The cost of replacing a physician is estimated at anywhere from $150,000 to $300,000—but how do you calculate the cost of a physician who’s physically present in the exam room but mentally miles away?
When doctors are having personal problems—from marital or relationship issues, to children in crisis or elderly parents in need of care, to financial investments gone bad—it often has an impact on the quality and quantity of patient care that physician is able to offer.
“Physicians tend to believe that they are immune to stress,” explains Dr. Alan Rosenstein, medical director for VITAL WorkLife. “The reality is they are often unaware of the toll that stress is taking on themselves and their work.”
Common Stresses, Uncommon Costs
All employers pay a toll for distracted employees:
- Relationship-related stress costs employers about $300 billion annually (Velasquez-Manoff, 2005)
- A 2006 MetLife Caregiving Cost Study estimated that that an employee caring for an elderly parent costs his or her employer $2,110 per year
- Employees dealing with major financial problems cost businesses an estimated $15,000 per affected employee per year1
These are average costs—at healthcare organizations where highly compensated physicians make up the majority of the workplace, the cost of normal life distractions are exponentially higher.
Given the stress of their profession, physicians also experience more stress in their personal lives:
- The rate of divorce among physicians is estimated to be 10 to 20% higher than in the general population.2
- Surgeons married to surgeons experience greater challenges balancing personal and professional life than surgeons whose domestic partners were employed in other professions or stayed at home.3
- According to The Annals of Internal Medicine, at least one-third of all physicians will experience, at some time in their careers, a period during which they have a physical, mental or behavioral condition that impairs their ability to practice medicine safely
Clearly it benefits healthcare organizations to intervene quickly and compassionately when they see that a physician’s personal problems are beginning to affect on-the-job performance.
Extreme Distractibility: A Case In Point
Rosenstein cites the example of a family practice physician referred to VITAL WorkLife who’d been going through a particularly difficult divorce while at the same time struggling with an adolescent daughter who’d been in and out of treatment for a variety of behavioral health issues.
“He was so concerned about his daughter that he dropped everything to accept cell phone calls from her and her siblings, no matter what he was doing,” recalls Rosenstein. “Patient feedback about the distractions was reaching not just his colleagues but the CEO of the organization.”
In addition to distracted patient care and disruptions in the schedule, the physician had also fallen deeply behind in case management and record keeping. The decision to refer the physician to VITAL WorkLife was not an easy one. The organization very much wanted to retain the physician, whose contributions were highly valued and whose performance, until recently, had been above reproach.
Working with the physician and referring practice, the VITAL WorkLife team made a thorough evaluation of the situation and developed a performance improvement plan for the distracted doctor that included:
- An agreement that his cell phone wouldn’t be taken into the exam room
- A temporary reduction in administrative duties and clinical load to give him time to catch up on his cases and medical records
- A therapist to help the physician work through his marital and parenting issues
- A Physician Peer Coach to work with the physician on more effective ways to balance his work and life issues
- An evaluation and coordination of the family counseling and behavioral health resources being provided to the physician’s family (at the request of the physician and with full permissions).
“In this instance, the physician was unaware of how his behavior was affecting patients, colleagues and staff,” notes Rosenstein. “He was actually somewhat grateful for the heads up and appreciative of the support the organization was willing to extend.”
The referring organization was able to see immediate and noticeable improvement and was kept apprised of the physician’s progress on a regular basis for a year, at which time it was agreed by all parties that the performance issue had been resolved and the ongoing family issues were being appropriately handled.
Clear Performance Issues, No Clear Cause
In smaller practices or medical groups, colleagues often know the underlying causes of a change in behavior: “He’s going through a divorce,” or, “Her father’s in the hospital.” However, staff at a hospital may have no idea why a surgeon suddenly becomes bullying or dismissive every time he or she makes rounds.
Rosenstein recalls a specialist referred by an organization concerned that one of its top performers had become so offensive to staff at area hospitals that his privileges were at risk.
“While the organization had no idea what was causing the behavior, the impact that allowing this behavior to continue would have on hospital staff and resulting quality of patient care was clear,” notes Liz Ferron, senior consultant for VITAL WorkLife. “There were also serious financial implications for the practice if hospital privileges were withdrawn.”
“We did a thorough assessment to rule out mental health and substance abuse issues,” says Rosenstein. “Ultimately, we discovered that while the doctor had typically used a certain amount of bullying and intimidation as a means of ‘motivating’ staff, those behaviors had intensified as the physician’s marriage had started to unravel.”
In this instance, feedback on his management style was not particularly welcome to the specialist, who insisted that he was only treating staff the way he’d been treated during training and that he couldn’t be expected to “suffer incompetency.”
“This physician had always been something of a workaholic,” notes Rosenstein. “As his home life become more fractious, he spent more and more time at the office and became more and more abusive to those around him.”
The performance improvement plan for the bullying specialist included:
- Therapy for his marital and work/life balance issues
- Coaching by the VITAL WorkLife senior consultant on the case on implementing a more “team-based” approach to working with staff
- Permission for VITAL WorkLife to monitor the physician’s participation and cooperation in recommended therapies and report back to the referring organization
At the end of the first year, the doctor had made significant progress and the organization was satisfied about his job performance. He continued to take advantage of the therapeutic resources available to him, but no further monitoring or reporting was required.
Combining Intervention & EAP: A Compassionate Approach To Work & Life Issues
When a physician is struggling with a personal issue, most healthcare organizations struggle to balance compassion and respect for privacy with concern about how a physician’s behavior will affect not only patient care but also the organization’s liability and bottom line.
VITAL WorkLife offers a discrete, compassionate intervention service that allows organizations to refer the physician for help. Once a referral is made, VITAL WorkLife comes in, does a comprehensive assessment, develops a plan, refers the physician for any needed support therapies or services, gets permission to monitor and coordinate services and provides progress reports back to the healthcare organization. Watch our video below to learn more about our Physician Intervention solution:
In addition, those with our Physician Well Being Resources can suggest that physicians who appear to be struggling with issues in their personal lives seek assistance and guidance on their own—for themselves and for their family members, who are also covered by the plan. They will have access to highly-qualified senior consultants and Physician Peer Coaches who can ensure that they can effectively identify the issues and get the resources they need, so that their personal lives don’t carry over into their work lives.
“The bottom line is that healthcare organizations can provide physicians all the help they need to become or remain productive without getting into the nitty-gritty details of the physician’s personal life,” says Ferron.
We Can Help
For more information, on our Physician Well Being Resources or Physician Intervention solution, contact us or visit our website at VITALWorkLife.com
Sources:
1 Journal of Employee Assistance, 1st Quarter, 2009, January 1, 2009
2 Sotile WM, Sotile MO: The Medical Marriage: A Couple’s Survival Guide. New York, Carol Publishing, 1996
3 Liselotte N Dyrbye, MD, MHPE, FACP, Tait D Shanafelt, MD, Charles M Balch, MD, FACS,Daniel Satele, BA, Julie Freischlag, MD, FACS “Physicians Married or Partnered to Physicians: A Compartive Study in the American College of Surgeons,” 2010 by the American College of Surgeons
