One of the great lessons I took from my experience in my first job was to spend more time with a potential team before signing on a contract. Things are often not as they seem. My partners sold me a specific image of the practice.
They were, they said, a tight group of doctors who were passionate about providing rural healthcare in all settings: clinic, nursing home, emergency department, and hospital. This was the perfect description of what I wanted to do, I thought.
I left my first medical staff meeting thinking, “What the hell is going on here?”
The vitriol, anger, and greed I heard in that meeting shocked me. I had never heard people talk more aggressively about money. Anytime someone floated a proposed change to staffing, coverage, or practice the meeting devolved into a squabble over potential effects on earnings.
I had thought that my partners were passionate about providing healthcare to this rural community. Instead, they were passionate about making as much as possible while providing healthcare to this community. Now, I am sure they would disagree with my assessment – greed seems perennially justifiable.
I have thought a lot about how we said the same words and yet meant completely different things. I have boiled it down to the difference between these two words: winning and success.
Why Winning and Success are not synonyms
While winning and succeeding seem similar aims, their underlying requirements vary in one significant way: comparison. We must have a yardstick to assess a win and success. The difference is which yardstick we use.
When framing accomplishment in terms of winning and losing, the yardstick becomes the performance of another competitor. When we talk about success, the yardstick can be any number of measurements. Success can stand on its own, a win necessitates another’s loss. A near limitless number of participants can share in success, it does not demand a vanquished competitor.
Success is a far more inclusive goal than winning.
what does this have to do with medicine?
Physicians’ ranks are subject to intense selection bias. The process of getting into medical school is rigorous and very specific. As such, people who get into medical school have tendency to be highly organized, driven, and ambitious.
Being ambitious does not require being competitive. However, in American culture, it is almost always synonymous. We arrange our culture into a series of competitions. As such, medical students have a strong tendency towards competitiveness, or winning.
What happens when everyone in a room has organized their lives around the pursuit of winning? They need to win. For many, their entire personal identity is wrapped up in the idea of “being a winner.”
In a world organized around competition, if you aren’t a winner, you are, by definition, a loser. Therefore, someone else has to lose to keep a winner’s personal identity intact.
The winner’s ego demands the sacrifice of others to maintain its self-perception.
If excellent leadership is present, these tendencies can be harnessed to provide a cohesive team culture focused on conquering some external competitor. Unfortunately, that takes truly excellent leadership, which is rare by definition.
culture changes slowly
Something I did not appreciate until I arrived in the “real” world of medical practice, was how change in medical culture lags our culture at large. Due to the hierarchical nature of training programs, the long delay between joining the profession and being in a position to affect change, new voices take a long time to be heard in medicine.
Historically, medical training was egosyntonic with physicians’ tendencies towards winning and autonomy. However, over the last 10-20 years, medical schools recognized the negative effects of this tendency and set out to try and train more collaborative doctors. They found a generation ready-made for this in millennials.
millennials and physician work
Millennials grew up with group projects, team-based learning, and the much-maligned “participation trophies.” In medical school, team-based care seemed logical and necessary. Many of us we unaware that what our professors told us was still NOT the norm in medical practice.
Many older physicians view the millennial physician as lazy and entitled, not interesting in working, etc. What many miss is that millennials are looking for something to work towards, preferably in a team.
We don’t want to win, we want to succeed. Millennial success doesn’t look like working hard just to have a bigger pile of money, house, or fancier car than our neighbor. We’ll keep our time, thank you very much, if all you have to offer is money.
Many health systems are fundamentally failing to address this change physician priority. Millennial physicians are putting an onus on the health system to provide a strategically sound and meaningful vision with which we can align. Yet, the organizations repeatedly fail. It would be so much easier to buy our complicity – it has worked up until now.
I believe millennial physicians are willing to work as hard as physicians ever worked, but for a reason – not for a paycheck.
I think my supervising partner’s eyes almost fell out of her head when after a mere 8 months in my practice I looked at her and said: “In residency, I was working 25% more hours for 1/6th the amount of money, and I was happier.” It simply, yet profoundly, did not compute.
evolve or die
Going forward, understanding what younger physicians are looking for will be the key to the success of health systems. I may be wrong, maybe enough physicians are willing to sell their time so health systems can get into bidding wars and pad upper management’s compensation.
When confronted with the reality of modern medicine, I bailed. I have no interest in working 80 hours a week to support a system in which the care of patients is actually just a means to an end. Caring for the patient becomes the intermediary goal, the task done to generate revenue.
Well, I should clarify, we document our care of the patient to make money.
The pursuit of winning in the economic morass of the American Hospital-Pharmaceutical complex is getting in the way of our collective success. As long as we care more about beating our competitor than building the best healthcare system, success will remain out of reach.