Draft Day
As I was getting my daily fix of ESPN this morning, something a bit different than the routine scores and highlights came across my TV. Two very talented men, both potentially bound for NFL stardom, were showcasing their talents for scouts, coaches, recruiters, and reporters – a panel of judges if you will. Although these players have certainly proved their talents in the past, these workouts will likely determine which player an NFL team will choose to build their future around. These workouts are vigorous, competitive, and very, very public. As draft day approaches, there is a running tally of whose stock is up and whose is down. Which player is at the top of Mel Kiper’s big board? Who will be drafted in the top ten? Will they succeed or be a bust?
As I listened to the reporter break down every step of Cam Newton’s latest pro day, I wondered what it might be like if physicians were put through this type of workout and evaluation before we were “chosen to play on a team?” If professional entertainers are subject to this type of scrutiny, shouldn’t we expect at least that from those of us sworn to care for the sick and “do no harm?”
I thought about the standard recruiting process for most physicians. A check of our background and training. A reference check from those with whom we have worked. An interview or two and a nice dinner. All of this is usually followed by an offer and a contract. Not exactly the NFL combine when it comes to assessment of quality.
The world of quality in healthcare is at a pivotal point in its history. Tracking of quality data and performance is certainly central to any health reform effort, but when it comes to individual physician performance, we admittedly have a long way to go. The arguments over which data are good enough and whether or not it “applies to me” continue to be the core of many discussions in many physician lounges and hospital board rooms. We may not ever get to the level of intensity seen on NFL draft day, but if we truly hope to deliver the highest level of quality for our patients, we must be more open to increasingly higher levels of scrutiny and evaluation of our performance.
Good idea for physicians to deliver more in the recruiting process. All family physicians are videotaped with patients when in their residency training programs. I ask residents who apply for a position to bring a videotape of their performance with a (consented in writing) patient so I can see their style and connection ability. This "game tape" is helpful.
The quality data in family medicine still don't measure quality of patient care, so one still has to be skeptical of those who measure the wrong items and allege that it has something to do with quality. Patients wouldn't agree with our misguided quality measures at present. They should tell us what quality is and whether we met their criteria for quality. Just my opinion. Thanks for the stimulating post
Pat, thanks for your comments. Your approach of having residents provide a "game tape" is certainly a step in the right direction of getting real life quality input to at least supplement the less than adequate quality metrics that currently exist.
-Mark
Really neat mash-up of ideas Dr. Browne! Your comment about quality being at a pivotal point resonates well. I wonder if the long-time-coming intersection of health IT (delivering data on quality) and consumer (be it employer, insurer or patient) awareness is going to be the equivalent of the physician draft.
Right now we have a public view to the training (undergraduate collegiate sports) and the trials process (Mel's big forehead...er..big board) for evaluating sports stars. Evaluating the clinical outcomes and quality of a physician, regardless of where they are in their training, is considerably more challenging. On the bright side, at least from the consumer's standpoint, it feels like we are on the precipice of having the data and means to make some of those evaluations.
To your point, I'm sure having the data will start playing a large role in the hiring process of post graduate medical students, post fellowship students and any physician entering a new practice or employment model. That's our draft!
Great post!
Your post got me to thinking about public scrutiny and accountability in health care. I absolutely agree that—hopefully—we’re finally at a pivotal point in efforts to drive toward sustainable high quality in health care. And those efforts depend on good information, including measures—wide public release of those measures—as well as engagement of the public with that information—and resources to help professionals learn from failures—and improve, iteratively. The point is to find and then minimize care defects—as much as humanly possible—to get the best, most efficient, care outcomes for patients and families.
I’d go a step or two further—given the importance of efficiency—we also desperately need to be at a pivotal point in our push toward care value, not just quality—that is public accountability for both quality and cost. The longstanding effort to measure quality and cost has trundled along for years—maybe, just maybe, that particular skyscraper is finally starting to rise out of the construction pit—it’s certainly taken a while.
But back to your professional athlete comparison—we could go even further here too. My 13 year old son wrestles on his school and community teams. Those matches are intense—immediate—nowhere to hide—examples of brutal accountability—for young men (and women) just learning a sport. Everyone in the gym—often hundreds of people—sees those kids’ victories and their devastating defeats. Try getting pinned in front of hundreds of people against one other opponent—now that’s high personal stakes public accountability.
Bottom line: Time for complaining about public cost and quality accountability for our best and most highly regarded professionals—health care professionals—has long since passed. Sorry if that’s hard to hear.
I agree that this is an interesting take on the issue of "fit for purpose" in the case of doctors. Our ability to know the quality of the individual often has to be left to other metrics, like their publishing record and their attainment of college fellowship.
I write from an Australian perspective but hopefully the comments are universal.
Given the expansion of the medical industry and the mobility of its employees (physicians) the dinners and get togethers that might have once been a pivotal part of assessing a job candidate rarely have relevance - even these used to be a surrogate measure of their performance in the consulting environment.
We now accept that reaching an agreed level of competence (ie College Fellowship) brings with it certain standard levels of skill. However, these do not always translate into patient interaction which is all-important. One way to do this is to assess new attendings (staff specialist) is to make them part of a health facility on a temporary basis. This practice happens regularly in Australia in the guise of locum consultants - covering leave, illness, sabbatical or other circumstances that mean that employed consultants are not at work. This process works incredibly well for determining whether individuals "fit" well within the healthcare team and fulfil the needs of their new facility. If they do "fit" then they are often retained through a permanent part-time appointment, progressing to full-time position. If not, then they finish their locum term and move on.
This process keeps the job market accessible to new Fellows, exposes the health facility to new personalities and skill sets and provides the opportunity to accurately observe performance. On the downside, it is a particularly stressful time for the new Fellows, as they may have significant uncertainty for a number of months/years depending on their chosen speciality and job location requirements.
But all in all the idea of reviewing performance is particularly important rather then relying on other less complete metrics.
Michael
@amacdt