The NEW normal....Jesh.

[Cideous]

Non clinical corporate clinic mangers have always been a little dismissive of mid-levels in my experience, but it just went to a whole new level.  Our Urgent Care clinics were sold to another UC chain recently.  The new UC took our mangers to a retreat to train them in the way they do business.  

 

When they came back, it was all out war on the providers.  

 

We were told straight up (BTW this was to me AND my supervising physician), that we are now reporting DIRECTLY to our in clinic office manager.  A person with a HS diploma, and nothing else.  We were told she was now fully in charge of us. Controlling everything from our schedule, to approving/denying PTO, to "training us how to properly interact with patients as to maintain a high customer satisfaction rating".  

 

We were instructed that any and all negative Google, Yelp or Facebook reviews regardless of cause would be very frowned upon, and that we would now be required to write an explanation to the office manager explaining what happened, why it happened, and how we are going to improve our customer service so that it does not happen again...

 

Our phone calls with patients are now to be recorded and listened to by the office manager for her to review our customer service skill and interactions with patients.  No joke.

 

It goes on and on...   Mind you, this is not in response to any event, but simply the way things are "now going to be"....we were told.

 

 

Providers in other locations are falling into two camps.  

 

1.)  Appeasement:  Mostly younger mid-levels and docs who have only been out of school a few years and have no idea that there was a time where being a Provider of medicine and the work that went into this profession, earned you just a little respect.  They are acting like dogs who tuck tail, pee on the floor, and fall over terrified of the corporate medicine managers.

 

2.)  Anger:  Those of us who have been practicing more then 10 years (I've been a PA well over 20), are just plain angry.  A couple have quit, my doc has interviews this week and will be most likely quitting.  

 

 

I am more dumbfounded then anything.  Well, that and angry.  I'm not an old "get off my lawn" kind of person, but this demotion of not just us, but docs as well, has left me reeling.  The sad thing is, this is the new norm.  Providers are treated like dirt by people who have no clue what it's like to practice medicine.  I actually had a district UC manager (again, non-clinical), refer to me and other providers as "labor".  And another that sent us a scathing directive requiring providers to not clock in more then 3 minutes before our shift started.....3 minutes!  

 

Sorry for the vent/rant, but it's just very hard to watch what is happening.  Also, the staff picks up on this lack of respect and responds accordingly.    Dunno, it's just very very very sad what Corporate medicine has brought us to.  

[mmiller3]

Every day I hate being in medicine just a little bit more.

 

Your post, sadly, is not unique. I know a lot of places where providers are treated like any other minimum wage employee.

[mandrew1]

I would quit in a heartbeat! I've been involved in a similar "takeover" and it never gets better.

[Reality Check 2]

Ahhhh, corporate medicine - those two words that don't go together.

 

Non medical mid level power hungry YES men and women - also known as turds.

 

What a disaster. I am sorry you too are having to experience this.

 

It is an insult to a career based on artful interpretation of signs and symptoms.

 

My new lottery dream - abolish corporate medicine.

[LazyLion]

May I ask what state this is in? Or area of the country? I'm in school now, but willing to re-locate anywhere really - hopefully somewhere that is PA-friendly. 

 

If we move in the direction of universal medicine or single payer, do you think this problem will get worse? Or better, if there is less corporate competition? 

 

This is a little depressing.... up to now I've spent my life punching in time clocks within a minute range - which is a demeaning practice, for anyone really. I always kinda dreamed of salaried position. 

 

This sounds a lot like what happened with the pharmacists though, at places like CVS. They get disciplined and managed by a store manager.... God forbid they don't meet their "time quota". 

[newton9686]

Theres a real easy answer. Own your own practice. Doesn't get you away from insurance, but gives you way more autonomy. And with the way healthcare costs continue to rise as hospitals buy up the outpatient setting, we need PAs to step into ownership roles and provide higher quality care at a lower price. 

[weezianna]

A new prn provider in our clinic recently retired from a large healthcare organization which has started treating providers similarly.  Potential bonuses are held back, and any time a patient gives a less then favorable report of customer service, the bonus is reduced.  So, when the drug seeker on the weekend doesn't get the desired drug and complains, you lose.

[Reality Check 2]

One community health center in our community used actual stop watches outside of the exam rooms to time providers in each exam room and how much time they spent with the patient and then how much time they had left to document and finish the chart and get to the next room.

 

This is a COMMUNITY health center serving all rungs of life and a HUGE disproportionate number of mental health, chronic pain and generally down on their luck unhealthy folks.

 

Providers got downgraded on spending "too much" time in the room for a freaking 10 minute appt for someone who has multiple problems and no resources. Add to that using a less than adequate computer system and their expectation was spending less than 6 minutes in the room and the rest to complete charts and paperwork.

 

Never mind getting to pee or the crying patient or the patient with actual freaking chest pain who needs a full blown workup - screw the 10 minute appt - this guy is having an MI type of thing.

 

The day that I am micromanaged to that extent is the day that medicine in the US can kiss my fluffy butt. 

 

The corp monster I made the mistake of working with used Press Ganey and published EVERYONE's on one spread sheet - you could read everything about everyone. How helpful is that? Well, the idiot ortho surgeon got HORRIFYING reviews ALL the time and was still encouraged to come to our office to pedal his wares and try to drum up business. HUH? 

 

I get ONE report from a workers comp patient that said I didn't help him and I get yelled at. Seriously - the guy had an open thumb fracture with crushed bone and I sent him to the surgeon urgently but didn't provide that pesky hydrocodone Rx on his way to the OR and he ended up losing the tip of his thumb anyway because you can't make bone out of dust..... WTH?

 

So, my mantra in current life. Medicine is not McDonalds or Burger King and Corporate Medicine is Hell on Earth and the death of the art of medicine.

 

Go solo or go home

[Maverick87]

Non clinical corporate clinic mangers have always been a little dismissive of mid-levels in my experience, but it just went to a whole new level.  Our Urgent Care clinics were sold to another UC chain recently.  The new UC took our mangers to a retreat to train them in the way they do business.  

 

When they came back, it was all out war on the providers.  

 

We were told straight up (BTW this was to me AND my supervising physician), that we are now reporting DIRECTLY to our in clinic office manager.  A person with a HS diploma, and nothing else.  We were told she was now fully in charge of us. Controlling everything from our schedule, to approving/denying PTO, to "training us how to properly interact with patients as to maintain a high customer satisfaction rating".  

 

We were instructed that any and all negative Google, Yelp or Facebook reviews regardless of cause would be very frowned upon, and that we would now be required to write an explanation to the office manager explaining what happened, why it happened, and how we are going to improve our customer service so that it does not happen again...

 

Our phone calls with patients are now to be recorded and listened to by the office manager for her to review our customer service skill and interactions with patients.  No joke.

 

It goes on and on...   Mind you, this is not in response to any event, but simply the way things are "now going to be"....we were told.

 

 

Providers in other locations are falling into two camps.  

 

1.)  Appeasement:  Mostly younger mid-levels and docs who have only been out of school a few years and have no idea that there was a time where being a Provider of medicine and the work that went into this profession, earned you just a little respect.  They are acting like dogs who tuck tail, pee on the floor, and fall over terrified of the corporate medicine managers.

 

2.)  Anger:  Those of us who have been practicing more then 10 years (I've been a PA well over 20), are just plain angry.  A couple have quit, my doc has interviews this week and will be most likely quitting.  

 

 

I am more dumbfounded then anything.  Well, that and angry.  I'm not an old "get off my lawn" kind of person, but this demotion of not just us, but docs as well, has left me reeling.  The sad thing is, this is the new norm.  Providers are treated like dirt by people who have no clue what it's like to practice medicine.  I actually had a district UC manager (again, non-clinical), refer to me and other providers as "labor".  And another that sent us a scathing directive requiring providers to not clock in more then 3 minutes before our shift started.....3 minutes!  

 

Sorry for the vent/rant, but it's just very hard to watch what is happening.  Also, the staff picks up on this lack of respect and responds accordingly.    Dunno, it's just very very very sad what Corporate medicine has brought us to.  

 

Interestingly, it's not just bad medicine, but also bad business.

 

Companies that refer to their workers as the "labor" and things like that never last. They will either fall to crap or be bought out.

 

My mother is currently working for a company like this. They were once mighty, but treat their workers terribly. The environment has been getting more and more toxic. Now there are rumors that they are about to get bought out.

 

What goes around comes around.

[PACdan]

This is horrible. Unconscionable. Despicable. There needs to be a rebellion.

 

Anyone who works in a place that institutes these behaviors and practices, who doesn't immediately quit, needs to simply say "no". Unequivocal, no debate, just say NO. This is unacceptable and dangerous, I refuse. Do that until they fire you. We have no reason to listen to any of it. The office manager with the HS degree cannot see patients, cannot write a script, nor finish an H&P. If everyone refuses to be subjected to their BS, they'll have no option. If any candidate they attempt to hire objects to their practices, they'll be left optionless. Unfortunately we may need to start wielding the power of our medical licenses to hold them hostage; if they feel that treating providers AND patients in such a way is acceptable. If we suffer this silently, both our position as providers of quality healthcare and subsequently those who we are attempting to deliver it to will ultimately suffer.

[kittryn]

Non clinical corporate clinic mangers have always been a little dismissive of mid-levels in my experience, but it just went to a whole new level.  

 

I've been contemplating my resignation letter for just the same reasons. And leaving the profession.

 

We are in the same boat where I work. We were recently told (because we looked ahead and saw train-wreck scheduling), "not to look ahead at our schedules and offer input on how we need our schedules structured".

 

No input from us??!!??? WTF?? we are the providers! Who knows better than us how to manage our patient flow?

 

Anything we tell them we need is done (maybe) once and then ignored.

 

I don't see anything good coming out of this, and I'm brushing up my past profession to jump for good. 

 

oh - and the kicker 2 weeks ago - I was hired for 24 hours/week at a very good hourly rate, no benefits (I would like PTO but Im off 4 days a week, so...) - hired as "staff" mind you...well, last week my schedule was light so they put my patients (without telling me) onto the new hire's schedule (the night before, mind you), then texted me to "take the day off" - meaning 1/3 of my weekly pay cut!!

 

I pushed back and told them I am staff, not per diem...and I ended up billing for the day. we then (the 2 other providers and myself) made it clear that we are hired for the baseline hours and no less. I think they're a little scared of us now. but I feel like my days are numbered anyway, so...

 

can you imagine, being hired for 24 hours staff with no bennies and then them thinking they can treat me like an on-call per diem?

 

and of course, they're telling us we have to increase our patient census (by shortening pt encounter times). another impediment to being able to provide quality care.

 

unconscionable.

[kittryn]

May I ask what state this is in? Or area of the country? I'm in school now, but willing to re-locate anywhere really - hopefully somewhere that is PA-friendly. 

 

If we move in the direction of universal medicine or single payer, do you think this problem will get worse? Or better, if there is less corporate competition? 

 

This is a little depressing.... up to now I've spent my life punching in time clocks within a minute range - which is a demeaning practice, for anyone really. I always kinda dreamed of salaried position. 

 

This sounds a lot like what happened with the pharmacists though, at places like CVS. They get disciplined and managed by a store manager.... God forbid they don't meet their "time quota". 

 don't be too hasty to dream of a salaried position...you'll work 50 hours and be paid for 40. that's a hefty chunk of change to "donate" to your employer each month. break that salary down to hour equivalents based on 40 hours, then on the hours you actually work...then you'll see how much you're being ripped off. no recourse.

[ventana]

stand together against them

 

 

demand a sit down meeting

elect someone as director and only report to them

 

 

Then can not see a single patient with out you......

[newton9686]

This really is a big problem. However we have to ask ourselves why it is a problem. Ultimately, it came down to doctors neglecting the business side of medicine. So to fill the void people with undergrad and master level business degrees come in and try to solve the problem without a medical education. Then we create "healthcare administration" degrees to at least familiarize them with the world of healthcare, but the problem only gets worse. What we really need are 3 year MBA/PA programs. We must encourage people who want to go into healthcare administration to be both providers and business savvy, because both are necessary to advance healthcare, but both are dangerous without the other. 

 

I really believe there is a niche for business savvy PAs to solving this serious and growing problem. So encourage PAs around you to own their own practices. Support schools that mix MBAs and PAs. PAs can answer this problem. 

[Reality Check 2]

I really believe there is a niche for business savvy PAs to solving this serious and growing problem. So encourage PAs around you to own their own practices. Support schools that mix MBAs and PAs. PAs can answer this problem. 

 

I like this idea but would hire someone without an MBA necessarily before one with. Common sense far outweighs a degree.

 

I would ban the current touchy feely words such as "reach out" and those other idiotic phrases that mean nothing. 

 

If a PA wants to MBA or manage then they have to have 10 yrs clinical experience and still see patients 1-2 days a week or they lose touch just like every other admin who was ever a provider.

 

I have contemplated this but thought I would probably want to jump off a cliff once indoctrinated into the admin dark side world of bean counting and RVUs and all that stuff that is meaningless to me in the first place.

 

The whole Everything I Need to Know I Learned in Kindergarten thing is not too far off - be nice, be smart, do the right thing, don't be a schmuck should actually work if advocated and rewarded.

 

Go to work, see patients, document clearly, follow up - be nice. 

 

Too bad it doesn't work on the suit types.......

[fishbum]

I like this idea but would hire someone without an MBA necessarily before one with. Common sense far outweighs a degree.

 

Common sense and education are not mutually exclusive. 

 

"If you know your enemy and know yourself, you need not fear the result of a hundred battles." 

-Sun Tzu

 

If your enemy is "corporate medicine" then you need a soldier who understands that enemy....like an MBA. My experience suggests that when healthcare workers (at any level) get run over by administrators, it's because we don't understand understand them, don't speak their language, can't communicate with them, and therefore fail to leverage any measurable amount of power. A PA (or MD or NP)/MBA might be a powerful ally. 

[anewconvert]

I would be willing to bet that, for every provider saying that Admin has no idea what they do and the challenges involved, there is an admin complaining about how providers have no idea what they do and the challenges involved.

 

 

I can't tell you how many times we have asked a lecturer about the billing/pre-auth implications of a treatment they are teaching us just for them to say "I have no idea.  I don't deal with that part".  My wife worked in pre-auth for a large neuro practice and daily had to fight with doctors to do the most cursory charting or H&P to get a procedure/medication approved.  Every single day multiple doctors would send a request for MRI without finishing their notes, or order pain management without ever documenting conservative treatment.  

 

 

I haven't gotten out into the PA world yet, still in school, but having seen both sides of the practice side of things this feels like it really is insurance driving a wedge between providers and administration in a divide and conquer tactic.  They make providers and management argue with each other over meaningless crap in an attempt to minimize the amount of otherwise contractually obligated payments they have to make, and they are good at it.

 

An MBA/PA or MBA/MD path would go a long way in helping to bridge the communication/information gap and unify us against them.  Having providers be more willing to learn the business side, and having the business side be more willing to pay the providers to learn the business side wouldn't hurt either...

[Reality Check 2]

I should clarify my standpoint - I don't believe in medicine for profit.

 

Fair wage for fair work but I am not working to support administrators or a large organization.

 

The large the number of administrators is wasteful. They don't produce revenue and the "revenue producing units" (us) have to SUPPORT their salaries by seeing patients. The money goes only so far. More people to support - they desire more money. A very poor motivation for making providers do more - with less - always.

 

That is why I work for a solo doc and would like PA autonomy for experienced FP PAs.

[BruceBanner]

Insulting for sure. I've seen different shades of this in my 4+ years as a PA. I imagine the contrast is even worse for older PAs.

 

At Kaiser we answer to "nurse managers" administratively, but these are non-practicing RNs with an MBA, MSN usually. Ours is very pro-PA, uses "APP" instead of midlevel, etc. We feel respected. We are also referred to as "labor" by administration, but the big thing here is we are union represented along with the rest of the non-doc staff so there are some very hard checks and balances in place to keep them from just treating us like glorified customer service reps.

 

Sadly though, the OP's situation is the new norm in corporate medicine. It's easy for us to sit here and say "Revolt! Rebel! Quit! Get out!!", but you have to work. Not everyone has the luxury of just waltzing out of their job when they feel disrespected.

 

I agree with the others though that this will not get better. If you can afford to just quit, I would do so. If not, then start putting CVs out today, and leave as soon as you possibly can. Make sure and tell them why you're leaving too, bluntly.

[BruceBanner]

Ventana made a good point too that providers generate revenue for the company. Without you, they cannot stay afloat. You are the frontline, critical personnel of that business. So, if you can get everyone on board, then a standoff of sorts may be possible. This is how unions came into fruition. Everyone banded together and said "hey, f*ck you, you cant treat us that way." But, this only works if everyone is on board. If it's only a few dissenters then they'll just fire you.

[newton9686]

If a PA wants to MBA or manage then they have to have 10 yrs clinical experience and still see patients 1-2 days a week or they lose touch just like every other admin who was ever a provider.

 

Reality, I would absolutely support this. Makes a lot of sense. Just enough to keep them still in the game. For example, my school requires our professors to have one clinic day where they have to work.  It keeps them grounded, up to date and prevents them from just teaching theoretical mumbo jumbo. 

 

I really do believe there is just a lack of understanding by administrations. Most are probably trying to be positive influences (in their own distorted way). They just need a medical background and regular medical practice to be able to support the healthcare team versus under mind .

[Guest Paula]

In my experience, the physician's who take on an administrative role, work part time in their field, still cross over to the dark side.  Eventually they either quit because they can't stand admin or they start tasking us with more and more patients and requesting we work harder "for the cause of the poor and downtrodden and to fulfill the ministry of Jesus", then say we need to make more money because 2% profit for a non-profit catholic healthcare corporation is not enough. We need at least 10 %profit. 

 

Does this make any sense at all?

 

I have visions of Jesus coming into the temple of corporate catholic healthcare and turning over the money-changers tables and driving them all out, Pharisees and all.

 

Then I will go light a candle and sit in the chapel for a bit and smile.

 

Disclosure: I am not catholic. 

[Guest JMPA]

In my experience, the physician's who take on an administrative role, work part time in their field, still cross over to the dark side.  Eventually they either quit because they can't stand admin or they start tasking us with more and more patients and requesting we work harder "for the cause of the poor and downtrodden and to fulfill the ministry of Jesus", then say we need to make more money because 2% profit for a non-profit catholic healthcare corporation is not enough. We need at least 10 %profit. 

 

Does this make any sense at all?

 

I have visions of Jesus coming into the temple of corporate catholic healthcare and turning over the money-changers tables and driving them all out, Pharisees and all.

 

Then I will go light a candle and sit in the chapel for a bit and smile.

 

Disclosure: I am not catholic. 

then you should not blasphemeand use the name of the Lord in vain

[Reality Check 2]

Paula's point is that medicine has been tainted by the shield of religion in some cases (GIANT Catholic behemoth monster corp medicine org not specifically named) but still wants MONEY. The root of all evil.

 

If we worked to the true meaning of our respective mission statements then RVUs and Press Ganey wouldn't exist.

 

If admins were honest they would just come tell us that they wouldn't have jobs unless we make the numbers and they don't care how we suffer to do it - they are self serving/preserving.

[JohnnyM2]

If we move in the direction of universal medicine or single payer, do you think this problem will get worse? Or better, if there is less corporate competition?

 

This is a little depressing.... up to now I've spent my life punching in time clocks within a minute range - which is a demeaning practice, for anyone really. I always kinda dreamed of salaried position.

 

This sounds a lot like what happened with the pharmacists though, at places like CVS. They get disciplined and managed by a store manager.... God forbid they don't meet their "time quota".

You need only look at what has been happening since the advent of the so-called ACA. If we move to a single payer system, you will be told how many patients to see, how long you may spend with each of them, and will treat everyone according pathway algorithms that leave you with no judgement. You will be evaluated on these metrics and will be disciplined if your patients complain...and they will, because patients will know their care sucks. Don't worry, though, patients will be treated even worse than you. Your job will be to placate them, but their complaints will fall on deaf ears. You will become a simple technician.

 

Single payer healthcare= government healthcare. It works ok for fractures, lacerations, and UTIs, but God forbid you should get cancer, diabetes, heart disease or other complex illnesses. Government cares about votes, not people.