Curiosity, Dialogue, and Knowledge
There are at least two sides to every argument. This holds true with the issue of productivity in the medical field. I’ve recently been reading a running thread from the special interest group on dysphagia that speaks out against companies that require 80%, 90%, or even 95% productivity from their therapy staff. The term productivity here, to be clear, refers to billable hours (1:1 time spent with the patient or the family member/caregiver).
Yesterday when I worked for 150 minutes, only 13 minutes were spent typing my notes into the computer, and all the rest was patient time. That made me roughly 91% productive with my time. Without boiling my notes down to a two sentence, slapdash, cut-and-paste note, I couldn’t have shaved any more time off my schedule. I’ve seen these type of notes, and I know why clinicians write them, but they help so very little in understanding the patient and what to do with the patient in therapy that they are nearly worthless. I may have even written a few…
Yesterday was a good day for productivity. There are worse days. A couple of weekends ago, I did an evaluation of a new patient, whose information I’ll blur a bit here. The patient was in their early 80’s, had a recent neck injury that resulted in surgery for fixation, and presented with quite a bit of confusion, lethargy, and a chronic cough with nearly all trials of food or liquid. I worked for close to 150 minutes that day, roughly 30 minutes were spent writing the report and 20 minutes were spent conferring with the patient’s nurse, and filling out all the paperwork needed to make sure the patient had a safer diet. That made me roughly 67% productive. I wouldn’t change anything about the way I provided care for this patient.
To be fair, the company that I do part-time work for hasn’t bugged me about productivity as of yet. I was told in the interview that they expect roughly 85% productivity.
Another article I read the other day tackles this from an M.D. student’s perspective. To see the post in full, by Abraham Nunes, click here. I’ll do my best to summarize his sentiments in a few lines: just because we are doing medical work doesn’t mean that we are entitled to spend our time on anything patient related and call it meaningful, and we are obliged to be productive because we should respect the amount of tax payer dollars that are funding our work. The best quote from his piece in my opinion is this,
Why the hell wouldn’t we want our physicians to be more productive? EVERYONE needs to be more productive. Doctors are no more entitled than garbage collectors in this respect. If garbage collectors don’t collect more garbage for fewer resources, we are either wasting too much money or possessing an excess of garbage water (like when we read nonsensical arguments).
His point about being productive edges us closer to the business argument. You start a business and expect to make profit based on the services you provide whether those services are baking cookies or providing medicine. It’s reasonable for a business to want to make profit. It’s capitalism. In a competitive market delivering services at a profit is not just a desirable outcome; without it your business will wither and die. Obviously if your business goes under, then you don’t provide services to anyone. Patient’s aren’t served well this way either. The hard truth here is that poor business decisions can be harmful for patients because there is only so much in the way of resources to go around. A business that thrives provides charitable outreach to the community in ways that a starving business does not and can not provide.
The general fear of the average worker, myself included, is that the businesses are squeezing more productivity out of us only for the betterment of a select few at the top of the financial food chain. We fear that despite lip service that touts patient first priorities, the true and driving force behind all of it is money. There is also a healthy fear that a toxic workplace atmosphere will develop that so cherishes the bottom line that patient care will become secondary to the primary goal of the business: money.
Productivity conversations with your employer should look at what is being required, and what exceptions to those requirements should be made. You never should have to sacrifice reasonable patient care or safety to be more productive. At the same time, you can not unreasonably demand more time to do things when you are not being a wise steward of the time and money you already have been given. Collaborate with your boss to work at your efficiency. If it’s still totally unreasonable, then take a walk. Capitalism provides many competitors in the healthcare marketplace. I’m sure you’ll find one that balances the books and patient care at the same time.