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I borrowed this from an area expert in another forum but it really touched a nerve as conversation about medicine being turned into a corporate business, over management by administrators who make decisions based on money and charts and graphs etc etc. It is a conversation we have all had many times:

The first criteria for burnout were recognized and researched by Maslach and Jackson in 1981, these criteria are, almost without revision, still used today.  The three components are:

1 Emotional Exhaustion =Loss of enthusiasm and interest for practice

2) Depersonalization = Poor clinical attitude and patients being treated by clinicians as objects

3)  Reduced Personal Achievement = Reduced sense of personal achievement and low self-value.

 

 

When I read this I thought it is the very definition of how most large institutions function. In fact most systems operate on a "sit down and shut up" and "how can we squeeze more money out of this" basis before ever giving any consideration of patient care.

Just an example from my personal experience. Yesterday, because it is cold and flu season now, myself and 1 LVN saw 49 people in the UC in 10 hours. The day was frought with angry patients because they didn't feel well, had long wait times, and often were told they had a viral illness and thus got "nothing" or "I wasted my time." Patient complaints were funneled to admin types who, even on Saturday, have time to call and hector the staff about patient complaints. However when same admin types were told we were getting dangerously mentally fatigued with 40 signed in in 8 hours had no answer other than "we will try to find someone to come in" on Saturday evening at 6 on no notice. You can imagine how that went.

Today I am here with the same staff to do it all again.

 

So my plan is to reduce my hours to 3 12 hour shifts a week and, no matter how many people are signed in, hold the same slow steady pace all day long, and let patient complaints get the attention of admin rather than trying to have any discussion about problems with our system which has been discouraged.

Conversations with colleagues all over the country suggest my situation isn't even close to unique.

 

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17 hours ago, sas5814 said:

I borrowed this from an area expert in another forum but it really touched a nerve as conversation about medicine being turned into a corporate business, over management by administrators who make decisions based on money and charts and graphs etc etc. It is a conversation we have all had many times:

The first criteria for burnout were recognized and researched by Maslach and Jackson in 1981, these criteria are, almost without revision, still used today.  The three components are:

1 Emotional Exhaustion =Loss of enthusiasm and interest for practice

2) Depersonalization = Poor clinical attitude and patients being treated by clinicians as objects

3)  Reduced Personal Achievement = Reduced sense of personal achievement and low self-value.

 

 

When I read this I thought it is the very definition of how most large institutions function. In fact most systems operate on a "sit down and shut up" and "how can we squeeze more money out of this" basis before ever giving any consideration of patient care.

Just an example from my personal experience. Yesterday, because it is cold and flu season now, myself and 1 LVN saw 49 people in the UC in 10 hours. The day was frought with angry patients because they didn't feel well, had long wait times, and often were told they had a viral illness and thus got "nothing" or "I wasted my time." Patient complaints were funneled to admin types who, even on Saturday, have time to call and hector the staff about patient complaints. However when same admin types were told we were getting dangerously mentally fatigued with 40 signed in in 8 hours had no answer other than "we will try to find someone to come in" on Saturday evening at 6 on no notice. You can imagine how that went.

Today I am here with the same staff to do it all again.

 

So my plan is to reduce my hours to 3 12 hour shifts a week and, no matter how many people are signed in, hold the same slow steady pace all day long, and let patient complaints get the attention of admin rather than trying to have any discussion about problems with our system which has been discouraged.

Conversations with colleagues all over the country suggest my situation isn't even close to unique.

 

Why I am out in the wilds of Alaska far away "Suits" with more than enough time to see my busy 2- 15 patients a day..........No one really cares about the provider staff as long as they don't have to answer for conditions of their own making.

 

 

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22 minutes ago, CAdamsPAC said:

Why I am out in the wilds of Alaska far away "Suits" with more than enough time to see my busy 2- 15 patients a day..........No one really cares about the provider staff as long as they don't have to answer for conditions of their own making.

 

 

agree. a really busy shift for me is around 20 pts in 24 hrs. 10-15 is more typical. high acuity, low volume, solo coverage. this is definitely the way to go. 

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7 hours ago, CAdamsPAC said:

Why I am out in the wilds of Alaska far away "Suits" with more than enough time to see my busy 2- 15 patients a day..........No one really cares about the provider staff as long as they don't have to answer for conditions of their own making.

 

 

oh man, tell me more!!!

 

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49 patients in 10 hours is insane. I switched to rural medicine about a year ago because in the UC I was previously at would consistently see 110-120 in a 12 hour shift split between 3 providers. Left most nights 2+ hours after closing due to patients coming in last minute or getting documentation finished as I will not do work on my own time. Now see 40/day between two providers on a “busy” day. I do see higher acuity patients where I am now but would gladly trade high volume/low acuity for lower volume/ higher acuity any day. 

 

To the OP: Hopefully decreasing your hours/days will help. Has the topic of a “closing policy” come up with the higher up’s? Implementing something like if say you close at 8pm that if there are more than two patients per provider in the waiting room an hour and a half prior to closing that you can stop registering patients to be seen? Might be worth asking for your own sanity at least. 

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It's a common scenario.  My previous gig offered PTO but no coverage, or had you find your own coverage.  This was in a walk in where 70 per 12 hours was the norm during cold and flu season. 

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special burn out for PA's

 

being told to do it one way, when you would do it a different way from you doc

what a croc of poo

makes me frustrated especially when the data shows my way is better....

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