Monday, November 11, 2024

Regaining happiness in our medical careers

In the previous blog, I discussed why physicians are unhappy. It is a multifactorial problem, but there are solutions to our unhappiness. In this article, I will provide a few suggestions that will allow us to return to those halcyon days when we enjoyed the practice of medicine. We can regain that same passion for medicine when we start our careers, and it allows us to take our eyes off the computer EMR and once again focus on the patient.

I think the road to happiness includes paths to financial security, prioritizing our own health, and achieving a favorable work-life balance.


Our finances


One of the most popular and conflicting statements is, "Money can't buy happiness." However, money is a factor that determines happiness worldwide, including for physicians.

Contrary to popular belief, doctors are not filthy rich. In fact, finances are a huge stressor for many physicians. Between decreasing reimbursements, rising overhead costs, and paying down student debt, it's easy to see why becoming a doctor isn't as financially favorable as it once was.


Being smart about your finances from the beginning of your medical career is essential.

With the average graduating medical student having a debt of $250K, it's common sense to want to pay it down as soon as possible. When a young physician begins their practice and makes more substantial payments on their loans, that debt is closer to $400,000.

Physicians, especially recently graduated or practicing physicians, often make the common mistake of thinking that they'll worry about finances and their debt later. That $250K debt starts accruing interest the moment they receive their diploma, and the interest on the loan starts accruing immediately after graduation.

For these reasons, it is necessary to understand financial basics. Unfortunately, our medical education systems do not prioritize business basics during our training. As a result, many doctors make mistakes that cost them a small fortune.


Importance of compounding


Compounding is a powerful investing concept that involves earning returns on both the original investment and the interest received on that investment. For compounding to work, you need to reinvest the principal plus the interest accrued.

Assume you are a physician in practice for a few years, and you begin by saving $1000 a month at 7% interest for twenty years.

To calculate the impact of compound interest, use the following formula:

A = P X (1 + r/n)t

Where:

A = the future value of the investment/account balance

P = the principal amount (the initial investment)

r = the annual interest rate (in decimal)

n = the number of times interest is compounded per period (usually a year)

t = the number of months

Assuming you're investing $1,000 monthly at an annual interest rate of 7% over 20 years (240 months), it would accumulate to $609,794. This result reflects the initial contributions and the additional wealth generated through compound interest over the investment period. A free calculator is available at investor.gov.

For physicians juggling demanding schedules, complex financial obligations, and long-term goals, regularly tracking finances can be difficult and daunting. However, advancements in technology have introduced budgeting apps as powerful tools to help physicians better manage their money.

Budgeting apps streamline tracking income, expenses, and investments, saving doctors valuable time. By automatically categorizing transactions and providing real-time updates, these apps make it easy to monitor spending and savings.

Using a budgeting app can help doctors manage their money, achieve long-term goals, and build a solid foundation for financial security.

I recommend beginning using a budgeting app to track your expenses. A complete list of free budgeting apps is available from capterra.com.

Your personal health


Our health and well-being should be the highest priority. We advise our patients to practice good health habits but don't take the same advice we give our patients. We need to prioritize our health because if we aren't healthy, nothing else matters, and we will never regain the happiness that we once had. This is like the advice regarding using the oxygen mask on an airplane. The adult passenger must use the oxygen mask first before putting the mask on a child.

I surveyed a group of male physicians and an aged-matched group of male attorneys. I asked each group about regular screening for cholesterol levels, colonoscopy, and PSA testing. It was of interest that lawyers participated in preventive health with greater frequency than physicians. How can we expect our patients to practice good health habits when their doctors don't set an example?


Suggestions for improving our physical health:


Start with small, achievable goals that fit your schedule, such as exercising for 15-20 minutes daily. We can incorporate more physical activity into our daily routine by taking the stairs instead of using the elevator.

Consider using a fitness app or wearables to track your progress and help you stay motivated. I recommend TechRadar, which lists top fitness apps with ratings, detailed features, compatibility, and pricing information.

PCMag provides a curated list of fitness apps along with their ratings, pros and cons, pricing, and detailed reviews. A website for home gym equipment is also available from pcmag.com.

My take-home message: Exercise is one of the first things we compromise on as we become busier. We must avoid sacrificing exercise to be busy. You can't take good care of patients unless you care for yourself. When you take care of yourself, you perform better and are better equipped to take care of patients.


Work-life balance


Physician burnout and unhappiness have reached epidemic levels. Few physicians disagree that our professional lives are often out of balance. Many of us had not even heard of the term burnout at the start of our careers. Now, more than 50% of physicians complain of one or more symptoms of the condition. Burnout can adversely affect patient care and is even causing doctors to retire earlier than they had originally planned.

Becoming a physician is an arduous journey, often taking more than 12 years after graduation from high school. Further, beyond seeing an increasing number of patients each day, many practices and health systems mandate same-day entry of detailed notes in the electronic medical record. That requirement has added a new term to the medical lexicon: pajama time. This is the time – typically one to two hours a day- that physicians devote to completing their medical records in the evening. This is time away from family, friends, and non-medical activities, such as hobbies, exercise, and relaxation. As physicians, we are seldom off duty. We are tethered to our mobile phones and make ourselves available to our patients 24/7. As a result, we don't take time to recharge our batteries.

In this blog, I cannot provide comprehensive solutions to the challenges of burnout. However, I do have one suggestion that will favorably impact your work-life balance: get unplugged. (This was described in Physician Practice in the December 15, 2023 issue) Disciplining yourself to not respond to emails, Facebook, Instagram, or TikTok videos for one day a week will allow you to move from imbalance to a better work-life balance.

Bottom Line: The amount of pressure and risk you take seeing patients for eight to ten minutes per session, the educational debt, and the fear of getting sued have created a climate of dissatisfaction and unhappiness in our profession. Physicians must cultivate healthy habits around sleep, exercise, nutrition, finances, and relationship building. A physician's career is fraught with challenges, stress, and anxiety. Doctors who do not prioritize healthy habits risk burnout and more dire health consequences, including increased mortality. Investing in relationships and fulfilling hobbies improves career performance and creates a favorable work-life balance. When doctors take care of themselves financially and physically, they perform better. They are also equipped to take care of their patients, and they put joy and satisfaction back into their medical practices. Ultimately, physicians prioritizing finances, health, and balance are healthy and financially secure when it is time to hang up the shingle.

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Friday, November 8, 2024

Why we aren't happier: The loss of joy in health care

Why are we so unhappy? When I go to the doctor's dining room or surgical lounges, I hear, "If I had to do it again, I wouldn't become a physician, and I would not recommend medicine for my children or grandchildren."

When I graduated from medical school in 1968, the doctor had a lofty position in America. Doctors were incredibly well-respected and enjoyed their work. We could become the kind of doctor who treats and cares for patients. After all, caring for people is why most doctors go into medicine. In the past four decades, American doctors have lost the status we used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart, sincere, and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become. In the past four decades, American doctors have lost the status they used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart, sincere, and ambitious, at the top of your class, there was nothing nobler or more rewarding than being a physician. We had an opportunity to regain our esteemed status after Covid 19 when doctors and other healthcare workers worked tirelessly and risked our own lives to care for acutely ill patients.

In the early stages of the pandemic, physicians were widely hailed as heroes for their tireless efforts in treating patients and containing the spread of the virus. However, as the pandemic progressed, public opinion became more divided. The public continued to hold physicians in high regard, while others began to question their advice on vaccination. There was widespread misinformation and conspiracy theories about the virus and the role of physicians in managing it. The pandemic also exposed systemic issues in the healthcare system, such as unequal access to care and disparities in health outcomes, which further eroded trust in physicians and the medical profession.

Despite these challenges, many physicians worked tirelessly to provide care and save lives, and their efforts have not gone unnoticed. The pandemic has also temporarily brought a renewed appreciation for physicians' important role in protecting public health.

American medicine went through a hallowed period in the 1950s. Doctors were not only incredibly well-respected, but technological innovations like coronary bypass surgery brought about many tangible improvements in medicine.

The advent of Medicare didn't cut into doctors' income; it skyrocketed. But that led to a backlash against fee-for-service, which led to managed care and all the restrictions we have now on doctors' autonomy.

As physicians, we are at the top of the income pyramid, with only 5% of the population earning more than $250,000. However, to earn a $250,000 salary, which is a healthy salary for doctors, we run like mice on a treadmill. That salary usually requires a doctor to see 25 to 30 patients a day.

A recent survey revealed that only 6 percent of doctors are happy with their jobs. They commit suicide at twice the rate of the general population. Over half of us are unsure if we would recommend the practice of medicine to young people.1 Prevalence and professional impact of mental health conditions among cardiologists. Journal of the American College of Cardiology, 81(6), 574-586.) This blog will discuss why physicians are unhappy with the practice of medicine and a few suggestions for returning to those days when we were happy with our practice and left at the end of the day without going home to complete medical records.


The root causes of our unhappiness


There are a variety of aspects of our jobs that make us unhappy. The top issues are lack of control (72 percent), clerical burdens (71 percent), and being emotionally exhausted (69 percent), i.e., burnout. In addition, the survey also identified specific tasks that hindered their happiness at work. The two top responses were clerical duties and administrative issues (both at 28 percent). Other issues were time constraints and lack of staff support. Insufficient pay was the lowest on the list for hindering happiness.2

Lack of time with patients may contribute to physician unhappiness, as 55 percent of physicians reported that time available for individual patients has declined since they started practicing.3


Lack of purpose


Doctors are unhappy due to a growing lack of purpose and meaning in their work and personal lives. This lack of purpose is occurring for two reasons. First, physicians spend as much as two days entering data into the computer to meet hospital and insurance company requirements.4

Unsurprisingly, physicians said they were burned out mainly because of too many bureaucratic tasks.5 The second reason for physician burnout was too many hours at work. The massive workload, much of which is paperwork and non-clinical administrative activities, coupled with the long hours, can cause even the most resilient physicians to lose sight of why they became doctors.

Additionally, doctors lack the time to find purpose and meaning in their personal lives. With so many hours spent on the job, there's only so much time left to focus on personal hobbies and interests, practice mindfulness, exercise, and build quality relationships. In essence, their work-life balance scale was tilting in the wrong direction.

The pressure and risk physicians take seeing patients for eight to ten minutes per encounter, the educational debt, and the fear of getting sued have created a climate of dissatisfaction and unhappiness.


Quality relationships


Having no or few strong relationships also negatively impacts physician happiness.

Good social relationships are the most consistent predictor of a happy life. Social connections are the cornerstone of happiness. In addition to contributing to happiness, strong relationships are linked with improved health and longevity.6

A Harvard study found positive relationships were the top contributing factor to living a happy, healthy, and long life.7


Finances & debt


One of the most popular and conflicting statements is "money can't buy happiness." As it turns out, money is only one factor determining happiness worldwide and for medical professionals. There are three main reasons physicians are unhappy regarding their finances. Inflation continues to negatively impact physician salaries, which consistently need to keep up. Physician compensation rose 14% between 2017 and 2022 to around $391,000 from $343,000. However, accounting for inflation, the real average compensation in 2022 was less than $325,000, a nearly $20,000 decrease in purchasing power.8

On average, doctors leave medical school with over $250,000 of debt, which continues to rise while salaries decline. Educational debt can take years to pay off, especially for physicians with poor spending habits who didn't start saving early in their careers and benefit from compounding.9

A lack of financial education often leads to poor spending habits among doctors, making it difficult for them to get out of debt. Far too many residents and young doctors begin spending like they're making the big bucks when they should be focused on lowering their debt as soon as possible. They spend to their limits since they've lived for so many years as a poor student. They start living a fancy lifestyle before focusing on paying down their debt and making smart investments.


Healthy habits


A career dedicated to understanding how the body works and what it needs to stay healthy would mean physicians care for their own health. Sadly, this is not always the case.

According to the 2023 Medscape Physician Happiness Report, 43% of physicians admitted they only sometimes look after their health and wellness, and 17% admitted they rarely or never look after their health.10

If you've ever experienced a health scare or chronic illness, you know how much health directly affects your happiness. So why do so many physicians neglect their health when they are so familiar with the negative impacts?

It all goes back to the rising impact of physician burnout and the stigma in healthcare around overworking to succeed. Getting into medical school is extremely competitive, and the pressure doesn't let up once you're in medical school and residency; it just intensifies.

Physicians continually neglect their health, and these bad habits continue into their medical careers with a lack of sleep, nutrition, and physical activity.

In 2022, Medscape found that 47% of doctors suffered from burnout, up from 42% the previous year. As mentioned above, a main contributing factor to physician burnout is too many hours at work, so it's not surprising that doctors struggle to prioritize time for their own mental and physical health.

Physicians are notorious for neglecting their sleep, and research shows that less sleep is associated with lower happiness. Getting quality sleep leads to a healthier life.11

According to Medscape's happiness report, 10% of doctors reported they never exercise, and 20% said they only manage to exercise once a week.

Physicians know the impact physical activity has on health and recommend regular exercise to their patients, yet a third of physicians neglect exercise, and another 36% only exercise two to three times a week.12

Exercise is a direct determinant of physician happiness and has been linked to decreased depression, anxiety, and even mortality. Going from low fineness to below average equates to a 50% reduction in mortality over a decade. However, going from low to above-average fitness is a 60% to 70% reduction in mortality.13

The World Health Organization (WHO) recommends weekly 2.5 to 5 hours of moderate-intensity aerobic exercise or 1.25 hours of high-intensity physical activity. The best way to exercise regularly is to build it into your daily habits and hobbies. For example, you could bike to work or commit to always using the stairs in your office or the hospital. If there's a show you never miss, roll out your yoga mat and stretch instead of just sitting on the couch, and instead of turning to your phone during your scheduled breaks, do planks, pushups, or yoga. I have a rebounder in my bedroom, and when watching a program such as the news or a football game, I jump on the rebounder during commercials. The rebounder is an excellent aerobic exercise with less stress on your lower extremities' joints.


Bottom Line:


Many doctors today are unhappy and burned out. The truth is that we have a lot more to be happy about, and we should focus on being happy to be doctors. In the second part of this two-part blog, I will discuss solutions for becoming a happy doctor.

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Wednesday, November 6, 2024

Determining the cost per lead and the lifetime value of patients

"Half the money I spend on advertising is wasted; the trouble is I don't know which half," John Wanamaker, early marketing pioneer.


Marketing your practice is an effective method of attracting new patients and retaining existing patients. It is important to find metrics and methods for measuring the effectiveness of your marketing efforts.

It is necessary to have metrics for gauging the effectiveness of your marketing efforts. Two helpful metrics for monitoring your marketing are the cost per lead (CPL) and the lifetime value of a patient (LTV).


Calculating the cost per lead (CPL)


The cost per lead (CPL) is how much it costs to attract the attention of a potential new patient to your practice. When you know your CPL, you can decide where to put your marketing dollars to maximize the value of your efforts. Understanding your CPL allows you to maximize the effectiveness of your marketing budget.


Deep six: The "gut" mentality


In the past, strategies to attract new patients were based on gut instinct when it came to understanding the results of marketing efforts. It was easy to track how much you spent, but measuring the effectiveness—as in which patients come to your practice directly from your marketing—was merely adding up the new patients entering the practice each month.

Now you can accurately track the patient CPL using market trackers. Market trackers such as LinchpinSEO.com and Hubspot.com can show if a patient is from an online ad, an email, a postcard, a newsletter, or even a billboard. These trackers can record the patient entering the practice and follow them to the end of their patient journey. Using these CPL trackers, you can know the exact patient value your marketing campaign brought in—without depending on your gut.

These trackers have calculated that the cost per lead ranges from $36 to $286, with an average of $162 per lead. These broad ranges give an idea of your practice's CPL.


CPL calculation


To find your patient CPL, it's a simple math equation:

CPL = dollars spent on marketing/number of patients who enter or contact the practice from the marketing effort

For example, if your practice sponsors a seminar and you spend $500 on a mailing list for potential patients and 50 prospective patients call for more information or, better yet, make an appointment, then your CPL is $10.

Of course, only some people who called the office made an appointment. Ten of the fifty people who called the office made an appointment to see the doctor. In this case, this patient acquisition cost (PAC) is $50. ($500\10 = $50)


Why CPL matters


Measuring your CPL provides you with valuable information. For example, if you have hired a marketing team to help grow your practice, ask them about their experience in healthcare and their CPL and PAC. You want to hire a marketing team that provides these metrics to justify your marketing expenses and to monitor their progress.

Even if your practice is doing a great job generating leads, taking the time to calculate your CPL gives you worthwhile insight into how your marketing works. Your CPL is valuable for understanding the effectiveness of your marketing strategies. It's a great indicator of what's working and what's not, helping you choose how to focus your future efforts. If you're ignoring your CPL, you're essentially taking a blind guess as to how effective your marketing is and likely sinking money into inefficient methods or ignoring the ones performing best.

Calculating the CPL of non-digital marketing, such as a direct mail campaign, takes more work, but it's still manageable. For example, a dermatologist spends $1,500 on a direct mail campaign advertising Botox injections. Through tracking the results — by training your staff to ask how patients found you or asking potential patients to bring the mailer in for a free consultation — you see that 40 people call for more information or ask for a free consultation to find out if they're a good candidate for the procedure. Dividing 1,500 by 40, you'd find that the CPL for the campaign was $37.50. You can follow a similar process to calculate the CPL for blogging and other web content, dividing your writing costs by how many leads you found via your blog.

Measuring your CPL has one other significant benefit: comparing your marketing results with industry benchmarks to learn how your results compare to those of other practices.

Remember that your CPL is just one metric to help track your success — it doesn't tell the whole story. Some leads may be more valuable, so a higher-than-average CPL might be worth marketing more expensive procedures. At the same time, some marketing methods might have a higher CPL but be more efficient at turning leads into paying patients.


Calculating the Lifetime Value of a Patient (LTV)


The calculation for LTV consists of multiplying the average value of an appointment by the average number of appointments per year by the estimated number of years a patient is likely to remain in your practice. This equation below should help you make the calculation. LTV = V x N x Y

Bottom Line: The time has arrived for those practices who desire to market and promote their practices to move from trial and error to using technology to monitor the success of marketing campaigns. Get started by measuring your CPL and the LTV of your patients. Now, you can remove a blind guess as to how effective your marketing is and likely sink money into inefficient methods or ignore the marketing efforts that are performing best. Let me conclude that these marketing metrics are only part of your efforts to attract new patients. Additionally, monitoring your online reputation and patient satisfaction scores improves the patient experience, builds long-term loyalty, and enhances your overall reputation. If you have any comments or suggestions regarding this concept, please let me hear from you.

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