How to mold that new associate

Watch the clock for punctuality; look for calluses; it takes more than med school to mold a good doctor.

By Paul S. Koch, MD

Hiring a new associate is strain enough, but what happens on the first day of work goes a long way to determining not only how it will work out but also how the associate’s career will develop. No matter how well you screen, interview, meet and negotiate, it remains a mystery as to whether it will be a marriage made in heaven or a first date from hell.

Some doctors come to work the first day wholly prepared for their futures. They arrive on time with a big smile, treat the staff like long-lost cousins and engage each patient with patience and concern. For those who have hired such a doctor, I offer my heartiest congratulations and an excuse from reading further.

For others who have hired the opposite, or fear that they may, I reference Maine’s esteemed legislator Margaret Chase Smith, born 1897. During discussion of a funding bill for a study on whether young people can take responsibility, she told her peers, “I already know the answer. Some can, some can’t.”

Thus advised, consider whether our new associate “Junior” needs coaching and counseling.

Channel your inner drill sergeant

Many of the Millennial generation have the same backstory. At age 4, mother starts them on their academic career. By the time secondary school rolls along, they fear missing out on the best college and spend summers taking classes or doing projects to boost an application. In college, they grind out the As to qualify for medical school, which is a conflagration of class, lab and clinic. Finally, at age 26 our gallant heroes escape for their internship, residency and fellowship before making their way to your door. (Click here to read "When the Millennial ophthalmologist comes to your practice")

What is missing from many resumes? Work. Dirty hands, a mean boss, rotten hours and bad pay — the kinds of experience you might encounter in a burger joint or a loading dock. These kinds of jobs usually result in two outcomes: they either teach you to interact with and get along with all kinds of people, or risk getting invited to meet Bluto* in the alley after hours.

I fear too many students become stilted because they sacrificed the social opportunities of college to spend extra time in the lab or library. Adults should discourage such compulsion. Dating, making mischief and spewing nonsense are all part of the college experience — they help to develop well-rounded citizens. All work and no play make Johnny and Judy dull doctors.

But Junior strikes you as being on the ball. He appears to have a good heart and an agile brain, is skilled in a sport, exudes a pleasant personality and possesses a modicum of competence.

For many, the minute Junior signs on is when the work really begins. Boss ophthalmologist becomes life coach. Consider including the following on the agenda.

Punctuality

Many students consider an appointment time a suggestion. Whether this is a generational thing or it’s a relic of the same societal changes that no longer force us to don a jacket and tie when taking an airplane, they rationalize not arriving on time. “It takes time to work up a patient, so why be early and have to sit around?”

Former year-round students may think they can just drift in when they want, but former burger flippers do not. They already learned working skills, including being onsite at opening time. Getting more diplomas does not change this.

Nip punctuality problems immediately in the bud. Stand by the door on the first day and tap off the time with the sole of your shoe. Express your displeasure if Junior arrives even one second late. Patients are waiting, and the first ones might be early; they might not need a long workup; the staff might have questions; and there might be phone calls to return. Whenever the day starts, that’s when they must be there.

Patient selection

I wish I had a nickel for every young doctor who said that he or she did not want to see certain types of patients.

“‘I do not want to see children, patients with itchy eyes, those who already had surgery and especially anyone who called this morning with an urgent problem. I do not want my schedule disturbed by having to see an extra patient.”’

This associate would be better off in solo private practice, taking out a big bank loan and sitting in a quiet and empty office waiting for the phone to ring. Fiscal responsibility breeds professional maturity.

Also, Junior may not understand that patients do not grow on trees. In residency training, long-term relationships do not develop. You might see someone for three years, then you’re out of there. If that patient never comes back to the clinic, you will never know.

It’s different in private practice. Patients come to you for generations, literally. My current patients are the children and the grandchildren of the patients I saw when I first opened.

Junior may not have that perspective. As far as he knows, the scheduling office magically fills the schedule. If he upsets, embarrasses or angers someone so much that he does not return to the practice, it’s nothing to him. A new patient fills tomorrow’s slot, and the paycheck is deposited on Friday.

Junior must understand that a patient who has a problem, asks friends for references, searches the Internet, selects your office, makes the appointment and arrives at the scheduled hour is one to be treasured. That patient and progeny can fill the office years into the future.

Coach your young doctor that the patient’s problem is the most important thing in the world. The eye had a moment of pain three months ago? Rather than responding, “‘So what do you want me to do about that now?”’ he should learn to say, “‘My gosh, that must have been frightening. Let me see if I can figure out what happened to you.”’

Every patient must leave wanting to tell his friends about the wonderful doctors he just met.

About the tear samples

A great coaching moment occurs when a patient comes in with dry and itchy eyes. Junior can handle this one of two ways.

“‘‘Here are a handful of tear samples. Try them all and whichever works best, go to the drugstore and get some more. Return visit as necessary.”’

Or, ‘“That must feel awful. Let me get some measurements, and I’ll suggest some things you can do to get relief. I want to see you again in a few weeks because if you are not better we’ll move on to Plan B.”’

Patient One feels Junior doesn’t know the diagnosis, doesn’t care and just wants the patient out of the office. The next time there’s a problem she could just go ask her pharmacist for suggestions. Why pay the doctor for, well, nothing?

Patient Two feels Junior is interested and wants to help.

Don’t allow any tear samples in Junior’s bottom drawer until he learns this lesson.

When the Millennial ophthalmologist comes to your practice

There’s more to this generation of clinicians than iPhones and Facebook — really.

BY ZAINA AL-MOHTASEB, MD

Millennials: Whether you see this generation (typically defined as those who were born between 1980 - 2000) as technologically savvy or technologically obsessed, idealistic or unrealistic, they are increasingly joining the workforce: as of 2016, they make up about a third of employees in America.

And they are coming to an ophthalmology practice near you, having graduated from residencies and fellowships. These ophthalmologists have different expectations of life and work than did their predecessors. While that can be frustrating to senior physicians and employers, the differences can also bring significant gains to medical practices. To build a positive working relationship and hold on to the good ones, here’s what you need to understand.

Tech savvy

As you may have noticed, Millennials are glued to their iPhones, iPads and tablets. They grew up in a digital world with massive amounts of information at their fingertips. While older generations may grumble that these 30-somethings have a short attention span because quick isn’t quick enough, their high-tech shrewdness is more helpful than not. Make no mistake: the Internet is their “weapon.”¹

Different work goals

Don’t confuse their quest for life balance with laziness. They have different goals for their lives and careers than previous generations. The correct interpretation is that they want it all, but on their terms: work to live rather than live to work. According to “The Millennial Leadership Study,” they are willing to make less money in order to live a more balanced and comfortable life.²

As their employer, look at the plus side. This desire contributes to grasping the importance of efficiency in the clinic — because achieving it will enable them to enjoy family and friends as well as having a successful career. And their focus on efficiency is helped by their passion for technology.¹ For example, when using Epic, this cohort is comfortable using smart phrases and smart texts to decrease the amount of typing needed in EMR for many of their patient visits. Instead of typing the same postoperative note, they create a smart phrase using three letters that automatically inputs a typical note. Time saved!

Seeking purpose ...

Another plus for medicine: Millennials are attracted to careers that offer purpose and meaning rather than merely an 8-to-5 job that pays the bills — a trait that puts them on track to being good doctors. In a Deloitte survey, six out of 10 Millennials said a sense of purpose was part of the reason they chose to work for their current employer.³

… And a work-life balance

While they hold certain things in high regard, loyalty may not be among them. John Berdahl, MD, an ophthalmologist in South Dakota, notes that Millennials are accustomed to seeking the best deals on Amazon rather than being faithful to a brand or a store. It’s an attitude that extends to their practice and to their technology. Millennials want the “detached best deal” and what is most convenient.

As a result, these ophthalmologists are more mobile. If they are not satisfied with the first job they take, they can easily move to another one. Sam Garg, MD, a Millennial ophthalmologist in Irvine, Calif., says that about half of the people who graduated fellowship his year did not stay at their first job.

In the past, workers wanted a desk, stable working hours, a pension plan and annual benefits. According to “The Millennial Leadership Study,” they would rather have a flexible schedule than get paid more money.² Millennials are less likely to want to be practice owners. They appreciate more intangible benefits, such as a friendly work culture with cooperation among workers, wellness benefits and sabbaticals.¹

Forget yearly performance appraisals

A product of growing up in a time when everyone won a trophy and received praise, this generation is often criticized as expecting a reward regardless of performance. But as they see it, feedback enables them to be successful. In 2015, Virtuali and Workplacetrends surveyed 412 Millennials in “The Millennial Leadership Study,” and 50% said their biggest problem with their current leader was lack of communication.² This cohort wants transparency at work and employer feedback and recognition for their contributions. These attributes help with employee retention.

Avoid a hierarchical system

Millennials expect pay, profit sharing and promotions to be distributed evenly among all involved, regardless of age or experience. The companies that Millennials voted the best place to work had those in common.⁴ They want open communication with their leaders and involvement in formulating the goals and policies of the practice.⁴ It’s particularly important to this group that their leaders make clear why things are done, rather than expect them to follow blindly “because that’s what’s always been done.”

Millennial ophthalmologists appreciate the work the older generation has done to make this an exceptional field and value their guidance. They look to continue to improve ophthalmology and to leave their mark for future generations. Maybe I am biased since I am a part of this generation, but I am optimistic about what the future holds. OM

References

1. Labrien, D. 8 Reasons Millennials Seem To Be Lazy At Work. Lifehack. Available at: http://www.lifehack.org/articles/work/8-reasons-millennials-seem-lazy-work.html. Accessed March 11, 2016.

2. The Millennial Leadership Study. Virtuali and Workplace Trends. July 2015. https://workplacetrends.com/the-millennial-leadership-survey/. Accessed Sept. 8, 2016.

3. Gillenwater, R. Why Millennials in the Workplace ‘Don’t Care,’ and 4 Things You Can Do. Entrepreneur. 2015. Available at: http://www.entrepreneur.com/article/246437. Accessed April 4, 2016.

4. Lewis, KR. Everything You Need to Know About Your Millennial Co-workers. Fortune. 2015. Available at: http://fortune.com/2015/06/23/know-your-millennial-co-workers/. Accessed March 11, 2016.

Zaina Al-Mohtaseb, MD, specializes in cornea, external disease and cataract and refractive surgery. She is assistant professor, Department of Ophthalmology, Baylor College of Medicine in Houston, Texas.

Get the test

I’m always mystified that many otherwise excellent ophthalmologists are afraid to obtain tests. They assume (herein I channel The Odd Couple’s Felix Unger) that their initial impression is correct. Have a pressure of 29 with a normal cup? It doesn’t look like glaucoma. Having recurrent headaches? It must be eyestrain. If your mother’s doctor said, ‘“The lump doesn’t feel like breast cancer. Come back in a year,”’ would you let her stay with that doctor or drag her to another?

At this stage, your new associate does not have any significant clinical experience to draw on. Making assumptions about a diagnosis without actually making the diagnosis is cocky and dangerous. Be sure Junior is willing to say, “‘I’m going to run some tests and figure out your problem.”’

Two gems

One of the best lessons I learned came from John Corboy, MD, founder of Hawaiian Eye. “It’s not enough that your patients send their friends to you,” he told me. “Your patients must not allow their friends to go anywhere else.”

In the 1979 movie “All That Jazz,” about choreographer Bob Fosse’s sordid life, several scenes show Fosse preparing to go on stage. No matter the surrounding situation, he forces a smile in the mirror and exclaims, “It’s show time!”

Every young associate needs coaching to leave every bad, sad or mad moment behind and face every patient smiling, with hand extended and with his undivided attention. This is the only opportunity to make a first impression, capture a family for generations and develop a raving fan who will not allow friends to see anyone else. OM

* If you don’t know who Bluto is, you’re the one I’m talking about. You’ve spent too much time in the books and not enough time watching cartoons!

About the Author
	Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, R.I. His e-mail is pskoch@clarisvision.com.