Rob Melendez, MD, MBA

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Burnout term is burning out…replaced with Moral Injury or “F Factor?”

I have been reading a lot about burnout and moral injury. Why is this issue important? Depression is on the rise within medicine and the physician suicide rate is nearly 2x that of the general population and even higher when compared to the military.  This is absurd and appalling to me and we should not tolerate suicide in anyone. It is heart breaking to know that fellow colleagues are suffering along this potential continuum. We need to help everyone along this path. As a veteran myself, moral injury should not be used in this context of physician burnout, but it is a better phrase than burnout. I think most of us know what the problems are and disagreeing on what term to use is not as important as the solutions. Once we get beyond this et terms, we should use a new term, the “F Factor,” or Fulfillment Factor. As physicians, we sacrificed many years of our lives because we care about patients, driven to learn, and have a desire to be give back to others. We need to focus on a Physician’s “F Factor.”  Irrespective of the term we use, we need to simply define what we are speaking about-conflict by the physician to put the patient first with other competing priorities- self interest and company interest.

Our first priority is to our patients. Physicians are second and anything the physician needs to enhance the physician-patient relationship, then it needs to be honored and respected. Do you need a scribe, then get a scribe. Do you need a stapler at your desk or a scanner or a printer, then get one. Arguments about adding a printer would be too expensive is where the problems are made worse.  A printer at the physicians desk or in the exam room needs to happen if that is what will increase the physicians “F factor.”  Albeit this is a simple example, create a list of issues that impede patient flow and limit time with the patient. Prioritize what will enhance the patient experience and increase your “F Factor,” and start addressing each one. Partner with your administrator to implement these solutions. 

Next, move to the larger system within your practice. Do you have enough technicians, do you need a scribe? Are there too many do’s and don’ts from upper management that interfere with your clarity of thinking about the patient first. Are you driven more by economics than what the patient needs? Obviously, be mindful of the economics, but do not be driven by them! 

Finally, focus on advocating for your patients at the national level by meeting with your legislators. Reduce burdens on physicians. The system focuses on physicians clicking too many times within their EHRs while ignoring the person, the patient. This reminds me of when I worked in the grocery business in high school and college where I saw customer service decline and more burdens were placed on the customer. We moved from manual cash register to scanners. We moved from serving the customer to the customer serving themselves by having them unload their own cart. Now, there are self check out stands, although it can be easier, it still requires a learning curve. The airline industry is doing the same thing, making the customer check-in on their own to print the boarding pass to even placing the sticker tag on the bags. The customer in this case is the Physician. We are burdened with so many bureaucratic lists. We have had to become coders, billers, clicking to oblivion to improve so-called quality of care, and we know that meeting MIPS standards does not equate to higher quality. This is merely a “C average” mentality which is contradictory to our mindset as physicians. We have strived to be far above a “C average” mentality. Standards should be set by physicians when it comes to the physician-patient relationship. I want all administrators to ask physicians, what resources do you need to be successful? Give them those resources and determine whether the “F Factor” increases, efficiency improves, morale is boosted, and most importantly, the patient’s and staff’s happy factor increases.

I know we can make a difference! We need to make sure we as individuals are doing our very best and practice self-awareness and avoid being a victim, but rather step up and voice our concerns and demonstrate leadership. We need to improve our EHR systems too by creating voice to text and improving communication across so many different platforms. Voice your concerns with your partners, practice, and larger systems. Own it.

Change will occur if we speak up as leaders.

Rob Melendez, MD, MBA


A must see video and references below:

Video by ZDoggMD: (Offensive language)

WHY I ADVOCATE? Dr. Rob Melendez, Ophthalmologist #MYF2018

The AAO’s “Why I Advocate?” Challenge.  #MYF2018

Is Twitter Dying for the Ophthalmologist??

Is Twitter dying for the Ophthalmologist?

Rob Melendez, MD, MBA and Pavan Angadi, MD

We performed a study to investigate whether ophthalmologists are joining Twitter at an increasing rate and to determine whether they are more active on the site. We searched  for ophthalmologists using the following terms: “ophthalmologist”, “ophthalmology”, and “eye surgeon.”  We found that ophthalmologists started joining in 2007 when Twitter started and the number of new users was at their maximum in 2009 (56) and has been declining since then and  in 2017 only one ophthalmologist joined Twitter (See Figure 1). There were obviously more ophthalmologists on Twitter, but were difficult to identify because they failed to mention in their profiles that they were an ophthalmologist. This raises the issue of why some ophthalmologists are on Twitter. The ones who did not self identify themselves as ophthalmologists are likely on Twitter more for personal use and not professional reasons to educate others.

We also investigated how active these ophthalmologist have been in 2016 and 2017. We found that the average number of tweets/month in 2016 was 60.6 and in 2017 it increased to 80.4 (38.6% increase). We also found that the total number of active users increased from 138 in 2016 to 169 in 2017 (22.5%). We also identified the total number of tweets from these  ophthalmologists in 2016 was 3739 and 5865 in 2017, which was an 56.9% increase. We found that although the number of new users on Twitter has declined since 2009, the existing users of Twitter has increased. Given the paucity of ophthalmologists on Twitter, suggests that it is a great opportunity for more ophthalmologists to become leaders on Twitter to educate others. We also identified which types of ophthalmologist are most active on Twitter (see Figure 2).



Figure 1. Number of Ophthalmologists on Twitter and what year they started.                                                Figure 2. Ophthalmologist Twitter Users by Subspecialty

The Art of Delegation


The Art of Delegation
Rob Melendez, MD, MBA
As you move along in
your leadership position as chief resident, stop and reflect on ways to involve
others more in your goals. As a leader, one of your jobs is to promote others. Seek to
include others in as many projects as possible. For example, as you begin
planning your goals for this year from creating a wet lab for your program to cre
ating a mock session for oral boards, invite others to chair one of those committees. If you do not have committees created, then take this time to create them. You will always have the title of chief resident and reap benefits from it, but think of others too who need help building their own leadership skills and portfolio.
Take assessment of your residency program to determine the weaknesses and create committees to create solutions for those deficiencies. By involving others, you are also practicing the art of delegation. This requires you to be willing to do any job yourself that you ask others to do. Delegation is not simply pawning a job off to someone that you would not do. Show extreme enthusiasm for any project to motivate the other residents. Remind them that you want them to take the lead on a specific project to help the program. If they are not motivated enough by improving your program, remind them that it will help them when they are applying to fellowship and for their first job. Obtaining planning and organizational skills during residency is great practice and will serve them well in future leadership positions. When we join a practice, we will be asked to oversee a project to improve the practice or department. Every resident should be given the opportunity to lead in a project to improve your program. I suggest creating a list of projects and solicit the residents’ ideas too and ask which one they want to implement. Can you imagine if every resident had one mini project to improve in their program? Our goal is to help every program improve and as a result will improve ophthalmology at large. Involve others.

Cataract Surgery Pearls: CW Technique for 4+ NS Cataract

Watch the video here:

Surgeon: Dr. Rob Melendez  @DrRobMelendez

Illustrator: Sam Hobbs, MSIV @SamHobbsMD

Cataract Tips for Young Surgeons. Academy Cafe Sat. 130-300 pm. #aao2015

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

Source: Ophthalmology Business – APR 2010

Preparing for Premium IOLs: Getting Started with Limbal-Relaxing Incisions to Correct for Astigmatism – American Academy of Ophthalmology #aao2015 Academy Cafe, Saturday 1:30-3:00 pm

Why do you need to learn how to perform limbal-relaxing incisions? Limbal-relaxing incisions (LRIs) are used alone and in combination with implantation of toric

Source: Preparing for Premium IOLs: Getting Started with Limbal-Relaxing Incisions to Correct for Astigmatism – American Academy of Ophthalmology

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