Feeling like I'm crazy

[kadiah]

Hey all. Newish poster, long time lurker. I honestly just need to vent about this, because my job is making me believe I'm crazy. And I'd like reassurance or ideas on how to proceed.

I've been in practice for almost five years, the last 3.5 have been in Urgent Care. When I started UC I actually loved it - I like to be busy, I like working longer hours and less days. Sure it's 80% cough and snot, but the 20% is stuff I love - sutures, I&Ds, injuries, rashes. I started in Primary Care (albeit at a private office that was also an urgent care and occupational medicine clinic... so too much of everything) and those patients pushed me into UC real quick. I didn't enjoy the endless conversations of "well the best way to control HTN/DM/Knee pain/ect is diet and exercise/our medicines can only do so much/I can't wave a magic wand and make this go away." That's now just how I view the endless cough and colds, but I still enjoy keeping on the look out for a patient I can ACTUALLY help - I've caught a spontaneous pneumo in a 16 year old girl who seemed like a text book costochondritis, I got a post partum Mom who came in "just feeling run down/like I might have a cold" to open up about her suicidal ideation and got her to the right place, just to name a few. 

This has been all well and good - until our hospital owned UC that was run by it's own administration "merged" with the community medicine practice. Since then, they've fired our previous administration or "downsized them" or however you want to put it - and started making changes. We've been told that we can't make referrals for chronic problems - like chronic diarrhea that needs a colonoscopy - can't refer to GI. Peds patients who've been seen in our clinic for their 5th ear infection this year (because they can't get an appoint with their pediatrician) - nope ENT refuses to see them if we refer them. But they want us to ALSO start to act like a PCP - if the alert pops up in our EMR that this patient is due for a colonoscopy/mammogram/PAP - yup we have to order it or set it up. They claim we won't be responsible for any abnormal results, but if I'm ordering it, I'm sorry, I have to f/u up on it.

But the real kicker is what has happened to me in the past 2 months. My boss (who used to be an NP college that I love and adore and consider a friend) came to me to ask if I'd move to the new clinic they were opening, that happens to be walking distance from my house. She came to me because she would rather have an experience provider who she knows would run it right open then an outside hire who she doesn't know. I said hey, why not, I can walk to work. Previously, it has taken about 3 months to open a new clinic and they've never opened a clinic without being fully staffed. That was when our old admin opened a clinic. Now - they built the building (it's the UC and a family practice office) and threw me in there - with no staff and it wasn't even set up. They justify this because "it's new, it will be slow." For the past 2 months I haven't worked with a nurse and had to completely set up the clinic and order everything myself, because our office manager had just quit. 

I've had days where I've seen 18, 20, and 25 patients without a nurse. At first they couldn't even guarantee someone to register patients and I had to call other clinics to register my patients. There was one time the nurse who was scheduled went home sick and they made me sit by myself - no other staff - in a huge building alone. (I'm a young, 5'0 female. the clinic is in a city - we're not a large city, but it's busy and not entirely safe to be alone in. My husband came to sit with me because he was so angry). They don't seem to see this as an issue - me and the provider that works opposite of me have sent email after email and made complaints to any admin that will listen - we've been told "the nurses will start the end of February and we're short staffed so there's no one we can pull." We use an online scheduling tool that they thankfully have kept turned off due to staffing - but yesterday they turned it on, without even asking or warning me, because "the clinic needs to get busier".

I'm just so over this. Even if they hire the new nurses, I just feel crushed and so devalued as a provider. I feel like if they're willing to do this and tell me to basically "shut up and take it"  I don't want to know how bad it will continue to get. I've looked at job openings in my area - we're a hugely medically under served area with a poor population, in a low cost of living area in the NE. The hospital system I work for is the dominate employer. Any private practice won't be able to compete with salary, which I unfortunately can't take too much of a pay cut on. My husband has a decent job here and would have a little trouble finding work if we relocated, as he's a lovable manchild who chose a degree in English for love, not employment prospects. It's just hard to know what my options even are at this point. 

[sas5814]

Leave. You have just had your first taste of corporate medicine which comes with lots of nonsense but there are/should be limits. I went through the same thing after a "strategic partner" took over our institution. To say it is maddening is an understatement. The HARD line is when admin tries to compel you to do things you know are medically wrong or stop you from doing things that are medically correct. This is corporate medicine run amok. It will not get better in this organization anytime soon. They told you to take it or leave it. Leave. Last year we had 60% of our APP staff quit after some crappy changes. Suddenly we were having meetings about how things could be done better. Our little group finally figured they couldn't admin their way through flu season without providers.

[kadiah]

Thank you. I know the answer is to leave. I think I'm just gun shy because I'll either have to make a huge change (move out of the area), have an 1+ hours commute to work, or just work in a different specialty in the system, which I don't see being a great change. 

[sas5814]

It will be difficult but later you will look back and wonder why you hesitated. Life work sanity balance is a critical commodity.

[BruceBanner]

My experience with frustrations like this is they come in waves.  You'll feel used and underappreciated, stressed, think about leaving, then things will settle out for a time until the the next opportunity admin has to make changes at your expense. But it wont get better. In corporate medicine you are at the bottom of the hill (which I've always found odd since you are the one generating revenue), and sh!t, as the saying goes, rolls downward.

So yes, you should start the wheels in motion for leaving. But think about maybe a different direction than urgent care, since they are all corporate or commercially-controlled.

[thinkertdm]

It's easier to find a job you love than to struggle in a job you hate and hope to one day love it.

And trust me, they will never, ever thank you for working for them.  You are worrying and stressing over nothing.

[rev ronin]

Don't leave.... wait.  Wait in your office until the patients are roomed and vitals are taken. Wait 8 hours at a time, if that's what it takes, with patients leaving in frustration.

Or, if you WANT to do MA work that's beneath you, take as long as you feel like to do it right.  It can take oodles of time to do things that aren't your job, can't it?

[ventana]

As above.   

 

You alliwed yourself to be to be taken advantage of.   Stop it.  

 

Have a meeting with admin.  State your value is seeingbpatients, generating revenue.  Let them know you are a team player but that your profession is a PA and that is how you will function.  You expect to be supported and given the opportunity to excel, not do everything.   Sometime I think it helps to show idiot bean counters that if you see a few extra patients a day all your support staff is paid for.   Utilize your revenue generation.  Not you MA skills.   Work with them.  Follow chainof command.  Be professional.  Define your expectations.   Tell them what your need (with in reason).  Above all be a team player as a PA. Not an MA.  

[Boatswain2PA]

3 hours ago, rev ronin said:

Don't leave.... wait.  Wait in your office until the patients are roomed and vitals are taken. Wait 8 hours at a time, if that's what it takes, with patients leaving in frustration.

I would rather get paid to wait, than get paid to room patients.  Think about how many CME hours you could get in while waiting! 

[kadiah]

I wish I had the balls to just wait. I couldn't take a hit like being fired, my student loan payment is like a second mortgage (but its 2 years from being paid off, so yay?) My coworker on the opposite shift of me beat my record and saw 32 patients by himself today. We both need these jobs until we find something else. The most protesting he and I do is refusing to do the bs busy work of double documentation they make the LPNs and MAs do with results and we've been refusing to do stat blood draws. 

My best friend talked me into applying to jobs by her, and an inpatient psych position was posted yesterday at a hospital near us. It's a huge change, but after ER my psych rotation was my second favorite. 

 

I figure anything is worth a try! 

[Boatswain2PA]

1 hour ago, kadiah said:

I couldn't take a hit like being fired, my student loan payment is like a second mortgage (but its 2 years from being paid off, so yay?)

I'm not picking on you about this, but want to use this quote from you to highlight what I often talk about on these boards.

DEBT IS SLAVERY.  This young PA feels TRAPPED in a job because s/he has debt payments that they must make, and probably doesn't have a 6 month emergency savings fund.

Kadiah - How would you feel if you were completely debt free, no stuloans, no mortgage, no car payments, etc...and had $30K in savings?  This problem wouldn't completely go away, but you would have a lot more options.

Over the past few years I've had a lucrative contract at an absolutely terribly run hospital.  Place was just a terrible place to work.  I didn't keep working there because I needed to, I kept working there because they paid me a LOT, and I had a terrific schedule there.  New CEO suddenly cancelled all locums contracts.  Ok, no big deal because I had a plan B at a terrific ED much closer to home that still paid well.  Whoops, they had just hired a FT PA and didn't have any more openings.  Plan C was to just pick up more locums shifts elsewhere; but those really dried up for about 6 months.  This would have been financially devastating for us, except we have virtually no debt.  I was able to work a few shifts a month at the terrific ED for >3 months as I shopped around.  Because I was ABLE to have patience I eventually found a great job, with even better pay and outstanding benefits.

People with complicated business degrees will tell you that you need to "leverage" your debt.  Mathematically they are right. However their math doesn't take into account the risks of LIFE.

Good luck Kadiah - please let us know how it works out.

[Cideous]

Sounds like a liability black hole.  No nurse/MA?  They call that MinuteClinic.  At least they mitigate risk by severely limiting what you can see there.  Colonoscopies from an Urgent Care?  So wrong on so many levels.

[CAdamsPAC]

On 1/25/2019 at 9:23 AM, kadiah said:

Hey all. Newish poster, long time lurker. I honestly just need to vent about this, because my job is making me believe I'm crazy. And I'd like reassurance or ideas on how to proceed.

I've been in practice for almost five years, the last 3.5 have been in Urgent Care. When I started UC I actually loved it - I like to be busy, I like working longer hours and less days. Sure it's 80% cough and snot, but the 20% is stuff I love - sutures, I&Ds, injuries, rashes. I started in Primary Care (albeit at a private office that was also an urgent care and occupational medicine clinic... so too much of everything) and those patients pushed me into UC real quick. I didn't enjoy the endless conversations of "well the best way to control HTN/DM/Knee pain/ect is diet and exercise/our medicines can only do so much/I can't wave a magic wand and make this go away." That's now just how I view the endless cough and colds, but I still enjoy keeping on the look out for a patient I can ACTUALLY help - I've caught a spontaneous pneumo in a 16 year old girl who seemed like a text book costochondritis, I got a post partum Mom who came in "just feeling run down/like I might have a cold" to open up about her suicidal ideation and got her to the right place, just to name a few. 

This has been all well and good - until our hospital owned UC that was run by it's own administration "merged" with the community medicine practice. Since then, they've fired our previous administration or "downsized them" or however you want to put it - and started making changes. We've been told that we can't make referrals for chronic problems - like chronic diarrhea that needs a colonoscopy - can't refer to GI. Peds patients who've been seen in our clinic for their 5th ear infection this year (because they can't get an appoint with their pediatrician) - nope ENT refuses to see them if we refer them. But they want us to ALSO start to act like a PCP - if the alert pops up in our EMR that this patient is due for a colonoscopy/mammogram/PAP - yup we have to order it or set it up. They claim we won't be responsible for any abnormal results, but if I'm ordering it, I'm sorry, I have to f/u up on it.

But the real kicker is what has happened to me in the past 2 months. My boss (who used to be an NP college that I love and adore and consider a friend) came to me to ask if I'd move to the new clinic they were opening, that happens to be walking distance from my house. She came to me because she would rather have an experience provider who she knows would run it right open then an outside hire who she doesn't know. I said hey, why not, I can walk to work. Previously, it has taken about 3 months to open a new clinic and they've never opened a clinic without being fully staffed. That was when our old admin opened a clinic. Now - they built the building (it's the UC and a family practice office) and threw me in there - with no staff and it wasn't even set up. They justify this because "it's new, it will be slow." For the past 2 months I haven't worked with a nurse and had to completely set up the clinic and order everything myself, because our office manager had just quit. 

I've had days where I've seen 18, 20, and 25 patients without a nurse. At first they couldn't even guarantee someone to register patients and I had to call other clinics to register my patients. There was one time the nurse who was scheduled went home sick and they made me sit by myself - no other staff - in a huge building alone. (I'm a young, 5'0 female. the clinic is in a city - we're not a large city, but it's busy and not entirely safe to be alone in. My husband came to sit with me because he was so angry). They don't seem to see this as an issue - me and the provider that works opposite of me have sent email after email and made complaints to any admin that will listen - we've been told "the nurses will start the end of February and we're short staffed so there's no one we can pull." We use an online scheduling tool that they thankfully have kept turned off due to staffing - but yesterday they turned it on, without even asking or warning me, because "the clinic needs to get busier".

I'm just so over this. Even if they hire the new nurses, I just feel crushed and so devalued as a provider. I feel like if they're willing to do this and tell me to basically "shut up and take it"  I don't want to know how bad it will continue to get. I've looked at job openings in my area - we're a hugely medically under served area with a poor population, in a low cost of living area in the NE. The hospital system I work for is the dominate employer. Any private practice won't be able to compete with salary, which I unfortunately can't take too much of a pay cut on. My husband has a decent job here and would have a little trouble finding work if we relocated, as he's a lovable manchild who chose a degree in English for love, not employment prospects. It's just hard to know what my options even are at this point. 

Treat them the way you are being treated, with disrespect and minimal if any notice leave; as they haven't earned and consideration from what you have written. Oh, BTW you are crazy to keep putting up with being used and abused by your current employer.

 

[SedRate]

6 hours ago, kadiah said:

I wish I had the balls to just wait. I couldn't take a hit like being fired, my student loan payment is like a second mortgage (but its 2 years from being paid off, so yay?) My coworker on the opposite shift of me beat my record and saw 32 patients by himself today. We both need these jobs until we find something else. The most protesting he and I do is refusing to do the bs busy work of double documentation they make the LPNs and MAs do with results and we've been refusing to do stat blood draws. 

My best friend talked me into applying to jobs by her, and an inpatient psych position was posted yesterday at a hospital near us. It's a huge change, but after ER my psych rotation was my second favorite. 

 

I figure anything is worth a try! 

I second what Boatswain said.

Start buckling down to build an emergency fund in the event of the worse.

Be careful about jumping into something else. I'm sure a lot of other things sound much better at this point, but make it a switch for the better, whatever that ends up meaning to you. 

[GetMeOuttaThisMess]

What state?

[kadiah]

On 1/26/2019 at 9:23 AM, Boatswain2PA said:

DEBT IS SLAVERY.  This young PA feels TRAPPED in a job because s/he has debt payments that they must make, and probably doesn't have a 6 month emergency savings fund.
 

Honestly I have close - about 5 months in savings. I'm just a very risk adverse person and throwing caution to the wind and completely quitting or daring them to fire me just gives me too much anxiety to think about. Would my husband and I be fine? Yeah, probably. But our goal is to aggressively pay down the rest of our debt, and we'll do that at the current rate in about 2 years. 

That's mostly what I'm worried about. Not much in my current area (Pennsylvania, for those asking) interests me. I've wanted to do ENT since school and there is a position in upstate NY in the area where most of my friends live, so I applied and am talking with their recruiter tomorrow. It's nice having almost 5 years experience behind you - the job hits happen a lot easier now. 

[Boatswain2PA]

8 hours ago, kadiah said:

Honestly I have close - about 5 months in savings. I'm just a very risk adverse person and throwing caution to the wind and completely quitting or daring them to fire me just gives me too much anxiety to think about. Would my husband and I be fine? Yeah, probably. But our goal is to aggressively pay down the rest of our debt, and we'll do that at the current rate in about 2 years. 

That is AWESOME!  

Relax my friend, you have tons of great options, from continuing your status quo (remembering you are 2 years from being out of debt), to walking away tomorrow and taking your time finding another job....and everything inbetween.

I think what I would do is push back more against admin (why kill yourself seeing 32 pts a day without staff support?  Just see 12, the rest will LWBS after sitting 6 hours in the waiting room) as I kept collecting their paychecks (while building up my savings more), while looking for better pastures.