Four Structural Changes Will Help Remodel the House of Medicine
A New Look at Work Habits, Productivity, Attitudes and the Work Environment
Women and men physicians work differently. The default for “how we should work” is based on the male model: work as many hours as possible, see as many patients as you can, in hierarchical settings. Where has this led us? To definitions of “productivity” which means work as many hours as possible, see as many patients as you can. And “professionalism” which means to keep an emotionally detached distance from your patients to preserve objectivity and rely on the “evidence” to care for and heal the patient, to relieve suffering and to understand their pain. What’s wrong with this picture?
Time to question this model as one to which we should aspire or emulate. So far the approach to the influx of women into the medical workforce has been to reprogram the women to work like the men. Bad move. Bad results. Time to think about restructuring the House of Medicine so that women physicians have a better time showing off their medical muscles and patients get a better deal–with more choice of how they are cared for and cared about.
In our last post, the “evidence” of research, incomplete and poorly done as it is, revealed 4 areas that women physicians have to remodel the House of Medicine both physically and functionally. These are: 1. physician work habits, 2. productivity measures, 3. attitudes by and towards women physicians, and 4. the actual work environment.
#1 Physician work habits (data from The Physicians Foundation 2012): In 2012, physicians are working 5.9% fewer hours than they did 4 years ago. Physicians are recognizing that with the increasing complexity of patients and the increasing demands of non-medically based work, e.g. maintenance of certification, compliance, HIPPA, and EMRs, there is more stress which results in less energy for patient care. So we self-regulate. Based on survey guesstimates (where women tend to under estimate what they actually do), women reported that they worked fewer clinical hours and saw fewer patients. I submit this is a good for those patients. Having a well rested physician who is not rushing through your visit to see the extra 2 or 3 patients that day. Reminder: energy is finite. Finding energy preserving work habits–such as increasing flexibility, predictability and control of one’s schedule–is beneficial to burned out docs and and to their patients. A huge change in work habits is needed for all.
#2. Productivity measures: All studies assign a negative value to the fewer hours or patients seen by women as a mark of their lesser value as doctors. The number of doctor FTEs is shrinking! goes the battle cry. Let’s use the thought processes (agree or not, and I don’t) that resident work rules as resulting in better rested, more focused residents. Why shouldn’t this same line of reasoning carry over into the hours and patient numbers for physicians? More is not better. More is just more. And better is not being measured. Time to get out a new measuring stick, a new ruler. Productivity measures need to become “evidence based.” Oh, what a novel concept.
#3. Attitudes by and towards women physicians: Women physicians spend more time talking to patients about preventative care. They do fewer procedures. The mechanistic, “let’s fix this broken piece of equipment (the patient’s body), is not the over-riding attitude exhibited by women physicians. Cost-benefit analyses of this “let time heal” approach is ripe for greater study. And as far as attitudes towards women, the not-too-well-hidden devaluation of women is in evidence by horizontally segregation–steering them into certain specialties where they are “better off ” and also, by the way, given less pay and prestige. And vertical segregation, keeping women at lower rungs of leadership, policy making and from being gatekeepers of what is the medical lexicon of evidence, hangs on the nasty hooks of gender stereotyping. Women cannot be assertive leaders and be seen as caring women. Attitudes are the hardest to change in a culture. The time is past to let it happen through the passivity of increasing numbers. Bold action steps to require new models is called for. How about turning over the editorial boards of journals every 5 years rotationally?
#4. The work environment: When we see patients, where we see them and what happens during an encounter is changing. New models from solo practitioners delivering care from their minivans right to the patients’ doors, to urgi-care centers, open 24 hours a day for ailments that are not “emergency room” material, are examples. What happens for the physicians? Increasing flexibility in hours and practice setting, greater predictability as to when and how we work, and greater control. New models, new interactions. We have abandoned the “living room/dining room” for the “great room” in our homes. Surely our hospitals and other medical workplaces could use some creative re-thinking.
And so there you have it. The bare bones prescription for how to remodel the House of Medicine for the benefit of its new women physician workers and all the patients for whom they will care for decades to come.