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Related: Culture Forums, Support ForumsTrouble in Paradise: If someone was looking to disrupt my enjoyment of my new job, they succeeded.
Since coming back on board my old community health organization after thirteen years of overwork with their crosstown rival, I've been working in the urgent care department, and also as a float, going to whichever clinic needs help on any particular day. I'm hoping to secure my primary care position in the next few months.
Urgent care stays pretty busy, and we have a good-sized team of providers, all of whom are wonderful colleagues to have, and with whom I really enjoy working. Sometimes, however, the unpredictable schedule in urgent care can lead to days that are slower than others, resulting in a decrease in billable patient encounters.
The organization's bean-counters think they have found a wonderful way to increase the number of billable encounters. Any time any of we urgent care providers are "not doing anything", they want us to surf the electronic in-boxes of certain specific medical providers who are not in urgent care, and sift through the items looking for opportunities to create billable encounters. If we find a notation that might lead to a follow-up visit for a medication refill or a lab result review, we're supposed to forward it to scheduling. This, according to those who dreamed up this cockamamie scheme, is because the primary care providers are too busy with their own encounters to work their electronic in-boxes.
If this sounds sketchy to any of you, it certainly does to the rest of us in urgent care. Why the hell should we be responsible for another provider's in-box? Isn't it that provider's responsibility? Claiming to be "too busy" to do one's paperwork is the height of unprofessionalism, as is expecting someone else to do it.
For thirteen years, I spent every single day keeping tabs on my e-inbox. Because I was always facing a tall stack of papers on my desk in the mornings, and needed office time to tackle that, I had to make sure my electronic in-box was cleared out so I didn't have to waste office time on it. Every single day, days off, weekends, sick days, vacations, holidays, I was always in there taking care of the work. When every category of item was cleared out, it was never more than an hour or two before it would start to fill back up again. I never allowed the work to get to an overwhelming level.
Now, I'm being told I have to do someone else's work. I pointed out to the architects of this scheme that it was ill-advised, and unfair to those of us who are doing our own work. They just about came unglued. The words "unprofessional", "insubordinate", and "a bad PA", names I was never, ever called before in my old job, were hurled at me all in the space of about fifteen seconds. After getting ambushed with this, I got up to leave, and one of them barked "WE'RE NOT DONE YET!"
It's been a pretty rough couple of weeks since that disastrous meeting. Mrs. Aristus is urging me to quit, even though we have the chance to soon be working in the same clinic. My confidence in myself and my work has taken a huge hit, and the Medical Director, and the Director of Operations, both of whom I have known and respected for nearly twenty years, are hearing from people who don't know me or my work that I'm unprofessional and insubordinate.
It's enough to make a man drink. (Which I intend to, soon. )
One of my colleagues in the float pool, whom I assume suffered her own ambush after objecting to that crazy scheme, has e-mailed the rest of us, requesting a meeting amongst ourselves before going to upper management. As in everything else, it's nice to know one has allies. The MD at the head of the float pool was scandalized when I told her how I had been treated, and I think I can count on her support, too. We'll see what happens.
But it's been a nasty knock, since I came here to get away from the toxic atmosphere of my old job. Right now, I'm holding out for my primary care position, when I will no longer be required to do some other provider's work for them.
If you've gotten this far, thank you for listening.
You are all very dear friends, and I love you all.
hlthe2b
(102,341 posts)But it is what we have and are stuck trying to make it work. I hope you can make it work for YOU too.
Joinfortmill
(14,448 posts)Somewhere along the line things went astray in medicine. So sorry it's come to this.
Aristus
(66,440 posts)My old employers were constantly on all of us for more billable encounters; more, more MORE! But they never forced me to do another provider's work, or called me unpleasant names if I expressed my reservations.
Joinfortmill
(14,448 posts)Also, so disrespectful. I worked in the Corp world for a long time. Lots of narcissists among those folks.
DENVERPOPS
(8,844 posts)the FOR PROFIT Corporations have descended on the Medical Care Industry with both feet.
Corporations are buying up Hospitals across the nation at a stunning pace.
Private practices are being wiped out in massive numbers everywhere.
Health care in Rural America was bad to begin with, now the lack of Health care in rural america is becoming non existent.
And yet, Rural America continues to vote for the Republicans, who have hastened this lack of health care in rural america....
The part all of these Republican Voters are too ignorant to realize is, that if the Republicans/Trump are put back in power the Republican voters will all be kicked to the curb. A Fascist Tyranny will be put in place that will no longer need their votes to rule America from that point on...........
Any election under the Republican Regime will be a joke, and closely resemble the elections in Russia......
I know...I know, it is un-fathomable how 70+Million Trumphumping Voters can be that stupid to not realize this.......
DJ Synikus Makisimus
(177 posts)If so, it would be worth checking the union contract (or consulting with a representative of the union) to see if that practice is a violation. If not, it's worth thinking about seeing whether there is sufficient interest among the folks you work with to organize. Unions are about the only defense we have against abusive practices and speed-ups in the workplace.
Aristus
(66,440 posts)I am well-paid and working conditions are good. I just object to being talked to that way by people who don't know me.
The rest of the float providers and I are considering having a meeting with the uppers. Either make this scheme part of our contract, or drop it altogether. There is strength in numbers.
bucolic_frolic
(43,257 posts)Nice to know the medical professions work just like lawyers and auto mechanics. A lawyer was told to write more letters for billable hours. Health care is not profitable enough, there's more money in sick care.
Silent Type
(2,935 posts)about 75% of medical staff by acquiring land to build medical offices AND bring on new doctors.
The next day, the 75% started sending their patients 30 miles down the road as a protest (the receiving hospital was in Marjorie Crazy Greens district, of all places). Took a few days for hospital admin to back off and apologize to docs.
Saw several other uprisings as well. Hope things work out. That kind of crud is totally unnecessary.
Easterncedar
(2,315 posts)This toxic attitude is sadly widespread, and it poses a real danger to the health care system in this country, where hospitals close, providers are forced to consolidate, insurers dictate the kinds of care we can give or be given and nurses are leaving at a shocking rate. The crowded and dangerous ERs are often just a nightmare, and finding a bed can be nigh impossible. Why? Because money.
Freddie
(9,273 posts)How can you even get into other providers emails?
Unwind Your Mind
(2,042 posts)It seems like a violation of privacy for the patients who think theyre writing to their own doctor or staff
Aristus
(66,440 posts)You know, where they can receive files of patient records, outside lab results, medication refill requests, requests for prior authorizations, imaging results, morgue reports, , etc, etc. These are actually easily accessible by any provider with the EMR system that we have. We do have to have this kind of access for when a provider needs coverage while on vacation, and so on.
The objection here is that the providers in question have full in-boxes, and rather than getting a nudge that it's time to address this, they just gang up on other providers (whom they have arbitrarily decided are "not doing anything at the moment" ) to do the work for them, under the rubric of generating more billable encounters.
You're right, though; it does seem unethical.
LoisB
(7,222 posts)I hope they rethink this.
TheRickles
(2,077 posts)Last edited Thu Apr 11, 2024, 07:55 AM - Edit history (1)
Silent Type
(2,935 posts)That wont change.
TheRickles
(2,077 posts)there will be much, much less pressure on providers to produce. Breathing room.
Silent Type
(2,935 posts)credentialed, audits have to go on, etc.
TheRickles
(2,077 posts)Last edited Thu Apr 11, 2024, 12:37 PM - Edit history (1)
will be dramatically reduced. By some estimates, the savings generated by shifting from standard insurance (where over 20% of premiums go to cover administrative costs) to Medicare (where the share is closer to 5%) could in and of itself cover the costs of Medicare for All.
debm55
(25,287 posts)Aristus
(66,440 posts)It may be again. We urgent care and float providers get dumped on due to the perception that we're "not doing anything" (when in fact we're pulling down 12-15 encounters a day). I'm hoping to get my primary care position soon. That will put an end to this.
malthaussen
(17,216 posts)I'm hearing weird echos from all the Adjunct professors I know who are "hoping to get a tenure-track job."
I know about zero about the health care profession, but what I do hear suggests to me that the suits want the professionals to be just as insecure and under the whip as they are in academe.
-- Mal
Mme. Defarge
(8,040 posts)Back in the day I thought of it as the migrant labor for higher education.
twodogsbarking
(9,792 posts)The bullshit got to her and she retired. She also got tired of watching people die.
Healthcare ain't like Grey's Anatomy.
onecaliberal
(32,887 posts)This scene is happening in so many places.
Aristus
(66,440 posts)I just dealt with it the way I dealt with bullying and name-calling when I was in junior high: I just reminded myself that if they knew me, they wouldn't have talked to me that way. No one who knows me and my work does.
onecaliberal
(32,887 posts)wendyb-NC
(3,328 posts)Healthcare can be flat out nuts. Like bean counters, with their bottom line, bringing in the cash and are using medical and health care professionals. Sounds like a scam in a way, searching for ways you can make clients/ patients come back in for a test, or other consultation, or treatment to bill them/their insurance for. Also, how do co-workers feel about having another, PA or NP going behind them and reviewing their work. Bad idea. Move that bean counter to the widget factory.
I will be holding you in the light to get that primary care, position. You deserve respect.
Fuck insubordination.
Aristus
(66,440 posts)Sometimes, a little light makes all the difference.
mahina
(17,693 posts)Sucky situation. Hope all goes well. Aloha kaua.
Bluethroughu
(5,176 posts)Unions sit at the table and negotiate what you want your day to be and bean counters give their opinions.
I've said for over a decade Doctors need a Union. These corporate healthcare companies have health care providers divided, together you all are equally strong against the corporate bean counters.
elleng
(131,073 posts)and been thinking things moving along nicely.
sprinkleeninow
(20,254 posts)PatrickforB
(14,586 posts)both patients and actual medical personnel.
Happy you are back at the community health org you want and hope you get your old primary care position back.
RainCaster
(10,911 posts)I had that from several bosses over the years. I don't work for them any more. Now I have a great VP, but I'm still retiring next year.
MLAA
(17,318 posts)patient records seems kinda iffy to me. You arent being to consult on the patients health, therefore having a need to know their health history, instead you are being sent to snoop until you find something billable.
Sending you strength and energy to manage the bullshit.
You describe the situation perfectly. It seems more than a little iffy to me.
niyad
(113,526 posts)new job is going. I wish I could say that I am shocked about that filthy scheme from the bean counters, but. . alas, I am not. I am shocked and outraged, however, at their treatment of you. HOW DARE THEY??? I know this does not help, but please know that some very unpleasant energies and wishes are headed their way. NOBODY gets to hurt, insult, abuse, malign or threaten my friends.
Please let us know if there is anything we can do to help.
Aristus
(66,440 posts)I'm always overwhelmed by the support of good friends and people who care.
Hekate
(90,773 posts)Aristus
(66,440 posts)LisaM
(27,827 posts)It bothers me. It adds stress and leaves a ton of room for error. And any job needs downtime.
cilla4progress
(24,760 posts)I'm sorry you are being subiected to this, Aristus.
highplainsdem
(49,027 posts)Skittles
(153,174 posts)I am curious if you watched the series THE RESIDENT, they addressed the for-profit-health system A LOT
AllaN01Bear
(18,346 posts)private industry can do it better . now there is hmos and for capital hospitals . what a waste.
AllaN01Bear
(18,346 posts)Sogo
(4,992 posts)And we look forward to hearing when you've changed to the primary care position!
ECL213
(215 posts)NotASurfer
(2,153 posts)Access to patient information not directly related to care for the patients that you're providing care for. That would raise some eyebrows in Compliance if they're on their game
malthaussen
(17,216 posts)"Billable hours," forsooth. Well, health care is a commodity in the USA, even if most of the people who provide it think of it as a vocation.
-- Mal
Unfortunately, they were other providers. Not in my chain of command, but pretty full of themselves nevertheless. One was an MD, and the other was a PA. She was the one who called me a "bad PA". I've already crossed them off my Christmas card list...
malthaussen
(17,216 posts)Whichever, they need help, soon.
-- Mal
cloudbase
(5,524 posts)my response would be "oh yes we are."
You have a valuable skill, and you were looking for a job when you got this one. Life's too short for that kind of aggravation.
montanacowboy
(6,098 posts)left last year and they still haven't replaced her. They are down to two MD's now and you can't even get an appt. I am a year over getting my annual and still haven't found a new primary care. I don't know what is wrong with this system anymore. Sorry for your trouble Aristus.
KT2000
(20,586 posts)and the value of nothing. I am afraid there are increasing numbers of people who place money above everything else. Sometimes bonuses are involved. This the corporate model now - destroy the intangibles such as cooperation, loyalty etc., and push and push. This will only stop with push-back but it has to be done all together, not individually.
They will suffer the loss of individual employees to the point of recruiting from foreign countries and working the system to be allowed to use less qualified workers. That is already happening with EMTs being allowed to triage on their own.
ShazzieB
(16,485 posts)As a patient, when I have a longstanding relationship with a health care provider, the last thing I would want is to get a call from some stranger sticking their nose into my care. My reaction would probably be something like, "How is my A1C (or whatever) any of your business, person who I don't know from Adam?" (I would be polite and civil, but that's what would be going through my head.)
Those bean counters need to stay in their own lane. They have absolutely no business trying to tell health care professionals how to handle patient care. And the way you were talked to was flat out abusive! These people are so far out of line they probably need binoculars to even see the line from where they are!
I'm glad you have like minded colleagues to band together with. That's almost always more effective than trying to tackle something like this on your own. There is power and safety in mumbers! I wish all of you well in dealing with those morons.
SupportSanity
(172 posts)Tough position.
The healthcare industry is full of "bright ideas" - something to be proud of.... They'll thank me later!
Absolutely full of it. STATUS! No way around it. And this is just this round in this particular position.
Maybe writing/making movies would be easier? Paul Schraeder (Taxi Driver,American Gigolo, The Last Temptation of Christ) says:
"Every time you think the studios have fucked you every way they can, they come up with a new way." quote from IMDB.COM
See if you can grin and bear it then move on. I wish you luck.
SouthernDem4ever
(6,617 posts)I hope you can get past this nonsense and back to doing your good work again.
Redleg
(5,827 posts)I am finding it very hard to not stereotype these folks as soulless and programmed corporate stooges. A good number of my university students are studying accounting and they seem like decent people, pretty much indistinguishable from their colleagues in management, marketing, economics, and finance. I guess their first real corporate gigs after graduation transform some of them into %#$@&*ers.
Voltaire2
(13,119 posts)All across our highly concentrated and financialized economy the 'bean counters' are 'growing' the quarterly profits by making every aspect of economic operations shittier.
AKwannabe
(5,676 posts)This stinks.
My unaskedfor advice
Ride this out till the meeting with colleagues.
Maybe see ya tomorrow night in the lounge!
Aristus
(66,440 posts)I'll probably be in the Lounge tomorrow night. But I won't be starting my drinking thread until Friday, the 26th.
calimary
(81,435 posts)You deserve it, and all the good wishes from your fellow DUers. It'll help you get through this.
Always remember what our Skittles once said, and still holds true: "Someone's always here." At ANY hour. If you need somebody to talk to or commiserate with or just to listen while you unload, ANY hour is good, here. Someone always WILL be here.
70sEraVet
(3,508 posts)Then you're not doing 'insubordination' right!
In my short Navy career, I had to go to Captain's Mast after I had recently been promoted to Third-class Petty Officer. My Captain pointed his finger at me, and yelled that promoting me to Third-class Petty Officer was the worst mistake the Navy had EVER made!
THAT is how you 'insubordinate'!
Marthe48
(17,011 posts)I would rather have you as a health care provider than people who think money is the be all and end all. Hang in there, and keep your head up.
Sorry you have to endure crap.
PatSeg
(47,567 posts)and unprofessional (on their part, not yours). I can completely understand your anger and discomfort. There is something seriously wrong with our healthcare system and what happened to you is just another example.
It is unnerving that so much of it as about billable encounters and not actual healthcare. I hope the primary care position opens up soon. No one should have to put up with that kind of abuse.
3catwoman3
(24,029 posts)I would not feel at all comfortable poking around in someone elses documentation looking for shortcomings. Its always infuriating when someone who doesnt do your job has some hare-brained idea of how you should do your job differently.
My boss would, from time to time, complain that I was took too much time seeing my patients compared to my physician colleagues. One time, I got brave and replied that I was diligent and thorough.
I was the only NP, working with 9 pediatricians. I felt the diligence and thoroughness was absolutely necessary as I never wanted anyone to feel that they got the short end of the stick because they were not seeing the doctor.
RobinA
(9,894 posts)death by a thousand cuts. I'm not in urgent care, I'm in mental health. Left two jobs because of suggestions that I do hour billing scams. Ones that could easily have been uncovered if anyone was looking. I'm 66 and hanging on to make the best of my pension, but I'm one insult away from the permanent walk out the door.