Do your Advanced Practice Providers choose the red pill or the blue pill?
In the current competitive business climate, aren't non-competes even more necessary?
That all depends on what kind of employees you want. Non-competes actually suppresses nurse practitioner and physician assistant motivation and creativity.
A non-compete tends to be counterproductive on different levels. Do you want to have APPs that would like to leave... but don't because of a non-compete? Do you want APPs who are immediately demotivated because they feel their human capital is not their own?
Which urgent care would you rather work for: the one that puts tremendous effort into placing legal and contractual stakes in the ground, or the clinic that puts tremendous effort into trying to be your employer of choice
Isn't it true that the APPs who don't want to sign non-competes tend to be the ones you want most? They're aggressive, motivated, have lots of ideas. The APPs who willingly sign are the people you don't want.
When a clinic or hospital demands non-competes, that employer create self-selection and a market for lemons: the people who unthinkingly sign a non-compete may feel they don't have the skills to get another job or take off on their own. Every employer wants employees who are self motivated, who have confidence, and who have aspirations.
Why put up artificial barriers that make it harder to attract great APPs, or indeed any other employees?
APPswant to develop their careers--maybe work for an urgent care system or hospital for a few years then become entrepreneurs, perhaps starting their own clinics.
Freedom creates more incentive to for APPs to connect, be visible, network, and develop themselves both within and outside the company--all of which benefits their employer.
Perhaps the only thing worse than forcing people to sign non-compete agreements is how hospitals and other big employers attempt to enforce that agreement when they leave.
If employees really want to leave, they'll leave. So then what do you do about it?
Some companies engage in irrational and counterproductive threats and even litigation. Say you can actually get a non-compete enforced; do you really want to develop the reputation as a clinic system that sues ex-employees? That sends the wrong message to current employees and to the talent you want to recruit.
So you just let your nurse practitioners go when some big hospital offers them a job, after all the time and training you gave them?
It's not like you have a choice. So rather than developing the reputation for being upset when employees leave, focus on the positives.
Really great people will leave your clinic all the time. It's fine. They need to find themselves. Instead of seeing this as someone who left to become a competitor, we see them as alumni, now working for a new customer of ours.
This mobility is a way to seed STLHealthWorks.com into other places. Even our competitors can quickly become collaborators and partners.
The Glass is ALWAYS Half Full
At STLHealthWorks.com, we run on multiple slogans:
Always treat every patient like you would your own family.
The patients don't come first - the employees do. Happy employees are the best way to get the best patient outcomes.
It will all turn out ok - just watch.
If you love somebody, set them free. When they return (and they will return), welcome them back with hugs!
Everybody wants to live a life of security, safety and perceived comfort. That's why, when one of our APPs leaves to go work for Mercy, BJC or SSM, we totally get it. They want to have the comfort of working for 'the big employer' which has billions of dollars. If that's what's important to the employee, then that's what they should do. No harm - no foul. If the employee wants the comfort and security of working for the big box, that's totally cool. They were meant to go. If however, the employee wants the excitement and adventure of working as part of the team of a growing company, then they stay. If they want autonomy, they stay. If they don't believe in non-competes or 25 cent annual raises, they stay. If they want the blue bill, and it's totally fine if they do, then they leave. If they want the red pill, with the authenticity of free will and being in control of their own lives, then they stay.
Since I was a teenager in London, encouraged by my father as well as the James Bond 'Scottish Shower' idea, I started taking these ice-cold showers every day. It was a bit like the swallowing raw eggs in a cup thing every morning (like all tough guys did in the 70's and 80's). The latter habit didn't last (too nauseating), but I did continue with the cold shower thing until I got married just over 11 years ago. Taking such a shower proved to be quite invigorating and it 'felt healthy', not just during but especially when I got out! As I recently started this practice once again, I thought I’d share with my readers and my patients, so they too can find a New Year’s resolution that will enhance health, without hormones, drugs or other such nonsense that you can see so many people throwing around these days.
In ancient times, hot water was a luxury. People had to live near a hot springs in order to enjoy the comfort of a hot bath, so for most of human history people bathed in cold water. The Spartans, hard-asses that they were, felt hot water was for the weak and timid. When they did take baths (which was, like, once a year) they used only cold water because they thought it tempered the body and made it vigorous for ass kicking I guess.
Many cultures incorporated a cold water dousing into their religious ceremonies. Some Native American tribes would alternate between sitting in a sweat lodge and jumping into an icy river or snow bank. Ancient Russians also took frequent plunges into ice cold rivers for health and spiritual cleansing. Japanese practitioners of Shinto, both in ancient and modern times, would stand under an icy waterfall as part of a ritual known as Misogi, which was believed to cleanse the spirit.
While most other doctors (unlike me of course) may no longer instruct their patients to take a cold shower or bath, and call them in the morning, a shot of cold water can still impart real health benefits:
1. It improves circulation.
Good blood circulation is vital for overall cardiovascular health. Healthy blood circulation also speeds up recovery time from strenuous exercises and work. Cold water causes your blood to move to your organs to keep them warm. Warm water reverses the effect by causing the blood to move towards the surface of the skin. Cold shower proponents argue that stimulating the circulatory system in this way keeps them healthier and younger looking than their hot water-loving counterparts.
2. It’s an anti-depressant.
Depression is yet another thing that cold showers help and prevent. It is caused by the stimulating effect the cold has on the brains "blue spot", the main source of noradrenaline for our bodies, a chemical that might be used to help alleviate depression. You will notice that after having a cold shower, you will feel very happy - sometimes referred to as euphoria. This feeling can be compared to the happiness you feel after exercise because of the endorphin released.
Every morning, after I take a shower with cold water, I leave feeling invigorated and energized. Your heart starts pumping, and the rush of blood through your body helps shake off the lethargy of the previous night’s sleep. For me, the spike in energy lasts several hours. It’s almost like drinking a can of Diet Mountain Dew, minus the aspartame. And while it hasn’t been studied, many people swear that cold showers are a surefire stress reducer. I’m a believer. I bet if you asked the people I work with, they’ll tell you that my energy levels lead them to suspect that I drink a gallon of coffee every morning. I never drink coffee :)
3. It accentuates one’s breathing.What you will notice as an effect of cold showers, especially when you first start, is that you begin inhaling very deeply, while asking yourself if you’re totally out of your mind. This is to try and combat the stress of the shock, the vasoconstriction and the overall need for oxygen to respire and keep yourself warm. I won’t delve into the benefits of something called Pranayama, but the principle is similar: regulation of breathing optimizes organ efficiency.
4. It helps you sleep.
Another great reason to start having cold showers is that for some reason or another, it aids sleeping. Insomniacs are sometimes advised to try this - the physical stress and shock of a cold shower before bedtime really helps you to calm down after the exhilarating feeling of being extra alive under the water. This actually works with hot showers too, but it’s even stronger with cold ones!
5. It augments your immunity.
The most established benefit of cold showers is that overall, they simply increase your chances of fighting off disease and infection. Several studies have suggested that people who take regular cold showers have less chance of getting:
Taking cold showers has been shown to help normalize a healthy human temperature, regulating the amount of sweat you produce in doing so. As a result of the increased brown fat levels, blood pressure and body temperature, chemical reactions in your body will happen faster (heightened metabolism) than they would have without regular cold showers. An increased metabolism is what a lot of people seek out because it means that any process in the body will become more efficient. This also means more weight loss because more calories are being burned to supply energy for more reactions. It also means faster growth/repair of muscles and other cells so any exercise you do will result in better results leaving a fitter, leaner body.
This process opens up the lungs much like strenuous physical exercise does and results in a higher average intake of oxygen, which is good for many things like not feeling tired during the day and doing better at sport or other exercises.
7. It keeps one’s skin and hair healthy.
Hot water dries out skin and hair. If you want to avoid an irritating itch and ashy elbows, turn down the temperature of your showers. In fact, itch receptors don’t even work in the cold, as I tell my patients who have had any kind of allergic reaction. Also, cold water can make your skin look healthier by closing up your cuticles and pores.
8. Potency & Fertility.
Cold showers appear to increase testosterone. During the 19th century, many doctors and ministers recommended that young men take baths in cold water to reduce the sin of “self-pollution”. Cold water was thought to extinguish a man’s flaming carnal desires. How wrong they were! The same study by the Thrombosis Research Institute cited above showed that cold water showers actually increase testosterone production in men. Increased testosterone levels not only boost a man’s libido, but also his overall strength and energy level. If you’re looking to increase your testosterone, instead of hormone supplements (which seem to be the latest fad gripping the nation these days), hop into a cold shower.
Trying to become a dad? Cold showers are good for your little swimmers. Your testes aren’t meant to get too hot; that’s why they hang outside your body. Sperm counts decrease when the temperature of a man’s testes increases. Experiments done in the 1950's showed that hot baths were an effective contraceptive. Men who took a 30 minute hot bath every other day for 3 weeks were infertile for the next six months. Perhaps this also explains why sperm counts drop when a country gets more running hot water.
9. Weight Loss
Brown fat, as opposed to white fat is heavily involved in burning energy. Exposure to cold naturally stimulates the production of these brown fats. These cells burn glucose (the calories you eat and the white fat that you store) to try and produces as much heat energy as possible. Having a higher amount of brown fat leads to more energy being burned per second and therefore, more weight is lost. Brown fat:
10. It improves our lymphatic system.
Unlike blood vessels, the lymphatic system does not contain blood. Instead it has lymph, which carries away waste products and white blood cells which handle infection. Also different from blood vessels is that the heart does not pump lymph around the body like it does the blood.
The lymph relies on the contraction of muscles. This contraction squeezes the lymph up to the thoracic duct so that the lymph can mix with the blood and then be dealt with by our organs.
Cold showers cause whole-body contraction and this works excellently with the lymph system, squeezing the fluid up through the body. If the lymphatic system is compromised and inefficient, then the fluid pools at far away places (usually the feet). This results in what is known as lymphedema (type of edema). The pooling of lymph can result in serious health detriments. Another result of the whole body contraction is that it results in the squeezing of toxins and waste products out of the skin. This means that they do not stay inside the body and cause infection or put extra strain on the organs responsible for breaking them down into manageable pieces. This detoxification can make you feel better and more 'fresh'. It also has a good effect on the skin which appears cleaner and younger.
Before Getting Started with Cold Water Showers
If you’ve spent most of your life taking hot showers, suddenly turning the dial in the other direction can be a big shock to the system. I took a break from the James Bond Showers for over 10 years. When I recently decided to get started again with them, my heart almost jumped out of my chest, and I nearly passed out from hyperventilation when the cold water hit my body.
So don’t try this at home (or anywhere else for that matter), if you’re not in awesome health to start with. Getting into the ‘Scottish Shower’ thing might be too much, too soon if you have the following, amongst other conditions:
Just like initiating a work-out program, it’s often a good idea to see your healthcare provider (physician or nurse practitioner) to give you a clean bill of health, before you start the ‘craziness’. So give me a call! How to start if you’re healthy enough:
If you decide to start taking cold showers, slowly adjusting the temperature is best advised.
1. Start off with the warm water (if you’re new at this)
2. Wash your hair with some Pinaud Elixir shampoo, just like 007.
3. When you’re ready to rinse, just turn it down to cold. Spend a few minutes under the cold water, meditating about a lost love or on how awesome your life is.
However, many people (myself included) decide to "throw themselves in at the deep end" of cold showering and start by simply throwing themselves under as cold water as they can get their hands on! This is of course a much quicker way of reaping the health benefits of cold exposure but carries the downfall of much more discomfort and risk to your health. For those with potentially weak hearts, the gradual 'easing' method is strongly advised.
And don’t forget to Save The Planet, like James Bond would do.
Perhaps not a direct health benefit, but taking cold showers also means using no energy whilst washing yourself - which means less CO2 and other greenhouse gases are emitted into the atmosphere. This results in less global warming and a lower electricity bill! So, if for no other reason, promote a healthier planet by taking a cold shower.
After about a week of getting into these cold showers, you will find yourself dreading the shower, which you know is good for you but..... man it’s cold and uncomfortable etc etc, and other such whining. Just don’t quit. Do it solidly for just 30 days, and your early hesitations will transform into enthusiasm. Yes, it’ll make you into a part-crazy-person (compared with all your weak-willed hot-showering peers), but at least you’ll be a happy and healthy, crazy person! Like anything worth doing in life, it’s tough at first, even off-putting (irritating, annoying, insert blistering negative adjective here), but just a sprinkle of perseverance and tenacity, and you will become a winner before you know it. No drug company is going to promote cold showers. Think about it.