Chapter 20: The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers

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Chapter 20: The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers

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Description

After sketching changes to the office of medical affairs in the last ten years, Dr. Rodriguez discusses the purpose and results of the regular survey of mid-level providers at MD Anderson. She notes that, in general, the workforce is very stable, but the institution wants to monitor reasons that pockets of high turnover exist. She notes results of the survey: everyone at MD Anderson is committed to the job; some fear retaliation if they voice complaints; many feel they are not paid enough. Dr. Rodriguez stresses that employees’ pay is in line with other state institutions. She talks about requests for mentoring made via the survey and how that was acted on and to what affect.

Identifier

RodriguezA_03_20150501_C20

Publication Date

5-1-2015

City

Houston, Texas

Topics Covered

Institutional Processes; Understanding the Institution; The Institution and Finances; Mentoring; MD Anderson History; MD Anderson Culture

Transcript

Tacey A. Rosolowski, PhD:

Can you tell me, I mean, I’m sort of wondering if there—since the Office of Medical Affairs has been in existence for a decade now, were there some important landmarks in its evolution? I mean, that’s—

Alma Rodriguez, MD:

Well, let me say that the Office of Medical Affairs has been here forever, I mean this is saying why are—

Tacey A. Rosolowski, PhD:

But I mean you being here—

Alma Rodriguez, MD:

Me as the person here? Yes.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

Oh gosh, everything. We, you know, when I stepped, again, into the role, we didn’t have a Physician Assistant Program’s office with the Director. I mean, Maura was sort of a volunteer Director, if you will, and she was sort of the volunteer Education Director. We established those as formal titles for individuals. We established roles and responsibilities, job descriptions for them. I can say with confidence today that, you know, Todd Pickard is the Director of this office, serves as an invaluable resource to all the departments and processes of evaluate—for starters, you know, how do you do an evaluation that’s meaningful for your mid-level providers, what do you expect of them? We’re right now—we just completed a really important survey looking at job satisfaction of the mid-level providers, and what do they see as [inaudible] their roles are meaningful to them or not, or what kind of disparities do they observe, what kind of dissatisfiers are there that we need to address? It’s very interesting, because they’re all very committed to their job. What we found is they’re all very committed to their roles, but they do observe major inequities in terms of work distribution and in terms of in a significant proportion, and slightly more than a third, they think that they’re not being—their jobs are not fully up to the optimum level of performance they could perform. If you will, they’re being underutilized—

Tacey A. Rosolowski, PhD:

Yeah, interesting.

Alma Rodriguez, MD:

—in their jobs. So, you know, they’re an incredibly valuable resource to the organization, and very—of all the complaints that we get, the group that gets the least complaints and the most appreciative notes is the mid-level providers group.

Tacey A. Rosolowski, PhD:

Wow. That’s amazing. What was the name of that survey?

Alma Rodriguez, MD:

I—it was just a mid-level provider’s survey.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

We made it up ourselves. We asked them, what do you want? What do you think? HR [Human Resources] helped us to develop it; it was just a survey of work environment assessment.

Tacey A. Rosolowski, PhD:

Wow. That’s amazing. And how will you use the information that’s come out of the assessment?

Alma Rodriguez, MD:

Well, that’s what’s in discussion right now.

Tacey A. Rosolowski, PhD:

OK. (laughs)

Alma Rodriguez, MD:

What are we going to do about this?

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

Yeah.

Tacey A. Rosolowski, PhD:

Yeah. Well, and it’s always a pleasure to discover a situation when people want to be doing more.

Alma Rodriguez, MD:

Uh-huh.

Tacey A. Rosolowski, PhD:

You know, to feel good themselves, and [inaudible].

Alma Rodriguez, MD:

Yeah. Very few of them said that they wanted to do less.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

Many of them did say that—well, let me put it this way. They were not dissatisfied with the challenge, the intellectual challenge and emotional challenge their job was offering them. They were dissatisfied with the physical stress of hours. Some of them work very long hours, and that probably is not appropriate. And they feel that there is inequity in distribution. Some of them have physicians who—but what ends up happening is that their job responsibilities are going to more or less mirror the physician’s. Some physicians have huge workloads, others don’t. But—so here’s the thing. If the mid-level providers have inequity, so do the physicians, right? I mean, I have to draw the parallel.

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

And it’s likely that that’s the case. So the next question is, what are we going to do about the physicians?

Tacey A. Rosolowski, PhD:

Yeah. Right. Right. Right. Now, just to ask the obvious question, I mean, are the mid-level providers paid equally regardless of that workload? I mean, is that part of the stress that they’re talking about?

Alma Rodriguez, MD:

Yeah, they’re paid differently, depending on the number of years or level of competence and experience, and so on. But they’re not paid more if they see more patients, or work harder.

Tacey A. Rosolowski, PhD:

Right. Right.

Alma Rodriguez, MD:

So that’s what—at the core, it’s really an issue.

Tacey A. Rosolowski, PhD:

Money, yeah. Yeah. Now, there was another survey that you did; this is the 2014 BIG survey of employees.

Alma Rodriguez, MD:

Oh, the BIG survey?

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

Mm-hmm?

Tacey A. Rosolowski, PhD:

So tell me about that. Because I was reading a lot about that. What was the motive for doing that? And what was the outcome?

Alma Rodriguez, MD:

Well, I think—so the institution has had this survey for quite a long time, it’s every other year, every third year—

Tacey A. Rosolowski, PhD:

OK. All right.

Alma Rodriguez, MD:

—I forget the time frequency. But it’s been going on for quite a long time. And the intent was simply to look at satisfiers in the workforce; you know, what makes the workforce, in general. And I think overall, we have an incredibly stable workforce. Our turnover rate, as I understand it, is relatively low compared to other organizations. Nonetheless, there are certain pockets of the organization that do have high turnover rate. So the questions were, you know, where are these pockets? Why is there dissatisfaction? Culturally, what are issues that we face? What I can say overall is that—or, what I’ve learned, and what has been consistent in the survey over time is, number one, everybody knows what our mission and vision are. They’re highly committed to it. Most find their jobs rewarding personally, on an personal level. Many want opportunities for improvement, or promotion that they think we failed to provide them, and that may be the case. I mean, it’s unfortunate, but not everybody can be a Manager or a Director. And sometimes you have to move either laterally to another department to be able to have that opportunity, or you need to go to another organization and move up the ladder there. You know, it’s just a reality. And we can’t have as many chiefs as Indians, you know, for lack of a better metaphor. So there is going to be only X-number of opportunities for promotion up the ladder in any one organization. And so the people who are very highly-driven motivated, ambitious and so on, unfortunately, we may not have an opportunity for all of them. So we find that consistently in our survey, every time that we’ve done it. The other issue that we find, which is very unfortunate, is that there is a fear of retaliation. If people complain, or at least that’s the perception, that if they bring up issues of things that are not going right that there’s going to be a negative retaliation against them. We’ve tried to do in-depth analysis of that; that seems to be across the board. Oh, and of course the other thing that people consistently complain about is that they’re not paid enough. That, as I understand it, our measurements are exactly the same as the national measurements in all health organizations. Fifty percent, or some of the people, think that they’re not paid enough. And that’s apparently the national norm. We’re not different than the national norm.

Tacey A. Rosolowski, PhD:

What’s the value of doing a survey of this kind, every two or three years?

Alma Rodriguez, MD:

I have no idea. (laughter)

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

I truly don’t know.

Tacey A. Rosolowski, PhD:

No big truth from the mount on that one.

Alma Rodriguez, MD:

Well, I mean, there has been some, there have been some things that we’ve done as a result of the survey. So let me say the biggest one is, we’re not paid enough. Well, there’s no way that we can changed salaries. They’re fixed by the state, OK? We paid whatever it is that the other state organizations pay. And then we also usually measure ourselves against—we do what is called a market analysis, and we look at what is it that our competitors are paying, and we try to match those benchmarks. So it’s whatever the marketplace decides and whatever government regulations decide, that’s what we pay. I mean, I don’t know what else we can do about that. So I don’t even know why we ask that question. Because to me, that’s kind of like a silly question. I mean, we should process that continually and proactively assess, are we doing the fair thing? Are we paid the fair salary? And if we are, we are. I mean, what else is there to—why are you asking that? You know? So the one thing that we did do, that we have done that I think is positive is that some people wanted to have an opportunity for mentorship. So they said you should establish this mentorship program to onboard new employees, or employees who wanted to transition to something else, or who could learn—who wanted to learn about something else. So, for examples, in the survivorship—in the patient—the Physician Assistant programs, we established a mentorship program for employees who wanted to learn about what the PAs do. You’d be amazed how many of the technical staff, like, laboratory technicians and so on, say, “Oh, I could go to medical school,” or, “I could go to PA school.” What they don’t know is that getting into PA school is just as hard as getting into medical school. It’s getting even harder, because there are fewer positions. So in any event, but so we said, OK, there are probably a lot of very capable people who could possibly be accepted to PA school. Why don’t we just have a program where we talk to them about what is it that we do, how do we do it? And the reason that we wanted to have a formal program is, we didn’t want—what was happening was, you know, a friend of a friend of a friend recommended that so-and-so shadow PA Smith in Orthopedic Surgery. And PA-X in Orthopedic Surgery then felt obligated because their friend, so-and-so so-and-so said that they wanted to have—so they would take this person around. And I said—when I started to discover this, I said, “Wait, time out. Has this person had all the appropriate training? I mean, you are exposing patients to individuals whose job descriptions do not permit that these patients be exposed to them.” I mean, you have individuals in vulnerable situations, maybe half clothed, or you don’t know. And there’s private information that’s being revealed or disclosed to these individuals who have nothing to do with this particular job function, they just want to do it out of curiosity or self-knowledge, or whatever. Fine. Let’s have a formal vetting process. They have to go through HIPAA [Health Insurance Portability and Accountability Act] training, they have to have ethics training, they have to have—

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

You know, do you know what I’m saying? I mean, you can’t just—

Tacey A. Rosolowski, PhD:

Absolutely.

Alma Rodriguez, MD:

—have people walk in.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

Or walk into the OR just because I want to observe what it’s like to do a hysterectomy. I mean, sorry, no!

Tacey A. Rosolowski, PhD:

(laughs) I can see people in the compliance office having coronaries!

Alma Rodriguez, MD:

Yeah, well, I was having coronaries.

Tacey A. Rosolowski, PhD:

And you too, of course!

Alma Rodriguez, MD:

Because that’s inappropriate. That’s—

Tacey A. Rosolowski, PhD:

I’m sitting here thinking, wow, I’m really glad that Dr. Rodriguez stepped in!

Alma Rodriguez, MD:

It’s a violation of patients’ rights.

Tacey A. Rosolowski, PhD:

Absolutely.

Alma Rodriguez, MD:

You know, so, no. So anyway, that’s why we established that. And there’s many other mentorship programs in the Institution. That’s the one positive thing that I’ve seen come out of the survey. Outside of that, honestly, I don’t think that much has happened.

Tacey A. Rosolowski, PhD:

Dr. Rodriguez, I just checked my watch, and we’re almost at noon.

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

And I want to make sure—I know you’ve got a meeting. So do you want to close off for today?

Alma Rodriguez, MD:

I—I think we’ve talked about a lot.

Tacey A. Rosolowski, PhD:

We have. And well, what I thought was that, you know, we could probably do one short session for the final things that I have to ask you.

Alma Rodriguez, MD:

Uh-huh. OK.

Tacey A. Rosolowski, PhD:

For follow-up, would that be all right?

Alma Rodriguez, MD:

Yeah. Sure.

Tacey A. Rosolowski, PhD:

OK. Because I don’t want to make you late for your meeting.

Alma Rodriguez, MD:

No, that’s all right. Thank you so much.

Tacey A. Rosolowski, PhD:

So I am turning off the recorder at 11:56, and I want to thank you for your time this morning.

Alma Rodriguez, MD:

(laughs) I’m just curious, have other people said that something important has come out of the BIG surveys? (laughs)

Tacey A. Rosolowski, PhD:

I’ve never asked anybody about it. Actually, it was—you were the only person where it was, you know, in your background research. All right, I’ll be turning off the recorder now.

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Chapter 20: The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers

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