Contract Renewal - Do I Stay?

[Incognito]

I am Incognito but not first-time poster......logging in under another name.   I need advice.

 

My contract comes up for renewal in 2 months and I will be having a meeting with the (fairly new) clinic administrator (CA) soon.  Since this administrator was hired a lot has changed and the culture of the clinic has become quite dysfunctional (more-so than before).  

 

The Issues:

 

We only communicate by email now and that is what the CA expects.  No more discussion between the clinic staff and no more meetings with staff to discuss clinic issues.  Initially we had an email from the CA of when monthly meetings would be held, what time (lunch hour) and that we were expected to be there.  The first month the CA never showed up to several meetings and the scheduled meetings lasted for two  months and now none for the last 9.  Apparently the schedule she developed has gone by the wayside although she has never emailed us or informed us of the change in schedule.  

 

New phone system installed in early August and we found out we could not call our local EMS.  The CA knew this but did not inform the staff who matters (the nurses, PA and MD).  I had an emergent patient last Thursday and because we DID NOT KNOW about the 911 issue there was a delay in care for the patient.  The CA was contacted about the problem and she says "I know that you can't call 911 and I guess we will have to get the lawyers involved."  We call 911 now on our cell phones.  The other system calls a central system in Colorado and we are 1,000s of miles away.

 

The MD does not notify me when he is going to be gone and neither does the CA.  He is gone alot...about 50% of the time developing his side business and is allowed to travel to CA, IL and to a local medical entity in his effort to sell his and his partners genetic testing kit.  I do not know if he continues to get salary on the days he is gone.  He never works Fri per his contract but is supposed to work M-Th.  The last time he was gone I confronted him about why I was not notified and asked him to let me know verbally when he will not be at the clinic. He, however when I am gone, will have a retired NP come in to work because he "can't work alone..he has too much work to do."   I on the other hand handled the clinic by myself and some of those days were killers.... One day with 25 pts. in a 7 hour day....frankly quite unsafe.

 

I requested my contracted CME off to attend a national conference starting next week.  I requested it 2 months ago and also requested to go to a state PA chapter CME in October. I also reminded him in Aug. I needed to know.  It was not approved as of last Thursday but the NP was working for him that day and she said she was asked to work during the time I will be at the conferences in Sept and Oct.   I was shocked and told her I did not have approval to go, had not registered, no plane tickets, etc..   She mentioned this to the MDs nurse at the end of the day.  The following day the nurse came and told me that the MD verbally approved me going to the conference.  I told her I did not have written approval and still can't make any plans per our accounting dep't and protocol.  Today the MD was back in office and both of us were busy.  He made no effort to talk to me.  I made an effort to talk to him...there's a long story behind this. Still no written approval. 

 

Over the last 6 months or so there have been staff changes.  The CA has recruited people to come work at the clinic and some did not have interviews.  She hired them out from the previous clinic she worked at.  One hiree is an RN who came for an interview and was hired immediately on the spot and the following day an announcement went out for us to welcome her to the clinic.  The Rad Tech had no interview.  

 

The clinic had a grant funded position for an LPN who worked with the pregnant women and families and managed all of our immunizations and the state Vaccines for Children program.  She was the backup clinic nurse and worked when the other nurses were on vacation or sick. She is also an EMT and breastfeeding educator and Doula.  She is highly qualified and an excellent nurse.  She was told in my presence and in the presence of the other clinical staff that she would be my nurse when the NP retired (I had no dedicated nurse until June 1) and the  NPs nurse was going to triage and case management.  Her grant ended May 31st. 

 

Lo and behold!  When June 1st arrived the CA came to the MD and told him the LPN was out of a job and would have to re-apply for the position when it was posted. This apparently was on order of the Board who wanted the position opened up rather than a lateral transfer since they had some family members they thought might like the job. The MD comes to me to tell my my LPN was out of a job at that moment (she had already left for the day).  I blew a cork and sternly (I did not yell) told him that was unacceptable to tell her one thing and then turn around and let her go.  I stood up for her and he ran back to the CA and they decided she could stay until the announcement came out and then could apply.  She stayed and the CA promised her she would notify her when the job would be posted.  She did not notify her and the LPN found it out by default at an EMS meeting 2 days after it was posted.  She applied anyway and interviews were 8/28.  She was told the following day at the end of the day she did not get the position.  A lesser qualified LPN was hired because of Board preference .

 

I was livid.  DId I tell you I have not been asked to interview any of the nurses or MDs that have been in for interviews?  I confronted the MD about that too and feel I should be included in the interviews because these are staff that I work with.  Shouldn't I have the opportunity to interview a nurse or physician who might get hired?

 

In the last 6  months the atmosphere at the clinic has become one of staff being afraid they will lose their jobs.  We have all learned to tiptoe.   I had 2 other discussions with the MD....one he called me into his office and said I was adversarial.  I think he does not like it when I challenge him.  He is medical director.  Shouldn't he be the one to make decisions? Yet he can't even sign off on our clinic policy manual to approve policies and we HAVE NO MANUAL because he won't sign the policies.  No policies for the 18 years he has been there.  I have been at the clinic nearly 3 years.  I have been told that I am the only one who has challenged him.  His nurse told me I was hard to work with the last couple of months.  She does not like it when I refuse to write scripts for patients of the MD for patients I have NEVER met and there are NO CHARTS on file for them.  They are his golf buddies and the people who call him at home for refills.   He asked me why I refuse to write scripts for his patients and why I would only give a 3 days supply of lipitor for one of his patients (huh, I really don't know what he is talking about) and I told him I won't for those with controlled substances or for certain meds for certain patients BUT I have renewed scripts for the basic meds like HTN, Lipid meds, etc.  

 

In May I finished up with a project of supervising two nurses (one Rn, one LPN) of that same grant funded position and the supervision was to make sure the project goals were completed.  Any nursing issues went to the MD since I cannot "supervise" an RN by state law.  THe RN has a sketchy background and was teaching the LPN the wrong way to give immunizations, wrong needle sizes, told her keeping the inventory wasn't all that important, told her to dispose of live vaccine in the waste basket, and several episodes of insubordination to me and going directly to Tribal president to get approval for travel, and a bunch more junk too lengthy to describe.  The management team at the time asked me to supervise her specifically as there were many complaints.  I did my job and the outcome was for her to be let go.  THE MD had no balls to let her go and then decided to put her on a 30 day probation...never happened because he delayed talking to her and then the new CA was hired.  He deferred it to her and she decided a 90 day probation was appropriate but then changed her mind and transferred her out to the child care center as a parent educator under a different grant.  She did not have to apply for the position.

 

After all of this I now feel it is time to leave.  Am I being petty and small thinking this way?  I love the patients and have a wide SOP and work up lots of sick and complicated patients.  That is what I love.  I have applied to a new job much closer to home and should have an upcoming interview in the next 2 weeks or so. 

 

At one of the meetings with the MD he kept asking me "Do you want to leave? If you do you need to tell me now!  I need to know if you are going to leave???  I could not answer him and was taken aback.  My only thought was  "If I leave he will have to work M-F" and might have to work alone and that is the only reason he doesn't want me to leave suddenly.

 

Should I just put my head down and go to work and ignore the CA/MD and try to work within the dysfunction?

 

I may not get hired at the other job.  He may not give me a good reference.  I feel like "The Help". 

 

Sorry this is so long.  Thanks for any insights.  I am very confused and of course this is my one-sided perception of things. 

[Boatswain2PA]

You may not be as incognito as you think here with your post....

[Guest JMPA]

Your answer is simple. What would a MD do in your position? Would an MD put up with all that? Do you go into work feeling degraded? It is amazing what one can accomplish when they are in a suitable environment. Do not settle for mediocre.

[Incognito]

wearing my heart on my sleeve. ..ouch. 

[Incognito]

Your answer is simple. What would a MD do in your position? Would an MD put up with all that? Do you go into work feeling degraded? It is amazing what one can accomplish when they are in a suitable environment. Do not settle for mediocre.

 

I never felt degraded until the last 3 -  4 months.  I think I hit critical mass after the build up of stress. 

[TWR]

Go if you can.  Nothing will change where you are and couls get worse.  After reading your post I WAS STRESSED!!  Maybe because I work in a high stress FP with totally disorganized Dr. who has her own issues.

Take the job closer to home.  Start fresh.

[gbrothers98]

Anyone whom has written the above novella about their work environment has already answered the question if they should stick around or go. Now all you have to do is seek a transition point and a soft landing elsewhere. I felt downright borderline after getting to the end.

Good luck

G Brothers PA-C

[Incognito]

Thanks to all input.  The MD had another discussion with me today...it was civil.  Again he asked if I was planning on leaving and if so he needed to find someone right away to help out.  Then he said we better get this problem hammered out before someone else hammers it out for me ( I think he means the CA in contract renewal).  Then he says..."you know there are a lot of other opportunities out there for you.  Let's meet after work soon and away from the clinic.  We could meet at a restaurant or at my house".  (Ha! are you kidding me!!!!!).

 

I am going to leave.  I am asking him to meet with me tomorrow at lunch time in one of our offices.  I am going to ask for a couple of things:  He provide me a good reference, I stay to the end of my contract (8 weeks), I get my remaining vacation and sick leave paid out.  If he wants me gone immediately, then I want a buy out of the contract, remaining vacation and sick leave paid out and health insurance in effect at my current premium until the date of the contract end.  

 

Then I'm praying like crazy that I get the interview at the other clinic. 

 

P.S. He still won't approve my CME. I may ask they pay me out the remaining CME money too. 

[winterallsummer]

Didn't read that entire post but from the length and what of it I did read it sounds like you really hate your job.

 

My advice is find another job or do locums while finding another job (there are tons out there). Just tell them you're deciding you don't have to tell them any earlier than outlined in your contract. My advice is look out for yourself here because it looks like everyone else is and you shouldn't bend over backwards to be loyal to people who make you feel like crap.

[Incognito]

It is amazing what an in-depth conversation can do to hammer out difficulties.  I had the opportunity to talk over each issue with the MD. He does not want me to leave.  He told me I am an incredible clinician and was doing an awesome job there.  He has gone to the CA and requested that we hire a someone to work part-time so that neither one of us works alone.  He has requested that we both get administrative time scheduled into our day so we can take care of tasks.  He has requested we stop the every 15 minutes appointments regardless of acuity or complexity.  

 

He and the CA arranged a meeting tomorrow with clinic staff to hammer out the schedule.  He asked me if he was taking advantage of me and my position.  He did not intend for things to get as bad as they have.  He apologized.

 

Some things he cannot control such as the hiring of the LPN and he cannot control the Board.

 

I have requested open communication in a verbal format.  We will be discussing that tomorrow .  We are planning on on-going discussion to work it all out.

 

So, for now I will stick it out and am hopeful.............

 

I love my patients and don't want to abandon them.    I want to love the clinic and my job again. 

 

I am planning on still going through the interview if I get called for one. 

[SHU-CH]

Sheesh - on the way out, I would sow salt in their lawn so nothing will ever grow there. Let it be a warning sign to all future PAs.

 

Good luck!

[primadonna22274]

About 3 paragraphs into the narrative I called it: tribal clinic. Trained in one of those. The level of nepotism was staggering. The level of interpersonal dysfunction was worse. Too bad really since the clinic had beautiful facilities and several clinicians who really wanted to do a good job...but were hampered by tribal meddling. Patient care WAS SERIOUSLY endangered. I wouldn't ever work in that environment again where I felt quite frankly disempowered to make any lasting changes.

Sorry but you aren't the first and won't be the last ????

[TWR]

Incognito,  There seems to be a 180 degree turn in their running of your practice.  I would proceed cautiosly and keep one eye open.  Beware of wolf in sheeps clothing.  I wish you well and know you love the practice.  Usually politics trumps the right thing.  This the world we live in.

 

As an aside, congrats to Primadonna as a physician/ pa-c 

[Incognito]

The meeting today about scheduling is certainly making me proceed cautiously and keep one eye open.  Case in point: I feel 15 minute appointments are unrealistic in this setting even for "simple" patients.  CA just couldn't wrap her head around that.  So,after the meeting I see several new pts. plopped in my schedule, one for 15 minutes with the c/o "jaundice?".  Hahahahahahaha.  It ended up being a 2 1/2 hour process. Concern for pancreatic cancer.  Will finish up with the referrals tomorrow.  Got out of the office an hour and a half after we closed.

 

For the first time I heard the MD use the term mid-level.  Unfortunately I was unable to correct him.  The CA uses the term.  I will be clarifying what she thinks my job is all about during contract negotiations and will talk about the term mid-level if that is discussed. 

 

I wonder what tomorrow will bring?  

[TWR]

Let us know  : )

[Incognito]

Contract negotiation begins this Monday, 9/22 after work.  My interview at the other place is Oct. 1st.  I won't make any decisions hastily. I am preparing for Mon. night over the weekend with my list of questions,etc.

 

Can't wait. 

[Incognito]

Contract renewal discussion took 1 1/2 hour with the CA and the doc present for most of it.  We discussed multiple issues and I was able to clarify my position and view of what I deem the PA profession to be.  I discussed the term mid-level and why it is inappropriate to use it, why I am not comfortable in some instances renewing the doc's prescriptions for a few patients, and that the nurses should not expect me to do that just because the retired NP did without question.  I was able to get my CME approved to attend in October.  We had a discussion where I pointed out the doc has also refused to cover for my patients (he did not like being held accountable) but I felt it was important to discuss this with the CA too.

 

He had to leave at the end before discussing salary.  I was glad because I don't think it is any of his business what I am asking for or that he should have any say in it.

 

The CA asked: is there anything you want to change in your current contract?  I answered that YES, since the advent of EHR I have been putting in extra hours and working lunch time so want to be compensated for the extra work beyond my contracted 40 hours.  She asked what I was thinking ?

 

I told her since I do 85-95% of what the physician does and provide the same care I would like between 85 - 95 % of his salary.  

 

Then I laughed and told that I was expecting $10,000 raise.  (I am already above the average PA salary in FP in this area by $12,000).  

 

My response is that not only do I provide FP services, but also provide UC and Internal Medicine and a bit of ER sprinkled in as I am expected to handle the emergent patients and monitor them until the EMS crew arrives and hauls them off to the nearest ER. 

 

I also asked since they denied me the opportunity to go to the FP conference in AZ if I could have a payout of the remainder of the budget to use as tuition for a doctorate program I am thinking about. 

 

She is going to get back to me.   I do not know if she discussed my request with the doc.  He is now in Italy for a 2 1/2 week vacation.

 

Today was serendipitous, peaceful and calm in-spite of a busy day simply because I am able to work to the top of my license and the doc is on vacation.  

 

I'll let you know what the counter offer is. 

 

If they say no, no raise, same salary I will ask for 2 more weeks vacation. 

[TWR]

thank you for the blow by blow description of your negotiations.  I think it will be helpful to others when they negotiate for themselves. Good Luck to you.  Tom

[kittryn]

sorry, but I can't believe you are still negotiating with these (proven!) untrustworthy and self-serving people.

 

If you stay - to put it bluntly - you're going to deserve the endless headaches and heartaches you will (certainly) have. you know the old saying, "cheat me once, shame on you, cheat me twice, shame on me)....

 

I would savvily bolt for the door (with recommendations in hand), and with giving appropriate notice.

 

IMHO, after 8 years as a PA, medicine is one of the most abusive, punitive, uncaring, dysfunctional systems of work in existence, and it is fueled by more ego than you could fill a stadium with.

 

I have been fired from 4 out of my last 5 positions for the kind of BS you describe, just bc I don't/won't/can't put up with the overtly disrespectful and insane BS loaded onto (this PA's) back. this last one was such an overt and unfair screwing that I'm seeing a lawyer for wrongful termination, and for the more than $7,000 in OT they are trying to cheat me out of. if I really want to go balls to the wall, I could try to sue them for the more than 70K I am out for termination before (their requested) extension of my contract - without notice, mind you, and with an acceptance letter signed by me - when they cut my contract short for totally trumped up reasons. I think it was bc I was the highest paid and they wanted to get cheap, new graduates in, but no, they had to trump up pejorative  reasons to get rid of me. calling my work ethic inferior; putting my professional reputation at risk (if I even have one left!).

 

I am also changing specialties. 

 

good luck, but I feel you will just waste the luck too, if you get any, and if you stay. I got a headache just reading your emails. or, trying to.

 

bottom line - we don't get rewards (except from our patients) for being a "good doobie". and if we try to stand up for ourselves with the aim of being treated fairly - OR EVEN LIKE A HUMAN BEING, we are labeled as "difficult", "unable to get along with others", "insubordinate", "poor work ethic", "risk to patient safety" (GASP!!!!), you name it, I've had them all. and they were completely undeserved. just a convenient way to get rid of someone who doesn't want to be treated like an appliance. 

 

all it gave me was a broken heart and a financial thumping.

 

best,

not incognito

[Incognito]

Update:

 

Negotiations resumed today after a few cancelations.  Reviewed what we last hashed out.  Dr. said I am an excellent clinician medically, technically, scientifically.  The best he's worked with (He's worked with two NPs and now me).  Then the shoe dropped....I was waiting for it as I knew it would drop from the outset.  

 

There is concern with bedside manner and some patients have complained.  Who? I ask, I'd like to know.  Well, um a few. um, um, who was that?  DO you want a specific name the CA queries.  YES! They outlined the person and ding ding ding.....I remembered the incident.  I had full schedule, only practitioner there, walk-ins only and I was just finishing a patient visit, had another patient waiting for me in a room and the receptionist double booked me with this patient that walked in....wanted treatment for depression.  I just couldn't do it..  I could not squeeze her in.  I stepped in the room and said I couldn;t see her today, please make an appointment tomorrow.  She stormed out of the room.  I went on to the waiting patient who ended up being a train wreck who had a hgb of 5 or something like that and it consumed the rest of the day, BTW was already the end of the day.

 

So, I could have said it more professional, not let the stress get to me, and should've walked her down to the behavioral health dept.  But I didn't. She came back next day and sees the doc.  He mentions NOTHING to me about this incident (2 months ago) until today.

 

CA...incognito you are just not warm and fuzzzy.  THe NP was warm and fuzzy and welcoming, the MD is gregarious and loud and people love him.  I say...I cannot change my personality, just like you Doc, you  can't change yours.  I tell my patients the truth ( I am kind, actually, they are jumping to wrong conclusion from one event).

 

Then the question/statement:  We are a family here, it's a small clinic and we all have a good time together.  Do you like being part of a family?

 

My response: Huh? What do you mean? Sure I like being part of a family, even a dysfunctional one, like this family, I've learned to live within the dysfunction.

 

Eyes were bugged out by then.

 

Doc says 'I really want you here, you are an awesome clinician."  We need you here.  But staff is still saying you are hard to work with".  WHAT?  WHO? We hashed this out one month ago and I thought it was all settled.  WHO? IS IT YOUR NURSE?  (his eyes beadily narrowed so I know that's a yes).  I have not refused to fulfill any requests she has had since we hammered out the issue.  I stated that it is the nurse's problem and she is the one who is hard to work with, since I have bent backwards to be receptive to her when she brings it med refill requests the doc doesn't want to do or is not present to do. 

 

So I got offered a one year contract, same salary, same benefits, same CME and license fees.  I'm way above the top salary for FP in rural clinic so I can live with that.

 

My interview for the other opportunity is Nov. 6th.  I'm definitely going to it. 

 

The oddest and (somewhat scary thing )is I kind of enjoyed the exchange in a  macabre sort of way.  After all when the whole staff dressed up for Halloween and I was looking at the CA who was dressed as a nerd with black glasses on with duck tape holding them together, plaid shirt and suspenders, and high water pants, and the doc sat there with his COWBOY outfit on and elephant skin cowboy boots and bandana....I could only think are they for real?

 

I dressed up as a PA.  Lab coat, nice set of scrubs. You know, my usual dress. 

[TWR]

One more year with increase in salary or benefits???????????? If the interview does not pan out on the 6th, you still need to move on asap. I love it when during negotiations, they bring up ONE negative issue to pour cold water on the possibility of more money or benefits. Would either one of them stay if they were being reviewed and expecting (deservedly) more money but told "you are great EXCEPT for yada yada yada." I suspect they would bolt. Incognito, I think I know who you are but we have never met however you are way better than they are giving you credit for being. Don't let them break your spirit!! IMHO

[Incognito]

Interview is tomorrow.  If I get offered a position and the salary is something I can live with, I'm outta here.

 

Just found out the other contracted employees were offered 3 years and the CA and doc told me the council only wanted to offer one year to all contracted employees, so they are lying to me. I can only think it is their way of telling me I'm on probation without actually telling me that.

 

Wish me well with the interview, I am nervous.

[Guest Paula]

Get the heck outta there.  You've made your list of pros and cons.  The cons out weight the pros. You will be so happy once you get a job that functions like a real clinic. If you have to take a pay cut, remember that money isn't everything.

 

Listen to me.

[BruceBanner]

Wow get out of this subversive, passive-aggressive b!tch fest. 

 

Unfortunately patient complaints can be like a silver bullet to clinicians. It only takes one well-timed complaint to reach the right (wrong) ears and your decline has begun.

[Joelseff]

RUN! SAVE YOUR SELF!!!