Urgent care overload

[Monte]

Hello,

I work in urgent care, Massachusetts. The clinic I work full-time at has been increasingly taking more patients to the point where I feel as though they are taking advantage of us providers (urgent care, what a surprise!).

Currently, as a solo provider site, my clinic is making a list of the first 40 people in line at the beginning of the day, giving them timeslots to return that same day for a visit. This is COVID related visits and can be all 40 med visits (as opposed to limiting them to nurse visits). Next, this urgent care accepts 2-3 online appointments for anything per hour. Typically, There are at least 24-30 online appointments scheduled per day. As you can see, that's up to 64-70 scheduled visits/day. Of course all of these people don't show up, but the problem occurs when they do. In addition, any lulls we have in the schedule are open to walk-ins IN ADDITION. I'm continuing to do DOT physicals, worker's comp, etc with several of these per day.

The lowest patient count I've had in the last two weeks was 41, highest being 55. The only reason that it doesn't reach the 60s is that I try my hardest not to let it happen.

None of this feels safe with COVID going on, we have positive patients leaving rooms with new patients entering them a minute later with basically no cleaning and lines of people in the waiting room.

*Edit - I have in fact reached out to my medical director through phone call and email three times, the regional manager through email, AND the owner of the franchise location through a phone call. All of these attempts at reason were brushed off as though it's what's expected right now, and that 50-60 patients is normal for urgent care.

My questions.. 

I'm ready to give my notice and quit. My work requested a 90 day notice when I signed on. Do I have any wiggle room out of this for feeling the way I do in regards to patient safety? Obviously I get the "burned bridge" idea of leaving sooner than 90 days but I honestly don't care in this case..

Have any of you ever left a similar situation and had them retaliate?

Thank you!

 

Edited January 26, 2021 by Monte
added to story

[CAAdmission]

Have you spoken with them at all regarding your concerns prior to now? If this is a "move the meat" kind of practice, you'll do well to get out. If you give notice and know you are leaving, as a short-timer you can start slowing down your patient load and there is not much they can do. 

If your boss is a halfway decent person, I would speak with them and say something along the lines of, "I'm aware that as a business we need to  see a certain patient volume to stay in business. The current load is unfortunately more than I can safely handle, and someone is going to get hurt. Can we do something to adjust this, or do you think this just isn't the right setting for me?" 

No one should stay in a crappy situation, but a surprising number of people just quit and never discuss the crappy situation first to see if it is salvageable. Granted, only you know the personnel involved and can make this decision. I think having the conversation above is less likely to burn a bridge that just dropping an "I quit" letter. And trust me, I have burned more bridges than General Sherman.

 

[cdcd67]

My job has the same thing in their contract but they were okay with me quitting in less than 3 months.

Likely because they know why APPs quit in the current ER I work at. (We have a high turnover rate.) In fact, when I first started, I had addressed my concerns with my boss, but he was already aware of the things I had mentioned but they were not in his control.

One of the things I hate about medicine is how it just becomes a numbers game in the end. All they want is someone who can see as many patients as possible as quickly as possible.

I agree with what OP wrote and try to see if they are willing to make any amendments. Also, I wouldn't quit until you have secured another job.

[ventana]

easy

get your PCP to give you a note taking you out to care for a loved one, child, parent, or due to risks of the job and your medical history (if indeed it can be proven true)

 

Where in MASS

I am in extreme western mass and have some need for provider hours coverage - max we see in a day is about 24 mostly in the mid teens,  dot, pcp, im  hours 8-5 no nights weekends or holidays.....

[cdcd67]

9 minutes ago, ventana said:

easy

get your PCP to give you a note taking you out to care for a loved one, child, parent, or due to risks of the job and your medical history (if indeed it can be proven true)

 

Where in MASS

I am in extreme western mass and have some need for provider hours coverage - max we see in a day is about 24 mostly in the mid teens,  dot, pcp, im  hours 8-5 no nights weekends or holidays.....

That seems sweet.

If I was in Massachusetts, I would have considered it.

[Monte]

1 hour ago, CJAadmission said:

Have you spoken with them at all regarding your concerns prior to now? If this is a "move the meat" kind of practice, you'll do well to get out. If you give notice and know you are leaving, as a short-timer you can start slowing down your patient load and there is not much they can do. 

Not only did I reach out to my medical director three times, but also the regional manager AND the owner of the franchise location. Both myself and the full-time provider I work opposite with have done the same- she is also seeking employment elsewhere. It's actually only gotten worse since these attempts. 

Edited January 26, 2021 by Monte

[Monte]

46 minutes ago, cdcd67 said:

My job has the same thing in their contract but they were okay with me quitting in less than 3 months.

One of the things I hate about medicine is how it just becomes a numbers game in the end. All they want is someone who can see as many patients as possible as quickly as possible.

I'm hopeful that they could be okay with it as well, but I'm predicting that the 3 months will be expected. I also don't need to quit on the spot, but feel that it's just too long under these circumstances. I guess I really just want to know if there could be legal issues if I say I want to stop at 4-6 weeks notice or so. And I agree with that hate

[Cideous]

Abhorrent, disgusting and UNSAFE.  These are the words that come to mind.

Just remember one thing...WHEN something goes wrong....not if but when!  They will drop you like a bad habit and you will be on your own.  Also remember that for the rest of your career you will get to explain that malpractice lawsuit.  Long after you are done with these masochists.  

[cdcd67]

3 hours ago, Monte said:

I'm hopeful that they could be okay with it as well, but I'm predicting that the 3 months will be expected. I also don't need to quit on the spot, but feel that it's just too long under these circumstances. I guess I really just want to know if there could be legal issues if I say I want to stop at 4-6 weeks notice or so. And I agree with that hate

I would definitely quit in your position as well.

I didn't face any legal issues. As long as you are in otherwise good terms with your boss, hopefully they will consider it.

Feel your pain though.

[Mayamom]

This is just unsafe.  An NP friend during the summer months was seeing upwards of 100 patients per day.  Mostly covid related but still unacceptable in my opinion.  Give 6 weeks.  If they bring up the 90 day then you may need to stick it out.  Be sure you have tail insurance!!

[rev ronin]

Out of curiosity, why would you give notice? Is this not an at-will state?

[Cideous]

Yeah, I pray this is a job where he got tail coverage.  Gawd if he didn't....

[Monte]

9 hours ago, rev ronin said:

Out of curiosity, why would you give notice? Is this not an at-will state?

I'm glad you brought this up. I don't know law enough, but I do know Massachusetts is an at-will employment state. Does anyone know more about what that means? I know that employers can basically fire someone for no reason but what does this mean for employees?

[ventana]

4 minutes ago, Monte said:

I'm glad you brought this up. I don't know law enough, but I do know Massachusetts is an at-will employment state. Does anyone know more about what that means? I know that employers can basically fire someone for no reason but what does this mean for employees?

at -will is superseded by a written contract

if you signed for a 3 month notice, you are bound by this contract

 

At-Will means they do not need cause to let you go - in accordance with the contract you have signed (they too are bound by it)

[Monte]

This is from the initial offer I signed -

"You must provide 90 days termination notice to cease employment. The company will provide you with 90 days’ notice for no cause termination, but terminate you immediately for cause in the event of the loss of your license, DEA certification.. etc."

No mention of penalty if this isn't done.. that's the only sentence about it. which is why I don't know the risk of leaving sooner.

[briansk]

In my practice, you would likely lose any PTO accrued and they may consider withholding pro-rated amounts of licenses, DEA, etc. from your last check. And would be  ineligible for re-hire.

[Cideous]

I will say it again.  Seeing those numbers alone, you are playing Russian Roulette with your career.  A bullet in 1 of 6 chambers, spinning it and pulling the trigger every day.  At some point, your luck will run out.

[ventana]

I would voice your concerns to HR

state that you feel that you are going to fast, and unhappy at the risk of missing something (they are making hundreds of thousands of dollars off you)

 

Ask to be released from your contract, with a great reference and with out any penalty and on the rehire list (get it in writting)

 

see if they will just let you walk - if not go at the pace you can do good medicine, put your foot down and stand firm.

 

I did a locums job at a regional UC clinic. First shift they were still checking people in when clinic was supposed to close.  I told them that under no uncertainty would I do this again. Everyone (non-providers) bitched about me and not wanting to work 12-13 hour days when scheduled for 10 - held firm and said that I was leaving 30 min after the end of my shift no matter how many people were left to see.  Low and behold they adjusted the policy to allow me to leave (I was closing the clinic/last person) so when I left they had no provider.   It was fine in the end. but it was a little rocky when I first stated this.  But so be it.....

 

Sometimes it is just standing firm on what you will and will not do.  This is totally defensible in the future if they try to fire you for cause - see what happens when you hire an attorney to make a claim against them for this when you were seeing 60 patients a day.....

[CAAdmission]

18 hours ago, Monte said:

Not only did I reach out to my medical director three times, but also the regional manager AND the owner of the franchise location. Both myself and the full-time provider I work opposite with have done the same- she is also seeking employment elsewhere. It's actually only gotten worse since these attempts. 

You have gone well above and beyond your due diligence. 

 

59 minutes ago, ventana said:

see if they will just let you walk - if not go at the pace you can do good medicine, put your foot down and stand firm.

This. If they won't let you walk, give notice and work at a pace that is safe. Just be prepared for them to get $h!**y with you - they might say you are working too slow or being insubordinate and terminate you for cause. 

[Monte]

6 hours ago, CJAadmission said:

This. If they won't let you walk, give notice and work at a pace that is safe. Just be prepared for them to get $h!**y with you - they might say you are working too slow or being insubordinate and terminate you for cause. 

I have a strong feeling they won't let me walk but I'm going to find out soon. In other news, today the MA told me they were watching me on the cameras as the manager called and told the MA I was going too slow and to go check on what I was doing in my office. I feel as though this is going to become a very uncomfortable/hostile workplace quickly. 

Edited January 28, 2021 by Monte

[Cideous]

9 minutes ago, Monte said:

I have a strong feeling they won't let me walk but I'm going to find out soon. In other news, today the MA told me they were watching me on the cameras as the manager called and told the MA I was going too slow and to go check on what I was doing in my office. I feel as though this is going to become a very uncomfortable/hostile workplace quickly. 

Holy shit LOL.  That is sick man!

[ventana]

document, document, document

 

it is amazing the power of simple handwritten notes documenting day to day happenings - conversations, comments and the like can truly make a legal case.  In your case it might be enough leverage to get released quickly with a guarantee good reference.  Seen it happen before.... 

 

forward yourself ALL work emails

BCC your own email on all sent emails

keep copies of everything

write down word for word in quotes comments that are negative

 

 

good luck

[AbeTheBabe]

14 hours ago, briansk said:

In my practice, you would likely lose any PTO accrued and they may consider withholding pro-rated amounts of licenses, DEA, etc. from your last check. And would be  ineligible for re-hire.

I don't know about pro-rating license/DEA, but PTO is an earned benefit and is to be paid out immediately at the end of employment in California. I'm hoping it's like that in all states. That's stealing your money if they don't pay it out.

[Rose66]

Find out most of the current jobs now at  "At will" which equal No job security but at least is a two way street and you can and should leave, under those conditions your are looking for trouble, and believe me they don't care a bit about your problems or your life, I will bet they will look for other candidates as soon as you give your letter, the longer I am in this profession the less I enjoy it , everyone wants to abuse us or get us out of the game ... is sad.

[CAdamsPAC]

On 1/27/2021 at 7:27 PM, Monte said:

I have a strong feeling they won't let me walk but I'm going to find out soon. In other news, today the MA told me they were watching me on the cameras as the manager called and told the MA I was going too slow and to go check on what I was doing in my office. I feel as though this is going to become a very uncomfortable/hostile workplace quickly. 

I'd be a real quick memory from that place!!