Confidants Needed

How did internist Jennifer Hester wind up scouting cooking schools just a few years after completing residency? The same way so many young physicians find themselves disillusioned - tortured, even - by the realities of practicing medicine. She jumped wide-eyed into private practice, figuring the biggest challenge would be patient care, only to find herself drowning in more than she could handle, and without a confidant to turn to.

"All I wanted to do was help people," says Hester, 29, of her decision to become a doctor. But upon arriving at her first job in Kansas, she desperately needed someone to help her. Swamped by too many patients, nearly nonstop call, reams of paperwork, and unsympathetic partners, she was ready to leave after her first month.

"It was a horrible situation. No one told me how to do anything," she recalls. "They'd say, 'When you bill these things, code them.' Well, what do you mean 'code?' How do you code?" Does Hester's story sound familiar? Although well trained clinically, many young doctors struggle badly to manage time and business issues during their first years, and sometimes the stress can be overwhelming. More seasoned physicians may recall feeling the same way when they first started - and the practice of medicine has only gotten more complicated since then. Yet like the group in Kansas Hester went to work for, many practices seem unaware of, or uninterested in, their younger physicians' struggles. But a big part of the solution - mentoring programs that match younger physicians with more senior colleagues - aren't very hard to create, as long as you have would-be mentors who are willing and able.

Guidance is needed

Mentoring programs are common in much of corporate America. Why don't more medical practices have them? One reason is that senior physicians feel they're just too busy. Another may be the inaccurate perception that most new doctors will simply navigate their own way through their early months without much difficulty. Medical students and residents are often mentored formally, and practice partners may figure that's enough to prepare young doctors for all aspects of practicing from their first day on the job.

"We don't tend to have the same kind of formal mentoring programs in medicine for physicians as they do in a corporate environment," says J. Denise Clement, MD, who has been involved in several mentoring initiatives during her career. "I think it has to do with the way physicians are trained. Once you've finished residency, the expectation is often that you're now ready to go out and fully function."

Yet according to physicians who have mentored young colleagues, new doctors with stories like Hester's are becoming more the rule than the exception.

"In training, you're pretty insulated," says Scott Hughes, MD, who mentors several younger physicians in Plano, Texas, for the hospitalist company IPC. "But you get out there in the real world, and you're pretty much on your own." Most new doctors, he says, "feel overwhelmed, they don't know how to handle the load, they don't know how to manage time. They'll call me up when they're at the end of their rope, wanting to pull their hair out, thinking they made the wrong decision."

Even many experienced doctors feel, as Hughes does, that "practicing medicine is so incredibly difficult, the business aspect is so horrendous, that many physicians just get frustrated." Imagine what it's like for physicians who don't even know what it means to code, much less how to do it.

Research bears this out, too. IPC's vice president of medical affairs, Mary Jo Gorman, MD, MBA, says surveys indicate that new hospitalists frequently feel unprepared to practice despite their medical training. She believes the phenomenon applies to physicians in many settings.

"It's not clinical knowledge they lack - those things they know," Gorman says. "It's business and administrative things. They don't understand anything about billing. They don't know anything about risk management, like how to tell a family bad news. They don't understand what an HMO is, what Medicare and Medicaid are, why these things have come about, and why they have to be bothered with them." These are just the kinds of issues that a mentor can help a younger physician sort through, and doing so can boost retention and job satisfaction.

Mentoring basics

A successful mentoring program need not be expensive or elaborate, though it's wise to follow two principles: First, never try to force a reluctant senior physician into mentoring, since that will only sour his relationship with his charge. And second, set clear, reasonable expectations for the mentor's responsibilities. Your senior physicians don't have time to hold their younger colleagues' hands, and they shouldn't be expected to. It is often enough if the pair simply go to lunch occasionally, or spend an hour or two together each week.

If possible, try to match new physicians with mentor volunteers who seem as though they would like each other personally. That process is more art than science, but when it works out, it makes for a more productive mentoring relationship. It may be as easy as asking new hires if there is anyone they felt a connection with during the interview process or after their first week.

At IPC, mentors work in different locations from their charges; the relationship works best when new doctors feel free to discuss whatever is bothering them without fearing it will get back to their day-to-day coworkers. It also allows the protege to hear from someone whose perspective may be different from those of his practice partners.

What should mentors and proteges talk about? A good first meeting will cover the questions, fears, and goals that the less experienced physician has about his new job, as well as each party's objectives for their relationship.

How long should they stay in contact? As long as each party thinks it's necessary and the mentor is willing to serve. Most mentoring relationships taper off naturally as the younger physician gains his bearings, but many develop into long-term friendships.

Real-life results

Jennifer Hester left the practice in Kansas for SwedishAmerican Health System in Rockford, Ill., where she believed things would be better.  But shortly after her arrival, a busy partner quit, and suddenly Hester's patient load again spiked out of control. Because Hester is young and female, the departing physician's many women patients were excited to see her; but for the new doctor, it was like running with the bulls in Pamplona with her shoelaces tied together. The wait for new patients was as long as three months, and Hester was working 14-hour days.

"And I started thinking, 'You know, I don't think I like being a doctor,'" she recalls. "'This is just how it was in Kansas. I can't escape this. This is what medicine is, and I'm not cut out for it.' I actually started looking for other things to do with my life. I was really serious about it - I wanted to be a chef."

But it turned out she was right about SwedishAmerican - things would be different there. With a little help from her friend, that is. Pam Wetzel, MD, who had been assigned to be Hester's mentor, took action. Wetzel secured from practice administration a change in her protege's hours and a reduction in her patient load. She recruited other staff members to help rearrange Hester's office, creating a file system that stratified paperwork based on urgency. She instructed Hester on the ways of practice efficiency, advising her, for instance, to write notes and do dictation immediately instead of waiting until the day's end, when she would struggle to remember the details of patient encounters.

It is SwedishAmerican policy that all new physicians be matched with mentors, and thanks to that philosophy, Hester was able to regain control of her practice - and her blood pressure. Cooking school has been put off indefinitely. The group's president, Thomas Schilling, MD, says situations like Hester's are precisely the reason the practice developed the program. Imagine, he says, being new to private practice and new in town, and having a vast patient load dropped in your lap even before you've found a dry cleaner or a good Chinese take-out joint.

"It was really too much for any new person to assume," Schilling says. "We try to match up physicians and mentors who are appropriate for each other, and we ask our mentoring doctors to engage in several activities," including holding regular meetings with their charges, helping them on business and efficiency issues, and showing them around town. "It's very valuable for these new people, because there's such a huge difference between life as a resident and life as a practitioner."

But it isn't just the new doctors benefiting from the program; Schilling says it's important to the entire practice, because it boosts physician retention (which saves money), and it increases physician productivity (which makes money). It also helps create a spirit of collegiality, so that it's more than the doctors' contracts binding them to the practice.

As for Hester, she's so happy these days that she's almost giddy. She talks of SwedishAmerican as her "family," and one gets the impression that it would take a lot to pry her away from the practice.

"Because of Pam, they listened to me, and they took care of me," Hester says. "Pam was my savior. If it wasn't for her, I might not be a doctor."   Bob Keaveney, editor for Physicians Practice, can be reached at bkeaveney@physicianspractice.com. 

This article originally appeared in the April 2003 issue of Physicians Practice.