Peer comparison linked to increased physician burnout

[Chartreuse Wombat]

https://www.pnas.org/doi/full/10.1073/pnas.2121730119

"In our study, a commonly used behavioral intervention—informing physicians about how their performance compares to that of their peers—has no statistically significant impact on performance. However, it does decrease physicians’ job satisfaction and increase burnout."

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[deleted1116990]

Definitely a plus of being in a solo practice.
Downside is of course coverage (less of a concern these days) and greater likelihood an administrator will treat you as their subordinate.

 

[communitydoc13]

https://www.pnas.org/doi/full/10.1073/pnas.2121730119

"In our study, a commonly used behavioral intervention—informing physicians about how their performance compares to that of their peers—has no statistically significant impact on performance. However, it does decrease physicians’ job satisfaction and increase burnout."

Nice link.

Here's hoping that PNAS articles find their way into management culture.

I plan to share with admins.

 

[seper]

I get a bi-weekly email ranking everyone's collections

 

[BobbyHeenan]

This makes sense to me.

Take a 50 year old doc and tell him or her they need to start being faster/slower or change their practice for some metric and all it'll do is make them anxious and not actually change their practice.

Aside: I had a mentor/attending in residency that was pissed about some sort of huge admin scoring initiative (must've been press ganey or something). Anyway, the attending's score comes back super high, very excellent scores. He sends admin an email saying basically "anything you ask me to do other than what I'm currently doing now can do nothing but bring my scores down, so keep this in mind if you ask me to do X or Y differently."

 

[Ubba]

I get a bi-weekly email ranking everyone's collections

Can't imagine a more toxic environment

 

[dieABRdie]

We get a weekly email with an excel spreadsheet regarding everyone's outstanding documentation.

I've never read it. Immediately delete...

 

[ramsesthenice]

(must've been press ganey or something)

I hate Press Ganey. Our admin wants to talk about every negative one we get. I think tracking metrics behind the scenes and making sure there are not systematic issues is worthwhile. But do we really need a conversation about why I was running 30 minutes behind after you hand me a fully booked clinic schedule and expect me to take the occasional in-patient consult? One key to dealing with this kind of s*** is knowing who the real stakeholders are. For me, the chair is the person with absolute decision-making regarding anything I actually care about (raises, bonus, promotion, etc.) and his opinion is if you make everyone happy all the time, you probably are not making sound oncologic decisions at least some of the time. Im not rude to admin, but I answer their questions and shrug it off. I can't imagine working at a place where the admin's thoughts and opinions on stuff like this actually carry significant weight. I honestly don't think I could deal with it.

 

[RadOncMegatron]

Definitely a plus of being in a solo practice.
Downside is of course coverage (less of a concern these days) and greater likelihood an administrator will treat you as their subordinate.

I think the administrator treating physicians as a subordinate is a universal healthcare truth. Are they even our equals? (Can't believe I even have to ask... LOL)

 

[RadOncMegatron]

I hate Press Ganey. Our admin wants to talk about every negative one we get. I think tracking metrics behind the scenes and making sure there are not systematic issues is worthwhile. But do we really need a conversation about why I was running 30 minutes behind after you hand me a fully booked clinic schedule and expect me to take the occasional in-patient consult? One key to dealing with this kind of s*** is knowing who the real stakeholders are. For me, the chair is the person with absolute decision-making regarding anything I actually care about (raises, bonus, promotion, etc.) and his opinion is if you make everyone happy all the time, you probably are not making sound oncologic decisions at least some of the time. Im not rude to admin, but I answer their questions and shrug it off. I can't imagine working at a place where the admin's thoughts and opinions on stuff like this actually carry significant weight. I honestly don't think I could deal with it.

Admins don't want any responsibility for understaffing and denial of other resources. All patient dissatisfaction comes from the doctor. Press Ganey should have a rating for admins to spread the pain.

 

[Sheldor]

Anybody have any thoughts why peer review is so rampant in Rad Onc? Why aren't surgeons required to run their surgical plan by a peer before performing surgery? Med Oncs don't review each other's chemo regimens prior to treatment in a standardized, required fashion. It has always struck me as odd how obsessed we as a field are with peer review. Yet another way we shoot ourselves in the foot

 

[evilbooyaa]

I hate Press Ganey. Our admin wants to talk about every negative one we get. I think tracking metrics behind the scenes and making sure there are not systematic issues is worthwhile. But do we really need a conversation about why I was running 30 minutes behind after you hand me a fully booked clinic schedule and expect me to take the occasional in-patient consult? One key to dealing with this kind of s*** is knowing who the real stakeholders are. For me, the chair is the person with absolute decision-making regarding anything I actually care about (raises, bonus, promotion, etc.) and his opinion is if you make everyone happy all the time, you probably are not making sound oncologic decisions at least some of the time. Im not rude to admin, but I answer their questions and shrug it off. I can't imagine working at a place where the admin's thoughts and opinions on stuff like this actually carry significant weight. I honestly don't think I could deal with it.

I consider myself fortunate that I have not once heard about Press Ganey. The entire concept of Press Ganey and 'patient satisfaction' has been shown to actively worsen patient outcomes. Not sure if the study has been debunked but I like what it's selling, so I'm buying.

 

[RadOncMegatron]

Anybody have any thoughts why peer review is so rampant in Rad Onc? Why aren't surgeons required to run their surgical plan by a peer before performing surgery? Med Oncs don't review each other's chemo regiments prior to treatment in a standardized, required fashion. It has always struck me as odd how obsessed we as a field are with peer review. Yet another way we shoot ourselves in the foot

I cannot tell you how much I agree with you.

 

[deleted1116990]

Anybody have any thoughts why peer review is so rampant in Rad Onc? Why aren't surgeons required to run their surgical plan by a peer before performing surgery? Med Oncs don't review each other's chemo regiments prior to treatment in a standardized, required fashion. It has always struck me as odd how obsessed we as a field are with peer review. Yet another way we shoot ourselves in the foot

I have no idea. If you have people in your group who are not very competent or reckless it can be helpful to catch particularly egregious stuff.

But I have personally experienced a physicist demanding that I present patients in a "peer review" to the entire staff as the only MD there. They were my "peers." Hard no. I am not going to waste my time justifying my treatment plan to RTTs and dosimetrist and fielding questions challenging why are we doing BID, contrast sim is unnecessary, etc. Admin came and tried to make me do it anyway and told me I needed to be more agreeable refusing to do these meetings made me a poor communicator and endangered patients. They also wanted to have a separate weekly meeting where I summarized every single OTV visit to the entire staff. Total joke.

 

[Fpg1245]

I had this done to me as a resident. They told me to get used to it because everyone does it. I’m glad someone finally stated the obvious.

 

[medgator]

I cannot tell you how much I agree with you.

Part of the imposter syndrome/inferiority complex/masochism inherent in the field imo.

Essentially spits in the face of the multi-part BC examination process we go through (including an oral exam not present for anything outside of surgical specialties these days)

 

[theradiator]

Where is our non-inferiority trial when it is actually needed?

 

[fiji128]

I did intern year at a very large hospital in a top metro area. The orthopedic surgeons definitely did a department wide X-ray based chart rounds. No idea how common something like that is. Pathology departments also do consensus rounds any place I've been. So this isn't something unique to rad onc.

 

[NotMattSpraker]

Admins don't want any responsibility for understaffing and denial of other resources. All patient dissatisfaction comes from the doctor. Press Ganey should have a rating for admins to spread the pain.

This would be brilliant. Anecdotally, a significant number of PG surveys seem to have comments in there where the lower scores are driven by systems issues... could easily be considered an "admin" score there. Perhaps there should be a quality withholding from their salaries.

 

[BobbyHeenan]

This would be brilliant. Anecdotally, a significant number of PG surveys seem to have comments in there where the lower scores are driven by systems issues... could easily be considered an "admin" score there. Perhaps there should be a quality withholding from their salaries.

You mean like the "long wait time to see the doctor" when you take a look is due to the front office taking forever to do paperwork/check in the patient.... and it taking the nurse forever to room the patient because the hospital expects wizard level skills from $12-15/hour front desk worker that is under staffed and a barely paid more than that nurse that has to do 15 MIPS metrics on the computer that is also under staffed?

But by all means, the doctor is way too slow in clinic so you better pick up the pace and get those scores up.

 

[deleted1111261]

We are so understaffed it is insane. Small town, limited available workers…

 

[NotMattSpraker]

You mean like the "long wait time to see the doctor" when you take a look is due to the front office taking forever to do paperwork/check in the patient.... and it taking the nurse forever to room the patient because the hospital expects wizard level skills from $12-15/hour front desk worker that is under staffed and a barely paid more than that nurse that has to do 15 MIPS metrics on the computer that is also under staffed?

But by all means, the doctor is way too slow in clinic so you better pick up the pace and get those scores up.

Yes. Long wait time for the lab too. Confusing communication on start dates, insurance, you name it. Of course it all rolls downhill to the front line workers.

 

[deleted1116990]

My experience with Press Ganey was having the same stupid meeting every month about patients not knowing how to score the "staff reviewed my medication list" question and not marking it perfect. So we had to waste 15 minutes pre-consult talking about labetalol dose and Symbicort frequency, and the numbers still didn't go up. Sorry sir, I have 5 other consults today, I don't really have time to get into specifics about your prior radiation history but lets talk about these 35 medications you have here. Oh, you are not sure if you take the purple one anymore? Was it the big purple one or the little purple one?

Kill me.

 

[deleted1111261]

My experience with Press Ganey was having the same stupid meeting every month about patients not knowing how to score the "staff reviewed my medication list" question and not marking it perfect. So we had to waste 15 minutes pre-consult talking about labetalol dose and Symbicort frequency, and the numbers still didn't go up. Sorry sir, I have 5 other consults today, I don't really have time to get into specifics about your prior radiation history but lets talk about these 35 medications you have here. Oh, you are not sure if you take the purple one anymore? Was it the big purple one or the little purple one?

Kill me.

Don’t do it.
Uncivil disobedience
Gandhi, but with anger and malice
Take your 1% performance bonus and shove it up your ..

 

[taserlaser]

We are so understaffed it is insane. Small town, limited available workers…

I’m in a huge centre (>20 ROs) in a publically funded system. We are so short physicists, therapists, ugh. Right now we’re down a few working machines and treating to 9pm and some weekends this month. Yayyyy

 

[medgator]

I’m in a huge centre (>20 ROs) in a publically funded system. We are so short physicists, therapists, ugh. Right now we’re down a few working machines and treating to 9pm and some weekends this month. Yayyyy

Just raised our chief physicist's pay after he got a compelling offer from a practice not far away.... such a shortage with that residency requirement now in effect for new grads. It is making the existing physics market very much a sellers market.

 

[Fpg1245]

I’m in a huge centre (>20 ROs) in a publically funded system. We are so short physicists, therapists, ugh. Right now we’re down a few working machines and treating to 9pm and some weekends this month. Yayyyy

Sounds like a wonderful day at PMH. Glad I’m not there

 

[taserlaser]

Sounds like a wonderful day at PMH. Glad I’m not there

Don’t want to self dox, but me too haha

Lots of love to my Toronto colleagues in all sincerity though. Hope you all are enjoying CARO

 

[ramsesthenice]

My experience with Press Ganey was having the same stupid meeting every month about patients not knowing how to score the "staff reviewed my medication list" question and not marking it perfect. So we had to waste 15 minutes pre-consult talking about labetalol dose and Symbicort frequency, and the numbers still didn't go up. Sorry sir, I have 5 other consults today, I don't really have time to get into specifics about your prior radiation history but lets talk about these 35 medications you have here. Oh, you are not sure if you take the purple one anymore? Was it the big purple one or the little purple one?

Kill me.

Poorly interpreted surveys don’t kill people. Stupid people kill people.

Seriously though, that’s the problem with a lot of these metrics. People don’t understand the difference between QC and QA. As a tool, PG is supposed to help identify PATTERNS, not individual negative experiences. But that’s not how many people treat them. The sad thing is it puts a bad taste in our mouths of something that can otherwise be useful and productive if used properly. This is in contrast to sharing things like other folks billing records or documentation deficiencies. The goal of those shenanigans is shame. Plain and simple.

The one thing I have to say though about PG is who the hell are these people that complain about the doctor being 30 min behind? I can’t remember the last time I went to the doctor and there were not that far behind (or worse) unless I was the first visit of the day.

 

[communitydoc13]

PG is supposed to help identify PATTERNS, not individual negative experiences

Every time. Pretty much all data does this. @TheWallnerus was discussing exceptional outcomes on the benign condition thread and how it's hard to report and often not reported. This is because you can't apply usual statistical reasoning to these things.

Admin will come to me about a single disgruntled patient who received care from a very high performing doc and ask "what should we do about this"?. I always say, "Apologize to the patient, encourage feedback, document the complaint and then ignore it. If there is a pattern, we will know."

Someone wanted to compare PG scores from a doc who received 60 completed questionnaires to another who received 2 and factor this into compensation.

Should be a Stats for Admins class out there.

 

[metallica81788]

On those surveys you receive one 4/5 rating and it plummets you to 20th percentile because of they way it's all measured
One "bad" rating will tank a Radonc's year if they only have a few patients responding to surveys.
Hospitals won't flinch to threaten to withhold 10% of your pay.

 

[Palex80]

https://www.pnas.org/doi/full/10.1073/pnas.2121730119

"In our study, a commonly used behavioral intervention—informing physicians about how their performance compares to that of their peers—has no statistically significant impact on performance. However, it does decrease physicians’ job satisfaction and increase burnout."

Does this also apply if you are better than your peers?

 

[RickyScott]

Just raised our chief physicist's pay after he got a compelling offer from a practice not far away.... such a shortage with that residency requirement now in effect for new grads. It is making the existing physics market very much a sellers market.

My dosimetrist makes quite a big more locumsing (on a per plan basis) than I do. I can babysit for 8 -10 hours in my market at 12-1500. She does 3 imrt plans in about 5 hours for more.

 

[Gfunk6]

re Press Ganey - all Rad Oncs who have to suffer through these ought to get a list of patients that the surveys were mailed to. That way we can call those patients ahead of time:

"Hello [your name], it was a pleasure treating you the other day. You will be receiving a Press-Ganey survey rating my performance. Please know that if you give me anything less than a 10 in all categories, it will be flagged and I will have my compensation cut by our Chair. If you think that any aspect of my performance was less than a 10, please call me personally so that I can make it right. Thank you.”

* Slightly altered repost from Business of Rad Onc forum