My wife, Kathy, and I enjoy completing Jigsaw puzzles. We leave the puzzle up and work on it when time allows until it is finished. On a recent evening, we completed a complex 1,000-piece puzzle before bed. When I arose the next morning, the puzzle we had worked on over days was back in the box. It was as if it never happened. But I know it did happen because I experienced the pleasure of working alongside my wife, listening to music, having easy conversations, and feeling a sweet belonging to a shared purpose.
I recognize the tension and disruption created by Evergreen’s continued growth. The need to include new providers within a supported environment, the sharing of limited resources, and the innovations required to lower costs and improve efficiency have impacted your work experience. Our hospitalist group is stretched by a census of 30 – 40 patients within a dysfunctional system. Urgent Care sees 200 patients daily, working late hours and weekends. Some of our providers in family medicine have quite large panel sizes.
Are these difficulties truly necessary? Isn't Evergreen creating its own problems? Is continued growth an indication of mindless ambition or greed? Is it our job to provide primary care to everybody in Douglas County? How is Evergreen different from any large primary care group like Kaiser or Optum?
These are not new questions. The answers lie in choosing which puzzle we are working to solve. About 8 – 10 years ago, the EFM Board held a critical meeting to address this decision. We had one clinic location at Edenbower, which was occupied by 12- 15 providers, all of whom were reasonably busy. There was a voice to maintain, but not expand our practice or services. We could be content and comfortable in our practice. The system was working for us. We could replace providers only as they left. The focus was on what worked best for our group.
The opposing voice advocated a commitment to community needs, even when that presented challenges to our group. This latter voice prevailed, and the physician who preferred the first course resigned from our Board. We have never looked back.
In the last four years, EFM has added 19,000 new patients, and we added 34 providers in that period. Which of those patients should we have turned away? Which provider should we not have added? We now have four clinic locations and will need to add more. But real estate is expensive, and stewardship requires us to innovate to use current space most efficiently.
What I present to you is a living puzzle. Every piece is necessary. We can enjoy the work even when frustrating and feel a pleasant belonging to a shared purpose. The difference is that we go back into the box when we are through, and what we have finished remains in the community as a legacy.
To answer my questions, these difficulties are unavoidable if we accept meeting community needs as a higher priority than our comfort. There is not a Board member or administrator at EFM who earns a nickel more because we have chosen this road to travel. We have accepted this burden because I don’t see another group in Douglas County that will. And because we can. Evergreen is different in that it is Provider-owned and governed. We have shown an ability to solve problems and execute a plan. Every Provider’s voice is heard, even if decisions don’t meet their approval. Board members who make those decisions labor under the same constraints and challenges.
The topics of dissatisfaction today are not the same as those of yesterday and won’t be the ones we face tomorrow. This is because as we solve the puzzles individually, more will surely appear. The puzzle changes. The mission doesn’t. Today’s problems will be footprints of a vision that undergirds our purpose. Change will be continuous. Expect it.
I hope you will continue your service with us at Evergreen Family Medicine. What you give is recognized and respected. I’m speaking to everybody. At a recent EFM Board discussion concerning this puzzle, the stresses and economics of our support staff were given higher priority than providers' preferences. Each life is a piece of our puzzle.
The Board is committed to puzzle-solving as problems are recognized. Solutions that work best for our group remain important. That won’t change. But everybody needs to know where this bus is heading—our mission—because that won’t change either.
Tim Powell MD