When I graduated in medicine in 1985 the world was a very different place. My career plan at that time could be summed up as “Give us a job, will you?” and, by absolute luck, enough people said yes that I was pleased to have the most wonderful, rich, early post-graduate training program.
I transitioned directly from the training program into partnership and, at the time, partnerships were much less cohesive. We would have partner meetings once a quarter because there just wasn’t much to discuss. Back then, it was a state provided healthcare service but, in the years since I’ve been practicing, it has become a state-run healthcare service and the two are not the same. Because the market was much less managed, we were not the subjects of as many hooks and levers to meet social government policy requirements as we are today.
At the time, the hospital sector was salaried and the General Practitioner sector was independent self-employed. The career path for people like me coming out of the training program was that we would virtually all go into partnership. There were some doctors who were employees of the practice partners but it was very niche. In addition, limited liability partnerships had not yet been invented. So, I transitioned into partnership thinking I was going to be an independent—not a partner—and my particular practice suffered.
Although it was very foreseeable, we weren’t able to foresee it because we were a young group of partners. The problem with a young group of partners is that they all grow old together and then they begin finding in themselves all the things about which they used to complain of in the older generation when they were younger. There are many things I know now that I wish I had known as a new GP Partner, bright eyed and bushy tailed as I was.
If I could go back and give myself one piece of advice upon becoming partner, it would be to understand that technical medical knowledge is not enough when delivering the service of patient care. I needed to understand that it is all the events surrounding the medical consultation by which the doctor and the medical staff will be evaluated when the patient assesses their quality of care. This can feel unfair to the medical staff who feels they have done their job well by providing the right examination, diagnosis, and treatment and are still faced with a patient who remains wound up and annoyed.
It is important to know that the study of the events surrounding the consultation are valid. If those events are clunky, then you will be viewed as clunky. For example, often the quality of a surgeon is judged by patients based on their interpersonal skills rather than their surgical skills. It’s important for general practitioners to understand that our patients are doing the same with us. We are being judged by both our interpersonal and inter-organisational skills rather than just our ability to practice medicine. I would say to my younger self that it’s ok to think outside of my own little box and look at the bigger picture.
From beginning to end, the patient experience is shaped first by ease or difficulty of access, including telephone answering times and waiting periods for open appointment dates, time spent in the waiting room and interacting with office staff prior to the consultation, and then, only later on, by the interpersonal skills and the diagnostic skills of the medical staff themselves. The importance of which events the patient will usually weigh in this order.
Had I been fore-warned that the management of the market would change, I would have understood that a practice requires a set of key skills involving corporate techniques in order to thrive. It would have been helpful to understand that having a degree in medicine does not mean you have acquired these skills and that it is possible to plan ahead for changes and get ahead of the game. Within my practice, we seemed to be always several months behind the curve. Instead of planning ahead, we found ourselves constantly reacting. Reactive care is what the medical model is good at: a problem walks in and we sort it. But that is a really hard way of running a business because you are always, every Monday morning, met with a bucket of cold water.
Fortunately, we here at Xytal are here to help ensure that your experience doesn’t have to include the weekly icy drenching that was mine. We have created a course specifically designed for GPs who are new to partnership to help you get ahead of the curve. Find out more here…
In my next article, I will share more about things I wish I had known and the lessons I’ve learned.
To Be Continued…
This blog was written by Dr Richard More.