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Dear Director,

I recently had my annual evaluation and it left me confused. It was entirely based on numbers and metrics, yet I feel I need to define my career success by more than that.

Make no mistake: when it comes to evaluations, I am a huge advocate for the use of metrics. We need the cold, hard numbers to keep things fair, particularly when money is involved. Metrics also help medical directors identify weak links and areas that need improvement. If your numbers are bad, or trending down, you will need to address the problem or find a new job. But while our evaluations are important, they aren’t everything. I wouldn’t let a good, average or even bad score completely define how I view my overall success on the job. There are intangible aspects of our practice that we must tap into, and remind ourselves of, if we are to maintain a passion for our work and stave off burn out.
It starts by moving beyond common benchmarks to a better understanding of our own values.

Consider writing a personal mission statement for your practice (which is harder to write than you might think). If you need a prompt, the Hippocratic Oath outlines some of the intangible professional values worth striving towards in medicine, like service, compassion, respect, education, commitment, quality, integrity, and professionalism. Once you spend a little time thinking about your top three core values, you begin to realize that your success, both personally and professionally, is much larger than what your medical director can grade you on during an annual performance evaluation.

Consider the value of commitment and service. Think about the overall impact of delivering care to 2000-5000 patients a year. Over a decade or a lifetime, that’s an incredible number of lives that you’ve impacted, which should be a source of enduring pride.

What about the value of compassionate care? I may have come into emergency medicine to save lives, but over the years, I’ve found myself gauging my success based more on my ability to engage with patients and simply make them feel better. If I show up with my “A” game and if I sit and listen to my patients and try my hardest to take care of them, I can generally feel pretty good about my day. I might not be saving a life every time I walk in a room, and rarely do patients send thank you notes, but they often leave the ED with a heart felt thanks or a high five from a toddler. Occasionally – on a really great day – they might even ask me if I will be their PMD. Those interactions – and those everyday signs of thanks – may be the ultimate gauge of a successful practice.

As you reflect on your core values, remind yourself of the passions that brought you into healthcare in the first place. For some of us, it’s the joy of teaching. Every department I’ve ever worked in has had nurses crave education by the docs.  It doesn’t take long to put together a 20 minute lecture on sepsis and give it at a monthly nursing staff meeting.  You’ll increase your rapport with the nurses and improve care in the department. Or you could easily become a go-to doc for your department’s disaster management planning. I am constantly attending meetings that require additional physician input. Whether it’s education, EMS, or healthcare policy, there is an outlet in your ED to rediscover the passion that brought you into medicine.  

Thankfully, finding joy in the small victories and tapping into your passions isn’t at odds with improving your cold, hard metrics. Let’s say, for instance, that you don’t feel like you’ve been getting a shower of thanks in the patient care department. Consider upping your game by calling your discharged patients the following day to see how they’re feeling. Not only do you get to follow the progression of the illness, you likely get to further educate them, and most patients are blown away with appreciation that an ER doc took the time to call and check up on them. If this sounds scary, cherry pick your nicest patients the first few times you do this until you get comfortable. I ask patients for their cell numbers and essentially tell them what time window I’m going to call and check in on them. They’re amazed and in that moment you realize that you’re providing great care. You’ll feel more fulfilled at having followed the progression of illness and providing superior care, and your patient sat scores will likely experience a bump as well.

I asked one of my grizzled vets about how he keeps coming to work long after I would have retired. He said it was simple—he puts the patient first and feels good about his job at the end of the day.  Both he and I know that we have a really tough job that requires hard work and dedication.  He understands how his core values define his success. I’ve worked with docs with outstanding metrics who still feel dissatisfied with their job and other docs on the lower end of the performance spectrum who feel incredibly successful.  Ultimately, metrics do matter because without good metrics, you could be out of a job. And if the ED doesn’t have good metrics, you could be out of a contract.  But we also need to reflect on our own values and set personal goals for growth, taking joy in the small compliments we get and in the quiet knowledge that we’ve delivered consistent, quality, compassionate care.


Michael Silverman, MD, is a partner at Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.

 

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