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Tuesday Nov 17, 2015

Safeguard Your Sanity -- and Your Specialty -- With a Bold 'No!'

One day I walked into my home after a post-call clinic, having delivered a baby with dystocia and admitted a terminal cancer patient into hospice. It was a long, long call.

My daughter ran to my legs and hugged them, my son asked what was for dinner, and the newborn let it be known that she needed to nurse. I gave my husband a quick hug and kiss, thinking about how I was going to give my patients the quality care they need when my clinic has been paralyzed by our hospital's decision to implement a new electronic health records system without seeking input from physicians in its outpatient clinics.

This conundrum, I am sure, is common among physicians. We are conditioned to multitask, go the extra mile and do it without a grimace. As new physicians, we know all too well the pressures placed on us as medical students and residents to accept more work and excel. Despite working long hours with inadequate sleep, we are programmed to overachieve.

I am four years out of residency, working as a medical director of a rural health clinic, dealing with meaningful use and quality measures while also being a wife and mother of three, and I realize that without boundaries, I am at risk of burnout.

Think about it: In light of the changes occurring in our health care system, we new family doctors are groomed to be prime assets not only to our patients but also to our communities. We understand that, and we innately carry the responsibility of leadership. It is how we are made.

With that in mind, however, I find myself redefining leadership as a means to make a deliberate impact. For me, it has become a much more thoughtful process than it once was. For the first time in my career, I have the ability to tailor my experience and maximize my talents and gifts so that I can become the type of doctor that I once wrote about in my medical school essays.

With this new approach, I see that I must be willing to take a stand to make a difference. Most importantly, there is power in saying no.

Say no to things that do not feed your vision. Medicine, especially family medicine, is as much a calling as it is a job. Although not everyone is passionate on a national level, we each have an impact within our unique settings. But without vision, we can fall prey to spreading ourselves too thin, leading to burnout. With vision, it is easier to say no to demands made by insurers, employers, clinic managers and others.

Before entering medical school, I always envisioned myself working within the family unit and caring for people worldwide. I didn't know at that point that the image of medicine that motivated me to excel was that of a family doctor.

I thrive by providing quality care to all members of my community, not simply those who can afford it. Now, I take care to prioritize my work with my life's vision. The more that vision crystalizes, the more centered I become in life.

Say no to interactions that do not respect you for the asset that you are. We are valuable revenue builders for our health system, and without primary care physicians, the health system could not function. Although our self-worth goes much deeper than our bank accounts, given the years of both social and financial sacrifice we've made, the way we are compensated is an important reflection of respect.

I work as an independent contractor for a hospital-owned clinic, so I have had to develop confidence in my professional worth that I draw upon during contract negotiations. We women often are paid less than our male colleagues, but it is important to find a work environment that aligns with your value. I am no longer afraid to ask for fair compensation.

Beyond money, it is imperative that we guard our time, which is so valuable. It is no secret that family doctors are the backbone of the medical system. We need to be bold enough to say no when we are asked to do work that is not equitable compared to that our colleagues are asked to do. In contract negotiations, we need to be willing to walk away from a bad deal. We need to demand what we value -- money, time off, quality improvement, professional development or educational allowances.

We need to be bold enough to say no to outside sources that attempt to dictate how we practice medicine. We are bogged down by prior authorizations, Physician Quality Reporting System requirements, filing scripts for durable medical equipment and supplies, or even finding a specialist for our patients who lack insurance. It will only get worse if we as a collective don't take a stand against the administrative hassles that drag us away from our patients.

Part of our job as healers is to protect the sacred space between doctor and patient. The only way we can do that is by being a presence our local, state and national leaders know and respect. Until we are recognized for the immense role we play in health care, the pressures of the system will continue to fall on our backs.

When we are ready to hone in on our time, we gain the ability to say yes to more fulfillment. Let's say yes to less burnout. Let's say yes to fair compensation. Let's say yes to better quality of life. Let's say yes to better patient care. Let's say yes to the freedom and joy of serving in such a noble calling.

Marie-Elizabeth Ramas, M.D., is the new physician member of the AAFP Board of Directors.

Posted at 03:30PM Nov 17, 2015 by Marie-Elizabeth Ramas, M.D.

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