Alternative Practice Options. Upfront Questions

Alternative Practice Options

Jay Kaplan, MD, FACEP

President-elect, American College of Emergency Physicians

Practicing Clinician and Director, Patient Experience, CEP America

Upfront Questions

What do you want? Are you getting it? Do you love what you are doing?

Are there things in the way of your loving it more?

Emergency Department Workday Assessment Work should be enjoyable. We want to make every workday satisfying and fulfilling.

Please rate TODAY ’S workday.

1=not wort h it at all 2=poor 3=fair4=good 5=fabulous

1.Overall e njoyment of the workda y. 1 2 3 4 5 a. What got in the way or contributed to being a great workda y?

______ ___ __ _________ ___ _________ ___ ___________ _____ __ _____ _____ __ _______ _ ______ ___ __ _________ ___ _________ ___ ___________ _____ __ _____ _____ __ _______ _ b. If not a grea t da y, please give s uggestions for pre ve nting recur rence of the s ame

has sle/problem.

_ ___ __ _______ ___ ________________ ____________ __ _______ ___ __ _______ ___ __ _______ __ _ __ __ _________ ___ _________ ___ ________________ __ _____ _____ __ _______ _ c. If a gre at day, pleas e say why and how we can ensure you have more of the same.

_ ___ __ _______ ___ ________________ ____________ __ _______ ___ __ _______ ___ __ _______ __ _ __ __ _________ ___ _________ ___ ________________ __ _____ _____ __ _______ _ 2.I was treate d with respe ct and courtesy by a ll me mber s of the health care t eam.1 2 3 4 5 3.Others were approa chable with questions and/or s ugges tions. 12 3 4 5 4.Ea se of wor king with other membe rs of the ED. 12 3 4 5 5. Communications regar ding patient plan of care treatments/tes ts. 12 3 4 5 6. I felt a cooper ative attitude fr om hospital departments outside of ED. 12 3 4 5 7. I felt like I was a part of a team working together for ever yone’s benefit. 12 3 4 5

(ED sta ff, pat ie nts , medica l staff, etc.)

____ nurse ____ CIM

____ unit clerk/reg istrar ____ cl inical assistant Date: ________ ____ ____ physician ____ resident

____ PA ____ x-ra y te chn ician Shi ft (optiona l) ___ __________ ____ ____ patient re prese ntative ____ other __________ ____ Name (optional ) ___________ ____

What made your day a great workday?

If a great day, please say why and how we can ensure you have more of the same. What made your day a great workday?

If a great day, please say why and how we can ensure you have more of the same.

The First Question:

Why the Interest in This Topic?

The First Question:

Why the Interest in This Topic?

Real-Time Professional Sources of Stress

Work at all hours of the day and night Threat of Malpractice litigation Risk of infectious disease exposure Risk of violence

Illness/impairment

More Specifically . . .

Critically ill patients, one after another Staffing shortages

EHR/Computer anything Limited resources of facility Drug shortages

“Difficult” Patients (Intoxicated, Angry, Entitled, Drug-Seeking)

Emergency Medicine 4.1

Medical Residents & Burnout

Journal of Medicine 09/12

Residents who reported burnout symptoms

Feelings of depersonalization

Quality of Life “as bad as it could be”

51.5%

28.9%

14.8%

Burnout Further Defined

“Burnout is the chronic condition of perceived demands outweighing perceived resources.”

- Gentry & Baranowsky 1998

“Compassion fatigue is burnout + secondary

traumatization.”

Overview

• What turns you on?

• What turns you off?

• Do you have written professional goals?

• What are your options?

Create a Balance Sheet

Need: “a physiological or psychological requirement for the well-being of an organism.” Want: “the state or condition of

not having any or enough of something; something desired.”

Self-Assessment

Do you have the interest? Do you have the skills? Do you need/want?

MBA CPE JD MPH

How Can You Get the Education You Need?

Study on your own

Join organizations, e.g., AAPL (formerly ACPE), NAEMSP

Seminars/Conferences

Degrees – for already engaged professionals – Masters in Business Administration, Masters in Health Sciences, Juris Doctor, etc.

Decide

Your passion Your income needs Your play needs Your flexibility

The number of clinical hours you desire

Key Decision Point

Revenue/unit of time expended:

$

You will not be paid for the time you spend in an activity . . .

You will be compensated for the value you bring to that activity.

Administrative Roles

Director (Associate Director) Fast-Track

Schedule maker Clinical Decision Unit EMS/Trauma Medical Informatics Resident education Ultrasound

Administrative Roles II

Director (Associate Director)

Performance Improvement/ Quality Assurance Patient Experience

Risk Management Reimbursement/Finance

Academics

How much protected time?

Protected for what?

Research Teaching Residency affairs Fellowship training

Strategies for Negotiation with Your Boss

You have special expertise.

It is a special interest of yours about which you feel strongly.

It will take a load off . . . You will do it well.

The ROI (Return On Investment) is . . .

Consultant - Operations

Administrative experience necessary Demonstrated results helpful

People skills crucial Travel can be extensive Great opportunity to see best/worst practices

Consultant – Medical-Legal

ACEP Expert Witness Reaffirmation

Credentials noted

Theater/Acting background helpful

Must understand concepts of duty/negligence/causation

Resort Doctor

Winters in Tahoe, Summers in the Caribbean?

Passion for travel

Few encumbering limitations Cruise/Vacation resorts Cruise line jobs often passed down.

(Check with the section)

Student Health Service

Regular hours Usually no call Salary with benefits Relatively healthy patients Have to be able to relate to adolescents

Prison Doctor

Legislator

Please get yourself elected!!

Pay is not great. The opportunity to make a difference is . . .

Pharmaceutical Consultant

Contact the Regional manager of your favorite pharmaceutical company to get started.

Author

Medical Humanities section Are you a writer?

Create a concept.

Find someone to write the book with you. Long timeline for publication

Speaker

A great place to start: your local community/ your hospital

Toastmasters Then: ACEP Speaker training extraordinarily useful. Create a library of stories

Tele-Health

Private Business

Medical informatics Venture capital consultant

Home Care practice – House Calls Free-Standing ED’s

Financial Implications

Clinical shifts: $$/hour

Medical Director: 4-6 non-clinical shifts/month @ the hourly

Other Admin roles: 1 non-clinical shift Medical-legal: $250-500/hour Consultant: $250-1000/hour

Speaker: $500-7500+/presentation or day Author: ?

Performer: Do it for fun

How to Get What You Want

Be up-front

If within the ED, express your interest Volunteering may be the way to begin.

If outside the ED, point out the value your activity will bring.

Wellness

Medical Humanities EM Practice Management

Cruise Ship and Maritime Medicine QI and Patient Safety

Emergency Medical Informatics

Find a Mentor

Mentor: “a wise and trusted counselor or teacher”

Someone who has “been there, done that.” Establish a relationship

Sponsor/Coach/Professional Trainer

Lessons

“You miss 100% of the shots you never take.”

- Wayne Gretsky

“I’m always doing things I can’t do. That’s how I get to do them.”

-Pablo Picasso

Passion

“The greatest force

on earth is the

human soul on

fire”

“The antidote to

exhaustion is not

necessarily rest . . .

It’s

whole-Summary

Start with your self-assessment Write down your priorities Identify needed skills Build a track record Find a mentor Don’t be afraid to fail

Without challenge there is no change. If you are always in your comfort zone, you are not where you need to be. We have got to get comfortable with being uncomfortable. Just because you can ride in spin class . . .

Doesn’t mean you can ride on the open road . . .

Excellence – What You Want

"Excellence can be obtained if you: ... care more than others think is wise; ... risk more than others think is safe; ... dream more than others think is practical; ... expect more than others think is possible."

- K. Sriram @ tompeters.com

Thanking you . . .

Jay Kaplan, M.D., FACEP

[email protected]