Workload Distribution Challenges and Solutions: Part Two

In this series, Karim Sirgi, MD, FCAP, details the causes, impacts, and solutions to workload distribution challenges. Read part one here.

Part Two: The Impact of Workload Distribution Challenges

Workload distribution challenges can have a significant impact on both the practice and individuals. The practice may have difficulty recruiting and retaining qualified staff in a highly competitive market. Additionally, workload distribution challenges create downward pressure on the group's culture and create risky patient care safety implications with potential medical legal ramifications. Individual staff members will struggle with work-life balance, job satisfaction, and an overall sense of fairness in their workload. This can be especially acute if compensation and opportunities for advancement are tied to a flawed evaluation process.

Succession Planning:

Even if internal systems and policies are properly in place and communicated, it only takes one unplanned employee departure to throw a wrench in workload distribution.

The matter is only made worse if a succession plan is not in place to pre-emptively address such contingencies and answer questions:

• Is there a clear succession plan for the group at all levels of the organization?
• Have actual or expected retirement intentions been clearly stated to the leadership?
• How would workload distribution be affected by the sudden retirement of a "key" pathologist, and what type of resource should replace such a key employee?

Perception of Fairness:

The best system will fail if responsibilities are not shared fairly by all pathologists. Certain attributes can create an unfair distribution of work, such as:

• Geography: Traveling to remote locations, especially if allocated to more junior pathologists because senior ones refuse to leave their offices.
• Subspecialty service lines: Pathologists covering highly subspecialized service lines (bone marrow, liver, or renal transplant services, for example) might need to cover more calls outside of their schedule because of their specialization.
• Experience level: Senior pathologists passing work to juniors to give them experience.
• Burnout: Colleagues refusing to assist with grossing duties because they consider it beyond their level of seniority.
• Apathy to non-medical work allocation: Partners refusing to participate in business growth and medical staff functions.

Group Citizenship:

Being successful as a group of physicians is only possible if the group establishes clear group citizenship criteria. These criteria set expectations for hours worked, participation in critical meetings and business growth activities, partnership vs. non-partnership duties, expected involvement in community and professional group events, and other activities outside of direct patient care.

Standing in the Marketplace:

In a closely knit industry like pathology, internal group dysfunction is not kept secret for long. Internal friction gets aired very quickly in local and national professional communities, which inevitably causes reputational damage to the group and jeopardizes its standing in the marketplace.

The reverse is also true and a well thought out workload distribution system is widely respected. A workload distribution system that enhances group harmony improves the group's reputation as a respected practice, allows for broader relationship building with other pathology groups, presents a more competitive stance in merger and acquisition negotiations and most importantly, creates an environment of excellent patient care.

Creating good governance around workload distribution

Workload distribution processes are dependent on group governance and decision-making. Three main models can be recognized:

1. Top-down approach: Daily duties are assigned to pathologists by leadership. This is usually the case in well-identified and hierarchical work environments.
2. Trust approach: Daily duties are shared with a tacit understanding amongst the group of what needs to be done and everybody pulls their weight on an honor basis. This is applicable in small to medium size groups where collegiality and sense of group citizenship are strong.
3. Team approach: A group representing various intra-group service lines design a system that is fair and applicable for most daily situations. Room for ad-hoc tweaking is embedded in the system to allow for unexpected staffing emergencies.

No matter which system is chosen, it needs to be supported by clear and transparent policies addressing:

• A clear definition of the inputs into workload distribution: Is it only based on recognized RVU/CPT codes, or are non-RVU activities also factored in?
• System monitoring: Is there an electronic system in place to track various activities which can be reviewed by relevant stakeholders?
• Enforcement: Is there a clear line of communication and enforcement?
• Modifying WLD: Can there be daily adjustments, and if so, who is in charge of that internal feedback loop?
• Reviewal processes: Who reviews pathologist productivity? Is it anonymized or shared openly?

The details above may seem tedious or even trivial, but they are critical policies to ensure transparency and open communication with all concerned stakeholders.

Workload Distribution and Compensation:

There are many models used to link workload distribution to compensation. These models can vary from one where all pathologists are paid equally irrespective of the amount of work they contribute to a model where compensation is directly linked to work performed. Many other models fall somewhere between these two extremes.

For a model to be successful, it needs to be consistently applied to all pathologists in a group. It also needs to account for all activities related to the group's success and, of course, to excellence in patient care.

Karim E. Sirgi, MD, MBA, FCAP, owns Sirgi Consulting LLC and offers expertise to medical groups in various aspects of practice management and leadership. Dr. Sirgi is board-certified in anatomic, clinical and cytopathology with additional surgical pathology fellowship training, he also holds an MBA and has 30 plus years of practice and leadership experience in private, academic, and hospital-based pathology and medical staff settings. Among his previously held positions, Dr. Sirgi served as president of the largest multi-specialty pathology group in the Rocky Mountain region and chair of the regional medical staff council for the largest hospital organization in the US. Dr. Sirgi is the immediate past-president of the American Pathology Foundation, the chair of the CAP Practice Management Committee, and the Chief Science Officer of Breath Tech.