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DPC: The Hero’s Journey
Douglas Farrago MD
Dr. Doug Farrago - My Journey into DPC
Once upon a time
…..a likeable but
flawed character
has her goal
threatened.
The Lay of the Land
• 54% characterized their morale as
somewhat or very negative.
• 63% said they have negative feelings
about the future of the medical
profession
• 49% said they often or always
experience feelings of burnout
• 49% of respondents would not
recommend a career in medicine to
their children.
The Physicians Foundation's Survey of America's Physicians
2016
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Premature Physician Progeria
Dr. Doug Farrago - My Journey into DPC
Then
Now = RoboDoc
ROS Phenomenon
-10
-5
0
5
10
15
20
one two three four five
Years in Practice
ROS
Suicide
• Medical profession consistently
hovers as one of the highest risk
of death by suicide.
• A doctor kills himself or herself,
on average, each day in this
country
Hero encounters
hurdle after
hurdle and
decides enough
is enough.
Dr. Doug Farrago - My Journey into DPC
The hero first
tries to work
from within the
system…
AAFP and Burnout
 AAFP Joins National Collaborative to Promote
Clinician Well-being
 AAFP Joins House Members to Spark Burnout
 Speakers Chart Paths from Physician Burnout to
Well-being
 I Bounced back from Burnout by Setting
Boundaries, Priorities
 I Filled My Prescription Against Burnout at the
Gym
 Try PROBE Tool to Help Stave Off Burnout
 Can Mindfulness Meditation Deliver Us From
Burnout?
 Physician Burnout: The AAFP is Winning Battles
For You.
Dr. Doug Farrago - My Journey into DPC
“The most unsettling thing for a physician
is when the patient doesn't trust you or
believe you.”
Obstetrician-gynecologist, New York City
“I know that Reader’s Digest recommends
bringing in a complete list of all your
symptoms, but every time you do, it only
reinforces my desire to quit this
profession.”
Douglas Farrago, MD
10 Question Burnout Test
1. Do certain patients on your schedule actually
make you violently shake or cry?
2. Do you secretly envy the job of old
friends….every time you see them pumping your
gas?
3. Are you slowly digging a hole through one of
your office walls to escape like the main
character in Shawshank Redemption?
4. Do you find yourself wanting to tell a patient,
“Shhh…you had me at hello?” in order to get rid
of them?
5. Are you secretly planning to get on disability by
contracting a “disease” that is seronegative?
6. Have you already gotten (and passed) a
stress test due to chest pain and/or
palpitations?
7. Have you already bumped your PPI to
BID?
8. Are your kids asking you how long it will
be until you retire? And they are less then
10 years of age.
9. Do you sarcastically answer patients in
your head and become uncomfortable
when they ask why you are smiling?
10.Are you actually considering becoming a
medical administrator?
Results
 0 – you are lying or are on some type
of psychoactive substance
 1 to 3 – you are fresh out of residency
or are retiring in the next year
 4 to 6 – Most doctors are here. Time
to start thinking about a career change
 7 to 10 – You are toast. DPC is your
last chance
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Administrators
 Want
◦ Control
◦ Productivity
◦ Money
◦ Awards
◦ Prestige
 Don’t Want
◦ Controversy
◦ Being Questioned
◦ Friction
◦ Resistance
◦ Disruption
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
With her goal
threatened, our
hero finds the
forces of evil too
strong….
“Physician happiness is
inversely proportional to the
amount of bureaucratic drag
on their lives”
Doug Farrago MD
Executive Leadership and Physician Well-being
Tait D. Shanafelt, MD, John H. Noseworthy, MD, CEO
Mayo Clinic Proceedings
Volume 92, Issue 1, Pages 129-146 (January 2017)
DOI: 10.1016/j.mayocp.2016.10.004
The Unsolvable Healthcare
Equation?
Kobayishi Maru
The hero finds
the magic
formula in the
magic land to
break the
system…
Dr. Doug Farrago - My Journey into DPC
The hero, once
headed to burnout,
emerges
transformed and
rewarded but…
…now others
attack, ridicule,
ignore or mock
her!
“I am not lucky. You know what I
am? I am smart, I am talented, I
take advantage of the
opportunities that come my way
and I work really, really hard.
Don’t call me lucky. Call me a
badass.”
Shonda Rhimes
Death Row Syndrome
Dr. Doug Farrago - My Journey into DPC
“They tried to bury us. They
didn’t know we were seeds”
Mexican Proverb
“The reasonable man adapts himself
to the world. The unreasonable one
persists in trying to adapt the world
to himself. Therefore, all progress
depends on the unreasonable man.”
 George Bernard Shaw
“Stop being a prisoner of
your past. Become the
architect of your future.”
Robin Sharma
You are the
heroes of this
story!
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
The heroes heed
the warnings and
shares them with
others..
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Dr. Doug Farrago - My Journey into DPC
Heroes motivate
others to act…
What you can do:
 Fulfill your dream
 Encourage
 Evangelize
 Don’t sell out
 Be patient
 Don’t compare
Most importantly:
Spread the DPC
Virus!
Remember…
Heroes continue
to break the
rules, disrupt the
system and
change the
world.
Dr. Doug Farrago - My Journey into DPC
Lee S. Gross
Only $20 Each
Shameless Self Promotion:
For Sale After the Talk!
Don’t Let This Be You
Find Your Balls
And live your life
happily ever
after.
The End

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Dr. Doug Farrago - My Journey into DPC

  • 1. DPC: The Hero’s Journey Douglas Farrago MD
  • 3. Once upon a time …..a likeable but flawed character has her goal threatened.
  • 4. The Lay of the Land • 54% characterized their morale as somewhat or very negative. • 63% said they have negative feelings about the future of the medical profession • 49% said they often or always experience feelings of burnout • 49% of respondents would not recommend a career in medicine to their children. The Physicians Foundation's Survey of America's Physicians 2016
  • 11. Then
  • 13. ROS Phenomenon -10 -5 0 5 10 15 20 one two three four five Years in Practice ROS
  • 14. Suicide • Medical profession consistently hovers as one of the highest risk of death by suicide. • A doctor kills himself or herself, on average, each day in this country
  • 15. Hero encounters hurdle after hurdle and decides enough is enough.
  • 17. The hero first tries to work from within the system…
  • 18. AAFP and Burnout  AAFP Joins National Collaborative to Promote Clinician Well-being  AAFP Joins House Members to Spark Burnout  Speakers Chart Paths from Physician Burnout to Well-being  I Bounced back from Burnout by Setting Boundaries, Priorities  I Filled My Prescription Against Burnout at the Gym  Try PROBE Tool to Help Stave Off Burnout  Can Mindfulness Meditation Deliver Us From Burnout?  Physician Burnout: The AAFP is Winning Battles For You.
  • 20. “The most unsettling thing for a physician is when the patient doesn't trust you or believe you.” Obstetrician-gynecologist, New York City
  • 21. “I know that Reader’s Digest recommends bringing in a complete list of all your symptoms, but every time you do, it only reinforces my desire to quit this profession.” Douglas Farrago, MD
  • 22. 10 Question Burnout Test 1. Do certain patients on your schedule actually make you violently shake or cry? 2. Do you secretly envy the job of old friends….every time you see them pumping your gas? 3. Are you slowly digging a hole through one of your office walls to escape like the main character in Shawshank Redemption? 4. Do you find yourself wanting to tell a patient, “Shhh…you had me at hello?” in order to get rid of them? 5. Are you secretly planning to get on disability by contracting a “disease” that is seronegative?
  • 23. 6. Have you already gotten (and passed) a stress test due to chest pain and/or palpitations? 7. Have you already bumped your PPI to BID? 8. Are your kids asking you how long it will be until you retire? And they are less then 10 years of age. 9. Do you sarcastically answer patients in your head and become uncomfortable when they ask why you are smiling? 10.Are you actually considering becoming a medical administrator?
  • 24. Results  0 – you are lying or are on some type of psychoactive substance  1 to 3 – you are fresh out of residency or are retiring in the next year  4 to 6 – Most doctors are here. Time to start thinking about a career change  7 to 10 – You are toast. DPC is your last chance
  • 34. Administrators  Want ◦ Control ◦ Productivity ◦ Money ◦ Awards ◦ Prestige  Don’t Want ◦ Controversy ◦ Being Questioned ◦ Friction ◦ Resistance ◦ Disruption
  • 38. With her goal threatened, our hero finds the forces of evil too strong….
  • 39. “Physician happiness is inversely proportional to the amount of bureaucratic drag on their lives” Doug Farrago MD
  • 40. Executive Leadership and Physician Well-being Tait D. Shanafelt, MD, John H. Noseworthy, MD, CEO Mayo Clinic Proceedings Volume 92, Issue 1, Pages 129-146 (January 2017) DOI: 10.1016/j.mayocp.2016.10.004
  • 43. The hero finds the magic formula in the magic land to break the system…
  • 45. The hero, once headed to burnout, emerges transformed and rewarded but…
  • 47. “I am not lucky. You know what I am? I am smart, I am talented, I take advantage of the opportunities that come my way and I work really, really hard. Don’t call me lucky. Call me a badass.” Shonda Rhimes
  • 50. “They tried to bury us. They didn’t know we were seeds” Mexican Proverb
  • 51. “The reasonable man adapts himself to the world. The unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.”  George Bernard Shaw
  • 52. “Stop being a prisoner of your past. Become the architect of your future.” Robin Sharma
  • 53. You are the heroes of this story!
  • 56. The heroes heed the warnings and shares them with others..
  • 63. What you can do:  Fulfill your dream  Encourage  Evangelize  Don’t sell out  Be patient  Don’t compare
  • 66. Heroes continue to break the rules, disrupt the system and change the world.
  • 69. Only $20 Each Shameless Self Promotion: For Sale After the Talk!
  • 72. And live your life happily ever after. The End