“Ego Arbitrage” for Physicians

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Just as arbitrage deals with using inefficiencies in pricing to extract additional value in a financial transaction, ego arbitrage uses inefficiencies in the status of certain tasks or behaviors to create additional value (or savings) in your career and in your life.

This morning I awoke to read a mind-blowing blog post over at Freedom Is Groovy where Mr. Groovy coined the neologism, “egotrage.”  The example he cited was briefly taking a job at the car wash down the street every Saturday to defray tuition cost while he was in graduate school. Ultimately his ego prevailed, dictating that someone with a university degree should not engage in menial labor like washing cars, and he quit the job, missing out on an opportunity to avoid debt and work his way through school.

The concept was compelling and immediately self-evident, the “baby on board” type of million dollar idea that’s been right under your nose until someone more astute and observant named the phenomenon.

Physicians are known for possessing a surplus of ego. Ego arbitrage offers tremendous opportunity for the savvy physician. I immediately thought of a few examples from work and home where employing such tactics can and does produce immediate gains.

Ego Arbitrage At Work
Physicians in the U.S. are constantly measured, and these quality and efficiency metrics are repeatedly touted as both the keys to improvement and the albatross around your neck that (for hospital-based physicians like ER docs and anesthesiologists) will help your group maintain their favored status with a hospital.

Like most emergency departments, during a busy shift there are several major obstacles to efficiency. Sometimes the volume simply overwhelms us – too many patients and insufficient staff. Other times specific understaffing is the culprit – a shortage of techs means urines don’t get collected and dipped or patients are not wheeled to x-ray in a timely manner.

After noticing that my “throughput” metric (the ability to evaluate and treat a patient from the time of arrival until the time of discharge) were not as competitive as some colleagues, I spoke to the leader in that metric to find out what he was doing that I hadn’t. It turns out he wheels patients to x-ray himself; escort patients to the bathroom and waits for them to exit and place the urine specimen cup in his gloved hands, which he then personally hands to a nurse or tech to dip. All he had to do was be willing to recognize the bottlenecks and pitch in by doing “non-doctor” tasks to improve patient care when other team members were swamped. I adopted his techniques and my metrics improved immediately.

Another physician colleague never missed an incoming call from a specialist, something that can plague a busy ED and delay patient care. I noticed she answered the phone herself when the unit secretary was on another call – and thus never let a consultant’s call slip through the cracks when the secretary was occupied. This additionally endeared her to our chronically overworked secretaries, who appreciated her help and went out of their way to ensure her pages were placed in a timely manner.  I adopted her technique and became a “docretary,” and my consultant pages became similarly prioritized. I also realized just how much bandwidth it takes to be one of our superstar unit secretaries in the ED, which transformed my interactions with our secretaries for the better.

Ego Arbitrage At Home
Turns out lifestyle ego arbitrage was something we were already doing, but simply lacked the proper terminology to describe. When we shop for clothes, my wife and I have a handful of thrift stores and vintage clothing shops that we visit.  You’ll never find the same thing twice, and we’ve come to appreciate the treasure hunt. Only a few fellow physicians will cop to similar habits, but once you find them, you really connect.

Visiting one of my usual haunts a few months back, I found a virtually new Marmot Gore-Tex raincoat for ten bucks. Being an amateur gear junkie, I recognized that this type of jacket retails for $200-300 new. Problem was, it was too large to fit me. I bought it as a gift for a friend who also enjoys treasure hunts. He took it on his annual backpacking trip to the Sierras and could not stop thanking me for it. I felt great about gifting it to a friend who will truly appreciate it.

Another opportunity my wife and I avail ourselves of is driving beater used cars. Where others measure their child’s growth in markings on the door post, I gauge my kids’ growth by comparing footprints on the upholstery of my car seats. I love not caring where I park it or how much sand gets into the trunk on beach days. And I had the unique privilege of reassuring a frightened elder who once rear-ended me at low speed in a Costco parking lot by getting out of my car, taking a quick glance at my front fender, and saying, “No big deal.” His relief was palpable.  Driving a low status car that suits my needs puts me in a position of low stress and paradoxically great power; in retrospect, it may possibly feed my ego more than it humbles it!

Empathy For The Win!
A final, tangentially related thought: A friend from medical school grew up in a family of migrant farm workers, and went on to become a faculty neurosurgeon at Johns Hopkins. He says he was motivated in part by his grandfather, who told him that in life he could earn his living using his back or his brain, and urging him that the latter would provide more options as he aged. He never forgot those words, and he never forgot his humble origins.

Many of us in medicine are the second or third generation in our families to benefit from a fancy education. Our calluses come from extreme paddle sports and guitar lessons instead of construction and landscaping jobs. There’s a great deal to be learned by experiencing how hard others have to work to make their living and by befriending folks from a different social status. Taking on “non-doctor” tasks to help a busy nurse, tech, custodian or unit secretary allows me to peek over walls that my income, education and professional status frequently erect. I can acknowledge how hard they work and how much they contribute; how fortunate I am to benefit from their hard work; and if I’m lucky, I’ll shrink my ego and gain a friend.

How might you benefit from ego arbitrage at home or at work?

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