to changes in quality or price.
Initially doctors just grumble, work more and adjust their services. As cuts deepen, doctors lash out. After years of repeated cuts, blame and slander, doctors give up. They reach a point of readiness for substantial change.
Grumble and Shift
Doctors cope by working longer and harder. It’s their first response.
Then, they adjust their clinical time. Doctors start to:
- Offer shorter visits.
- Consider fewer problems per appointment.
- Down size their practice.
- Move into cosmetics.
- Take more time off.
- Close satellite clinics.
- Spend more time operating on WSIB patients
- Expand time with military clinical services
- Retire
These are not threats. They are facts.
Speak Out
After 2 1/2 years of cuts, grassroots doctors explore activism. Small coalitions of frustration pop up. A group of Ontario MDs formed on FaceBook with over 11,000 members. They met with MPPs, media and mobilized to Queen’s Park. They got heard.
Seek Substantial Change
But activism without outcome does not satisfy. Doctors diagnose and treat. They care by doing. Without tangible outcomes, doctors start to fidget. By nature and training doctors want to identify work accomplished.
Doctors have two options, change work or change the system.
Journalist Andre Picard wrote an article telling doctors to relax. Stop sounding so entitled. Empty threats of leaving sound pathetic. Government should just say, “There’s the door.”
Many have left. Young doctors plan to leave as soon as they can. Two patients asked to join my practice last week; their doctor had gone back to Florida to escape Premier Wynne’s attack on doctors.
But even more doctors leave in a different way. They check out. They give up trying to change the system. They turn attention to work that offers tangible outcomes. A number of physician leaders in medical politics have said, “I’m done.” They already have jobs in related administration or some other area.
In many ways, this helps government. Government would love novice or less passionate doctors to step up.
Doctors tell unbelievable stories. They talk about horrible hours, disrespect and a grim future for medicine. At some point people start asking docs, “So, how’s that working for you?” What they really mean is, “Why don’t you change jobs?”
Doctors are human. They cannot perform when demoralized. We do not want doctors shifting their time away from patients or considering other careers. But it’s happening. As healthcare unravels, we might ask voters, “So how’s that working for you?”
photo credit: pinterest.com
Well said, Shawn. My speciality (Nephrology) was heavily targeted in 2012 (nearly 12 percent loss) and then Feb 1st of this year (loss of the E078 code)(an additional 20 percent loss). Most people were very unsympathetic at that point because of the thought that we are very highly paid in comparison to the rest. Unfortunately, like all numbers, there are errors and spin. When actually adjusting for the correct number of practicing nephrologists the average nephrologist actually bills less than the reported number quoted by Hoskins. I am not asking for any sympathy at all but certainly appreciate your point about adjusting practice. There is no question that I’ve reduced my expenses significantly and find myself doing more sponsored talks and other type of consulting work (not sure if this is good or bad but it certainly forces me to read more!). I also really appreciate the patients that actually don’t have a health card and have 3rd party insurance (out of country patients or those that opt out). These people are not subject to the clawback or cuts and so incredibly appreciative for the care they receive…I think it’s because they actually know the cost of each hospital, physician and ancillary service. As for exiting the system, I’m sure the time will come when it isn’t worth it from a stress perspective. I’ve been around long enough to realize that you should do medicine for yourself and for your own fulfilment. You will help and care for people in the process but that is a side effect of your work. I love what I do because that is what is fulfilling…once the activation energy crosses that threshold, it will no longer be fulfilling and I will exit the system. Thanks again for your blog.
Thanks Mark!
I especially liked your comments about people being “so incredibly appreciative for the care they receive” when they had to pay for it. Bang on. Ideology aside, Tommy Douglas said we all value what we pay for. So Tommy insisted we had to pay a little something even for the ‘free’ care we receive.
You make another great point. Docs will drift their clinical time, even if they do it unconsciously. Patients will feel the impact.
Thanks SO much for reading and sharing. Personal experience holds much greater weight than any stories I could tell.
Best regards,
Shawn
Query why some of your colleagues who are specialists continue to “assist” OHIP against residents of Ontario in legal proceedings at the Health Services Appeal and Review Board. Query whether they are supplementing their income in that OHIP pays them a substantial hourly fee plus expenses.
Great question!
Great article. We know that Ontario has the lowest number of MDs per 100,000 population. We also know from CIHI that we have the lowest fee for service across canada. So when dr Hoskins and our premier talk about Ontario MDs being the best paid on average one of 2 things are happening(excluding APP and capitation payment models). Either they are lying or the MDs are providing a greater number of services to get to that highest avg billing.
If the second is true, then MDs are already at a burn out stage. This will simply push them over the edge. We have seen that on the concerned MDs Facebook site. One simply cannot continue to provide that level of service when one is denigrated and laughed at when called human. Expect consequences of reduced services as MDs look to become more “human” and start cutting back or leaving for places where they are respected for their dedication and being “human”
Thanks for this, Brad. Excellent points all!
For good or bad, government tries to manipulate our behaviour to align with the ideologies and political aspirations of those in power, as well as fiscal constraints. This is not necessarily rational nor in the best interest of patients and providers. Docs opposed to socializing healthcare at the outset likely saw the downside of becoming public employees. Despite cuts however, MOH is still funding rural and northern, as well as emergency locum physicians in under serviced areas disproportionately. There remain opportunities for personally rewarding work that serves our patients and pays reasonably well.
Thanks for offering a glimmer of hope! There are places desperately in need of docs in the north. I’m sure residents are looking. Thanks for taking time to comment!