To Dr. Kealey, self-assessment plays a significant role in helping physicians with their career goals and ensuring that their careers are on track and on target.
At HealthPartners, physicians fill out a self-evaluation form on which they list all activities they’ve been involved in over the previous year. Then they are asked what they got out of these activities, what their career goals are, and whether they are meeting them. They’re also asked how the group can help them reach those goals.
“We ask them to pause and reflect on where they’re headed with their career and their life, and put it down in writing so that in that moment they take the time to ask, ‘What is it that I’m ultimately after?’ ” says Dr. Kealey.
Day to day, they are immersed in patient care and focused on doing a good job. “But in the trajectory of where they are headed—the committees, projects, and educational activities they are involved in—are they all aligned and pointing in the same direction and the right direction?” Dr Kealey asks.
The process, which HealthPartners hospitalists have been using for about 10 years, was modified from the American College of Physician Executives course “Managing Physician Performance.”
“It is a tool to help hospitalists pause and reflect on their career and how to move it forward,” Dr. Kealey says.
Marc B. Westle, DO, FACP, president and managing partner of the Asheville Hospitalist Group, PA, in Asheville, N.C., relies on ongoing conversations. This group also uses Crimson’s Physician Management Software to track various group quality and cost indicators, looking at data from as many angles as possible.
“It’s an excellent tool to look at a group, it is a poor tool to look at an individual,” Dr. Westle says. “Although the insurance companies like to say you can apply it to the individual, in reality there is no good way to attribute that data down to the physician level.”
Within the group data, it may be possible to recognize underperformers, but still it is anecdotal, based on experience and interaction.
“Under, ‘How am I doing?’ there is an objective category in the software where there are hard end-points and measures you can look at,” says Dr. Westle
On the subjective side, Dr. Westle collects data on relative value units (RVUs), non-monetary, numeric values Medicare uses to represent the relative amount of physician time, resources, and expertise needed to provide various services to patients. They review total RVUs as well as individual-components that make up total RVUs.
“I’ll track how many simple, moderate, or complex follow-up visits were made, how many simple or moderate histories and physicals or consultations, how many procedures are they doing.” Dr. Westle says. “I’ll track every statistic that way for every individual and give them that feedback so they can see how they’re doing from a performance and a work standard, compared to their peers within the group, and nationally as published by Medicare.”
Dr. Westle uses charts and graphs to drive his points home.
“It just gives them an idea about where they are,’’ he says. “It doesn’t mean they’re doing a bad job. Our patients may be sicker than some other patients. And that is why we do it as a group, too, because their patients should be similar to the group’s patients and the group’s patients may be different than the average Medicare patient.”
They also look at hospitalists’ quality of life, their schedules, and the quantity of work the average physician is doing compared with those around the country. They discuss scheduling, income, disposable income, and the kind of work they’re doing in the hospital. “All this comes into a discussion of where they are in their lives and are they happy with what they’re doing,” Dr. Westle says. TH