Totally Burned Out...and less than a decade in. What's next? [VENT]

[sas5814]

anew that is great advice for the individual but doesn't solve the greater problem. There is a broad institutional shift in leadership from people familiar with healthcare to administrators and bean counters. My own organization, which is really better than many, is rife with mid-level managers who make bad policy because it looks good on a spreadsheet or flow chart but is bad for both the patient and the provider. They do so because they are steeped in an institutional culture that is poisonous to the provider/patient relationship sacrificing that at the alter of money and the next promotion. I hear horror stories every day of solo providers in UCs seeing 50, 60, 70 patients a day with minimal support who are supposed to perform this task day after day without missing anything while achieving 100% patient satisfaction surveys. That is just one example among many and it seems to be getting worse. 

It has to shift somehow. Physicians abdicated their positions at the head of the health care train to be employees all while complaining about losing control. They aren't going to take it back any time soon. The next best way to force change is to make sure responsibility and ownership (the real kind not the kind they rah-rah about at staff meetings) is appointed to the person responsible in a very real and tangible way.

[MT2PA]

On 4/9/2019 at 1:20 PM, Ryanseacrest said:

If the legal responsibility is on the provider, then the provider is free to go at their own pace? 

Until A: you have a waiting room full of patients not being seen and/or B: your employer says you're not meeting contract goals and then you have no job. 

I see that you are pre-PA.  I hope you'll revisit this and laugh if/when you become a practicing PA and realize that medicine is a business and unfortunately we are employees with very little control over what our employers demand/expect.

[Cideous]

We have little to no control in the business world of medicine.  Basically zero in corporate owned Urgent Care.

[PASamsOTHERacct]

On 4/9/2019 at 3:48 PM, anewconvert said:

Get to the inpatient world!

 

I see my patient load at my pace. I eat when I get hungry. I talk to colleagues when I need their help. I talk with patients when they need to vent or need to understand. No one rushes me out the door. No patient expecting me to respect “their appointment”.  Admits sit in the ER until I can get to them. Discharges sit in their room until I can discharge them. I respond urgently to two groups of people: sick patients and scared nurses... otherwise I move at my pace and have my entire day to get it done. When I am done I go to the OR and assist with zero expectation that I have to be there because I am handling the stuff the surgeons don’t want to be bothered with. Sometimes I even just stand in front of the window and take a couple minutes to talk to no one  

 

 

Hospitalist work is similar without the OR and wound care demands of my job. Find a community hospital, sell your years of UC experience, and then start seeing patients. 

I'm curious...as my Hospitalist/Inpatient rotation was a total waste of time, what exactly...are the demands, the typicals, what exactly is the day like?   As a UC PA, what would I have to do to transition well? Oh, and....generally speaking, are there non-12-hour hospitalist jobs out there?

[anewconvert]

16 hours ago, PASamsOTHERacct said:

I'm curious...as my Hospitalist/Inpatient rotation was a total waste of time, what exactly...are the demands, the typicals, what exactly is the day like?   As a UC PA, what would I have to do to transition well? Oh, and....generally speaking, are there non-12-hour hospitalist jobs out there?

I can’t accurately speak to hospitalist work as I am in general surgery. From my perspective it is admitting, coordinating care between different services, responding to  rapid response/codes, and discharge/disposition. 

 

If a a hospitalist day is anything like my non-OR surgicalist days it is rounding, conference, discharges, evaluation of morning orders/tests for result, and sporadic admits. 

[anewconvert]

On 4/10/2019 at 8:50 AM, sas5814 said:

anew that is great advice for the individual but doesn't solve the greater problem. There is a broad institutional shift in leadership from people familiar with healthcare to administrators and bean counters. My own organization, which is really better than many, is rife with mid-level managers who make bad policy because it looks good on a spreadsheet or flow chart but is bad for both the patient and the provider. They do so because they are steeped in an institutional culture that is poisonous to the provider/patient relationship sacrificing that at the alter of money and the next promotion. I hear horror stories every day of solo providers in UCs seeing 50, 60, 70 patients a day with minimal support who are supposed to perform this task day after day without missing anything while achieving 100% patient satisfaction surveys. That is just one example among many and it seems to be getting worse. 

It has to shift somehow. Physicians abdicated their positions at the head of the health care train to be employees all while complaining about losing control. They aren't going to take it back any time soon. The next best way to force change is to make sure responsibility and ownership (the real kind not the kind they rah-rah about at staff meetings) is appointed to the person responsible in a very real and tangible way.

No doubt. I was only speaking to that individual situation. That being said I am a proponent of the “ok” and do what I was going to do anyway method of dealing with demands. If do what I can at a pace that I can do it and if that upsets someone and they demand more I say “ok” and keep going about my day as I was before. 

 

 

I agree that the system is broken but I don’t have the insight to offer a solution beyond my world. I heal where I can, help where I can, and facilitate communication where I can. Beyond that I can’t.