Eyeworld

EW NEWS & OPINION 22 December 2016 To the point: Simple practice tune-ups for complex times by Corinne Wohl, MHSA, COE, and John B. Pinto to teach or learn. Such alignment takes energy and commitment from the top to supersede personal pref- erences and longstanding internal conflicts. Why is it tempting for indi- viduals to make decisions without thinking of the entire practice? • Employees are generally evaluated and rewarded as individuals, not as teams. • Doctors are often economically rewarded based on individual performance. • Self-motivation is common for super-achievers often found in health care settings. • Favoritism by doctors or manage- ment can stoke this fire. • Perhaps most important is a lack of communication about overall practice goals. Here are five ways to help prevent turf wars from adversely im- pacting judgment and decision-mak- ing—and perhaps for also cooling down the turf wars themselves. 1. Promote formal, written, regularly scheduled communication about common practice goals—not just long-term company goals, but day-by-day imperatives to increase patient satisfaction and care excellence. est, and not necessarily worthiest, pod getting attention and resourc- es from management. • Another common conflict that can impair management and boardroom decision-making is the struggle between reception and tech staff cohorts. Appointment schedulers just trying to follow the booking rules conflict with techs trying to lighten the load for their doctor. Practices run at their best when doctors and staff understand that functioning collectively as one co- hesive team ultimately benefits all. But this is often not an easy lesson department and the front office staff. Because each of these two departments depend on each oth- er's work being correct, and they don't appreciate the pressures and constraints each side experiences, each side tries to convince upper management and the board (the ultimate decision-makers in the practice) that the "other" side is incompetent. • Turf wars can surface between technician/doctor pods in your clinic area, with each side feel- ing competitive or protective of its own subspecialty area and its needs. This can result in the loud- "Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them." –Paul Hawken D ecision-making that consistently prioritizes the practice and its patients— rather than doctors and workers—leads to organi- zational success and ultimately the benefit of all. In contrast, poor decisions flow from paying too much attention to the various "sides" in your practice, and the turf wars that quietly (or loudly!) bubble up in any large, complex organization where the stakes are high and the people are smart. Over-hasty decisions that ben- efit only individual providers, man- agers, or specific departments, more than the overall practice, may feel the most expedient in the moment, but can often backfire over time, to the detriment of patient care and overall financial performance. Are underlying turf wars impact- ing not only behavior but also your practice's problem-solving ability? Turf wars can crop up in differ- ent ways. • Classically, they may emanate out of friction between the billing Are turf wars impacting decision- making in your practice? Like others, Dr. Goldman noted considerations other than starting salary. "[There are] much more import- ant details such as buy-ins, which often they won't offer right away, but at least you can see what the pattern is if they've allowed others to become partners and what their structure is," Dr. Goldman said. The AAO survey found that while partnership was offered to 72% of job switchers, only 25% were aware of partnership conditions upon hire. Conversely, 92% of job retainers were offered partnership, and 64% were aware of partnership conditions at hire. Dr. Goldman thinks the best way to learn more about a practice is from pharmaceutical and surgical representatives. "They get to see how a practice truly runs, how the physician treats others, and how that practice com- pares to others in the area," he said. As for the issue of preferred loca- tion and the potential for saturation in some markets, Dr. Goldman said he tells people to "practice where they want to practice." "You have to be happy, and if you're making a lot of money in an area you hate, you won't be hap- py," he said. "No matter where you practice, as long as you provide good care, you will be successful, it just may take a little longer." Large, regional HMO Being based in Orange County, Cal- ifornia, Ken Lin, MD, PhD, Irvine, California, is in one of the most saturated areas of the country. With his fellowship in the same area, he was able to interview for jobs that weren't traditionally advertised, finding connections through local drug reps and preceptors. Just out of fellowship, Dr. Lin landed at a private practice as a glau- coma specialist where he stayed for a year before joining Kaiser Permanen- te. He also maintains an affiliation with the University of California, Irvine. "I am fortunate to have a hybrid model in which I can combine teaching, research, and private practice," he said. Dr. Lin recommended job seekers make a list of the five most important things to their happiness in the next 10 years and prioritize them. While most people can't have it all, "you are way ahead if you can achieve your top two items on the list," he said. "By spending a good hour and having an honest self discussion of what aspects of career and family are most important to your happi- ness, you can often arrive at what a good job should be. … Once you identify your priorities in life, you will excel at whatever [practice] setting," he said. Dr. Lin also recommended re- viewing this priorities list periodical- ly should they change as your career and family changes. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Goldman: drdavidgoldman@gmail.com Lin: link@alum.mit.edu Melendez: robertmelendez@mac.com Yeu: eyeulin@gmail.com Starting continued from page 20 continued on page 24

• Cover