I had a conversation recently with another pediatrician who had been employed by a large hospital system owned practice, but who had recently been let go. It seemed that her approach to patient care didn’t align with the organization’s financial goals anymore. She was willing to manage complex chronic patients (who require more time), and she was devoted to her late teenage and early college-aged patients whom she had seen since birth, but whom also admittedly generate fewer office visits at their ages (compared to an infant who comes in every 2 months). Recently, she was also starting to get push-back from the newer/younger physicians who had joined the group, because they saw her patients as “time sucks” that hurt their bottom line. She’d been with this practice for almost three decades. She had a loyal, if not fiercely devoted following of families. And yet, the hospital system saw no value, not only in her as a skillful and compassionate physician, but also in her patients, whom they clearly viewed as replaceable and a liability to their revenue column.
If this sounds familiar, read on.
Since these stories no longer trigger shock in me anymore, she and I didn’t waste much time lamenting the sadness of it all, but rather we jumped right into a discussion about the irony and paradox of a system that is filled with so many brilliant minds, yet has such little insight into the business of taking care of people. Years ago, I was introduced to the book Drive, by Daniel Pink. It changed the way I think about life, relationships, and the physics of human behavior. The premise is simple. Pink reviews the science of what makes people do the things they do, and more specifically, what works to motivate people…and what doesn’t. He discusses a study, financed by the Federal Reserve Bank and conducted by economists from MIT, The University of Chicago, and Carnegie Melon, in which graduate students at MIT were asked to do a series of tasks, ranging from memorizing a sequence of numbers, to word puzzles, to simple physical tasks like shooting a ball in a hoop. They then told the students that if their performance of these tasks was meager, they would get a small monetary reward, those whose performance was somewhere in the middle would get a medium-sized monetary reward, and those who performed the best, would get the largest monetary award. What they found, was that when it came to tasks that involved even rudimentary cognitive work, bigger rewards did not equate to better performance. In fact, the group who initially performed the best and who received the highest monetary reward? Their performance actually began to tank, and they essentially became worse than the other two groups. The researchers were baffled by these results, and thinking that maybe their sample (MIT students) were possibly just not sufficiently motivated by the dollar amount they were offering, they decided to take the variable of affluence out of the equation, and they took their study to a location on the globe, where money is in short supply…rural India. And guess what? They got the same results. Even in one of the poorest areas of the world, the dangling carrot of more money, did not equate to better performance.
I’m guessing that most of you are smiling a little bit, by now, as I did when I first read about these mind-baffling results. “Yes! We’re not puppets, for God’s sake!” I found myself thinking. And yet, that’s exactly the approach most organizations take with their employees, and most certainly the approach that many healthcare corporations take to the cogs in their wheels…the physicians and nurses caring for their patients.
What Daniel Pink goes on to say, is that what really motivates human beings, actually has nothing to do with money at all. It boils down to three things: autonomy, mastery, and purpose. That’s right folks. Science proves time and time again, that if you 1) get out of people’s way 2) allow them to work at becoming better at something and 3) demonstrate how they are contributing to a greater purpose outside of themselves and even outside of the organization…you’ll not only have better performing companies…you’ll have happier, better performing employees.
So, you can see why, after being introduced to this concept, and after watching it play out time and time again, in my own life, and in the lives of my colleagues, I’ve made a commitment to go PINK. It’s not only made all the difference in my life and in the lives of my team, but it’s changing the way parents and families are experiencing healthcare. And that, gets me out of bed every single morning. I’d love to hear your thoughts.
It is just hard to be a working mom. (It’s also cold at the South Pole.) Seriously, people. Most days, I feel like I am about at the “meets minimum expectations” level of parenting. And to be honest, I actually think I’m halfway decent at it. But it still never feels like I’m doing well enough. Some of that probably stems from unrealistic expectations and worries (thanks a lot Pinterest, Jessica Alba’s Instagram account, and msn.com’s articles on teen vaping and the oxycontin epidemic) but truthfully, a lot of my feelings of inadequacy as a parent stem from my own warped sense of what constitutes success. I know this will probably be shocking to many of you (sarcasm translation: not), but I’ve always been someone who attacks life with laser focus and a wicked drive for excellence. Seemed to serve me quite well during “the early years”, but you can imagine how much I was thrown for a loop when I tried to apply that same methodology to parenting in the beginning. Like, if my kids weren’t sleeping through the night or didn’t want to eat their broccoli, I assumed that it was because I just wasn’t trying hard enough. I know…
So, fast forward past the toddler years, into the time- and labor-intensive elementary school years, and let’s just drop right down into where I am currently, as a parent: The teenage years. Call it karma, call it irony, call humbling of a prideful nature, call it whatever you’d like. Nothing will make you realize how much you can’t hard-work your way to success, like parenting teenagers. They, like, have all of these thoughts, and ideas, and opinions. And they are smart and funny and witty and maddening all at the same time. Yes, the idea that I am going to turn these teenagers into the kind of adults that I think they should become, just by trying harder Linda is just nuts. To that end, the older I get, the more I grow to hate the movement/hashtag/photo caption, #hardworkpaysoff. Like, saying that to someone like me (who went to med school because “it was the hardest thing I could think to do” and who runs marathons as my primary hobby), is like giving a pound of free heroin to an addict. It’s intoxicating. It’s also dangerous. The road is littered with people who hard-worked themselves right into the grave, or worse, up the corporate ladder, only to find that the pay-off they were expecting, wasn’t a pay-off at all. Want to be rich? Sure, ok. Just make sure that you’re getting rich with the kind of currency that actually has value in your own life. Spoiler alert: For the first few decades of my adult life, I didn’t understand what that meant. Relate? Read on.
My dear friend Stacey is an art teacher by degree, but she’s also a painter, sketch artist, MLM business owner, home decorator enthusiast, and fashionista. When she is faced with a prospect of any kind – a job opportunity, a new relationship, a vacation, a purchase – whether she realizes it or not, she considers both how much creativity that “thing” is able to offer her, as well as how much creativity she’ll be able to offer that particular scenario in return. Creativity is at the top of her list of things she sees value in. It’s her currency. In contrast, I had several med school classmates who went into Emergency Medicine. For them, the nature of shift work, no call, clearly defined hours, and little to no continuity in patients from one shift to the next, allows them to leave work at work, and be completely present in their personal lives. Compartmentalization is their currency, and it not only adds value and richness to their lives, it also allows them to add value to the lives of those around them. For me, when I became a mom, I realized that I did not like the feeling of someone telling me I couldn’t go to my daughter’s classroom party or my son’s soccer game. I wanted to work. In fact, as I’ve already pointed out, I spent the first half of my life demonstrating just how much work ethic I had. It wasn’t that I didn’t want to work, now that I had kids. I just wanted to have more freedom and flexibility in my work schedule, so that I could do the work things and the mom things. Flexibility….it’s my currency. Bam.
Here’s the thing. Medicine and flexibility have not historically gone together. Not only have they not historically gone together, it’s kind of like a priest saying he’d like to only work a Tuesday/Thursday part-time schedule. Like, what??!! In a way, I feel like I’ve come “out” by publicly declaring my desire for flexibility in my work schedule. It’s just not something that is valued, or quite frankly, even found, in most healthcare spheres. But, just like you can’t potty train a child by bribing them with brussel sprouts (do. not. even. email. me. and. tell. me. how. much. your. child. loves. brussel. sprouts), you can’t get the most out of your healthcare providers unless you know what really has value and meaning for them. RVU’s and production bonuses certainly pay mortgages, car payments, and college tuitions, but I’d venture to say that a lot of the physicians I know would happily give up some of those things, if it meant they could really dial into what is most important to them. Their currency, I dare say. Yep. I said it again.
So, I guess my message is this. If the current version of your life doesn’t really resemble anything like what you’d like it to resemble, consider what your currency is. It might only be a small fraction of the equation for you. But maybe, MAYBE, it’s actually a big old slice of the pie. And maybe, MAYBE, you’re chasing after the wrong currency and turning around and paying for life with the wrong currency, too. It turns out, that was the case, for me. Once you figure that out? Well, get ready for massive pay-offs.
It’s true. What you give to the world, the world gives back to you. It’s a lesson that has practical application in areas of life that go way beyond attracting the “right” friends and acquaintances. It’s also a lesson that has rescued me time and time again, and it’s one that is rooted in authenticity, transparency, and a willingness to put yourself “out there.” What’s funny is that in my case, I kind of went about it completely backwards. A few years into my endeavor with Pediatric Housecalls, I found myself surrounded by a tribe of vibrant, loyal, hard-working, brilliant, and caring providers and families, and only after much introspection and careful analysis (INTJ anyone?), have I realized that it hasn’t been by accident. That whether we realize it or not, the little every-day choices we make, the “vibes” we give off even in the simplest of interactions, add up to what our life’s journey ultimately becomes. What’s that other saying? You gotta to know what you don’t know? For me, there was a heck of a lot I didn’t know about running a business, when I first opened Pediatric Housecalls. When it became clear to me that owning and operating a medical practice required far more than just clinical knowledge, experience, compassion, and a desire to help, I’ll admit that I felt the wind let out of my idealist sails a little bit. Naive or not, the idea that I had to consider the economics of the patient-doctor relationship left me feeling sad, confused, and overwhelmed. Let’s be real. I am so uncomfortable talking about the exchange of money when it comes to running a medical practice, that I don’t even like to use the word money. I just used the word economics instead. (Exact quote 4 lines above: “the economics of the patient-doctor relationship.”) Bless. The obvious point that I discovered pretty quickly into my journey with Pediatric Housecalls (that I had zero training in medical school about how to run a business) precluded the second point (that I had zero desire to deal with that part of it.) So much so, that after returning from a medical mission trip to Guatemala, I secretly wondered if mission work was the direction that I was supposed to go in, instead. The simplicity of serving, without insurance red tape or exchange of money, and the dire needs met with the simplest expressions of care, certainly fills a certain selfish need to feel like a helper, with no strings attached. But as the weeks, months, and years progressed, and Pediatric Housecalls continued to grow and thrive, another new question seemed to repeatedly work its way into my mind, almost like a toddler on a mission to get your attention in the checkout line of the grocery store. And that question was: “Why?” To be sure, this was not a “Why am I called to do this?” question. It was not, “Why do I want to take this on?” Or even “Whydoes it have to be so complicated?” But it was rather, “Why is Pediatric Housecalls…actually…working?” (Pillar of confidence, huh?!) As Pediatric Housecalls continued to gain traction and serve more and more families, I honestly found myself asking, almost incredulously, “Why is this thing actually working?!” Part of that comes from a place of self-doubt, and let me tell you, nothing on earth prepares you for the kind of self-doubt you face when deciding to challenge the status quo, especially the kind of status quo that can creep into the medical establishment. Part of the “Why is it working?” question, though, also stemmed from the fact that despite all conventional business wisdom, we were succeeding. Surely we weren’t the most skilled in insurance contract negotiations, the most experienced in hiring and managing people, and we certainly didn’t have the backing of either of the two major healthcare systems in our area. We had no advertised hours, I let every team member decide for themselves on a daily basis, if they wanted to work, when they wanted to work, and how often they wanted to work. I rationalized that if I was craving freedom and flexibility as a working doctor-mom, then I was bound and determined to offer that same freedom and flexibility to anyone who was interested in jumping on board with me. Sounds like a stellar business plan, no? Pediatric Housecalls, as it began to grow, was in essence, a practice made up entirely of part-time working mothers, with no set hours, no brick-and-mortar presence, and absolutely zero precedent to pave the way for what we were doing. And yet…It was working. Parents continued to seek us out, and we continued to grow. So, as the weeks turned into years, that little bit of self-doubt continued to constantly chirp in my ear, “Seriously. Why is this working? It’s got to be a fluke. I’m not a business person. How can I possibly grow this practice and make it survive?” If you haven’t read much about the idea of “imposter syndrome”, I encourage you to do so. It’s a fascinating concept, and one that I could certainly be a poster child for. Which, after reading much about it, I wear that badge proudly, as many of the world’s most accomplished persons (statistically, more often women than men), have suffered from this syndrome at some point in their careers. The bigger issue at hand, though, I felt, was not figuring out why that nagging question kept creeping back into my mind. The bigger issue, for me, was figuring out what the heck the answer to that question actually was. Seriously, guys. I needed to understand why Pediatric Housecalls was succeeding as well as it was, despite our unconventional approach to just about every aspect of the business side of running the practice. After thousands of interactions in the homes of thousands of families, I’ve come to believe our success boils down to two very simple things. Neither of which are business concepts. And that delights me. Because simplicity is one of my love languages. And business is not. The first concept: Accessibility. I don’t mean accessibility in a starch, sterile sense. Any business can be accessible. Any practice can add hours, or weekends, or providers to increase their accessibility. And actually, if we had a drawback as a practice, is was our lack of availability from time to time in the traditional sense, given that we had built a team of all part-time working moms. What I mean, is garden-variety human accessibility: Being accessible during patient visits to listen as long as necessary, to dissect and review every one of the parent’s concerns, being emotionally accessible to see what is driving that parent’s fears, and therefore, their behavior. Of course, removing the barrier of parents having to drive to an office, sit in a waiting room, and figure out what to do with healthy siblings, certainly makes us more accessible to parents than the typical healthcare encounter, so that’s part of it. But it’s not the whole story. What’s more, is that so much of pediatrics is the diagnosis and caring for illnesses that are viral…things that we can’t prescribe medicines for. I agonized over this a bit, when I first started, worrying that parents might perceive my house call as “useless” or a “waste” if I didn’t prescribe anything. What I quickly realized, is that more than anything, parents want to know what to expect. I never used to spend more than a sentence or two on this. I now spend the better portion of most visits talking about this. Taking care of a sick child is scary for a lot of parents. But what is even scarier for them, is taking care of a sick child and having no idea when they are sick enough to have them seen again, or when it has gone on long enough that it might mean something else is wrong, or how long they might have a fever, or what to do if they see x, y, or z. Knowledge is power. And most parents can handle a fever of 104 in their child, even if it is due to a virus, and you’ve just told them it’s going to have to “run its course”, as long as you give them a life-line. That life-line sounds like this: I know this is stressful. I know you hate to see your child so miserable. I am going to give you a clear list of things you can do, in the short-term, to make them a little more comfortable. I’m going to make sure you know what to watch for, that would signal it’s time to have them seen again. I’m also going to make sure that you don’t have any lingering worries in your head about your child’s illness that I haven’t thought to go over yet. Even if they seem outlandish, I want to hear the things that you are worried about. I’m not finished with the visit, until all of these things are done. That is true accessibility. The second concept: Kindness. This is inextricably tied to the first, because no one…no one…can possibly be emotionally accessible to another human being, without being kind. This means a lot of things. It means listening without judgement. It means being patient. (Lest I remind you that fear and worry – two of the most common emotions that parents experience when their child is sick – do not speak the language of efficiency or logic.) It means empathizing. It means naming their concerns out loud. It means reassuring them out loud. It means reassuring them that they are capable, and doing a great job, and going to get through this. It means having a sense of humor. It means not taking their words or actions personally. It means maintaining a sense of gratitude for even being allowed into the sacred space of caring for another human being. It means showing love. What is another way of looking at this? Our values. Our style. Our priorities. Our mission. These were all of the little small choices we were making, day after day, month after month, year after year, without really even being aware of it, that have ultimately all added up to our “vibe.” And it continues to surprise me and bring me joy, in the roads that it leads us down. So, what does this mean for everyone else out there who is pursuing a goal, or starting a small business, or raising a family, or doing anything, quite frankly, that makes them occasionally wonder why it is all actually…working? It means that you shouldn’t discount those intangible things you bring to the table. The parts of you that someone else might say are a liability may turn out to be your greatest strengths. Remember the misfit gang of part-time working moms who decided to band together to slay the world of pediatric sickness one house at a time. Success is often illogical. Stay true to who you are, be yourself in every single interaction, big or small, and you might just find that you attract those things right back. Sometimes it might even surprise you, how well it all works out…
I got invited a year or so ago, to talk to a bunch of really bright high school students, about a career in medicine. It was for a National Science Honor Society chapter meeting, and when I walked into the room, about 60 eager sets of eyes were camped out in a small cramped classroom, waiting to hear me slay some magic words at them about what the magic formula is for getting into med school. You know…let them in on some top secret combination of the magic SAT scores, the magic number of community service hours, the magic kind of volunteer and shadowing experiences, and the magic GPA, that might propel them into what (I suspect) many of them view as a top-tier profession, therefore requiring top-tier academic prowess, and top-tier planning during their sophomore and junior years of high school. OK. Can I just say, that when I was a sophomore and junior in high school, I was more worried about whether or not my parents were going to let me go to the Bon Jovi concert, than what my future career was going to entail? And I’ll take it a step further, and say that even when I was a sophomore and junior in college, I was still more worried about figuring out a way to record episodes of Melrose Place than I was about how I was going to best position myself to get into med school. So you can imagine the mental struggle I was having as I was preparing what I wanted to say to these fresh-faced, really brilliant kids. Blame it on the mid-forties-loss-of-verbal-filter (Oh, you haven’t gotten there yet? Just wait. It’s a lot of fun…), or maybe it was the inspirational podcast I had just listened to, or probably it was the glass of wine (or two) that I treated myself to, as I sat down the night before, to jot down some thoughts. Whatever the reason, I WENT ROGUE. I did. I went rogue. And it was the best time I’ve ever had talking at a career day. (I’ve done a few…) I’m suspicious that it was also maybe the best time the kids had ever had listening to a guest speaker on career day. They certainly didn’t break eye contact. And there were lots of questions at the end. Lots.
So what did I tell them? I told them my story. And that story sounded like this.
During the spring of my junior year in high school, I went to the mandatory meeting with my guidance counselor to plan out my senior class schedule. “So, Sara, you’ve put it off and put it off, but you’re going to have to take Chemistry 1 in order to graduate next year,” she said to me. “What?!” I cried. “That is the dumbest thing I have ever heard. I am never going to do anything in my life that requires me to knowanything about science. I hate science. This a a crock. This completely sucks,” I said to her. Melodrama was my M.O. back in those days. (Quiet in the peanut gallery…ahem…Dave DuMond). My guidance counselor went on to say that it was either Chemistry 1 or Physics 1, but there was basically no escaping taking one of these two science classes if I wanted to graduate, regardless of whether or not I was planning on becoming an actress, a Supreme Court judge, or an astronaut. I took what I thought was the path of least resistance (Chemistry over Physics), and I kid you not, during the ’89-’90 school year, my friend Meg and I were the only two seniors in this introductory science class filled with underclassmen. (We actually managed to turn it into a positive and worked that whole angle to our advantage, but that’s a different story for a different time…)
Needless to say, when I shot out of the blocks with this story, it garnered me lots of laughter out of this room full of National Science Honor Society superstars. Feeling good about where the talk was heading, I then turned to the white board and began to draw a little visual for them that I felt best illustrated my life trajectory from junior in high school to now. The visual ultimately looked something like this. (There were a few arbitrary “points” thrown in there, but the shape of the line was key point):
Here was the rest of my story. While I stomped my feet and pitched a temper tantrum about hating science and having to take Chemistry to graduate, just a mere 15 months later, I was heading off to a college 3 states away, declaring myself to be a Biology major. (What can I say? Interests change. So do goals.) A year after that, I transferred to an entirely different college. (Thank you very much, high school romance crumbling under the weight of long-distance in college. Ask me if the guy I changed colleges for is the guy I married? Spoiler: Nope.) Two years after that, I decided I no longer wanted to be a biology major, and switched to Physical Therapy. Reason? Everyone else I knew who was a biology major was getting ready to apply to med school. And I chickened out. A Melrose Place lifestyle seemed like a much better fit for me at the time. A year after that, I changed my mind again, and decided I had sold myself short, and I actually did want to go to med school. Then came med school, and deciding on a specialty. For about a month I was convinced that I wanted to deliver babies and become an OB-Gyn. Then I realized I was actually more infatuated with the babies once they came out. Boom. Pediatrics. Then I moved to a new state (ironically the same state where I had originally gone to college for that one year, my freshman year). Then after residency I took a mainstream job. Then after 8 years, I got burned out and decided to open a kind of practice that no one else was doing or even was even talking about at that time. The take-home? Twists and turns aren’t always bad. In fact, almost everyone whom I admire and consider to be either a mentor or an expert in their field, has a story that involves heading off in one trajectory, and course-correcting to a different one. And most of the time, they didn’t even realize in the moment, that they were actually course-correcting. For a lot of us with a crooked line, it sure felt a lot like screwing up. Only looking back now, do I appreciate it for what it was: learning and growing.
I finished the talk, invited them to approach me before I left if they had any specific questions, and can I just say, that there was a line. I stayed for at least another hour, after the official talk was over, just answering questions, or hearing stories of these kids’ own crooked lines, or hearing stories of how they were agonizing over trying to make their crooked lines straight.
The take-home? Life isn’t always (or ever?) a straight line from point “A” to point “B” and anyone who tries to teach you, sell you, or convince you in some way, that it is, is just plain wrong. In my field, specifically, now more than ever, being authentic and transparent is literally what families and patients are craving. I suspect that is the case in almost any industry. At a time when it feels like we’re living in an “every man for himself” culture, I would argue that the world needs more crooked lines, because it’s ultimately our crooked lines that unite us. I, for one, plan on continuing to take the scenic route. And want to know another secret? It’s this exact thing that is propelling my success. If any of this resonates with you, stay tuned. I’ve got a lot to say…(Quiet in the peanut gallery!)