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Had a job interview....2nd time I have been asked this:


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Job is with an Urgent Care chain (corporate owned like most)

 

Pleasantries out of the way, their medical director said she only had one question....

 

Doc:  "If a patient comes in with a virus that you know is a virus (i.e. URI), and asks for a Z-pack because that's all that works, what do you do?"

 

Now...I know the answer she is looking for, but it shocks and saddens me that I am being asked this by an M.D.  I respond something to the fact that every case is different and each needs to be evaluated on it's own...etc etc etc.

 

Doc:  "Well I just wanted to make sure that you will give them what they want, because here at (redacted) we are *VERY* sensitive to negative Yelp and Google reviews.  We just can't have them. (Doc continues):  I get some APP's who say they will never give an antibiotic for a virus to keep the patient happy because of resistance, etc" (I swear she said that word for word), and I just need to make sure that you understand your roll here.  To keep patients happy".

 

Me:  <blank state>

 

This is the 2nd time I have been asked this exact question by an Urgent Care corporate chain.  The 1st was by the admin interviewing me, but this was by the medical director, an M.D.  

 

I guess after all these years of practicing medicine, I am just crushed to see what we have become as providers.  Literally whoring ourselves out to corporations who have Zero interest in practicing decent medicine.

 

At the end of the day, these are the jobs in my field that are available.  I like many others with a family and responsibilities, have to work.  It's easy to sit on a message board and take the high and righteous road by saying..."I would turn them down just on principle!".   Principle does not put food on the table or put my kids through college.

 

Dunno, just sad over the whole thing.....

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To have peace of mind this is why I tell them there's a <10% chance of bacterial cause and here are the three signs to look for (fever makes four). Push Neti pots. At that point it's out of my hand. Whose to say that in 7-10 days that they won't need one and you've provided them access to appropriate treatment? No azithromycin though, I give amoxicillin. If an arse, then Augmentin or clindamycin.

 

I agree with your frustration. Can't get out soon enough.

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.....At the end of the day, these are the jobs in my field that are available.  ....

 

This is simply not true (unless your "field" is urgent care).  

 

I get multiple emails every week for PA jobs.  Got one Friday for one with pay of $100K-$140K + bonuses for a rural family practice gig that's only 35 minutes away from a major metropolis.

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I cannot tell you how many times I explain to patients why they don't need the ZPak and the potential harm it could cause, and they look at me and say "I'm relieved I don't need antibiotics, really, I don't need antibiotics???"

 

They actually walk away happy. 

 

I usually say something like:  You have a condition called rhino sinusitis  or rhino bronchitis (ok, I made that one up) caused by the rhinovirus, or in other words, the common cold.  I'm sorry to inform you of that because it really sucks that the ZPAK or any other antibiotic won't work and you will be miserable for a few days.  Here is a script for nasal spray, prednisone, cough syrup, tessalon perles or something to make them feel like I "did something" for them.  Plus, give em a day off of work, which is what they really wanted or needed anyway or would be fired. 

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Job is with an Urgent Care chain (corporate owned like most)

 

Pleasantries out of the way, their medical director said she only had one question....

 

Doc:  "If a patient comes in with a virus that you know is a virus (i.e. URI), and asks for a Z-pack because that's all that works, what do you do?"

 

Now...I know the answer she is looking for, but it shocks and saddens me that I am being asked this by an M.D.  I respond something to the fact that every case is different and each needs to be evaluated on it's own...etc etc etc.

 

Doc:  "Well I just wanted to make sure that you will give them what they want, because here at (redacted) we are *VERY* sensitive to negative Yelp and Google reviews.  We just can't have them. (Doc continues):  I get some APP's who say they will never give an antibiotic for a virus to keep the patient happy because of resistance, etc" (I swear she said that word for word), and I just need to make sure that you understand your roll here.  To keep patients happy".

 

Me:  <blank state>

 

This is the 2nd time I have been asked this exact question by an Urgent Care corporate chain.  The 1st was by the admin interviewing me, but this was by the medical director, an M.D.  

 

I guess after all these years of practicing medicine, I am just crushed to see what we have become as providers.  Literally whoring ourselves out to corporations who have Zero interest in practicing decent medicine.

 

At the end of the day, these are the jobs in my field that are available.  I like many others with a family and responsibilities, have to work.  It's easy to sit on a message board and take the high and righteous road by saying..."I would turn them down just on principle!".   Principle does not put food on the table or put my kids through college.

 

Dunno, just sad over the whole thing.....

 

Now, I'm only a PA school applicant but I'm already annoyed with this. The clinic I work at do not place this burden on the providers BUT instead, the MAs... the clinic received < 5 (-) reviews and now it's our (the MAs) responsibility to ask every (EVERY) single patient (except the ones who seem irritated at their discharge) to leave a review. So not only are we tying up the rooms, slowing down ACTUAL triage, but we are being selective who gets to leave a comment based on end-of-visit satisfaction (talk about false advertisement) LOL. Me and my naive self had no idea patient satisfaction = excellent/competent medical care.

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It's certainly obvious to all of us, but I expect the 'patient satisfaction' thing to die a slow death over the next few years, now that the evidence is in that higher patient satisfaction means worse patient outcomes.  I would take the high road, personally, and walk away from that non-offer.  At some point, it will be incumbent upon us to report practices like that as practicing substandard medicine to the appropriate authorities.  I long for the day when "mystery shoppers" from the state medical boards try to get Z-packs with URI symptoms and no physical findings... and fine the providers who give them!

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It's certainly obvious to all of us, but I expect the 'patient satisfaction' thing to die a slow death over the next few years.....

 

 

 

You're kidding yourself if you believe this.

 

As more practices are sold to corps like most Urgent Care clinics have been, patient satisfaction evals are going hardcore.  You see, non-clinical corporate admins do not judge quality of care by patient outcomes, they judge it by patient satisfaction surveys, Yelp and Google reviews.  Now I expect it from Admin types, but I was frankly shocked to be slapped with it by a Medical director.  She was so straight faced when she told me what was expected of me.  Give the patient what they want, get the good review.....

 

Just sad.

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You're kidding yourself if you believe this.

There is something more powerful than corporate administration, though really just as evil: malpractice attorneys.  Your commentary about the blindness of corporate structures is well taken, but ignores their higher calling--fear of lawsuits, especially of the class-action variety.

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If someone were brave enough to record an interview like that and send it to the state medical board, the CDC, the AMA and Youtube then the issue could be brought to public attention and likely be turned into a PSA for antibiotic resistance.

 

Crap like this needs to be exposed and called out for what it is - BAD MEDICINE BUT BIG BUSINESS.

 

I couldn't take that job unless there were no other options in a 50 mile radius and bankruptcy was looming - and then only long enough to find another job.

 

My patients don't need to adore me to know I did right by them.

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Wow. Sadly I'm not surprised. Dont take that job!

 

I hope Rev is right in that the patient satisfaction disease will die a slow death, but I'm not optimistic. With corporate takeover of primary care and urgent care, medicine is not much different than any other commercial storefront venture, where customer satisfaction is #1. Urgent Care A wont survive if Urgent Care B across town has 5-star Yelp reviews when someone Googles clinics on their phone. 

 

The bigger issue is that this reinforces patient entitlement and people's lack of tolerance for any sort of discomfort, when they can just go to the local clinic and get their feel-better pills, because "it's the only thing that works". This is happening at my job, where we place "patient access" above all else and will see anyone and everyone for any complaint, same-day if at all possible. Half my day is devoted to 2-day sore throats, 1-day coughs, and foot pain without injury for 36 hours.

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The bigger issue is that this reinforces patient entitlement and people's lack of tolerance for any sort of discomfort, when they can just go to the local clinic and get their feel-better pills, because "it's the only thing that works". This is happening at my job, where we place "patient access" above all else and will see anyone and everyone for any complaint, same-day if at all possible. Half my day is devoted to 2-day sore throats, 1-day coughs, and foot pain without injury for 36 hours.

 

 

^^^ THIS.

 

As for recording it, I had actually thought "what if" after the interview.  I don't know that I am brave enough to take a chance on throwing my career down the tubes over it.  Mostly broken at this point and falling into line with what's expected seems the only real choice.

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^^^ THIS.

 

As for recording it, I had actually thought "what if" after the interview.  I don't know that I am brave enough to take a chance on throwing my career down the tubes over it.  Mostly broken at this point and falling into line with what's expected seems the only real choice.

 

PLEASE don't cave if there are any other options.

I have a longstanding distaste and anger for corporate medicine and how it forces us to behave sometimes.

Recording the interview is an afterthought and that always looks better.....

Maybe someone would be willing to interview who is not even interested in the job or comes from out of town and will never be seen again - a sting operation of sorts.

You could try an anonymous letter to the state board citing the push of the medical director. Or an anonymous letter to the CEO of the group. Surely this person says this many times during interviews and it wasn't specific to you or your interview.

I truly understand the push and pressure of being a breadwinner and how discouraging it can be - try to hold true and be strong.

I feel your pain

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Unfortunately I'm not surprised by this - as many of my colleagues have pointed out, patient access equals patient entitlement and they want their medicine like they want their McDonald's.  Drive through style.  This is evidenced by the places who are doing telemedicine home visits - Skype or FaceTime on your phone and get your scripts. 

 

I understand where you're coming from - principles don't put food on the table or money in the bank.  I encourage you to document your interactions with the medical director thoroughly, stand up for your principles and leave the job as soon as you possibly can, and then release your documentation as stated above.  The way they are telling you to practice medicine is not what we were taught in school, it's not why we decided to go into medicine in the first place.  It is not in keeping with the Hippocratic oath.  Some of the docs I work with are easier to pry the Zpak from than others and I admit I take a middle-of-the-road stance on this.  I maybe give more than some of the docs, but less than a lot of the other PAs. 

 

I have been saying this for a few years now, but I'm pretty sure urgent cares signaled the death of good medicine.  It's not that you can't practice good medicine in an urgent care - you can.  It's harder to do than in a standard practice.  But what it has done for the public at large is create unreasonable and improper expectations of medical providers - docs and PAs alike. 

 

Good luck.  I don't envy your position. 

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Ace - I agree.

 

The advent of the Urgent Care gave some patients a method of perceived anonymity to only deal with that which THEY feel important and keep information separated between their PCP and specialists - although not working with corporate medicine and EHRs.

 

We have taught society that illness or injury is a weakness and they must be productive at all times and never miss work, never take time off and come to work sick or send kids to school/daycare sick to prevent absenteeism.

 

We have eradicated common sense, the use of a basic thermometer, home supportive care, tincture of time and actually allowing illness to heal. 

 

Life is not always better living through chemistry.......................

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I work in a family practice clinic. Unfortunately, many patients do not feel that they have been properly treated unless they receive a prescription. I believe it is every provider's responsibility to only use antibiotics when necessary. Perhaps you can advise the patient that you will give a prescription, but only to fill the prescription if not better, or worse, in 2-3 days. Document that in the chart, too.

 

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I work in a family practice clinic. Unfortunately, many patients do not feel that they have been properly treated unless they receive a prescription. I believe it is every provider's responsibility to only use antibiotics when necessary. Perhaps you can advise the patient that you will give a prescription, but only to fill the prescription if not better, or worse, in 2-3 days. Document that in the chart, too.

 

 

 

It's not about educating patients.  Trust me, I've been educating them for well over 20 years.  It's that no matter how much I talk to patients about viruses and antibiotics, 2 in 10 will leave negative feedback via Yelp, Google or go straight to the companies Facebook page and trash us there.  That feedback goes straight to my corporate overlords who literally freak-the-hell-out when they see anything but a 5 star review.  At that point we get "re-educated" on providing better customer service......

 

The event I described in the initial post happened during the interview process with the head M.D. (regional medical director), I guess that's what hit me so hard about it.

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I've never gone for the prescription to take "if it doesn't get better".  I have a suspicion 99% of those people just take it as soon as they leave the office.  Also, when you get sued because of any number of reasons, what is your defense going to be?  "I TOLD them only take it if they needed it!"? 

I would estimate that 99% of what people come in for don't need antibiotics at all.  Bronchitis, pharyngitis, even UTI's. 

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With CDiff and antibiotic resistance, I just cannot fall into this fallacy that patients will really WAIT to take anything.

 

I think this Urgent Care is a pariah and an insult to the actual art of medicine.

 

I can't do this - just cannot. I try to not cave and thankfully work in a practice where Press Ganey doesn't exist and I don't read Yelp.

 

My doc is supportive - not perfect but supportive.

 

We HAVE to change the mindset that accurate and adequate treatment does NOT equate with what Rx is given. 

 

I would not want to be party to this type of organization. The litigation WILL come - not if - WHEN.

 

The person who dies from CDiff or gets a 5 year course of it or the one who dies from anaphylaxis due to unnecessary antibiotics will indeed reset the scales of what is right.

 

I wouldn't want the person who suffers these issues to be my family or friends.

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Job is with an Urgent Care chain (corporate owned like most)

 

Pleasantries out of the way, their medical director said she only had one question....

 

Doc:  "If a patient comes in with a virus that you know is a virus (i.e. URI), and asks for a Z-pack because that's all that works, what do you do?"

 

Now...I know the answer she is looking for, but it shocks and saddens me that I am being asked this by an M.D.  I respond something to the fact that every case is different and each needs to be evaluated on it's own...etc etc etc.

 

Doc:  "Well I just wanted to make sure that you will give them what they want, because here at (redacted) we are *VERY* sensitive to negative Yelp and Google reviews.  We just can't have them. (Doc continues):  I get some APP's who say they will never give an antibiotic for a virus to keep the patient happy because of resistance, etc" (I swear she said that word for word), and I just need to make sure that you understand your roll here.  To keep patients happy".

 

Me:  <blank state>

 

This is the 2nd time I have been asked this exact question by an Urgent Care corporate chain.  The 1st was by the admin interviewing me, but this was by the medical director, an M.D.  

 

I guess after all these years of practicing medicine, I am just crushed to see what we have become as providers.  Literally whoring ourselves out to corporations who have Zero interest in practicing decent medicine.

 

At the end of the day, these are the jobs in my field that are available.  I like many others with a family and responsibilities, have to work.  It's easy to sit on a message board and take the high and righteous road by saying..."I would turn them down just on principle!".   Principle does not put food on the table or put my kids through college.

 

Dunno, just sad over the whole thing.....

 

I would report this to a local news station and hopefully some reporter will bite and chase the doc down outside the clinic with their microphone and camera while the doc gets in their car and says " no comment." The negative press then hopefully puts them out of business. I'd find much satisfaction with that.

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