This month, an article in JAMA gives us some ideas of why American medical costs are so high. The authors analyzed data from the OECD (Organisation for Economic Co-operation and...
I am on 29 committees that involve everything from our hospital, the broader medical center, our department, and the college. So, I spend a lot of time in meetings and so do a lot of other physicians. Your hospital probably has a committee for just about everything. Next time you are in a committee meeting, take a look around you and see if you can estimate the cost of the time of the people there.
We’ll start off with an assumption that the average physician makes about $270,000 and has $30,000 in benefits for a total of $300,000. Primary care physicians make a lot less, medical specialists make a bit more, and surgeons make a lot more. Now let’s assume that the average physician works 51 hours a week for 46 weeks out of the year (figuring holidays, CME, and vacation). That works out to about $130/hour
Let’s now say you are in a meeting with 10 physicians plus a few administrative personnel. The cost of that meeting in physician time alone is $1,300 per hour or $22 per minute. If you are not making a $1,300 decision, you probably shouldn’t be having that meeting. So, if the meeting was to decide how to orchestrate the department Christmas party for 50 people and you spent 15 minutes trying to decide whether to serve steak at $25/person or chicken at $22/person then you just spent $866 to make a $150 decision. You would have been better off just ordering the steak dinners and had the physicians on the committee spend an extra 15 minutes seeing one more return patient in the clinic.
This doesn’t mean that you should purge your hospital of all committee because sometimes you need physician input in order to preserve the physician’s sense of self-determination and democracy and some would argue that these are priceless. But you do have to be prudent given the high cost of meetings with physician members. For a medical director here are some considerations:
- Be organized. A half-hour or hour getting all of the background information and preparing for a meeting can save hundreds of dollars of physician time in a meeting.
- Have an agenda. Without one, your meeting can devolve into free-flowing anarchy and will expand to fill the hour with unproductive talk. An agenda gives you permission to cut off discussion before you lose control.
- Don’t be afraid to table an issue. If it looks like you are not going to be able to approve a motion or there is not enough information, don’t spend more time on it. This can also serve to reign in meeting participants who are being difficult by sending a signal that you are not going to waste other attendees’ time on issues that are not going anywhere.
- If you have a regularly scheduled meeting and you don’t have any discussion items, cancel the meeting.
- Schedule meetings strategically. Primary care physicians are in their offices from 8-5 so don’t schedule committee meetings at that time if you want them to attend. Hospitalists are under increasing pressure to get daily discharges out before noon so don’t schedule morning meetings for them. Surgeons and anesthesiologists often start their day at 7:00 AM and morning meetings are not good for them either. Emergency physicians who get done with their night shift at 7 AM are not going to want to come back to the hospital for a noon meeting when they are trying to sleep. Prime times for committee meetings for physicians are 7:00 AM and 5:00 PM.
- Use committees judiciously. If your hospital has too many committee meetings, it is hard to make decisions about anything. However, committee meetings are invaluable for building consensus for difficult decisions.
- Use electronic meetings judiciously. Although connecting by phone or internet can be a great way to minimize travel time for physicians in outlying practice sites, it is often too easy to become disengaged when attending a meeting by phone. It can be very tempting to put the phone on speaker mode and then do emails or charting in the electronic medical record.
- Committees as a defensive weapon. A medical director often has to make unpopular, no-win decisions. Sometimes, it is useful to be able to say “The committee decided that…” rather than “I decided that…”.
- Feed them and they will come. Serving breakfast or lunch during a meeting can allow busy physicians to make double use of an hour in the morning or at noon. But beware of huge boxed meals – too many calories will put everyone to sleep by the end of the meeting. To paraphrase Machiavelli, “It is better to serve both food and coffee but if you can only serve one, serve coffee.”
- Committees are immortal. It is hard to make a committee die, even after it has out-lived its use. If you have a single defined issue that needs to be addressed, create a time-limited workgroup rather than a committee.
- Be sure that there is a committee reporting structure. Make sure that it is clear where the committee’s findings and recommendations get reported to. For example, the Medication Safety Committee reports to the Pharmacy and Therapeutics Committee that in turn reports to the Medical Staff Administrative Committee that in turn reports to the Board of Trustees.
- Keep minutes. Documentation of the committee’s recommendations and findings need to be written down. Partly so that after the fact, everyone can agree on what was discussed and decided. If there is no documentation of the committee’s work, then the flames of conspiracy theorists in the hospital will be fanned with wild suspicions about what happens behind the conference room doors.
- Choose the committee chairman carefully. The chairman should not be the one who talks the most or makes unilateral decisions. He or she should be someone who encourages all of the members to talk and promotes consensus rather than makes unilateral decisions.
Committees are an expensive necessity in the hospital. Always be sure that the value of the committee’s work is greater than the cost of the committee meeting.
July 28, 2016