At the annual meeting of the Large Urology Group Practice Association (LUGPA) in Chicago, Illinois, attendees participated in a robust “open mic” group discussion about their most pressing concerns. Bryan Mehlhaff, MD, who comoderated the open mic with David Ellis, MD, said in an interview with Renal and Urology News that he thinks the wide range of topics covered is a good sign. “I thought [the discussion] was very far-ranging,” he said.

During the session, physicians and administrators discussed everything from how to best administer hypofractionated radiation treatments to how to deal with physician burnout. Regarding hypofractionation, one physician said members of his group practice found it to be an odious task that they preferred to have radiation oncologists do instead. Another physician said that after ten or fifteen uses, hypofractionation is a no-brainer. He advised using general anesthesia the first several times to “get over the learning curve.”

Another topic that many attendees spoke about was the problem of convincing a group’s older physicians to retire. Older physicians are typically partners who make more money than younger ones do, but are less willing to be on-call. One attendee said his practice has a lot of older physicians who are indecisive about whether they want to retire. “It made it hard to hire someone,” he said. The group practice found a solution by implementing an “exit ramp” strategy. With it, physicians close to retirement reduce the number of calls they have to take along with the money they make in a stepwise fashion. Two of its members have taken the exit ramp strategy so far, he said. 

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The discussion then turned to physician burnout. One attendee said she thinks it’s difficult to wrap one’s head around what “burnout” even means, noting that younger physicians may have different ideas than older ones do. “I don’t think defining it is possible,” said Dr Ellis. To him, it means “you have more to do in the day than you comfortably can.” A number of physicians agreed with this characterization, citing the larger workload doctors now have in dealing with completing notes and entering them into computer databases as sources of burnout.

Employee turnover and morale was another common complaint. An administrator in the audience said she finds it very difficult to recruit and retain employees, and added that finding employees who will “really commit over the long term” in a way that allows them to develop the experience and wisdom the job requires. The result is that it can be “extraordinarily difficult for administrators to maintain their departments,” she said.

“One of the things I’ve learned recently is that people don’t leave their jobs, they leave their boss,” Dr Ellis said. To prevent that, administrators should be personally engaged with their employees. “Even just knowing their names is huge,” he said. “It doesn’t hurt to be nice, [or] compliment employees who do a good job.

Dr Mehlhaff said he thinks the value of open-mic style sessions is that it allows physicians and administrators to network and share ideas about how they grapple with common problems. “At different points people say, ‘wow, that’s a great idea,’” Dr Mehlhaff said. “I think that’s really the best part of LUGPA is the networking that doctors have.”


Mehlhaff B, Ellis D. Open Mic – What Keeps You Up at Night? Presented at: LUGPA 2019 Annual Meeting; November 9, 2019; Chicago, IL.