Work satisfaction and confidence

[jb5158]

Hey everyone. I've worked in an outpatient neurology clinic since I graduated, about 3 years ago. I loved my job for the first year and a half, until they let go of the NP that also works with my doctor. This was mainly because of RVUs and left all of us a little bitter, especially as she had devoted over 20 years to this hospital. They kept me, I think just because I can see pediatrics and have the potential for more RVUs.

 

Fast forward to now. My role is very autonomous, which I should be really happy with. I see consults and follow-ups on my own, with my doctor just reviewing the consult notes. She's barely in the office now but has told me that she trusts me and that I should have become a doctor (which I'll take as a compliment and not get riled up about it making is seem like PAs just settled, because I know she means well). However, management sucks. We're constantly talked to about RVUs and patient satisfaction. Seriously, if you get one survey that comes back with 4s (good as opposed to very good), they tell you to think about having someone shadow you to give you "tips" on improving, which is humiliating. I just received one that had all 4s and one 3....I typically get all 5s.....so I just know I'm going to get a lecture. This has made me go job searching in the past, but I stay because the doctor I work with is amazing and I love my coworkers. 

 

I also tend to feel like patients are settling on seeing me because I have sooner openings than any of the doctors and I get really insecure about it. I never used to feel this way and no one in particular has made me feel this away....no patient has complained about me and like I said, normally I get 5s. Sometimes the scheduler will make small comments - she'll complain about my doctor cancelling patients and that patients tell her that I'm great, but it was their turn to see the doctor. Small comments like that affect me way more than they probably should. It just makes me feel like a consolation prize.  With consults I introduce myself as Jen, the PA that works with Dr. So-and-so, and get on with the visit, but I feel like a lot of people don't get what that means and are confused later on when I want them to schedule a follow-up with her. 

 

The more autonomy I get, the more insecure I get and it's really messing with my head. I think it's a combination of RVUs, patient satisfaction scores, my coworker getting let go, little comments from patients, and my own issues and anxiety. 

 

Sorry for the rambling...I guess my questions are 1. How do you introduce yourself or explain your role in patient care, especially if you are the consulting provider and the doctor is not there, and 2. Has anyone else felt like they give great care but still feel really insecure about patient's perception of you? 

[jb5158]

Also, I don't know how other companies do Press-Ganey, but they rank providers against each other. You could have a total of 95%, but be ranked at the bottom if everyone else got all fives that quarter. Then you're told you're under the 75% percentile, don't get a decent raise, and be told you should have someone shadow you.....even though I think 95% is pretty darn good. Essentially, at least 75% of our providers are regarded as failing since they require you to be above the 75th percentile...which is crazy and illogical. 

[electric130]

We do not do these patient surveys with the current group that I am with but this seems to be the direction most large healthcare organizations are going and I personally find it insulting and nauseating to think that my competence and worth as a provider is based completely on surveys and RVUs.  Patients very much respect me and I get told at least once a day that someone really likes seeing me, that I have done so much for them or that they feel more comfortable with me than their MD.  Those things along with making sure I am providing every patient with the most up to date best care possible no matter what is my goal.  There will always be patients that are not happy.  Either just because we do not have that "MD" by our name or we didn't give an inappropriate antibiotic or pain med that they wanted.  That is where these surveys are out of touch.  This is not sales, this is medicine.  I think surveys are fine if they are taken with a grain of salt, to expect perfection though from very subjective patient experiences well that is ridiculous. 

I have fortunately been sheltered from this to a degree, no surveys that I know of anyway and there is a definite pressure for productivity but I have no problems bringing in enough to make everyone happy.  As far as patients being scheduled with you or the MD that just takes time to not take personally.  At this point if a patient only wants to see the MD to me that is fine.  My schedule is busy and the patients I see generally like me.  Usually those people are high maintenance and I know for a fact the care they are getting from the MD is no different than what I would typically do.  It sounds like you are doing a stellar job, you are only 3 years out and seem to be a huge asset to the practice.  If your SP is supportive and giving you those type of compliments I would take that to heart and feel really good about where you are at.

[GreyhoundGirl]

We actually did a small study about our survey where I work, and how the survey company takes the 1-10 category of satisfaction with your provider and turns it into an dichotomous positive (9 or 10) or negative (8 or below). This makes it seem like the doctor has a 75% approval rating, but really the numerical average is over 9. You have to be so careful with the statistics. The method they use to rank providers against each other sounds like another of these tricks. Don't you want ALL of your providers to be ranked well? Then why rank them AGAINST each other?

[SHU-CH]

i was at a lecture given by either Press or Ganey and I asked about how they felt about their survey being used as a club to beat clinicians. They advised that they actually have some language somewhere that discourages their surveys from being used in the fashion that you describe.

 

These surveys are crap. They select out disgruntled people with nothing better to do.

 

Hopefully FACHE comes out with a healthcare executive effectiveness survey someday.

[EMEDPA]

i was at a lecture given by either Press or Ganey and I asked about how they felt about their survey being used as a club to beat clinicians. They advised that they actually have some language somewhere that discourages their surveys from being used in the fashion that you describe.

 

These surveys are crap. They select out disgruntled people with nothing better to do.

 

Hopefully FACHE comes out with a healthcare executive effectiveness survey someday.

yup, the methodology is also suspect. they only survey ER pts who are sent home, not those likely to be the most appreciative, the admitted pts...

[kittryn]

this is why I was basically ready to leave medicine. it's gone completely insane, and the pressure from all sides is untenable. I was ready to quit, but now work for a fee-for-service; no insurance, no RVUs, no "surveys"...what an AWFUL way to treat health care providers! medicine is going down the dumper, fast.

 

ps I think your insecurity is coming from thi same dynamic. how can you relax and do your job when your in hostile territory, always at risk of losing your job, or being micro-managed? it's terrible to treat a medical professional like this. can you talk to your doc about it, since you have such a good relationship? I know it may not do any good, bc the docs don't have any control over any of this either. but maybe you can ask your doc to advocate for you, tell the patients that you are her trusted and completely competent colleague....? just a thought. but don't blame yourself - it's the system, and it's really gone insane.

[Maverick87]

I would quit and look elsewhere if I were you. Surely, not EVERY place can be like this.

[jb5158]

Thanks everyone for your input! It's nice to know that I'm not the only person who thinks all of it is ridiculous. The other PA in our practice also complains about it too, but when we try to tell our managers how none of it makes sense and it's not really fair, they just say that they know and it sucks, but in the same breath says we still aren't getting extra raises because of it and should think of having someone shadow us. A different giant health system is taking over our hospitals though...hopefully they use something different or use the PGS more appropriately. Thanks again!

[kittryn]

Thanks everyone for your input! It's nice to know that I'm not the only person who thinks all of it is ridiculous. The other PA in our practice also complains about it too, but when we try to tell our managers how none of it makes sense and it's not really fair, they just say that they know and it sucks, but in the same breath says we still aren't getting extra raises because of it and should think of having someone shadow us. A different giant health system is taking over our hospitals though...hopefully they use something different or use the PGS more appropriately. Thanks again!

 

I hope it works out for you - but don't be afraid to look elsewhere, even private practice (where you will often be treated much better, although there are other pitfalls - such as screwy office politics - in those situations often...) in order to save your sanity and self-esteem. you have a good track record where you are and obviously will get a great rec from your SP.