From
Dr. Lee Ponsky
S02EP22: Beyond Our Surgical Day Job with Dr. Lee Ponsky
With Dr. Lee Ponsky · hosted by Dr. Em Gootee
Part of
Burnout 4 items
Chapter 1 of 7 · Fundamentals
Career satisfaction
Introduction and Career Satisfaction
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Journal Club: Review of 2018 Pediatric Surgery Practice Gaps
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Dr. Lee Ponsky
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UH Urology: Hot Ones with Dr. Lee Ponsky- Chairman
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What the experts said
High school students are now asking what they need to do to prepare for medical school, including research and mentoring, which Ponsky finds concerning as evidence that the competitive conveyor belt starts too early.
The year-long sabbatical in Australia was the beginning of opening up opportunities to look at things outside academic medicine, and upon return Ponsky's group received their first R01 grant.
Ponsky experienced job dissatisfaction from hitting roadblocks when trying to implement innovative ideas within his institution, which he now recognizes was because he was trying to channel all entrepreneurial energy into his day job.
As a leader, Ponsky came to understand that individual priorities may not align with organizational priorities and budgets, even when ideas are good, which requires strategic thinking rather than frustration.
Taking entrepreneurial energy outside the day job, in a non-conflicted and fully disclosed manner, can relieve the need to find all fulfillment within academic medicine.
Most hallway conversations Ponsky has with colleagues are about people feeling frustrated, stuck, and uninspired despite having ideas they want to pursue.
Ponsky does not consider himself a true entrepreneur because he is unwilling to 'sleep in a dumpster' or bet everything—he wants his guaranteed income and salary.
Ponsky found that he liked his day job activities—seeing patients, operating, teaching residents, and working with colleagues—which was an important realization before pursuing outside interests.
Ponsky's department was one of the first outside the emergency department to implement scribes for physicians.
Ponsky's internal study showed he was spending 85% of his clinic time not face-to-face with patients.
In a large system of 32,000 employees with approximately 3,000 physicians who bill, any time a physician spends not seeing patients that could be done by someone less expensive represents an efficiency opportunity.
Implementing scribes allowed Ponsky to see more patients, improved his satisfaction and patient satisfaction, and increased his productivity.
After Ponsky demonstrated the scribe model with data, other department chairs wanted to implement the same approach.
In 2022, when hospitals were having financial trouble, Ponsky proposed leasing out newly hired faculty who had capacity in their first 2-3 years to non-competitive markets to offset expenses, but the hospital found it too complicated to implement.
When the hospital couldn't implement the physician staffing idea, Ponsky started his own staffing company to pursue the concept independently.
Ponsky's first advice to people with an idea is to buy the website URL as a concrete first step to overcome analysis paralysis.
To collect data on clinic time usage, Ponsky had his nurse write timestamps when he opened charts, entered rooms, and exited rooms for three weeks, then added up the totals—a simple approach that didn't require an analyst.
Ponsky calculated that if he could see two additional new patients per day with a scribe, it would pay for the scribe's cost.
A scribe costs approximately $250 per day or $1,000 per month.
To roll out scribes department-wide, Ponsky required physicians to be at a basic level of productivity first, then with a scribe they had to add about 10 new patients to their clinic schedule to demonstrate increased productivity.
The scribe implementation created a win-win-win: the hospital saw increased revenue that covered the expense, doctors made more money through productivity incentives, and physician satisfaction improved dramatically.
When Ponsky surveyed doctors via text message about their scribes, responses were universally positive with comments like 'I've never been happier,' 'this is a game changer,' and 'never going back.'
When Ponsky had young children, he did not have the luxury of extra time for side projects because his kids were his priority and required significant day-to-day physical work.
Ponsky does not golf, so he recognizes that time others might spend on hobbies can be used for entrepreneurial pursuits that fulfill him.
Ponsky started a tattoo removal company as an example of a business venture outside his day job that required evening and weekend time for emails, meetings, and work.
When Ponsky has an idea for a company, he always finds a partner who can be the operator because he recognizes his time limitations and cannot be the day-to-day operator for multiple ventures.
Ponsky is willing to contribute financially to start ventures and handle evening/weekend communications, but is honest that he doesn't have time for day-to-day operations.
Ponsky believes medicine is a beautiful field and considers it a privilege to be in the profession, and would choose to go into medicine again.
Ponsky observes that other fields like law and business have professionals who routinely get involved in activities outside their day jobs, which is less common in medicine.
Early in a physician's career, they may have less time for outside pursuits and need to focus on building clinical skills, which takes a long time.
Ponsky believes burnout occurs in part because physicians try to find all fulfillment solely from their day job, which is all they've been exposed to since college and medical school.
Realizing that fulfillment can come from beyond the day job may make the day job itself more enjoyable.