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jmj11

A Post-Burn Out Method of Practice

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We often talk about burn out, which is real and becoming a bigger problem in this post ACA world.  I suffered a rather severe burn out when I owned my own practice for five years. It was working seven days a week, usually 10-16 hour days (at night I had tons of paper work that had to be done to run a business) AND, the finances started to go down the tubes when insurances made it more and more difficult to get paid. By the end, I was very serious about leaving the profession and leaving medicine with a great disillusionment. I would have retired if I had had the money. I was facing extreme exhaustion and a mental health crisis.

 

So, here is my strategy and it appears to be working for me. This  may or may not work for others, but just one plan.

 

Step 1: I closed my business (sold it) and jumped on a plane to a remote part of the world where I had no access via phone and I closed my e-mail account for one month. I slept a lot, drank a lot of good coffee and wrote.

 

Step 2: I have come back to my old job but with a lot of leverage. They too were facing bankruptcy without my help. So I wrote my own ticket. I am paid only on productivity and at the same rate as the physicians.

 

Step 3: I have NOTHING to do with the business end. I see patients and I go home. If I want more money, I see more patients. If I don't need the money, I take a vacation whenever I want to (I have no paid leave time).

 

Step 4: My real passion is writing. I have three books started and I begin my day at the coffee shop (sometimes with other writers) and write. I write between patients during the day. If a patient no-shows, I write on my books.

 

Step 5: I have a no-drama practice. As soon as a patient starts to argue with me, I literally tell them "I'm not the right provider for you" and I show them the door. If it happens at the beginning of the visit, I won't bill them. If it happens at the end, I will bill them. But I will never schedule them back (if it is not clear to them from our conversation, I will dismiss them as not sharing the same goals).

 

Step 6: If I ever get a complaint, I first make sure it is not my fault, and if it isn't, I throw away the complaint an send the patient a letter saying, "I see that you are not satisfied with the care I have given you. I have done my very best and therefore cannot improve. You deserve to see the provider whom you think is the best. Therefore I will not see you back." (this has only happened twice in six months).

 

Step 7: If a patient calls and ask a stupid questions (Dr. Oz said such and such) or leave a message that they don't agree with me and wants me to call them back, I mark it as a FYI and I don't call them back. Good luck if they can find another provider. 

 

Step 8: I don't do drug rep lunches. If they bring me food, I will eat it. But, I use lunch to call patients, chart or write on my book. If they insist on talking to me, they have to make an appointment like my patients.

 

Step 9: I only take off hours call for my patients and I give my patients a handout as why there is no need to call me off hours.

 

I think I have recovered very well and will stay in medicine now. I wish I had made some of these decisions years ago . . . but again, it won't work for everyone.

 

I have to go as a drug rep is on the schedule for an appointment.

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^^ fantastic!

 

Not your particular solution (other than it works for you), but to have taken the time to figure out what you want in life. That is absolutely a critical key to being happy.

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Sounds like you've been able to get a good compromise Mike.  Good for you.  What are you writing?

I just finished (and it is under legal review right now, the last step before the presses start to turn) a book that took me ten years to write. It is about the influence of Plato and Aristotle on the development of western culture. I traveled the world doing research on that one. It was the first time I had real publishers interested in one of my books. I am now working on my first novel (wrote some before that I never tried to publish). This one I will take all the way to publishing. It will have a snowball's chance in hell of getting a real, major publisher interested in it as novel manuscripts are now a dime a dozen. However, I have created my own publishing company (LLC) and will published under that brand if there are no major publishers are interested. It is a medical, thriller story. It brings great pleasure to write and create, even if I am the only one who reads it.

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Wow!   Super impressive.  Writing sounds like good therapy. 

 

I've started blogging - still toying with ideas for my first book, but it does help vent and make you think of things in a more positive light...and come up with constructive solutions to what's making you write in the first place I find.  I've had several people suggest military experiences, medical experiences or both. 

 

Glad to see you back at things jmj - missed you around here for awhile.

 

SK

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Awesome turn of events for you.

 

I have an opportunity to help grow a younger doc (younger than me) in his private solo practice. I still have to address the "customer service" thing, though.

 

I don't like that. I told a really horrible patient that her issues were self inflicted (the truth) and that I wasn't going to prescribe pain meds for her bad behavior. She came back to him the next day bawling and he caved and then got kind of angry with me.

 

I didn't back down. I told him she was going to be a problem and she is. Now on pain meds regularly through him and continues to make bad choices and be a pain in the arse. He hasn't apologized but he has recognized that this isn't my first rodeo and there is a fine line between taking care of a patient and enabling their crap behavior. I will not spoon feed a patient on their path to stupidity. PERIOD.

 

It has promise but I still don't relish doing this for 20 more years with the condition of the US medical system and commercial insurance.

 

I am still brewing my dreams, desires, opportunities and skills for other things for my future. Trying to distill them down to reality and possibility instead of pipe dreams. My hardware store idea needs ¾ million dollars to get a franchise. I checked the couch cushions and the change jar - no such luck.......

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Would you please send me an autographed picture?  I'd like to admire it!  Seriously, dude, you are incredible!

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Step 5: I have a no-drama practice. As soon as a patient starts to argue with me, I literally tell them "I'm not the right provider for you" and I show them the door. If it happens at the beginning of the visit, I won't bill them. If it happens at the end, I will bill them. But I will never schedule them back (if it is not clear to them from our conversation, I will dismiss them as not sharing the same goals).

 

Step 6: If I ever get a complaint, I first make sure it is not my fault, and if it isn't, I throw away the complaint an send the patient a letter saying, "I see that you are not satisfied with the care I have given you. I have done my very best and therefore cannot improve. You deserve to see the provider whom you think is the best. Therefore I will not see you back." (this has only happened twice in six months).

 

Step 7: If a patient calls and ask a stupid questions (Dr. Oz said such and such) or leave a message that they don't agree with me and wants me to call them back, I mark it as a FYI and I don't call them back. Good luck if they can find another provider.

Love this! I wish I could do this in my shop... I'd probably get written up or some dumb crap...

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

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This list is awesome, I especially like number 7.  I also love that you have control of your patient load and you are paid on productivity at the same percentage as the docs.  That is huge.  Encouraging to hear.

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We often talk about burn out, which is real and becoming a bigger problem in this post ACA world.  I suffered a rather severe burn out when I owned my own practice for five years. It was working seven days a week, usually 10-16 hour days (at night I had tons of paper work that had to be done to run a business) AND, the finances started to go down the tubes when insurances made it more and more difficult to get paid. By the end, I was very serious about leaving the profession and leaving medicine with a great disillusionment. I would have retired if I had had the money. I was facing extreme exhaustion and a mental health crisis.

 

So, here is my strategy and it appears to be working for me. This  may or may not work for others, but just one plan.

 

Step 1: I closed my business (sold it) and jumped on a plane to a remote part of the world where I had no access via phone and I closed my e-mail account for one month. I slept a lot, drank a lot of good coffee and wrote.

 

Step 2: I have come back to my old job but with a lot of leverage. They too were facing bankruptcy without my help. So I wrote my own ticket. I am paid only on productivity and at the same rate as the physicians.

 

Step 3: I have NOTHING to do with the business end. I see patients and I go home. If I want more money, I see more patients. If I don't need the money, I take a vacation whenever I want to (I have no paid leave time).

 

Step 4: My real passion is writing. I have three books started and I begin my day at the coffee shop (sometimes with other writers) and write. I write between patients during the day. If a patient no-shows, I write on my books.

 

Step 5: I have a no-drama practice. As soon as a patient starts to argue with me, I literally tell them "I'm not the right provider for you" and I show them the door. If it happens at the beginning of the visit, I won't bill them. If it happens at the end, I will bill them. But I will never schedule them back (if it is not clear to them from our conversation, I will dismiss them as not sharing the same goals).

 

Step 6: If I ever get a complaint, I first make sure it is not my fault, and if it isn't, I throw away the complaint an send the patient a letter saying, "I see that you are not satisfied with the care I have given you. I have done my very best and therefore cannot improve. You deserve to see the provider whom you think is the best. Therefore I will not see you back." (this has only happened twice in six months).

 

Step 7: If a patient calls and ask a stupid questions (Dr. Oz said such and such) or leave a message that they don't agree with me and wants me to call them back, I mark it as a FYI and I don't call them back. Good luck if they can find another provider. 

 

Step 8: I don't do drug rep lunches. If they bring me food, I will eat it. But, I use lunch to call patients, chart or write on my book. If they insist on talking to me, they have to make an appointment like my patients.

 

Step 9: I only take off hours call for my patients and I give my patients a handout as why there is no need to call me off hours.

 

I think I have recovered very well and will stay in medicine now. I wish I had made some of these decisions years ago . . . but again, it won't work for everyone.

 

I have to go as a drug rep is on the schedule for an appointment.

Well said

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I just finished (and it is under legal review right now, the last step before the presses start to turn) a book that took me ten years to write. It is about the influence of Plato and Aristotle on the development of western culture. I traveled the world doing research on that one. It was the first time I had real publishers interested in one of my books. I am now working on my first novel (wrote some before that I never tried to publish). This one I will take all the way to publishing. It will have a snowball's chance in hell of getting a real, major publisher interested in it as novel manuscripts are now a dime a dozen. However, I have created my own publishing company (LLC) and will published under that brand if there are no major publishers are interested. It is a medical, thriller story. It brings great pleasure to write and create, even if I am the only one who reads it.

 

Good for you, writing can be a great joy.

 

I wrote and self-published a book on dating for men last year---it did modestly well on Amazon for my first book. MUCH more work than I anticipated, and it was only about 100 pages! I outsourced the editing, obviously, and the cover design/formatting. Well worth it for a finished product.

 

I wish I had the flair for fiction; I've tried but I don't think my mind is geared for storytelling. Nonfiction comes much easier.

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I would LOVE to be doing what you're doing! I hope to eventually write a book - I like fiction - and get it published. (I have one that is actually half-written, lol. Casually putting it together.....)

 

But the working conditions you have are a dream to me.

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