Practice Perfect 697
How Are YOU Evaluated for Job Performance?

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Jarrod Shapiro, DPM, FACFAS, FACPM, FFPM, RCPS Glasg

Practice Perfect March 10, 2020

Today’s issue is dedicated to all of the doctors who are employees of someone else. If you’re employed by another podiatrist, a group, university, or healthcare system of any sort, a periodic evaluation and assessment during the year is a known and expected part of the job.

When I was employed in my first job years ago by an individual proprietor, my “performance review” didn’t actually exist, and I mostly knew I was doing well by the fact that I didn’t receive complaints, and I was not fired. This passive type of evaluation is the most minimal version possible. After transitioning jobs to a hospital-based multispecialty practice, my evaluation consisted of a yearly minimal review that simply examined my productivity (AKA how much money I brought in). With my current employer, there is a much more vigorous biannual assessment that includes feedback on several aspects of my performance as a teacher but not much in terms of how effective a doctor I am.

The theme that runs across each of the podiatric career job evaluations I’ve had at my various types of jobs is the difficulty in assessing performance in terms of clinical quality. Was I actually an effective podiatrist when I was working for these folks? Did my patients have good outcomes? Did I function within the practice or environment effectively? Did I interact well with patients and staff or was I an abusive jerk? How profitable was I as an associate for my bosses, and did I demonstrate consistent improvement over time? To be honest, I would say very few of these characteristics were assessed during my first two jobs, and how good of a doctor I am now is not currently assessed to an appreciable level.

An interesting article from Medscape discussed this issue, citing a high physician burn-out rate despite an even higher reliance on production bonuses¹. The authors advocate for a different system, highlighting the Kaiser Permanente medical group’s system as one model to improve physician motivation. Taking focus away from RVUs, tracking multiple types of data about their physicians’ performance, reporting the data to the doctors, and emphasizing collaboration between physicians are some of the methods this organization has successfully employed.

Available Credits: CPME 0

I agree that monetary collections should not be the only metric on which to evaluate physicians. Our jobs are very complex, so the assessment method must, by necessity, be multifactorial. Physician assessment must also include a method to help doctors improve and be a motivator rather than a contributor to burn out. Additionally, the assessment method must reflect the organization’s goals, mission and purpose. What might this method look like?

The Rules of Physician Assessment

Rule 1- Assessment should be well rounded - Physicians interact with patients, various assistants, other doctors, administrators, etc. Some type of anonymous protected survey of all involved members of the care team interacting with the physician would provide a 360-degree evaluation. The focus of this aspect is obviously subjective and focused on interpersonal rather than technical skills. This type of assessment also helps to evaluate leadership aspects of the job.
Rule 2 - There should be a special place for peer assessment - Who better to assess the skills of a doctor than another doctor? For a podiatric surgeon, having another surgeon do the evaluation would be highly effective. Obviously, the evaluating surgeon must be qualified to evaluate another surgeon. The focus here would be on the technical aspects of the job. This is also a great place to build camaraderie and satisfaction within a group if that group meets regularly and discusses – in a safe environment – their outcomes. Perhaps an additional aspect would be for a randomly selected number of charts to be pulled and reviewed in a way similar to ABFAS board certification. Clearly, this peer assessment method requires open minds and respectful communication.

Rule 3 - Objective metrics should be part of the assessment - This is an easier and currently more common part of physician assessment. Profitability, volume, numbers of complications, on-time chart completion, and other metrics are easier to track and report than those listed in the first two rules. Similarly, patient outcomes can be objectified by using reporting methods such as the ACFAS Foot and Ankle Scoring System. This is usually used for research purposes but why not apply to it everyday patient care? Clearly, this would take a lot of work since there is an objective measurement and subjective patient survey component.
Rule 4 - Observe the trends - The one issue I’ve always had with my University’s performance review method is it only compares the current evaluation to the one previous year. As someone employed by one institution for the past almost 10 years, I would like to see a comparison of all metrics over this period to see if I have shown a trend toward improvement or one of decline through the years.

The other question that stems directly from this is, what are the results of an evaluation? Keep the job? Earn a bonus? Adjust job responsibilities? A positive evaluation should, of course, have some kind of reward while a negative evaluation would presumably have some result to help the physician improve, modify their job, or – in the worst-case scenario – remove the person from that job. I personally fall on the positive side, looking to help doctors improve. Let’s take a look at what to do with this information in next week’s issue where we’ll examine physician motivators.

Best wishes.