Are You Involved in Medical Practice Governance?

There is a concept in medical practice of good citizenship. This refers to going beyond just seeing patients and doing charts and rounding on patients. It involves committee attendance, practice meetings, voting on medical staff bylaws, and so on. And, it is in jeopardy. Years ago, this type of extension of clinical practice was commonplace. It was a chance to connect with colleagues, influence local hospital politics, and commiserate on the changes in healthcare. Nowadays, it feels like one more "to-do" on a list that already feels out of control.

Within my hospital system, we struggle to get all our physicians to call-group meetings, during which major decisions may be made about the future of our group. By necessity, these meetings occur before or after clinic hours, and therefore interfere with getting kids off to school, making it home for dinner, or any one of a number of other commitments most physicians have. Adding on committee work (a necessary component to deciding everything from how physicians are paid to clinical practice standards) further increases the time spent away from practice, family, and personal time.

As a working mom with too little time, I am sympathetic to those physicians who struggle with the time burdens associated with simply seeing patients. As a physician leader, I struggle to encourage my colleagues to participate in the very important work required to keep our collective practice running well. I think that issues around citizenship can be some of the most divisive in a call group.

It's not clear how to best encourage or mandate citizenship activities. In a healthcare system increasing focused on "revenue-generating" activities, meetings and committees don't receive high priority. In a society which emphasizes work-life balance and intensive parenting, it is no longer acceptable to most professionals to miss bedtimes and soccer games in order to sit in a committee meeting.

So where's the happy medium? I know that some healthcare systems either require or incent citizenship activities. It may be tied to compensation or be a required "gimme" that all physicians must participate in, uncompensated. Many organizations are probably like ours - balancing committee and other administrative work on the backs of those few brave and hearty souls still willing to volunteer. The former tends to be difficult to sustain in our increasingly lean healthcare reimbursement environment and the latter burns people out quickly.

In the strict focus on RVUs and productivity, it is easy to devalue other components of a successful medical practice. Yet, simply walking in the door at 8 a.m., seeing patients for eight hours, and then leaving your clinic at 5 p.m., is not likely to provide a well-run medical group. Compelling busy physicians to sit in a mandatory meeting produces exactly the type of uninspired involvement you'd expect. I do think, though, that many physicians are willing to sacrifice a portion of uncompensated time to make their clinical practice run better and improve the environment in which they exercise their profession.

The key, though, is to make the time well-spent. When you are giving up time with your family or time spent pursuing a hobby or time you could use to sleep, it is imperative that your time is treated like the precious commodity it is. It is essential that you see a result from the effort you put in. And it is crucial that you can directly see how your involvement impacts the larger practice. If we were able to provide better output in a shorter duration of time spent, I think we would have fewer problems with meeting attendance.