The Affordable Care Act and market changes like baby boomers entering their senior years with a decreasing amount of doctors to care for them are driving a mind-blowing rate of change in healthcare. Medical practices, including pathology, will sink or swim based on how they adapt to the new realities.
One of those realities is that the new collaborative model means we must all start thinking like administrators. The simple Fee-for-Service model will soon be a distant memory. Administering care and services is getting more complicated and so is getting paid for it. We are tasked with the challenge of delivering better results with less resources.
I feel fortunate to have learned some lessons on this early in my career from my first boss in the military, Dr. Renata Greenspan. Dr. Greenspan would go on to become the first female director of the then 141-year-old Armed Forces Institute of Pathology (AFIP) prior to the AFIP being closed as part of the BRAC in 2005.
Her parents escaped Nazi Germany as her father was a Jewish physician and a target during World War II. Dr. Greenspan would join the United States Army years later following the Vietnam War and have a multiple-decade long career in the military including overseas tours, consultant to the Army Surgeon General, and Transfusion Medicine consultant for the Army.
She was tough as nails and a no nonsense leader. On our first day as residents, Dr. Greenspan oriented us with a very simple but complete value proposition by saying “I provide you microscopes, cases and staff to sign-out with you – you show up in your uniform every day on time.” That was it. Orientation was suppose to last 2 days. It took 20 seconds. You knew where you stood with her and that was that.
After finishing residency and staying on as staff at Walter Reed, there was a period of time we were severely short staffed and everyone at the hospital in the pathology department had increasing demands on their time. Clinical duties combined with administrative, teaching, research support, Army training, and more.
One particular day was particularly bad as I was acting chief for her and her back-up and had a full clinical plate and the responsibilities that went along with these roles. I was a staff pathologist for six months and feeling a little overwhelmed. I mentioned this to Dr. Greenspan, questioning whether it was possible for one person to get what needed to be done, done on time and likely done well. I am running down the hall chasing her as I make these complaints. Without hesitating, Dr. Greenspan slowed to a slow jog, looked at me and said “Welcome to Executive Medicine”.
It was an important lesson to learn and I never forgot it. At the time, without knowing it, we had a great group, practice, clinicians, surgeons, residents, fellows and supportive administrators and managers to serve the needs of the patients. Budgets were in surplus, there was protected research time, infrastructure to support the research, and all things considered we were adequately staffed. We had an appropriate, but not exhaustive, number of cases to meet projections on efficiency and justify our position. Today, regardless of the setting, that is sadly no longer the case. Everyone is doing more with less.
- More cases with diminished reimbursement
- Less administrative, research, and managerial support.
Hospitals across the country are trying to run leaner and leaner to meet their goals. Laboratories, as with other areas of the hospitals and as business organizations are having to meet those challenges.
Fortunately, I learned a lesson 20 years ago about being efficient, doing more with less, time management, doing it right the first time, and doing a job you can be proud of, even if it doesn’t feel that way when you are actually doing it.
Increasingly, the pathologists of today (and tomorrow) are going to have to learn to do more with less. The salad days of doing less with more, and for more, are probably over.
The changes over the past 2 years trump those over the past 20 in the practice of pathology.
We are all going to have to think about getting the right slide on the right case at the right time on the right patient all the time. Working smarter, more efficiently, more precise, with less waste and downtime. Leaner and meaner.
Welcome to Executive Medicine.
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