The Executive Suite: Physician flexibility: Bamboo or oak?

When I refer to flexibility, I am not referring to the ability of a doctor to touch their toes—which, by the way, I cannot do! I am referring to flexibility in the face of difficulty and adversity. I will use the metaphor of oak and bamboo trees to explain the concept of physician flexibility.

If you take a dry oak twig and bend it, you will find that it will quickly snap into two. However, take a bamboo branch, bend it in half, and let go. It will quickly return to its original position without breaking. The bamboo bends but doesn't break. The strength of the bamboo is that it can be stressed without breaking. Bamboo has a greater tensile strength (or resistance to being pulled apart) than steel, and it withstands compression better than concrete. Both strength and compression are essential to keeping the bamboo plant, which grows to nearly 60 meters but is only as wide at the base as the very top, from falling over even in a brisk wind. It needs compression strength to hold its weight and tensile strength to bend in the wind without breaking.

We are all going to face an element of adversity at some point during our medical careers. How we cope with adversity will ultimately determine our mental and physical health. Managing adversity means dealing with difficult situations; it means you either work through or work around problems in a way that keeps your life in balance. As a result, it makes us resilient to burnout, which impacts over 50% of all medical doctors.

Examples of adversity in my life include Hurricane Katrina in 2005, which flooded over 90% of New Orleans and resulted in the closure of my medical practice for four months. More recently, the pandemic has resulted in many of us practicing medicine virtually, not being face-to-face with our patients, and being able to examine the patients. Those two situations were reasonably short-term events. However, adversity can be long-lasting, like a physical disability or chronic illness that changes our lifestyles and ability to practice medicine.

There are many ways to cope effectively with adversity, such as bending like the bamboo tree instead of snapping like the oak twig. When you're faced with a hard or unexpected situation, remind yourself that you have choices—you get to choose your attitude, you can ask for help, and you can often find alternatives.

You may decide to "recalculate your route." If you travel with a GPS, you've likely missed your exit or the turn you were supposed to take. The GPS responds with "recalculating route."

That could happen in your medical practice, too. Your hospital does something like hire physicians competing with your practice, or an insurance company wants to renegotiate your contract and reduce your reimbursement. You find that you may be forced to recalculate your route.

It's possible, however, that there is a good reason for taking a new path instead of the familiar trail. Maybe you've been using the same route or skills you learned decades ago in medical school or your residency\fellowship training. Perhaps it's time to change the direction your practice is taking or to recalculate your route.

When faced with adversity, we have an opportunity to learn new skills. Learning to manage minor setbacks and challenges helps provide the emotional and life tools for handling larger challenges that we will certainly face in our careers and our personal lives. If we learn to bend like the bamboo tree, we can become more resilient, reduce our stress levels, and be less likely to succumb to burnout.

Let me provide another example of how becoming more like the bamboo tree allows us to face obstacles and frustration. Most practices now are faced with the requirement to obtain prior authorization before ordering a test on a patient or before prescribing a drug for the patient. Doctors are told that prior authorizations are implemented to ensure appropriate care is given to patients. Still, these time-consuming, costly checks can lead to delays in care. Prior authorization approval can take days or weeks, sometimes even months. According to the 2019 AMA Prior Authorization physician survey, prior authorizations take 14.4 hours a week per physician. This is uncompensated time for a physician or their support staff and detracts from patient care. Additionally, the findings show that only 30% of physicians have staff dedicated to working on prior authorizations. That is, 70% of physicians give that responsibility to other staff members in the practice who already have other responsibilities.

We can become more like a bamboo tree by having a dedicated prior authorization specialist communicate with the payors and off-load that function to others so that the staff and the providers can focus on patient care.

Bottom Line: The Chinese metaphor for bamboo is that you must bend with adversities and problems. If you don't bend, you break. Bamboo's strength is its ability to bend, and that's its unique advantage. Hopefully, we are more like bamboo than a dried oak twig!