Realizing a Forgotten Vision

My first evaluation explored not only what my supervisor expected of me, but what I expected from my employer, as well as what I expected of myself.

During that meeting, my supervisor expected me to do my best to create the “Next Mayo” while fulfilling my contractual obligations (RVUs, patient satisfaction, publications, committee involvement, and student evaluations). His goals were that I meet all promotion requirements so that I could progress from Assistant Professor to Associate Professor. We discuss what the Next Mayo would look like, and the environment and culture needed to achieve that goal in another blog post.

I expected that my employer would provide me with the support and supplies necessary to meet the contractual requirements. Our discussion included what would be needed to create a successful and exceptional residency program.

My contract required me to produce 4200 relative value units (RVU) a year based on Medical Group Management Association (MGMA) data from the year that I was hired, while serving an average of 0.8 full time equivalents (FTE). So out of 5 work days, 4 were to be dedicated to seeing patients. The other 1 day, we would build the residency, write manuscripts for publication, teach, participate in committees, and engage in other ad hoc meetings. That’s what a 0.8 FTE means.

With 4200 RVUs over approximately 208 days of work (if I never took vacation) at a 0.8 FTE rate, I would have to earn 20.2 RVUs per day of clinic. A standard cold is coded as 99213 (0.97 RVUs), while a diabetes follow up with modification of medication is coded as 99214 (1.5 RVUs). To meet my requirements, I would need to see 21 colds every day of clinic, or see 13 more complicated visits. Not too bad, right?

To see and manage 13-21 patients daily requires support staff to help screen, communicate with, and follow up with patients as well as deal with insurances, pharmacies, and families. This is a lot of work and only gets more complicated as every insurance has different rules that are always changing.

My expectations of myself have always been aggressive. My goal was to exceed the requirements of my contract while reaching higher. My vision at that time was to become a Residency Program Director. The years that followed have been frustrated by injury, insult, and traumatic brain injury. It took years to regain the level of function that I had started with in this position. In the process of recovery I burned a lot of bridges (turns out that politics is how you keep bridges strong… TBI didn’t keep that part of my brain functional for a while).

I had given up on my goal of becoming a Program Director after my injury, recognizing that I had lost something inherently necessary for that role. After years of struggle, learning to learn again, and constant deliberate practice to regain what I lost, I was offered that forgotten vision.

Choices. There are so many alternative paths that I have envisioned over the last 3 years (more blog posts to follow). Having already fully engaged in one of those paths, I will continue to serve my employer, supervisor, hospital, and contract until I have fulfilled the contractual obligations. Integrity binds actions to words.