I hear from palliative medicine physicians whose experiences suggest that their successes often go unrecognized, or at best taken for granted, while their failures are highlighted, particularly during times of program evaluation or subsidy renewal. What prompts these misguided views and feelings? Is it numbers-driven executives who see these palliative medicine practices producing revenue that in best cases meets no more than half of the practitioners' salaries? Or is it underperforming physicians whose practices fail to meet productivity standards? Or is it quite simply a misunderstanding of the value of palliative medicine programs in general, and of palliative medicine physicians specifically?
Our study suggests that another factor is at play here. Call it a misalignment of expectations, a misalignment that manifests itself in role confusion. What is role confusion, and why should palliative medicine be more vulnerable than others to this rather abstract influence? The short answer is that most palliative medicine programs were launched on the proverbial shoestring, and when met with growing demand for their services, turned their attention to their most recent referring sources. These new referring sources, of course, were not the ones behind the launch of the program. Additional MD or NP resources to serve this growing demand are months way from being hired, if at all. And so we find role drift, which inevitably leads to role confusion. This is the time, we find, for the introduction of performance management programs.
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