Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why managing physicians is like herding cats

Hans Duvefelt, MD
Physician
October 8, 2017
Share
Tweet
Share

One cold winter night many years ago, someone dropped off a calico cat and her two kittens in our snowy driveway, and we went from a two cat family to a five cat household. I learned a few things from that.

When I was a resident, two thirtysomething family docs had an office upstairs from the residency program. Ned and Peter precepted us, and they sometimes ran downstairs to ask the director, Dr. Pete, for his input when they had a tough case themselves.

It was very clear to me that Ned and Peter had a shared vision of how a practice should run, even though I’m sure they weren’t clones of each other. They also seemed to be really in tune with the residency, and one of them later became its director.

My first job after graduation was with two middle-aged doctors in a small Maine mill town. They covered seamlessly for each other, even though they seemed like very different people. I realized quickly that my comfort level with some of the things they tackled in the hospital was never going to catch up with theirs, so I moved on to where I am now the medical director. I did express my discomfort with handling patients in the intensive care unit, for example, and they did tell me they were considering giving it up, but not right away. I was their employee, and although they offered me a partnership, they were the majority and the founding partners.

The clinic where I ended up spending most of my career is very different, and very typical for medical practices today. We are a nonprofit organization with a board and a chief executive officer. I may be the medical director, but the physicians and nurse practitioners here really answer more to the CEO than to me.

The providers here are a little like my one-time herd of five cats, gathered under one roof by circumstance rather than from a clear and particular desire to work with each other. Sure, Dr. Brown was my doctor when he worked in the city many years ago, and he came here in part because he knew me, and Dr. Kim had practiced in the next town over and had been curious about us. He did call and talk to me before going very far in negotiations with our CEO, just to make sure he’d fit in, but others came here because of our location or some other reason besides knowing that we would all work well together or that we shared some deep practice philosophy.

We are not a group practice in the sense that group practices were formed when I started out. So my job as medical director is a lot more like herding cats than leading a group of like-minded visionaries in the early days of the new specialty of family practice. Also, because I care for a full compliment of patients alongside my colleagues and depend on their coverage and cooperation, I am in no position to be heavy-handed in leading our medical staff. I may work to set an example in some cases, by building consensus in others, but I seldom lay down commandments on stone tablets.

That is a stark contrast to Elijah Lamb at Cityside Medical Group. At his hospital owned mega practice, he isn’t just the medical director, but a hospital vice-president of medical affairs. He is more clearly in the chain of command, and his medical staff knows it. He even fires people.

Right now, a newly hired provider at my clinic is asking that we not contradict her antibiotic stewardship when she sees another provider’s patient for a bronchitis. I did a “practice style inventory” several months ago, and we all said we didn’t prescribe antibiotics for a bronchitis of fewer than seven days duration. But Karen knows we often do, and she feels we undercut her by giving in to patients that call us the day after seeing her.

We have also had several exchanges and meetings about how we handle opioid prescriptions. When one of my colleagues reduced her hours in semiretirement, Dr. Kim inherited many of her patients, and started tapering some off their opiates. Much unrest followed. We had to sit down to find common ground about whether patients could switch from Dr. Kim to another provider just to see if they would reinstate their opioids. We decided, along with our CEO, not to allow internal transfers of that nature. Anything else would likely tear apart the fabric of our group, we reasoned. Interestingly, the retiring physician told us that the patients Dr. Kim had tapered off opioids were people she herself had contemplated doing the same with. She just hadn’t done it yet.

Do I wish my job was more like Dr. Lambs? Would I be happy seeing a few token patients and spending the rest of my time being a medical administrator? I don’t think so, no more than I would have preferred not to live with five cats of different disposition.

As a doctor, I never tell my patients what to do. I outline, explain and support my patients in choosing between options. That is how I act toward my colleagues, too. Just like with integrating five cats, it may not be the quickest way to get things done, but in the big scheme of things, it is the only way that really works if you want peace in your house.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Don't take opioids off the market. Make it harder to abuse them.

October 8, 2017 Kevin 1
…
Next

How the pain scale and patient satisfaction leads to death

October 9, 2017 Kevin 8
…

Tagged as: Infectious Disease, Practice Management, Primary Care

Post navigation

< Previous Post
Don't take opioids off the market. Make it harder to abuse them.
Next Post >
How the pain scale and patient satisfaction leads to death

ADVERTISEMENT

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The risk physicians take when going on social media

    Anonymous
  • Beware of pseudoscience: The desperate need for physicians on social media

    Valerie A. Jones, MD
  • When physicians are cyberbullied: an interview with ZDoggMD

    Monique Tello, MD
  • Surprising and unlikely rewards of social media engagement by physicians

    Lisa Chan, MD
  • Physicians who don’t play the social media game may be left behind

    Xrayvsn, MD

More in Physician

  • How subjective likability practices undermine Canada’s health workforce recruitment and retention

    Olumuyiwa Bamgbade, MD
  • Why judgment is hurting doctors—and how mindfulness can heal

    Jessie Mahoney, MD
  • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

    Olumuyiwa Bamgbade, MD
  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why managing physicians is like herding cats
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...