Navigating the Complexities Around Workload Distribution

• Pathologists Leadership Summit

Julie McDowell:

The topic of workload distribution, whether linked to a pathologist's productivity and compensation, or simply considered as a part of group dynamics, is often treated as a taboo subject or completely ignored, by not only leadership, but individual pathologists. In this CAPcast, Drs. Moira Larsen and Karim Sirgi will discuss how to determine workload distribution while navigating the associated group dynamics. Dr. Larsen is currently the Physician Executive Director of MedStar Medical Group Pathology, which is part of MedStar Health, an integrated care delivery network in Washington, D.C. in Maryland. Dr. Sirgi owns and manages Sirgi Consulting, LLC, which offers expertise to medical groups in various aspects of practice management and leadership. Both members of the CAP's Practice Management Committee, Drs. Sirgi and Larsen will be leading a course on this topic at the Pathologists Leadership Summit, which will be held virtually and in person in Washington, D.C. on April 30th through May 3rd. So, Drs. Sirgi and Larsen, I'd like to start by having each of you elaborate on the perceptions of fairness and the associated challenges regarding workload distribution among pathologists. Dr. Sirgi, can we start with you?

Dr. Sirgi:

Sure. Thank you, Julie. So, fairness in workload distribution registers as one of the top reasons for severe heartburn for pathologists working in various practice settings. In many groups, workload is linked to productivity evaluation and subsequently to overall compensation. In the absence of national standards for such evaluation and consequent remuneration, formulas are locally cooked by group leaders, are often opaque in their constituent ingredients and almost always poorly digested by their pathologists, especially the most junior members among them. In my experience, consulting with colleagues around the country, the matter of linking productivity to compensation is handled very differently, or not at all, based on many factors, including the group's strength of leadership, overall practice philosophy, group sub-specialization, business ownership, group communication and other factors too.

Julie McDowell:

Dr. Larsen, can we hear from you?

Dr. Larsen:

Sure. Thank you so much, Julie. This is a really challenging topic to figure out because everyone has their own personal perception of their workload and the status of their workload compared to everyone else in the practice. But pathology work and pathologist's work style is very individual. A set of slides that might take me two hours to review and diagnose might take another pathologist only one hour or take someone three hours. The same workload is there, but the amount of time involved to complete it, gives people the perception that the workload is poorly distributed. We can do significantly different numbers of RVUs, and that doesn't always match up to the numbers of slides we're performing. Further, in pathology, we're mandated to do a lot of non-RVU generated work by the CLIA 88 law, things related to laboratory management and regulatory issues.

And these are measured in medical staff, hospital administration, and patient satisfaction, as well as our regulatory accreditation. And there can be a sense of unfair distribution related to how much of the RVU generating and non-RVU generating work each member of the group is performing, leading to a breakdown in the sense of cohesion and cooperation.

Julie McDowell:

Now, Dr. Larsen, keeping with you, why do you feel it important to appropriately address perceptions of fair workload distribution, especially as a leader?

Dr. Larsen:

One of the most important roles of a practice leader is to build the team, and the team has to be able to coordinate and cooperate in order to produce the best quality work and the highest level of patient safety. This requires every member of the group to feel they're contributing a valuable and equitable amount of effort to the workload and contributions to the practice.

Julie McDowell:

Dr. Sirgi, what are your thoughts on this?

Dr. Sirgi:

So I entirely agree with Dr. Larsen. I would add that addressing fairness in all aspects of a practice, not only fairness in workload distribution, but all aspect of a practice, is one of the major responsibilities of the group's leadership. And that can be such as fairness in workload distribution, fairness in performance evaluation, fairness in remediation, because perceived unfairness, or even worse established unfair practices, will most certainly lead to resentment, disengagement, and consequent loss of job satisfaction, if not frank burnout.

Julie McDowell:

So keeping along with this topic of fairness, what is the best way to address perceptions of unfair workload distribution? Dr. Sirgi, can you talk a little bit about this?

Dr. Sirgi:

Sure. So addressing perceived or real unfair workload distribution also implies addressing leadership strength and decision-making, overall appropriateness of transparent and open communication within the group. The degree of group's members engagement with finding solutions to these challenges and openness of the leadership to solutions advanced by their members. It's a two-way communication. It shouldn't be top down, it shouldn't be down-top, it should be bidirectional and involve all levels of the group. Open communication. It also implies the recognition by all parties involved that fairness in workload distribution does not necessarily mean exact equality in daily work burden. Exact equality in daily work burden, quite frankly, does not exist. Many activities that cannot be precisely quantified are immensely valuable to a group's standing in the community. And the loss of such non-quantifiable activities will seriously jeopardize that group's overall success.

Julie McDowell:

Dr. Larsen, what are your thoughts on addressing perceptions of unfair workload distribution?

Dr. Larsen:

I think Dr. Sirgi has given us a really good basis for this evaluation and consideration. In my experience, transparency and communication are key to minimizing perceptions of unfairness. It's important to recognize that every member of the pathology group has different strengths, different unique skills and gifts that they bring and contribute to the practice. And making sure that that's recognized, that that's publicized and acknowledged, allows each person to feel a valued member and to recognize that what others might be doing enable them to do more of what they do best. I agree and think it's very important to emphasize with what Dr. Sirgi said, "That fairness and workload distribution does not mean exact equality." Just like with your children.

Julie McDowell:

So, how would a practice benefit from addressing perceptions of unfair workload? Dr. Larsen, can we stay with you on this topic?

Dr. Larsen:

Sure, Julie, thank you. Perceptions of unfair workload really break down the team. They make it difficult for people to work together, to support each other, to respect each other. It's important to have a cohesive team in pathology. It works better with administration. It provides you with a better position with your medical staff. It makes the individuals be more willing to work together, to cover for each other and place the health of the organization and safety of patients first. It also leads to a positive and encouraging work environment with less staff turnover and less risk of burnout.

Julie McDowell:

Dr. Sirgi, what are your thoughts on this?

Dr. Sirgi:

I can share with you a very long list of disadvantages of not addressing fair and transparent workload distribution in a group. Resentment, loss of trust among members, feeling of being abused by colleagues, junior and senior colleagues, burnout, taking work home, taking bad moods home, loss of valuable energy and time in endless internal bickering and other disadvantages. So to me, it's not even a possibility for a leader, a strong leader, to not really spend the time on addressing this very important character of the group, which is to be fair in workload distribution. Now, I'm not suggesting that addressing workload distribution will make all parties happy and satisfied all the time, but it will give the group an opportunity to address these challenges together as a team, as Dr. Larsen mentioned. And to revisit the issue from time to time with fresh ideas and potential incremental improvements.

Julie McDowell:

So finally, what types of new skills will the participants at the Pathologists Leadership Summit learn in your course that they can immediately put into practice? Dr. Sirgi, can we start with you?

Dr. Sirgi:

Sure. Thank you, Julie. So, I truly hope that participants will learn that they are not alone, or unique in their perceived challenges. Although some solutions to these challenges may have to be uniquely customized to their practice setting. They will also learn to include various aspects of workload evaluation, not only those aspects directly linked to CPT and RVU codes. What we do as pathologists day in and day out is much richer than just generating CPT and RVU codes. What makes us relevant to our colleagues as consultants go way beyond CPT and RVU codes. They will also learn to appreciate various aspects of overall work burden, independently of case numbers or specific daily assignments.

Julie McDowell:

Dr. Larsen, what are your thoughts?

Dr. Larsen:

I think as we've discussed, Julie, the skill of dealing with workload and its distribution and pathologists' satisfaction with their work-life balance is a critical aspect of what every leader of a group needs to do. But it's also a critical aspect of what every member of a group needs to do. They have to understand how complex this is and all of the different considerations that go into evaluation of workload. What people will learn in our course is that they're not alone. That, while the workload process has to be transparent, it involves everyone from the leader through the most junior member of the group. They have to understand and work together towards their own success and to enhance their own practice. We won't be able to provide a specific answer for everyone, but hope to present enough examples, guidelines, and ways to think about this process that will help people look at their own situation in a new way and make it better for everyone.

Dr. Sirgi:

So Julie, if you don't mind, I'd like to add a couple of sentences to what I stated first and what Dr. Larsen also stated, because it's a developing story. Our participants will also learn that the way we addressed workload distribution pre-pandemic may be very different from how we look at workload distribution and what needs to be included in our evaluation of workload distribution and therefore fairness in workload distribution post-pandemic. It goes without saying that the pandemic has changed many, many, many things in our lives, including how we practice together, from where we practice together, the kind of technologies available to us to practice together and solo, from remote locations. So Dr. Larsen and myself really hope to add that very important feature to our presentation, which has to do with the post-pandemic world in which we navigate.

Julie McDowell:

Well, thank you both for discussing this topic. As mentioned, Drs. Larsen and Sirgi will be teaching a course on this topic on Sunday, May 1st at the Pathologists Leadership Summit, which will be held virtually and in person in Washington, D.C. For more information, please visit pathologistsleadershipsummit.org.

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