Overstaffed and underworked

[v_chicky]

To those seasoned PAs out there, have you been asked to "bring in more patients"? Is this the norm? This is completely new to me. The clinic I have worked for for the last 4 yrs doubled the number of providers this year and subsequently, all of our pt numbers/encounters/RVUs have gone into the toilet. The total number of encounters for the practice has inched up by about 1%, but dividing that between all the providers, we are all seeing a lot fewer patients (we see mainly walk-ins). Now, during my contract renewal discussion, I'm being threatened with lowering my salary if I can't bring in more patients. Upon explaining that all providers' encounters have dropped off sharply, I was told that it was just me who is low. One simply needs to look at our schedules over the last few months to disprove this statement (unless other providers are "up-coding"). I have offered to widen my hours to 7a-7p to capture the working population who ends up in neighboring urgent cares, but this suggestion has fallen on deaf beaurocratic ears. So, beside providing great, personable, friendly care to patients, what else is it fair for a walk-in PA to be expected to do drum up business?

[jmj11]

To those seasoned PAs out there, have you been asked to "bring in more patients"? Is this the norm? This is completely new to me. The clinic I have worked for for the last 4 yrs doubled the number of providers this year and subsequently, all of our pt numbers/encounters/RVUs have gone into the toilet. The total number of encounters for the practice has inched up by about 1%, but dividing that between all the providers, we are all seeing a lot fewer patients (we see mainly walk-ins). Now, during my contract renewal discussion, I'm being threatened with lowering my salary if I can't bring in more patients. Upon explaining that all providers' encounters have dropped off sharply, I was told that it was just me who is low. One simply needs to look at our schedules over the last few months to disprove this statement (unless other providers are "up-coding"). I have offered to widen my hours to 7a-7p to capture the working population who ends up in neighboring urgent cares, but this suggestion has fallen on deaf beaurocratic ears. So, beside providing great, personable, friendly care to patients, what else is it fair for a walk-in PA to be expected to do drum up business?

 

I feel your pain. I had to create my own practice from scratch here but it was very different because it was sub-specialty care. I did join a family practice group once and upon my arrival the hospital owner suddenly put everyone on productivity. The docs suddenly increased their patient load from about 18 to about 25-28 patients per day. They fought over all new patients and set a rule that the PAs (two of us) could not have any of the new patients nor could we see any patient which had established with the doc. It was horrible.

 

In Urgent Care, I don't have a clue how you could bring in more business. Frustrating isn't it? I mean, it would be really, really hard to stand out in that setting. Few patients would say, "I want to go to Urgent Care B, instead of A because of the great PA over there at B." You could be the greatest PA who ever walked the earth, or the greatest medical provider in general, and still not have an advantage. I hope it works out for you, if not . . . might mean you start looking.

[ajnelson]

Ouch, this is really frustrating, I'm sure. I was offered a job in an urgent care/FP setting where they wanted me to start out seeing some overflow, but my eventual pay would be based on how many patients I would have been able to bring in to the practice. I'm not a business person for a reason...

Being in the setting that you are, if you are able to bring in more patients, who is to say that you would even be the one seeing (and getting credit) for bringing these patients in.

In the ED, even though our census has been about the same (or maybe slightly lower), we have had to cut back significantly on provider hours because of reimbursement (lack of). No insurance and decreased reimbursement means we are making less money on each patient. So when we are working, we end up working harder and having to stay past the end of our shifts to finish paperwork, discharges, etc....

Wish I had some good answers for you. And if you were at my end of town, I'd say come work with us, we'd love to have you in our ED :)

[cervantes21]

What are their suggestions for bringing in more patients? I would be pretty pissed off to put it nicely and tell them it's their job to advertise and bring in more patients and my job to dx, document, and follow up with pts.

Best of luck to you, keep us posted!

[LIPPER]

Ask to see the manager's business plan for generating revenue (every good manager/owner has a business plan). See if he can justify his bright plan for hiring more providers then there are apparently needed for the # of patient encounters.

 

"I'm a medical professional. Unless I'm ordering inappropriate tests/unreimbursable procedures then I'm doing my job......YOU are the marketing person...are you really saying I have to cover YOUR ***?

 

 

Cervantes has a good idea....Perhaps run to Staples/Office Depot, price out printing costs for flyers, business cards... maybe get a quick quote for a simple website/web-designer. add in your costs for marketing (hourly rate)... Then present that in a nicely designed format to the power requesting you to attract more clients. Have them agree to foot that bill, then maybe you can assume responsibility for attracting business.

[v_chicky]

We (the PAs who've been here longest) have asked repeatedly why we keep hiring providers and we are routinely told that patients will manifest with time. 9 mo later, they still haven't. The first time I asked, I was assured that "the administration is not against making any difficult staffing decisions if patient encounters do not support the number of providers." I took that to mean they would let providers go as needed. Well, you know what they say what happens when you assume. Apparently it meant they'd use it to find an excuse to lower all of our salaries. We have a bonus structure in place but there is zero hope of making out base RVUs with the current staffing situation. Several of us have also reminded them that we are clinicians, not PR people. They'd like us to hold comminity health fairs to hand out cards and shmooze. I detest shmoozing. The idea of pimping myself out to patients nauseates me.

 

The writing is certainly on the wall. I could leave at the end of my contract, however if I tough it out for one more year, I will leave this job debt free except my house. Loan repayment is fantastic and putting up with a lot of BS is worth it. Unfortunately, I no longer have any desire to stay on after my loan repayment commitment is up. Very sad as I want to work with the underserved, it's why I chose medicine. Over the last several years, I've gotten pretty good at it. I hadn't intended to leave this position just because my government obligation was at an end. However, I am no doormat and have no desire to abide an unsupportive and clueless administration.

[Marilyn1122]

I was wondering if anyone has been in touch with the Department of Labor or local HR attorney regarding these abusive practices? Medicine is not business school. To force a medical professional to go out and find patients takes away from the job at hand... to provide the best medical assistance possible. Are there certain medical facilites that do this more than others?? This is shameful.

[Iain1028]

That is total BS, doesn't your company have a director of marketing?

 

Bringing in more patients is not your job and to even mention it is unreasonable.

 

Do they want you to be an ambulance chaser?

[LIPPER]

I was wondering if anyone has been in touch with the Department of Labor or local HR attorney regarding these abusive practices? Medicine is not business school. To force a medical professional to go out and find patients takes away from the job at hand... to provide the best medical assistance possible. Are there certain medical facilites that do this more than others?? This is shameful.

 

there is nothing illegal/unethical about it.

[andersenpa]

there is nothing illegal/unethical about it.

 

Unless it can be argued that this was not explicit in the contract.

[jmj11]

there is nothing illegal/unethical about it.

 

 

I agree that there is nothing illegal about it. You could argue the ethical values among your friends, but it too wouldn't have any merit in court.

 

In my situation, which I mentioned above, I ended up suing and winning but only because I had a clause in my contract which protected me. It is a long story, but the medical director, who was hiring me, told me that the hospital was looking into putting everyone on strict productivity. I saw the writing on the wall. I added a clause to my contact that said, "There will no artificial barriers imposed on me that would prevent me from seeing at least 18 patients per day." (something like that). So, when the docs went on productivity the head doc in my clinic went to the schedulers and said he wanted all of my patients put on his schedule from that point forward. He also threatened them saying he wanted all new patients assigned to him in our clinic and if they didn't do it he would have them fired. So, when the hospital's attorney deposed our witness (one of the schedulers) they quickly settled. They knew that they were in a violation of my contract and I would win in court.

 

But it HAS TO BE IN WRITING. My attorney said that if that clause was not in my contract we wouldn't have had the chance of a snowball in hell. It didn't matter if it was greedy and unethical . . . the court is only concerned about what violates and doesn't violate a clearly written contract.

[d2305]

I'm sitting on my posterior waiting for a pt. Just my 2nd week here though.

[jmj11]

I'm sitting on my posterior waiting for a pt. Just my 2nd week here though.

I've always said that being underworked is always more frustrating than being over-worked. I'm being very much over-worked right now but I still wouldn't trade it for being underworked (except for a day now and then to catch up).

[v_chicky]

"The physician assistant agrees to faithfully serve the clinic and to devote such time as may be necessary for the adequate performance of her duties."

"The physician assistant will perform all other related duties as assigned or requested."

"During September of that year, the previous 12 months of RVUs will be evaluated and the base compensation MAY be altered to more accurately reflect the provider production over the last 12 months. It will never be increased or decreased by more than 10 percent."

 

Nothing's illegal. Inept business/hiring practices, aggravating, insulting... but not illegal or even necessarily unethical. I see the clinic's point of view, they need to adjust/contain their costs. However, having created the problem by over-hiring, it seems less than fair (though still legal) to handle it in the manner they've chosen.

 

There are other aggravating circumstances not mentioned in this post. We are now switching to more primary care and less acute care (to my displeasure). I recently switched to a fantastic SP whose patients love him. He sees 30 patients a day and normally has a few openings that are not filled each morning. So when his patients call or walk in with something acute, the schedulers offer the openings on his schedule. Since he's great, they want to see him. I don't necessarily think that's a reflection on me, they've just been his patients for 10yrs and want to see him if they can. I have not tried to create my own panel because I was supposed to be doing strictly walk-ins and acute care. Now with the changes, I'm having to poach patients from other providers (both here and at other clinics) to boost my numbers. Instead of "Follow up with your PCP," now it's "come back and see me in a week." Slowly, I am creating my own panel.

 

Other PAs here don't have the greatest/friendliest SPs and so those docs' patients would prefer to see the PA over the doc. Those PAs numbers are higher. I don't see how I can change that... except to steal those patients when they happen to get scheduled with me. This creates an adversarial and competetive environment amongst providers that I really dislike. Perhaps this is the norm in other practices. This was my first PA job so I have no exposure to other practice policies.

 

C'est la vie. Only 14 more months.

[LIPPER]

I agree that there is nothing illegal about it. You could argue the ethical values among your friends, but it too wouldn't have any merit in court.

 

In my situation, which I mentioned above, I ended up suing and winning but only because I had a clause in my contract which protected me. It is a long story, but the medical director, who was hiring me, told me that the hospital was looking into putting everyone on strict productivity. I saw the writing on the wall. I added a clause to my contact that said, "There will no artificial barriers imposed on me that would prevent me from seeing at least 18 patients per day." (something like that). So, when the docs went on productivity the head doc in my clinic went to the schedulers and said he wanted all of my patients put on his schedule from that point forward. He also threatened them saying he wanted all new patients assigned to him in our clinic and if they didn't do it he would have them fired. So, when the hospital's attorney deposed our witness (one of the schedulers) they quickly settled. They knew that they were in a violation of my contract and I would win in court.

 

But it HAS TO BE IN WRITING. My attorney said that if that clause was not in my contract we wouldn't have had the chance of a snowball in hell. It didn't matter if it was greedy and unethical . . . the court is only concerned about what violates and doesn't violate a clearly written contract.

 

Wow... Yours is an important lesson. Always get it in writing.