gmf04 Posted June 7, 2019 Share Posted June 7, 2019 I've worked in Primary Care for 19 years. 12 years with a private solo doctor until he retired and then the past 7 at a corporate hospital owned outpatient primary care office. There was a merger a few months ago and dozens of providers were let go. Those of us left were given essentially an ultimatum to be at or above the 65% for WRVUs. With the layoffs and subsequent providers quitting, our schedules are being jammed full day after day. The other PA and I have no say in anything with our schedule. No limit to # of new patients in a day, physicals, complex patients, patients who can't get in with their regular MD at another office. Does anyone else have any limits or restrictions to their schedule by choice? Also, and even with all the years of practice I don't know legally our rights to defer a patient to the MD in the office. This has not been an issue until being with this corporate group. There are some patients that have so many issues, recent hospitalizations, non-compliance etc that are being put on our schedules b/c we have availability first that we are becoming inundated with these types of patients. When I say, "maybe they should see the MD" I am told by our office manager "no". If I have availability and the patient is ok seeing a PA then I will see them. There are times when I look at our schedules and it doesn't seem rational. The MD may have a cholesterol follow up and follow up for refill on zoloft while I have a new patient with cirrhosis, edema, heart failure, chronic pain and neither our manager or "higher ups" seem to have any issue with this. We are essentially told "too bad". I am becoming increasingly concerned about liability risks due to the sheer number of patients and their complexities. Quote Link to comment Share on other sites More sharing options...
Cideous Posted June 7, 2019 Share Posted June 7, 2019 ROFLMAO.....I mean, hahahahaha! Brother, I'm not laughing at you, but at the situation. I'm really crying inside for you. Are you at higher risk of liability? Damn straight. Welcome to corporate medicine....... LOL man and they wonder why we struggle with our own sanity in this field.......... Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 7, 2019 Moderator Share Posted June 7, 2019 Do a good job on each patient. Make them wait. Push back. Have your cv ready. Quality medicine is marketable and you will likely have to leave. 5 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted June 7, 2019 Share Posted June 7, 2019 29 minutes ago, ventana said: ....you will likely have to leave. This is unfortunately true gmf04 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted June 7, 2019 Administrator Share Posted June 7, 2019 Let me guess... you're salaried? Quote Link to comment Share on other sites More sharing options...
PAinPenna Posted June 7, 2019 Share Posted June 7, 2019 This is exactly why I left Family Medicine. Quote Link to comment Share on other sites More sharing options...
gmf04 Posted June 7, 2019 Author Share Posted June 7, 2019 Yep I'm salary. So sad that the answer seems to be to leave. Especially since there is a primary care shortage. It almost seems like these corporations want us to leave. Its so bad that an internal medicine doctor who just joined us in February with 25+ years experience is leaving already. He said he can't work like this, and he has been seeing less pts than I do because he is new to the office. Some of these pts I have seen for nearly 20 years and sad that seemingly I will be forced to leave. Going to another primary care office wouldn't be an option b/c its just the same thing different place. I guess I was optimistic that someone could give me hope that they were able to come to agreements on a daily max of pts or just some reasonable guidelines with scheduling. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 7, 2019 Moderator Share Posted June 7, 2019 you can try with one sit down meeting bring some data about what an average number of patients to see is state that you are trying to protect the facility from getting sued hold firm - just see the right number of patients for you (making sure you have a job lined up) One more thing...... although I dislike unions I am starting to see more and more need for them to push back against corp greed and policy which turns into medical decision making.... start organizing a union.... Who cares if you get let go you are going to quit anyways.... 1 1 Quote Link to comment Share on other sites More sharing options...
BruceBanner Posted June 7, 2019 Share Posted June 7, 2019 Sounds like a nightmare. Our good friend Scott Stegal says you have to speak to them in a language they will understand---which means slowing down. This can work in a walk-in clinic, but in your scenario all it will do is put you behind, piss patients off, and reduce your productivity from admin's perspective. Unfortunately it is just a losing game. Corporate primary care is maybe one of the worst areas in all of American medicine. They literally do not GAF about you as a human being and this is evidenced by their expectations of you. They only care about throughput and patient satisfaction. 1 1 Quote Link to comment Share on other sites More sharing options...
gmf04 Posted June 7, 2019 Author Share Posted June 7, 2019 Oh it is a nightmare. Pts can come late to appointments and if I don't fit them in to my already filled 25 pt schedule, then I'm asked by management why I'm "refusing" to see them. Then of course the patients get the surveys if they were seen within 15 minutes of their appointment time, if we spent enough time with them, if they get calls back the same day, if they get an appointment as soon as they ned one. Of course patients are now considered our "customers". All the signs in the breakroom advise us how to keep our "customers" satisfied. Like I said, I'm baffled why they are pushing providers out of primary care when there is a lack of primary care providers. There is a big chance me and the other experienced PA here will leave sooner or later. 1 Quote Link to comment Share on other sites More sharing options...
PAinPenna Posted June 7, 2019 Share Posted June 7, 2019 30 minutes ago, BruceBanner said: Unfortunately it is just a losing game. Corporate primary care is maybe one of the worst areas in all of American medicine. They literally do not GAF about you as a human being and this is evidenced by their expectations of you. They only care about throughput and patient satisfaction. The craziest part is my only Press Ganey complaints from patients were that I was "too rushed" . I wanted to bang my head off a wall when I saw those. 1 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted June 7, 2019 Share Posted June 7, 2019 Sign on a print shop door: “We can do it fast, we can do it well, we can do it cheap. Pick two.” This is how the following article starts, worthy of a read. Probably won't turn heads of suited admins who count beans. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617939/ The VA is ALL internal medicine - all day long - all the time. Polypharmacy, multiple chronic medical problems, PTSD, etc. My schedule will never see more than 14 patients in a day - period. However, private and corporate practices don't care - money over everything. All the providers have to support non-income producing suits that seem to keep overpopulating like rabid bunnies. I would seriously hate to make a medical mistake because I felt rush or overwhelmed to see 25+ patients a day. No one deserves less of my attention or less accuracy. I hope we can all play a role in reworking this process which is just wrong on so many levels. 3 Quote Link to comment Share on other sites More sharing options...
Cideous Posted June 7, 2019 Share Posted June 7, 2019 28 minutes ago, Reality Check 2 said: All the providers have to support non-income producing suits that seem to keep overpopulating like rabid bunnies. That made me straight LOL....... 2 Quote Link to comment Share on other sites More sharing options...
gmf04 Posted June 8, 2019 Author Share Posted June 8, 2019 7 hours ago, Reality Check 2 said: Sign on a print shop door: “We can do it fast, we can do it well, we can do it cheap. Pick two.” This is how the following article starts, worthy of a read. Probably won't turn heads of suited admins who count beans. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617939/ The VA is ALL internal medicine - all day long - all the time. Polypharmacy, multiple chronic medical problems, PTSD, etc. My schedule will never see more than 14 patients in a day - period. However, private and corporate practices don't care - money over everything. All the providers have to support non-income producing suits that seem to keep overpopulating like rabid bunnies. I would seriously hate to make a medical mistake because I felt rush or overwhelmed to see 25+ patients a day. No one deserves less of my attention or less accuracy. I hope we can all play a role in reworking this process which is just wrong on so many levels. There is a VA outpatient clinic nearby that I am considering looking into. I am definitely interested in talking with PAs who work there to see what it's like. I know no place is perfect, but wondering if it would be better than corporate primary care! Quote Link to comment Share on other sites More sharing options...
sas5814 Posted June 10, 2019 Share Posted June 10, 2019 As has been said welcome to corporate medicine where demands you see more patients, to admin, is no different than demanding you make more chicken sandwiches at Chick-Fil-A (where it is entirely possible your new CEO used to work). I could go into a long explanation and tell horror stories but here is what it boils down to...comply or move on. Admin doesn't care about your opinion. Admin doesn't understand or care about your safety or liability concerns. They care about lashing you to the machine and generating money. Period..... 1 Quote Link to comment Share on other sites More sharing options...
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