Our UC was last week (videos up soon) and it was an awesome affair. Were there music videos? Yes. Choreographed dancing? Yes. Networking, teaching, mentoring, consulting? Yes, yes, yes, and yes. Did we have fun?
Like no one else.
However, I am reminded every year of the friends who weren't able to make it. On the second day of the conference, I received the email below. It's from a long time, but former, PCC client who was forced to sell their practice to the local healthcare system because of health and financial reasons - I completely understood and supported their decision. However, they wrote to say how much they missed the UC and then asked that John Canning and I share the message below with our clients. I have not changed a word of it except to obfuscate some identifying information. I won't share their identity, lest their employer catch wind and react. Tell me what you think.
Hoping you have an incredible week of UC events coming up this week. I so wish I still had reason to be there.
If it helps, please share the following words of wisdom with PCC staff and/or UC attendees, especially those who express frustration with PCC.
It's now been [time] since I made the transition from PCC to Epic as part of a practice acquisition that had to happen but which has been anything but pleasant.
I miss everything imaginable about being independent and of being part of the PCC family.
Do everything you can to retain your independence. Where once everything I did was to serve my patients and their families, now it often seems that serving the system comes equally to or even before serving patients and their families. And change management is near impossible - when one identifies an issue, there are dozens of steps that need to take place to get even the simplest fix put into place. When one has been used to identifying a problem, proposing a solution with one's staff, and running a PDSA cycle or two to address it, this becomes ever more frustrating.
Based on workflow issues alone, the change from PCC to Epic has made every day in practice an exercise in "are you kidding me's" if not downright misery. The simple act of charting a phone call or portal message can happen 10 different ways that are often inconsistent with each other and which sometimes don't even leave a record of the interaction on the chart. Documenting information on consult notes in a way that allows for quick reference to what happened is also just about impossible. Even the simple act of setting up next appointments and doing reminder and recall is a daily exercise in futility. Losing access to CHADIS (not an Epic issue, but rather an issue of the system I joined) has made proper screening in the office something that adds hours of work to the day and leaves room for so many errors. There are so many inefficiencies in how Epic works and everytime we think we have come up with a more efficient way to implement processes more like what we had when we were with PCC, something else breaks and makes it that much more difficult to run the office. This is especially magnified when the system is trying to use the same Epic build to serve primary care clinics, specialty clinics, urgent care offices, inpatient hospital needs and more.
My office used to be a well-oiled machine and now I need twice as much staff (but don't have it) just to accomplish the daily tasks we used to be able to do with a very lean ship. It feels like we are operating a Rube Goldberg machine in a black box where nobody knows how things get from point A to point B (and act kind of like the brain pathways of kids with ADHD or the old Family Circus cartoons).
On top of everything, all the old issues of staffing and worrying about money are still there, just with a lack of much control over them. Somehow, we still have to do tons of claims follow-up because the central business office just assumes there is going to be a certain amount of bleed and hopes that volume makes up for it.
PCC offers help with so many aspects of not just the EHR experience but of practice management in general and one only has to take advantage of those opportunities to be set up for success with smart work.
There were multiple factors that led to my joining a system - a need for much better health insurance and much more financial security given personal health problems and a lack of being able to compete in a market where so many other practices had been brought into systems or bought by private equity. And there is some good - I'm on call a lot less often and I'm not constantly worrying about how to pay bills to cover overhead.
Overall, however, pediatricians should cherish or promote their independence whenever possible. They should utilize the many resources that PCC offers and that they can learn more about at Users Conference and beyond (including PMI, Pediatric CEO, and more) to do what they can to remain independent and provide truly patient and family centered primary pediatric care. Better preparing for the unknown and crises that might (and did) come up go a long way to making that happen.
MIss y'all greatly! Have a great week in Burlington. Drink a Heady Topper or two and some of that great Buffalo Trace made for Burlington whiskey for me.
Sobering, isn't it?
They then wrote back to add:
(1) there’s no death by committee in independent practice (well maybe in larger ones but it still can’t be as bad as what I’m seeing now)
(2) So few of the docs in my network are involved in organized medicine. I’ve now come to realize that that’s because the hospital offers all the CME they need and a billion committees for them to serve on. But I really think that this leads to dangerous group think and to much slower innovation.
(3) It’s a lot harder to be an advocate, because any sort of testimony or press that you do has to be approved of by the mothership. Despite years of experience doing legislative and media advocacy, the organization seems to be wary about letting he do anything even after going through their training.They had one more point to share, but I can't include it because it will certainly out them, but it was to share examples of where they had lost their ability to work with the media to get the message out. Everything needs to be approved, but requests for approval are often met with silence.
Sigh.