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  • #16
    Boost your numbers with the happy patients.  Whenever I have a patient with a beaming smile that tells me how appreciative they are or how good my nurses were, I transition the conversation into "Thank you so much. If you happen to get a survey it would really mean a lot to my nurses and myself if you could fill it out."  My pay isn't correlated to satisfaction but my continued presence in the group and hospital contracts also depend on satisfaction.  I don't give narcs for surveys and I try to be reasonable with "wait and see antibiotics".  I call BS when I see it and understand that sometimes it is better to get a 1/10 than foster recurrent poor behavior.

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    • #17
      Also curious to know how much of the 20% is PG score and what the rest of it is.

      My last job went to a system like this were they have 10% of salary back and gave it to us as quarterly "bonus." It was pretty annoying to have my own money called a bonus.

      As irritating as it sounded the metrics were so easy that I could hardly fault the dept for withholding money from those who couldn't meet them. There were like chart completion, attending faculty meeting, and completing required training stuff. Interestingly getting unsatisfactory teaching scores was a big deal as well but that only affected probably 5% of the docs (and they had real issues).

      I would be hesitant to take a job where a sig amount of pay depended on satisfaction. My own satisfaction scores swing wildly, leading me to conclude that the numbers are largely horseshit.

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      • #18
        And our healthcare system wonders why there's an antibiotic resistance and opioid crisis.

        Simple root cause analysis (or survey to docs) will point exactly to this as a primary factor despite all the position papers that medical societies put out.

        I like the unibomber terminology and it evokes a lot of the same sensation of how these scores terrorize physicians and dentists--will use that at our next systems meeting when PG comes up.

         

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        • #19
          I would not take a job where any portion of my salary were dependent on patient satisfaction scores. There is actually data out there showing they are dangerous to patients- they actually worsen care. At any rate, they certainly aren't statistically significant.
          Helping those who wear the white coat get a fair shake on Wall Street since 2011

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          • #20




            I dealt with similar surveys, with some salary at risk.

            Your frustration and anger is understandable, but possibly misplaced.

            These surveys are rapidly becoming the norm, or perhaps they already are.  I wouldn’t leave your job just because of this quality metric, because you’ll probably run into the same thing at your next job.

            Think of this:   If you have your own practice, your income will depend on patient satisfaction, but you won’t have a numeric score to tell you that your patients don’t like you.  Instead, you’ll have unfilled appointment slots.

            When I looked at other doctors’ scores, they generally corresponded to what I would have expected.  There were few surprises.  The friendly doctors had high scores.  The grumpy, brusque ones had low scores.  My hospital had consultants who would coach low scoring docs, and it seemed to help.  Also of particular note is that new doctors generally started out with very low scores, which would generally rise quickly to scores more in line with the more experienced doctors.

            So I suggest that you give this some time, and seek advice or formal coaching if possible.   Some doctors were videotaped during their patient visits ( with patient permission, of course ) as part of their training.

            I know one surgeon who always scored 100%, year after year.  I don’t know what he did to achieve that.  Another surgeon used to send an email, similar to one that i get from some businesses: ” You may be getting a survey in the mail.  Please let me know if you feel that you can’t give me a 10, so that i can improve my care to your satisfaction”.   I think it worked.  I never did any of this, because I usually didn’t get dinged ( but sometimes I did).  The whole process is demeaning, but then, there’s a lot of demeaning things that I would do for money.

            The bottom line for you is that for whatever reason, you may be doing worse than your peers, so you should try to find out what they are doing better than you, even if it’s only gaming the system, whether or not you stay in this job.

             

             
            Click to expand...


            this is absolutely a sort of pure truth, wrapped in a thick cocoon of stockholms syndrome.

            Yes, pt satisfaction kind of matters...in private practice or non closed systems, which many of the docs that are most subjected to this are not in. The actual reason is of course to lower your salary, this 20% is just the first bite. It has zero to do with anything else. As everyone had long suspected, pt surveys make pez dispensers and poor counselors of physicians.

            Fwiw, Im in a 100% survey/ratings/word of mouth based field with a ton of competition, aesthetic plastic surgery, so Im not some eccentric old timer that doesnt "get it". My surveys are probably vastly different than the bs you'll be getting. They also havent influenced the medical side of things. I agree everyone would be better off if they were socially just more aware and learned a few tricks, but this seems to follow a sort of limited change kind of doctrine. Those that will do well anyway just do so quicker, and those that dont have a chance get marginally better but much more discontented.

            And again, the proper response is to push back on bs, not acquiesce and learn it. That has been the doctor model for decades and look where we are now. We already know these surveys are actually harmful to pts health outcomes. What else is needed to know to drop them in our evidence based lives?

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            • #21







              I dealt with similar surveys, with some salary at risk.

              Your frustration and anger is understandable, but possibly misplaced.

              These surveys are rapidly becoming the norm, or perhaps they already are.  I wouldn’t leave your job just because of this quality metric, because you’ll probably run into the same thing at your next job.

              Think of this:   If you have your own practice, your income will depend on patient satisfaction, but you won’t have a numeric score to tell you that your patients don’t like you.  Instead, you’ll have unfilled appointment slots.

              When I looked at other doctors’ scores, they generally corresponded to what I would have expected.  There were few surprises.  The friendly doctors had high scores.  The grumpy, brusque ones had low scores.  My hospital had consultants who would coach low scoring docs, and it seemed to help.  Also of particular note is that new doctors generally started out with very low scores, which would generally rise quickly to scores more in line with the more experienced doctors.

              So I suggest that you give this some time, and seek advice or formal coaching if possible.   Some doctors were videotaped during their patient visits ( with patient permission, of course ) as part of their training.

              I know one surgeon who always scored 100%, year after year.  I don’t know what he did to achieve that.  Another surgeon used to send an email, similar to one that i get from some businesses: ” You may be getting a survey in the mail.  Please let me know if you feel that you can’t give me a 10, so that i can improve my care to your satisfaction”.   I think it worked.  I never did any of this, because I usually didn’t get dinged ( but sometimes I did).  The whole process is demeaning, but then, there’s a lot of demeaning things that I would do for money.

              The bottom line for you is that for whatever reason, you may be doing worse than your peers, so you should try to find out what they are doing better than you, even if it’s only gaming the system, whether or not you stay in this job.

               

               
              Click to expand…


              this is absolutely a sort of pure truth, wrapped in a thick cocoon of stockholms syndrome.

              Yes, pt satisfaction kind of matters…in private practice or non closed systems, which many of the docs that are most subjected to this are not in. The actual reason is of course to lower your salary, this 20% is just the first bite. It has zero to do with anything else. As everyone had long suspected, pt surveys make pez dispensers and poor counselors of physicians.

              Fwiw, Im in a 100% survey/ratings/word of mouth based field with a ton of competition, aesthetic plastic surgery, so Im not some eccentric old timer that doesnt “get it”. My surveys are probably vastly different than the bs you’ll be getting. They also havent influenced the medical side of things. I agree everyone would be better off if they were socially just more aware and learned a few tricks, but this seems to follow a sort of limited change kind of doctrine. Those that will do well anyway just do so quicker, and those that dont have a chance get marginally better but much more discontented.

              And again, the proper response is to push back on bs, not acquiesce and learn it. That has been the doctor model for decades and look where we are now. We already know these surveys are actually harmful to pts health outcomes. What else is needed to know to drop them in our evidence based lives?
              Click to expand...


              One can play the game (well) while still actively trying to change the rules (get real data, weed out BS, ensure significant n-value, look at outcomes, etc) or holding hospital executives responsible for some things (physical space, support staff, etc).  Everything is rated, for better or for worse.  I have a favorite restaurant and could care less what others rate it...to a degree:  If my joint were to get a bunch of bad yelp/critic reviews, this might drive away customers to the point they'd go out of business.  (Or, if they suddenly got 3 michelin stars, I might not find be able to afford it nor want to deal with the reservations process.)  It is specious to believe it is different with healthcare.

              Although I am in private practice, I work in a hospital and yeah my employment requires this Ultimate Customer be happy with me.  The data may be flawed, but the hospital has a vested financial interest in satisfied "customers."  The hospital has a portion of their reimbursement tied to "satisfaction."  Many patients can choose which hospital they go to.  When companies negotiate contracts, they certainly choose which health network to utilize.  Isn't this the same stuff you deal with?

              Don't get me wrong, while I try to spin a positive side to this, I do believe that surveying patients about their doctors is about as useful as surveying airline passengers about their air traffic controllers.

              Comment


              • #22
                i have long thought this was a bad trend in healthcare and elsewhere.  When I buy a product I am more interested in what experts have said about it rather than the general public. I have noticed that my millennial age receptionist puts great faith in product reviews done by the public.  I guess it is an age based thing.  I feel like only the disgruntled patient is really going to fill out surveys.  I agree that it is a way to decrease the hospital based doc's pay.  In the private practice world every day is about patient satisfaction or you will not make it.

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                • #23
                  This is the sad state of medicine now.  Not only have we become "providers", we might just as well ask the patient what they want and they can enter it into the EHR.  That would sure speed up the appointments.  Our physician leadership has failed us by allowing this to happen.  The big companies that do these surveys make sure that these will become the standard measuring tool.  Don't even try to see if they actually accomplish what they intend to accomplish, there is way too much money involved for these companies and for the people who can pay you less based upon the surveys.  No reasonably intelligent person could think these make sense.  Just another reason to up your savings level so you can walk away from a job that demands this of you when it gets bad enough.

                  Comment


                  • #24










                    I dealt with similar surveys, with some salary at risk.

                    Your frustration and anger is understandable, but possibly misplaced.

                    These surveys are rapidly becoming the norm, or perhaps they already are.  I wouldn’t leave your job just because of this quality metric, because you’ll probably run into the same thing at your next job.

                    Think of this:   If you have your own practice, your income will depend on patient satisfaction, but you won’t have a numeric score to tell you that your patients don’t like you.  Instead, you’ll have unfilled appointment slots.

                    When I looked at other doctors’ scores, they generally corresponded to what I would have expected.  There were few surprises.  The friendly doctors had high scores.  The grumpy, brusque ones had low scores.  My hospital had consultants who would coach low scoring docs, and it seemed to help.  Also of particular note is that new doctors generally started out with very low scores, which would generally rise quickly to scores more in line with the more experienced doctors.

                    So I suggest that you give this some time, and seek advice or formal coaching if possible.   Some doctors were videotaped during their patient visits ( with patient permission, of course ) as part of their training.

                    I know one surgeon who always scored 100%, year after year.  I don’t know what he did to achieve that.  Another surgeon used to send an email, similar to one that i get from some businesses: ” You may be getting a survey in the mail.  Please let me know if you feel that you can’t give me a 10, so that i can improve my care to your satisfaction”.   I think it worked.  I never did any of this, because I usually didn’t get dinged ( but sometimes I did).  The whole process is demeaning, but then, there’s a lot of demeaning things that I would do for money.

                    The bottom line for you is that for whatever reason, you may be doing worse than your peers, so you should try to find out what they are doing better than you, even if it’s only gaming the system, whether or not you stay in this job.

                     

                     
                    Click to expand…


                    this is absolutely a sort of pure truth, wrapped in a thick cocoon of stockholms syndrome.

                    Yes, pt satisfaction kind of matters…in private practice or non closed systems, which many of the docs that are most subjected to this are not in. The actual reason is of course to lower your salary, this 20% is just the first bite. It has zero to do with anything else. As everyone had long suspected, pt surveys make pez dispensers and poor counselors of physicians.

                    Fwiw, Im in a 100% survey/ratings/word of mouth based field with a ton of competition, aesthetic plastic surgery, so Im not some eccentric old timer that doesnt “get it”. My surveys are probably vastly different than the bs you’ll be getting. They also havent influenced the medical side of things. I agree everyone would be better off if they were socially just more aware and learned a few tricks, but this seems to follow a sort of limited change kind of doctrine. Those that will do well anyway just do so quicker, and those that dont have a chance get marginally better but much more discontented.

                    And again, the proper response is to push back on bs, not acquiesce and learn it. That has been the doctor model for decades and look where we are now. We already know these surveys are actually harmful to pts health outcomes. What else is needed to know to drop them in our evidence based lives?
                    Click to expand…


                    One can play the game (well) while still actively trying to change the rules (get real data, weed out BS, ensure significant n-value, look at outcomes, etc) or holding hospital executives responsible for some things (physical space, support staff, etc).  Everything is rated, for better or for worse.  I have a favorite restaurant and could care less what others rate it…to a degree:  If my joint were to get a bunch of bad yelp/critic reviews, this might drive away customers to the point they’d go out of business.  (Or, if they suddenly got 3 michelin stars, I might not find be able to afford it nor want to deal with the reservations process.)  It is specious to believe it is different with healthcare.

                    Although I am in private practice, I work in a hospital and yeah my employment requires this Ultimate Customer be happy with me.  The data may be flawed, but the hospital has a vested financial interest in satisfied “customers.”  The hospital has a portion of their reimbursement tied to “satisfaction.”  Many patients can choose which hospital they go to.  When companies negotiate contracts, they certainly choose which health network to utilize.  Isn’t this the same stuff you deal with?

                    Don’t get me wrong, while I try to spin a positive side to this, I do believe that surveying patients about their doctors is about as useful as surveying airline passengers about their air traffic controllers.
                    Click to expand...


                    Im saying the point of the surveys/reviews should make sense, which they dont necessarily. "How happy are you that your doctor told you to stop eating ice cream 4x/d and start exercising?" is not valid nor a good way to measure a doctor. The better doctor will have the worst reviews. Hospitals/governments should have been much more careful with these measures. Im sure at some point it was supposed to be for improvement of the system. However, it is simply a cost control method at the hospital/practice/etc...level, it is nothing more.

                    What I deal with is just like restaraunts, and yes its tied to compensation, however I dont have to jump through any bs documentation, hoops, or do something that makes pts worse off to get good results. I simply try to do my best work, and what follows is the result. If it turns out its not valued, business goes down, if it turns out great, it improves. Very simple. Everyone is either explicitly or implicitly on such a system to one degree or another. Only large systems with loads of pts arent, and yet these are the ones most likely to use some other kind of "satisfaction" survey.

                    Comment


                    • #25
                      This game is here to stay. CMS requires that hospitals collect and report patient satisfaction data.

                      The worst part of Press-Ganey is that it is a 2 point scoring system disguised as a 5 point scoring system-a 4/5 ("satisfied") is no different than a 1/5 ("completely unsatisfied"). Therefore, it is essential to reframe the questions so that patients answer them the way they are scored. "You may get a survey in the mail about how well I was able to help you today. If you feel like you want to score a question as less than 5/5, please let me know what I did wrong so it can be corrected." This makes a 5/5 score the "normal" outcome and the other answers "abnormal."

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                      • #26
                        CMS requires the data but who decided physician pay should be linked to it?

                        Comment


                        • #27
                          I think zaphod summed it best.

                          Stockholm syndrome is real and some of these responses trying to even hint at justifying patient satisfaction surveys is ridiculous

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                          • #28
                            we have to pick our battles sometimes.  especially if your batna involves a new job which forces your spouse to quit a job they like and move to a new community or even state.

                            there are many ways to get screwed by your employer.  this is just one.

                             

                             

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                            • #29




                              we have to pick our battles sometimes.  especially if your batna involves a new job which forces your spouse to quit a job they like and move to a new community or even state.

                              there are many ways to get screwed by your employer.  this is just one.

                               

                               
                              Click to expand...


                              They may be a fact of life for many, but that doesnt mean you have to pretend it actually matters or means anything. Sadly this just further cements it into reality and everyones lives. Such is the case with docs, giving in wholly first, asking questions when its too late, then advising the younger generation to close their eyes and take it.

                              Where has that gotten us? We still hold 99.9% of the power. Not an entity can collect a dime without us as an intermediary. Lets not fool ourselves that is exactly how your employer sees you, just as the med mal attorney sees you only as a representation of the key to your insurers vaults. Play this game unto its predictable longer term end and we will be cut out of this role, and any power we once had, and then medicine will be truly awful. Make no mistake they are trying and getting little wins every day even in this regard, but it does not end well.

                               

                              Comment


                              • #30
                                I've got to disagree with several of the posters. Our new contracts start January 1st (we've supposed to receive a copy to review soon, but you know how that goes), and I'm sure patient satisfaction scores are going to be a part of our salary/bonus structure. However, I'll refuse to prescribe inappropriate antibiotics, give opiate prescriptions when they're not warranted, or solicit patients to go online and rate me. My dignity and ethics aren't for sale.

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