Doing work

[SHU-CH]

This thread is ridiculous. You could post some the same mumbo jumbo from 20-30 years ago about the youth.

 

I suppose it is generally true that each generation gripes about the one that follows. But unlike the days of Socrates, we have some data:

 

 

Either:

 

1. The undergrad curriculum is getting easier. (I argue against this; knowledge is exponentially increasing. The average PA student probably knows 10 times what a physician in the 1960s knew.)

2. Students have become astonishingly smart. ( I have not personally seen evidence to support this.)

3. Expectations have been lowered.

 

I would argue that we have lost the meaning of "average." Somewhere along the line being average became insulting. People can no longer tolerate being told they are average at anything (much less below average).

[MT2PA]

I suppose it is generally true that each generation gripes about the one that follows. But unlike the days of Socrates, we have some data:

 

 

Either:

 

1. The undergrad curriculum is getting easier. (I argue against this; knowledge is exponentially increasing. The average PA student probably knows 10 times what a physician in the 1960s knew.)

2. Students have become astonishingly smart. ( I have not personally seen evidence to support this.)

3. Expectations have been lowered.

 

I would argue that we have lost the meaning of "average." Somewhere along the line being average became insulting. People can no longer tolerate being told they are average at anything (much less below average).

 

^^  Precisely.  I am of the generation (dare I say millennial?) where we were always told we could be anything we want, we should want better for ourselves than what our parents had, and the world was our oyster.  I like to think I'm old enough to have at least had instilled in me that you have to WORK for it to get it as opposed to some (of any and all generations) that believe it is their RIGHT to have everything.  Regardless, when every person is told to aim high and that anything less isn't good enough, we find ourselves with a great divide.  You have it all or you have nothing.  

 

'Average' is a pretty good place to be, if you think about it.   When you're 22 and trying to get into PA school, average is not encouraging.  But once you're done with school and you realize that all you want is to not live paycheck to paycheck, be happy, and life your life, you realize there are MANY ways to accomplish that - and not all of them involve very expensive master's degrees - they do, however, require work.

[jesij1212]

See, I'm in an interesting camp on this one:

 

1) I'm a new grad - barely 2 months into practice

2) I'm 32 years old and have had many jobs before going to PA school

 

I work in gen surg/ICU and feel like I don't know ANYTHING. So I work my butt off 12 - 13 hours a day to do what I can to mitigate the fact that I'm still learning.

 

Many of my classmates made me wonder "how are they going to survive?" Because they came straight up the college route, never had jobs (which is why they all had stellar GPAs).

 

I know I'm struggling right now - I have no idea how someone can have this as their very first introduction into the working world.

[myironlung]

Amazing this thread has been allowed to even be open here. Personally I am all for free speech, confrontation and the most taboo things you can think of to discuss, however I love the hypocrisy of some members here who would whine about certain threads being too offensive, being inappropriate or other such nonsense.

 

Simply replace the OP's word "younger" with black, jewish, student athlete etc..... and you most certainly understand how the "younger" people feel about this even being a discussion. I am pretty sure in this case this is blatantly ageism.

 

And "work hard"??? What does that even mean? You think seeing more patients is working hard??? Or spending more hours at a job? Is this a joke? Americans are more and more being known to shun those who take vacation, call out sick, and work less hours, where other countries take more vacation and work fewer hours with a much higher quality of life.

[electric130]

I honestly have seen just as many "lazy" physicians, spending too much time in the lounge, their much younger 20 something PAs working well past their agreed upon 40 hour work week while they are on their way home.  I don't think this is the norm, but I can name at least three times that I have seen this in action.

 I think this is just something that you will see in any profession, and in my opinion I have seen it more in older physicians than in any younger PAs.  I honestly am annoyed by the "work is the source of all good" ethic in this country, when most are just working super hard to feed their consumer habit.  That is all well and good, but don't act like you are doing some higher good by shoving 30 patients in during the day.  Just call it what it is....wanting to make a profit, greed, whatever. This is coming from a 14 year PA that has worked very hard for those years, typically averaging 4 patients an hour, and honestly I am just about worn out but trying to hold on a bit longer, hoping to be done with this rat race by age 50.

I truly understand where the original poster is coming from, I do see this laziness in customer service and other professions so I am sure there are providers that are lazy and trying to get out easy.  I completely get that, I think there is a fine like though between perceived "laziness" and just not wanting to work at the frenzied pace that is medicine these days.  

[TWR]

Work ethics have gone down with each generation in all professions and jobs. Medicine is not any different than any other profession or job. I suspect it will get worse and because we are "midlevel' I hate that term) they will throw more on us. I think 33 patients a day is a little much! Different ethnicity and countries have different work ethics. I think IMHO, ours sucks! Asians, and some European countries as well as hispanics have a better work ethic. Entitlement?? IMHO. Just rambling now.

PS I have been working for over 55 years so my perspective is different than a young person. I'm done.

[EMEDPA]

I found my self starting to get burned out a few years ago after almost 30 years in em so changed jobs to rural sites. now I see 5-18 pts/shift instead of 25-50. soooooo much better,,,

[treejay]

^^^^^^^ this

 

Let's face it, it is appalling the insane burnout statistics in the field of medicine.  It is not acceptable for > 50% of medical practitioners to be experiencing burnout, according to numerous studies including a Mayo Clinic study earlier this year.  From my perspective, I want to work hard and do good work, but I want to find an appropriate work life balance.  Tons of jobs are structured in a way that is not sustainable in achieving this resulting in practitioner burnout whic is bad for the practitioner, the patient, and the employer.  I would like to see a lot more advocacy addressing this head on.

[camoman1234]

To answer your question: Yes, newer generation providers are (generally) lazier.  They don't want call, they don't want to be too busy, and they don't want to handle difficult cases.

As a millennial, I love when I hear from the baby boomers and/or generation X say "the newer generation is lazier." Speaking for myself and as a millennial, that is far from the truth. I have worked construction (my dad's business) since I was 8 and held a job every second of my life until I started my 1st day of PA school. I worked nights, evenings, weekends, etc while I was going through undergrad and still had time for family and friends. I will not bore you with my life and "prove" to you why I am no more lazy than you are. Here is the facts (I had to attend multiple seminars on "generation gaps and understanding" through the hospital I use to work for). This seminar was done to help different generations understand how each others style of work is and what each person can bring to the table. Baby boomers and more of generation X follow, "live to work" while millennials follow, work to live." Simple truth, I care/love WAY more about my family then my patients. This is why I work 30-32 hrs/week, just to give me enough money where I am conformable and my wife can stay home with our children. I thought it, why would you waste your life working when you can be having fun. Especially when you have a job/career like use that affords us a flexible life style (if you choose to and if you choose the specialties that allow it). My life is too short so I want to have fun with family and friends and not wasting it away at work. I'd rather volunteer my time in the community helping the homeless, needy, etc then stressing about CPT/ICD-10 codes, PQRS measures, etc. Just my two cents. 

[LT_Oneal_PAC]

I suppose it is generally true that each generation gripes about the one that follows. But unlike the days of Socrates, we have some data:

 

 

Either:

 

1. The undergrad curriculum is getting easier. (I argue against this; knowledge is exponentially increasing. The average PA student probably knows 10 times what a physician in the 1960s knew.)

2. Students have become astonishingly smart. ( I have not personally seen evidence to support this.)

3. Expectations have been lowered.

 

I would argue that we have lost the meaning of "average." Somewhere along the line being average became insulting. People can no longer tolerate being told they are average at anything (much less below average).

As you can see on the graph though, it was a continual lowering of expectation long before millennials were even born. I would also argue that it's not the fault of the student if the baby boomer professor is handing out easy grades.

 

To the OP:

 

Don't misunderstand me, I too see many people getting into this profession wanting to work as little as possible. I don't see it as a lack of work ethic though, I see it as a lack of passion for medicine. I love medicine. For me this is my hobby and my career. So I work more hours and work harder while doing it. I don't think I have a better work ethic because I see them work way harder at admin duties or some other project that I would typically shy away from.

 

I also think the newer generation is less motivated to work more hours for monetary gain, which isn't wrong. Having different values is what makes a functioning society. We can't all want the same thing and get it.

 

As far as the number of patients per hour goes, I'm with rev and emed. Can't wait to get out of the military and actually have some schedule control.

 

I'm not saying your young coworkers aren't lazy dirtbags, but my 10 years in healthcare has shown me just as many lazy 50+ year olds not wanting to do the work up, shrugging off symptoms because it means more exams and charting, dumping call on a colleague at the last minute, switching undesired shifts with no reciprocation.

[Maverick87]

There's a difference between working hard and working smart. I notice that many Boomers work very hard, but are not very good at streamlining processes to make things easier and more efficient. Most Boomers seem to equate putting in a butt load of hours at work as proof of a good work ethic. I disagree with this. Also, Boomers are terrible with technology and need their hands held through anything even remotely complex.

 

And, finally, lest we not forget which generation completely destroyed our economy due to their overconsumption, all the while growing up in a completely stable and prosperous economy that was created by the generation before them.

 

That last part is not really relevant to our profession, but is absolutely worth noting in a big picture sort of way.

[Katera]

Boomers are the gen who have destroyed this country with their selfish policy decisions.  They are killing the planet for their children and grandchildren and could care less.  Who can blame millennials from being disillusioned?  It's the boomers policies that have left them with insane college costs, housing out of reach if they grew up on the coasts, and a SS system that will be bled dry long before any Millennial gets their crack at it.  The greatest generation (WW2) are rolling over in their graves at what their kid boomers have done.

 

GenX is the only hope this country has left....not to mention early 80's music was the best!  :-D

[EMEDPA]

Rock on Katera from one Xer to another...

[mgriffiths]

Simply replace the OP's word "younger" with black, jewish, student athlete etc..... and you most certainly understand how the "younger" people feel about this even being a discussion. I am pretty sure in this case this is blatantly ageism.

 

I think it is a terrible fallacy to equate "younger" with "black" or "jewish."  I am not even sure why you would put "student athlete."

 

"Younger" includes every group regardless of color, religion, class, etc.  We were all "younger" at some point.  To take offense at the term is just ridiculous.

 

Also, I really don't understand "ageism."  Is it "ageism" to fire or "let go" a doctor who can no longer do their work?  For example a surgeon who begins to develop Parkinson's Disease (has happened many times).  What about firing or "letting go" an older worker who just is unable to keep up with the pace of work either because they don't understand technology or don't work as fast.  For example, my wife works in a doctor's office and "works up" between 40-50 patients per day - the average between the majority of the workers.  A much older woman works up only 20-30 because she does not understand the EMR and just does not have the stamina.  The practice wants to be rid of her, but is afraid of a lawsuit over "ageism" - and this is in a "right to work" state.  I don't understand...

[rev ronin]

For those of you who are seeing 20+ patients a day...

* When a patient starts to cry, do you hand them a tissue and wait sympathetically, or shut them down and move on?

* When a patient is still smoking/overweight/poor glycemic control/whatever, do you take the time to listen to them, build on their desires, and encourage them?  Or do you just berate them?

* Do you notice patient's weight loss or smoking status has improved and say "Good job" and give them a sincere smile?

* Do you ask about the non-medically-related-thing the patient was concerned about last time?

* Have you built up enough goodwill and insight to a patient that you have a good sense for when failure should be gently reprimanded rather than unconditional acceptance communicated?

 

One of the reasons I cannot see more patients a day is because I am emotionally exhausted trying to congratulate, cajole, mourn with, listen to, and teach.  The medicine isn't hard; but nor is it sufficient.  I refuse to become someone who treats all patients as solely specific medical problems.  They are each men and women worthy of respect, doing the best they can in a world of conflicting values and priorities.

 

I work a lot harder than many people who see far more patients a day.  It's just a different sort of hard.

[Acebecker]

Amazing this thread has been allowed to even be open here. Personally I am all for free speech, confrontation and the most taboo things you can think of to discuss, however I love the hypocrisy of some members here who would whine about certain threads being too offensive, being inappropriate or other such nonsense.

 

Simply replace the OP's word "younger" with black, jewish, student athlete etc..... and you most certainly understand how the "younger" people feel about this even being a discussion. I am pretty sure in this case this is blatantly ageism.

 

And "work hard"??? What does that even mean? You think seeing more patients is working hard??? Or spending more hours at a job? Is this a joke? Americans are more and more being known to shun those who take vacation, call out sick, and work less hours, where other countries take more vacation and work fewer hours with a much higher quality of life.

 

To equate my question with racism is laughable. 

 

To the rest of the legitimate replies - thanks for the discussion. 

 

Here's something I want to clear up a little - my concern is not for making a buck for myself primarily.  If you'll note the 3 things I referenced earlier - my top priority is taking care of people.  Our patients.  Our younger providers don't have the desire to do it because it's hard.  It requires adding them onto busy schedules and in the UC it requires taking a few extra minutes to get the lab or the xray or go down the hall and talk to the Pt's PCP to work out a treatment plan.  My concern in that case is that you can sit face-to-face with a patient and determine if their PNA needs management inpatient or if an outpatient trial is reasonable - you can do that safely in a relatively short amount of time.  But they're not putting them into the schedule - they're sending them to the ED.  Same with belly pain - push on the belly and if it's minimally tender without rebound you can check back with them in 24 hrs. 

 

Yes, money is a concern - private practice here so we have to keep our doors open.  If we don't, then the 19,000 people our clinic sees annually have nowhere to go. 

 

What I'm seeing is 1 of the older guys and 3 of the younger guys who don't seem to want to work in our patients and take care of the people we have promised to take care of.  So I see it as an issue with newer providers, younger people in general. 

[Will352ns]

Gen X! Gen X!  Hell yeah!

 

Those lazy kids!....I heard the same thing when I was younger.  That said, the millennials do need to get off the "we are doomed mantra".  I remember being told that my generation would be the first to not be expected to as well as their parents.  

 

There are always generation gaps. It's easy to say a young colleague is lazy when they appear to be going slow.....it's easy for older colleagues to say they are "pacing" themselves due to "wisdom".  

[greenmood]

Lazy people exist across the age/generational spectrum.

 

It's silly to suggest there is something inherently wrong with "young people" yet every generation finds some way to do it. Many examples in this thread. I look forward eagerly to the day when we older millenials get our own new generation to bitch about for no reason.

 

My first thought when I come across an inexperienced (read: younger) colleague who seems unwilling to complete a task: they are uncomfortable and need education or support. Meaning they don't want to work up that pneumonia because they aren't confident and may be afraid of harming the patient or making the wrong call. They don't know which antibiotics to use on their elderly lady with 20 allergies and are afraid of judgement if they admit that. They don't want to talk with the PCP about the patient's hospital dismissal because they aren't sure what they are supposed to say or don't have enough knowledge of the patient to answer deep questions.

 

Now, the best response from an inexperienced provider would be to seek additional help or education. But we all know that sometimes people try to cover up insecurity and lack of knowledge. We'd all like to encourage those people, but that doesn't happen when the response from the experienced provider is to say "you're a lazy asshole who makes my job harder."

 

In the UC setting, I wonder how the habit of turfing patients started. I'll bet one provider started doing it and new guys saw that and thought, "hey, that's how we do it here."

 

Sounds like a workplace culture issue. Good news about that is that workplace culture can be changed a lot faster than you can get those damn kids off your lawn.

[myironlung]

I think it is a terrible fallacy to equate "younger" with "black" or "jewish."  I am not even sure why you would put "student athlete."

 

"Younger" includes every group regardless of color, religion, class, etc.  We were all "younger" at some point.  To take offense at the term is just ridiculous.

 

Also, I really don't understand "ageism."  Is it "ageism" to fire or "let go" a doctor who can no longer do their work?  For example a surgeon who begins to develop Parkinson's Disease (has happened many times).  What about firing or "letting go" an older worker who just is unable to keep up with the pace of work either because they don't understand technology or don't work as fast.  For example, my wife works in a doctor's office and "works up" between 40-50 patients per day - the average between the majority of the workers.  A much older woman works up only 20-30 because she does not understand the EMR and just does not have the stamina.  The practice wants to be rid of her, but is afraid of a lawsuit over "ageism" - and this is in a "right to work" state.  I don't understand...

 

you don't understand? perhaps your ageing cerebral matter is troubling you, no? sorry is that ageist? i'm sure you don't mind though.  The term younger classifies a certain group of people, and then a broad generalization was made without any evidence, this is stereotyping, which is obviously wrong. I mentioned student athlete because once again, it is a specific group of people that can be categorized, not sure how you can't grasp that. And congrats on your wife and her co-workers for working up 40-50 patients per day, hopefully none of them died. And yes that person you speak of should be let go if your practice wants a certain goal of # of patients, that's free of your practice to require and isn't illegal. But you are simply implying that because she is old that she doesn't understand EMR and lacks stamina. You can let her go because of those traits she has but not simply because she is old.

 

 

To equate my question with racism is laughable. 

 

To the rest of the legitimate replies - thanks for the discussion. 

 

Here's something I want to clear up a little - my concern is not for making a buck for myself primarily.  If you'll note the 3 things I referenced earlier - my top priority is taking care of people.  Our patients.  Our younger providers don't have the desire to do it because it's hard.  It requires adding them onto busy schedules and in the UC it requires taking a few extra minutes to get the lab or the xray or go down the hall and talk to the Pt's PCP to work out a treatment plan.  My concern in that case is that you can sit face-to-face with a patient and determine if their PNA needs management inpatient or if an outpatient trial is reasonable - you can do that safely in a relatively short amount of time.  But they're not putting them into the schedule - they're sending them to the ED.  Same with belly pain - push on the belly and if it's minimally tender without rebound you can check back with them in 24 hrs. 

 

Yes, money is a concern - private practice here so we have to keep our doors open.  If we don't, then the 19,000 people our clinic sees annually have nowhere to go. 

 

What I'm seeing is 1 of the older guys and 3 of the younger guys who don't seem to want to work in our patients and take care of the people we have promised to take care of.  So I see it as an issue with newer providers, younger people in general. 

 

Nah I'm pretty sure your post is laughable. "Younger people are lazy" is blatantly stereotyping, which is wrong, see above. Racism is no different from stereotyping, it's just that racism involves race obviously. I mentioned how your post is blatant ageism, which it is. Also, some people are comfortable with a certain set of #patients, who the hell are you to judge if they can fit more people in just because you do? Who are you? If you don't have a life outside work, awesome! But I do, so bye bye work ins!

[Acebecker]

bye bye work ins!

 

And there is the problem.  These people need you.  You don't seem to feel any sense of duty to them. 

 

First and foremost - we are in a primary care crisis.  Patients need their PCPs to see them.  The data shows that when primary care providers work-up their own patients for non-emergent concerns, the workups are less costly and more expedient.  Putting these people off leads to ER overuse.  ER overuse breaks the safety net.  

 

You are so offended because I have pointed at age as a possible source of laziness...  Fine.  Remove age from the discussion.  I really don't care about age - I care about taking care of people.  I care about taking care of people that have come to our clinic asking for our help.   The reason age became a question was that more of the younger providers in my particular clinic have less of a penchant for taking care of our patients.  As mentioned in the OP - I'm open to input on this.  But calling me ageist is essentially a red herring fallacy coupled with an ad hominem attack.  Greenmood makes a good point - I need to think differently about the treatment dispositions (turfings) than I am. I can see greenmood's point and I appreciate it.  If you have something constructive to say, please do. 

[mgriffiths]

you don't understand? perhaps your ageing cerebral matter is troubling you, no? sorry is that ageist? i'm sure you don't mind though. 

Haha!!!  My "ageing cerebral matter" - I'm 27, so if anything I am generally considered part of the "younger" crowd.  But instead of being hurt or taking offense at someone classifying my generation as lazy, I work to try and change this by my own actions.

 

And congrats on your wife and her co-workers for working up 40-50 patients per day, hopefully none of them died.

Again you're making an assumption.  This is an ophthalmology office where she is working up patients for injections for multiple docs pulling a 12 hour shift.  Many of the docs in her practice see 60+ in a day for injections, which is actually below average.

 

Stereotyping, racism, prejudice, etc. are all rooted in making premature conclusions.  You sir/madam have unfortunately done the exact same thing.

[rev ronin]

Guys, let's keep the focus on problems, not personalities here, please.

[Reality Check 2]

I agree with ACE 100% and with Rev.

 

No one is making accusations about age and ability - The US healthcare system is not working well to provide actual care and prevention to nearly 300 million people.

 

As in other threads, The Affordable Care Act has given access to INSURANCE but not access to care. Having insurance does not imply that there are enough of us to take care of these folks or provide timely access or that the patient can afford the deductible, coinsurance or even the premium.

 

Hopefully everyone here went into medicine to provide care - not to punch a time clock, meet quotas or just collect a pay check.

 

If one goes to work in a factory making widgets and one has to make 100 widgets per shift to meet demand and need - then one should make 100 widgets. If there aren't enough people or equipment and 80 widgets is the maximum - then you have a production problem. More workers, fixed equipment needs to be addressed. Whipping the employees won't make 100 widgets. The system is broken.

 

If the employee only thinks it is fair to make 80 widgets a shift - then you have an employee problem. The employee is likely capable of making 100 widgets and you ensure they have the equipment - then you have to deal with that employee.

 

Very simplified above, but medicine is having issues with this concept. 

 

Another issue is responsibility. If an employee only wants to crank out widgets and do no quality control - then you have crummy widgets that don't work.

 

If someone goes into medicine to see a MINIMUM number of patients per shift and not have to deal with things like EKGs, D-dimers, actually understanding labs and - heaven forbid - actually addressing the patient's concern - then this person shouldn't have gone into medicine. 

 

I have a 12 yr old doing outpatient appy vs mesenteric adenitis/influenza workup right now - explained it bluntly to mom - we do this now or I send you to the ER for a 6 hr wait, frustration, fatigue and heavy expense. The kid isn't toxic or I would have sent to the ER without hesitation. 

 

 My lunch is trashed, I am behind but this kid will get the right things done in a timely fashion at less expense and the parents' trust and confidence is important to me. 

 

So, age and everything else aside - we either work because we care and we DO THE RIGHT THING or we are wasting the patients' time and the publics' trust is misplaced. 

 

The system is broken - we, as clinicians are not broken. We shouldn't act imposed upon or burdened. We do this because we care.

 

If this isn't the case for anyone here - feel free to move on to another profession - hopefully not making substandard widgets.........................

[CAAdmission]

The children of the "helicopter parents" are now entering clinical practice. Many members of this generation was utterly shielded from any kind of negative feedback by their parents. They have been continually told they are utterly talented, unique and special.

 

When they hit the workplace, they find out they are average at best and easily replaceable. And there is no one for mom and dad to call.

[PACdan]

And there is the problem.  These people need you.  You don't seem to feel any sense of duty to them. 

 

First and foremost - we are in a primary care crisis.  Patients need their PCPs to see them.  The data shows that when primary care providers work-up their own patients for non-emergent concerns, the workups are less costly and more expedient.  Putting these people off leads to ER overuse.  ER overuse breaks the safety net.  

 

You are so offended because I have pointed at age as a possible source of laziness...  Fine.  Remove age from the discussion.  I really don't care about age - I care about taking care of people.  I care about taking care of people that have come to our clinic asking for our help.   The reason age became a question was that more of the younger providers in my particular clinic have less of a penchant for taking care of our patients.  As mentioned in the OP - I'm open to input on this.  But calling me ageist is essentially a red herring fallacy coupled with an ad hominem attack.  Greenmood makes a good point - I need to think differently about the treatment dispositions (turfings) than I am. I can see greenmood's point and I appreciate it.  If you have something constructive to say, please do. 

 

 

50 people need you in a given day. 100 people. Probably more. Realistically there is an upper limit to the number of people you can see and treat in a given day while still providing safe and appropriate care. A few walk-ins on top of an already full schedule, split among available providers? Sure that sounds reasonable. But you seem to be dealing with new/younger providers. How new are they? Are they reluctant to take on the increased patient load for other reasons that may not being addressed? Do they feel unsafe at that volume? Are they stressed beyond what they feel is achievable for them? Certainly a veteran provider will feel more comfortable at a faster pace. For those of us that haven't honed our clinical acumen that sharp, I can see a concern.

 

I am much like Rev, in that I know I cannot see 25-30 patients a day in family medicine and provide the quality of care I believe they deserve. It would stress me too far and be doing my patients, and myself, a disservice. I'm being upfront with that during job interviews, and I'm sure it has/will cost me offers. That is fine. I will take less pay to see patients at a pace which provides them my best service and skill. Especially in the first few years out of school. I'm sure as I gain experience I'll grow more comfortable and be able to see more patients per day. But this will be a gradual process, not something achieved in 4 weeks.

 

There is certainly a sense of duty. Primary care providers should be the first stop for most patients. We need more PCPs, but it remains a less attractive field for many. Yet no two providers are the same. And I believe that providers need to be honest with themselves and employers and establish expectations BEFORE starting a job. For new grads, this is even more important.