Regina Santos, MD, has a meeting this morning with the nurses in her practice. She has been dissatisfied with patient flow; she feels that the nurses' processes are inefficient and cause unnecessary delays. She has given the matter a lot of thought and wants to propose a way they can examine the problem and come up with some solutions.

Frederick Ling, MD, has a meeting this afternoon with the administrator of his large practice. He has been doing a lot of study in sports medicine recently and has taken some excellent CME courses. He's excited about the prospects that branching out in this area might offer in terms of both professional satisfaction and practice marketing.

Joe Alagordo, MD, has a special interest in health maintenance. He wants to devise a system whereby he and his 20 colleagues scattered throughout their Midwestern city can do a better job of keeping patients up-to-date on health maintenance recommendations. The physicians have studied their HMOs' reports of their performance on health maintenance quality indicators. Although they all admit they could be doing better, they've been unsuccessful in changing their behaviors. Joe has ideas about ways to improve their health maintenance efforts by issuing patient reminders and involving the nurses. Now he just needs to figure out how to put those ideas into practice.

What do these three employed physicians have in common? They're trying to make their professional lives work better.

If you asked them, they probably wouldn't see themselves as managers. In fact, for many salaried physicians, the word manager may be slightly distasteful, suggesting an activity they would just as soon avoid. Managing may connote manipulating or controlling other people. At the very least, we tend to think of managers as those who supervise the work of others, and physicians often choose to become salaried precisely because they don't want to contend with supervision and administration.

Yet each of us is accountable for his or her sphere of influence. In the case of employed physicians, our responsibilities include our personal lives, our panels of patients and our relationships with nurses, front office staff, practice administrators, colleagues, hospital administrators and our communities.

It's important for salaried physicians to acknowledge that we have managerial responsibilities. Doing so moves us from a passive, “it's someone else's job to fix this” way of thinking to a more active, “it's my responsibility to find a solution” mode. Rather than implying manipulation or supervisory drudgery, managing can mean directing, educating or administering. While it may also mean taking on more work, recognizing and seizing our managerial opportunities can offer rich rewards in personal and professional satisfaction.

So how can employed physicians do a better job of managing? Here are a few pointers:

1. Acknowledge your role. You are a manager, regardless of whether you view yourself in that light. Accepting this fact moves you from feeling stuck to feeling empowered.

2. Identify the many spheres you manage and your goals for those parts of your life. Good managers don't merely ensure that they're steering straight; they chart courses toward destinations they want to reach. Think about where you want to go in each of these areas:

   Your own life. What balance do you want to strike between the demands of your professional and personal lives? Even physicians who choose salaried practice as a way to reduce their professional stress must work to keep themselves physically, mentally and spiritually healthy.¹

   Your practice. Are you satisfied with your diagnostic, procedural and counseling skills? Are you seeing the mix of patients you want? Are you doing a good job with health maintenance? What about patient education? Is there an area of practice into which you'd like to branch out?

   Your interaction with the nursing staff. Are the nurses as well-trained as you'd like them to be? Could you help them improve their work in patient education or health maintenance? Are you giving them the feedback they need to feel respected and valued?

   Your interaction with the front-office staff. How could you help them improve their phone skills or their handling of difficult patients? How might you work with them to increase the efficiency of your referral process or patient check-in and checkout? Is the feedback you give them timely, appropriate and encouraging?

   Your interaction with your practice administrators. Do they know your strengths and interests? Are you working together to maximize your contribution to the practice?

   Your interaction with your colleagues. We can learn a lot from each other, but we have to create opportunities for sharing information.

   Your involvement with your hospital. To what extent do you want to serve on institutional boards and committees?

3. Within the areas that you feel merit additional attention, pick the one thing you would most like to change. This is an exercise we often ask patients to do when they present with multiple concerns. Let's take some of our own advice.

4. Devise a concrete plan for making the change. A plan is more than an intention. You'll be much more likely to effect change if you set goals, measurable objectives and deadlines.

5. Once you've made the change, tackle the next area you want to improve.

As salaried physicians, we needn't feel that we just show up each day and punch a time clock. Recognizing that we can — and should — take responsibility for the environment in which we practice can lead to better patient care and greater professional satisfaction.