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Think a lot of you heard my preamble during that webinar.
So much of that rings true. There is a “club” that most of us aren’t a part of, sometimes by choice but sometimes because of the clique-y nature of a once elite field. And you see this on interactions on Twitter.
Recently, I’ve noticed this with the way people “socially discipline”. If it’s someone who is “small”, there will be a “call out” or some “tsk-tsk”. But, if the bad actor is “big”, there is a deafening silence, especially from those that are so quick to call out the various other “-ism”s to that are “ailing” our field. My buddy Matt got insulted by a chairman and no one said a word. His own faculty say to me “that’s *** being ***” and laugh. If my doc spoke to someone like that online, they’d hear about it and be told to act like a decent human being and not someone that doesn’t have to hew to community standards of behavior. And that’s if they were above or below me in the hierarchy.
And, the constant expectation to kiss the ring, act like best buds with people you don’t know.. I get it. President Eichler says in this era we have to network, and he isn’t wrong. But, it’s an indictment of where we are at in that “the good practices don’t post jobs” and that we have to somehow find ourselves at the same conference or other boondoggle to get an in to find ourselves a job? What if you’re just not that social ? What if you aren’t as comfortable in those situations but are an incredibly effective clinician? How do you find your way? This “networking” approach systemically excludes many excellent people and it shouldn’t be pushed by leadership as how we should find a job.
I love that you think I have cojones. I do - I admit that. I push the envelope. But, remember, these are just people like you and me. Just because they don’t like to be challenged or act annoyed by it doesn’t mean we shouldn’t do it. If they want to be public figures, talk about things, publish things - the modern medical landscape has changed. I don’t care if you’re the chairman or Madame Curie, herself - you are not better than us.
And finally just wanted to say, leadership is by example and by what you do, not what you say or “like” or write. I left my group to join one that I am more aligned with and have an opportunity to make a difference. And with intention, I changed to a cancer center led by a woman (a brilliant one, if you’re wondering), my physics leads are women, my dyad admin partner is woman. The highest earner at my practice was a woman (by far). So, do think of the voices that talk about this stuff - and see what they are actually doing, what kind of practices they join and what those practices look like and who they are led by.
Think about financial toxicity, and who is doing what and where they work. Do they talk about value based care and proselytize about it, or do they practice it? And this means more than fractions and technique. What do their costs and charges look like? Do they question their own practice and cost-ineffectiveness?
I’m creating a practice where we are thoughtful, where we listen, where we are cognizant about the future of our field. My joint runs Ph1-4 trials, has a robust cancer center, and more than enough volume to potentially start a residency. Will we? **** no. Never. I never will. But, we are doing some great things with peer review, workflow optimization (stay tuned for a possible event at Astro!), and we will continue to grow. I will definitely need a few in the coming years but we won’t hire based on “projections”. Once we secure the work, and make sure everyone agrees, we will hire. I think 10k rvu per doc is a worthy goal (until we find a better way to measure) and allows us to earn a great income without killing ourselves. That’s with an admin day at home- this should be standard - if not, ask why? We also don’t tell each other how to practice, but if I do something dumb, my folks are not afraid to tell me (and they have!). Peer review does not work well when ego and hierarchy play a large role. The wrong dose or volume is wrong even if the person doing it is a Gold Medalist.
You guys rock. Keep it up! I’ll see you here and on The Bird, and MedNet. Sorry I’ve been a stranger!
So much of that rings true. There is a “club” that most of us aren’t a part of, sometimes by choice but sometimes because of the clique-y nature of a once elite field. And you see this on interactions on Twitter.
Recently, I’ve noticed this with the way people “socially discipline”. If it’s someone who is “small”, there will be a “call out” or some “tsk-tsk”. But, if the bad actor is “big”, there is a deafening silence, especially from those that are so quick to call out the various other “-ism”s to that are “ailing” our field. My buddy Matt got insulted by a chairman and no one said a word. His own faculty say to me “that’s *** being ***” and laugh. If my doc spoke to someone like that online, they’d hear about it and be told to act like a decent human being and not someone that doesn’t have to hew to community standards of behavior. And that’s if they were above or below me in the hierarchy.
And, the constant expectation to kiss the ring, act like best buds with people you don’t know.. I get it. President Eichler says in this era we have to network, and he isn’t wrong. But, it’s an indictment of where we are at in that “the good practices don’t post jobs” and that we have to somehow find ourselves at the same conference or other boondoggle to get an in to find ourselves a job? What if you’re just not that social ? What if you aren’t as comfortable in those situations but are an incredibly effective clinician? How do you find your way? This “networking” approach systemically excludes many excellent people and it shouldn’t be pushed by leadership as how we should find a job.
I love that you think I have cojones. I do - I admit that. I push the envelope. But, remember, these are just people like you and me. Just because they don’t like to be challenged or act annoyed by it doesn’t mean we shouldn’t do it. If they want to be public figures, talk about things, publish things - the modern medical landscape has changed. I don’t care if you’re the chairman or Madame Curie, herself - you are not better than us.
And finally just wanted to say, leadership is by example and by what you do, not what you say or “like” or write. I left my group to join one that I am more aligned with and have an opportunity to make a difference. And with intention, I changed to a cancer center led by a woman (a brilliant one, if you’re wondering), my physics leads are women, my dyad admin partner is woman. The highest earner at my practice was a woman (by far). So, do think of the voices that talk about this stuff - and see what they are actually doing, what kind of practices they join and what those practices look like and who they are led by.
Think about financial toxicity, and who is doing what and where they work. Do they talk about value based care and proselytize about it, or do they practice it? And this means more than fractions and technique. What do their costs and charges look like? Do they question their own practice and cost-ineffectiveness?
I’m creating a practice where we are thoughtful, where we listen, where we are cognizant about the future of our field. My joint runs Ph1-4 trials, has a robust cancer center, and more than enough volume to potentially start a residency. Will we? **** no. Never. I never will. But, we are doing some great things with peer review, workflow optimization (stay tuned for a possible event at Astro!), and we will continue to grow. I will definitely need a few in the coming years but we won’t hire based on “projections”. Once we secure the work, and make sure everyone agrees, we will hire. I think 10k rvu per doc is a worthy goal (until we find a better way to measure) and allows us to earn a great income without killing ourselves. That’s with an admin day at home- this should be standard - if not, ask why? We also don’t tell each other how to practice, but if I do something dumb, my folks are not afraid to tell me (and they have!). Peer review does not work well when ego and hierarchy play a large role. The wrong dose or volume is wrong even if the person doing it is a Gold Medalist.
You guys rock. Keep it up! I’ll see you here and on The Bird, and MedNet. Sorry I’ve been a stranger!
