1st Attending Job Question

[B1GM0N3Y86]

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Hey guys, been a while since I have posted anything but I had a question. I had accepted an Outpatient only FM Position with a 2 MD and 2 Mid-level office staff with a health system in the region. Overall, the compensation base pay and RVU compensation looked aboved average for a new attending.

Few things that I noticed my first week which I wanted to share and ask if something seems "off"
- During orientation day at lunch time, staffing attempted to get me to sign a form. When I asked what it was, they d/w me that it was a supervisory form for the mid-levels. I stood my ground, refused to sign the supervisory agreement and after 20 minutes of telling them I was not comfortable with it they backed off
- During my first day, I find out the one Full Time position doctor was actually going PART TIME on my 1st Day. He now does not work any Fridays.
- I also found out that the other doctor in the office works 4 ten hour days (Mon-Thursday) essentially leaving me with 2 mid-levels on Fridays to hold down the fort
- And just now, I have started to get lab results that are coming back for the 2 MD's that arent here today. (the one doctor warned me about 10-15 INRs that may come back on Fridays, but no one d/w me about how they would expect me to monitor not just CRITICAL results but also NL results).

Question I have,
Is this NL for a 1st time gig. B/c I dont know if I just sound like a complainer, or if this is trending on a bit of a abuse.

Appreciate any insight from seasoned attendings.

 

[VA Hopeful Dr]

One of my partners takes Fridays off as well. I will deal with his critical labs, otherwise they can wait until Monday.

If you don't want to supervise midlevels then don't.

 

[Sushirolls]

Sounds like you need to work 4 tens, and take Mondays off. Then it all levels off.

 

[B1GM0N3Y86]

Agreed, I have already told mgt that I am not going to supervise mid-levels since it wasnt in my contract. Just found it irritating that they tried to get me to sign the agreement (take liability without any increased compensation).

I do not mind handling the 10 or so INR's, nursing handles the patient calls and orders for INR rechecks. However, I think I am going to have a conversation with the 2 other MD's that unless you have critical results, they can wait till Monday.

Appreciate any further insight over this.

 

[AMEHigh]

I personally would not be happy about the Friday thing and would talk to your supervisor or the other doctors about it. I certainly wouldn’t want to be the only doctor there on Fridays as someone just starting out and then expect that the mid-levels are going to expect to come to you with questions. Nope.

 

[linguistafeliz]

I agree that sounds off. Agree maybe good to push for 4 10 hr shifts and Monday's office. Be careful with them.

 

[Splenda88]

They are just taking advantage since you are a new attending. Most organizations do that.

 

[DoubleBogey]

If it’s not in your contract, you don’t have to format, I would not sign the form unless there is additional compensation which would be an amendment to your recently signed contract.
Very common to have individuals out throughout the week and schedule time off, Fridays are very common as well as Mondays or Wednesdays.
I would not be as upset about this, as far as handling lab results, INR‘s take two seconds to follow, but I think practice as a whole could be more efficient, ordering INR’s on Wednesday so this way the results either later Wednesday or Thursday allowing for the absent physician to respond to the lab.

 

[deleted480308]

If it’s not in your contract, you don’t have to format, I would not sign the form unless there is additional compensation which would be an amendment to your recently signed contract.
Very common to have individuals out throughout the week and schedule time off, Fridays are very common as well as Mondays or Wednesdays.
I would not be as upset about this, as far as handling lab results, INR‘s take two seconds to follow, but I think practice as a whole could be more efficient, ordering INR’s on Wednesday so this way the results either later Wednesday or Thursday allowing for the absent physician to respond to the lab.

Yeah, if you don’t work on friday, you don’t put coumadin clinic on Thursday. That’s just dumping work

 

[deleted480308]

One of my partners takes Fridays off as well. I will deal with his critical labs, otherwise they can wait until Monday.

If you don't want to supervise midlevels then don't.

I’ll add that if you aren’t the supervisor, they don’t get to run patients by you.

Get paid enough that you want the risk/hassle or don’t discuss anything with them or sign any agreements...

 

[B1GM0N3Y86]

Hey guys, quick update. Appreciate the advice especially since I'm new to the whole attendinghood life. Had a short 5 mi ute meeting with the office mgr.

I simply just said that unless it's a critical result or an INR that needs managed, the ordering provider can handle the task when he or she returns to office. Seemed to go over well. Seems tho if you aren't willing to set boundaries early on, they will push to get you to do more than what is called for

 

[B1GM0N3Y86]

Hey guys,

So another update. After saying everything previously to the office manager on what I was willing to do or not do, I found some interesting news today. So in recap, I was told when I was interviewing that there was 2 Full Time MD's and 2 midlevels and that the 1 MD was considerring going to part time in distant future. I made it clear prior to signing that I wouldn't want to be by practicing without having a colleague to bounce an idea off of my first few years since I just graduated. I was also told call would be 1 in 5 and planning to go to 1 in 6 when they sign another doctor on board.

So in a matter of 10 days since starting, I was told the one FT doctor is now Part Time my first day and he doesn't work either Mondays or Fridays as well as the other FT doctor doesn't work Fridays since he does 4 day work weeks.

Today, I found out the 4 day work week FT physician is leaving January.

So starting in January, my 4th month on as an attending. I will be the only FT doc in office. Have 1 PT doc Tues-Thurs. ANd have 2 midlevels that I have refused to supervise. And call is now 1 in 4 weeks.

Is this NL for gigs, or is this a sh#tty set up.

 

[Splenda88]

@cicchri

If you signed a contract and all these things are outside of the 4 corners, you can break that contract... Why do people think they can take advantage of new grads is beyond me?

 

[SLC]

I worked alone Thursdays immediately out of residency. I don’t think you can complain too much about that, you’re attending now. You are trained, licensed, and board certified to do this alone and unsupervised now.

But if you aren’t contracted to supervise midlevels, they should be told (by you) to not expect to run patients by you. And if you are kind enough to share a pearl with them, they don’t name you in the chart.

I wholeheartedly agree that you shouldn’t cover other providers labs unless critical and TBH, I think unless you guys have set up a formal agreement you should have all criticals sent first to the ordering doc, even if it’s their day off. And you only address it if the ordering doc is unavailable to be reached. And then there better be an understanding that you’re not gonna get blamed if something is not done a certain way. If there’s an expectation on how you address something, it needs to be signed out to you in an If:then fashion, so you can just follow the ordering doc’s preference. Informal “results coverage” is an easy way for the “new guy” to get burned if you handle it differently than the ordering doc would prefer.

 

[deleted87716]

If there’s an expectation on how you address something, it needs to be signed out to you in an If:then fashion, so you can just follow the ordering doc’s preference. Informal “results coverage” is an easy way for the “new guy” to get burned if you handle it differently than the ordering doc would prefer.

I'd be careful of that, too. If you're the one making a decision, it's ultimately your decision. If sh-t goes bad, you won't be able to fall back on, "But, Dr. So-and-so told me to do this!" Any time somebody signs a patient out to me, I take any of their recommendations as just that...recommendations, not orders.

 

[SLC]

I'd be careful of that, too. If you're the one making a decision, it's ultimately your decision. If sh-t goes bad, you won't be able to fall back on, "But, Dr. So-and-so told me to do this!" Any time somebody signs a patient out to me, I take any of their recommendations as just that...recommendations, not orders.

Well yes, obviously you gotta do what you know is right. But if there’s any room for differing approaches to a lab, then I’d be asking the ordering doc “what would you prefer I do if this result is abnormal”. If for no other reason, to make sure they’re at least putting some thought into it and not just “dumping” work on you.

But in practice, I just don’t get into covering inboxes unless a partner is literally out of the country. There’s an understanding in my office that we can all be contacted at home on our days off with lab or other issues. We decide ourselves what can and can’t wait.
And when we know we’re gonna need box coverage, we do our best to anticipate issues and give the covering doc a heads up.

 

[d2305]

There are critical labs and labs that require immediate attention. If you're there with midlevels your're responsible for them whether you're on their supervisor form or not.

 

[SLC]

There are critical labs and labs that require immediate attention. If you're there with midlevels your're responsible for them whether you're on their supervisor form or not.

Not where I work. They’re the responsibility of their supervising doc, who by law needs to be easily reachable, if not in the building, whenever they work.

 

[d2305]

If you're in the practice, you're likely to be served when something untoward happens.

 

[VA Hopeful Dr]

If you're in the practice, you're likely to be served when something untoward happens.

I'm going to need you to provide some examples of that, because I find it very hard to believe that if one of my partners is sued by a patient that I have never seen or Cross covered on that I would be named in the lawsuit.

 

[SLC]

I'm going to need you to provide some examples of that, because I find it very hard to believe that if one of my partners is sued by a patient that I have never seen or Cross covered on that I would be named in the lawsuit.

To be fair, I’ve been asked to give deposition in a Med-mal case recently. Patient who died under my care in residency due to the actions of a doc who had the patient before I did.

My lawyer was wanting to grill me in practice to “iron out any kinks that might get me sued“. When I asked her how I could be named if I didn’t harm the patient, she said “all it takes to get named is the plaintiff deciding they want to name you. Let’s make sure you don’t say something to make them think they want to name you...”

 

[VA Hopeful Dr]

To be fair, I’ve been asked to give deposition in a Med-mal case recently. Patient who died under my care in residency due to the actions of a doc who had the patient before I did.

My lawyer was wanting to grill me in practice to “iron out any kinks that might get me sued“. When I asked her how I could be named if I didn’t harm the patient, she said “all it takes to get named is the plaintiff deciding they want to name you. Let’s make sure you don’t say something to make them think they want to name you...”

There's the catch - a patient under your care. Its not surprisingly to me that you were named in that case.

My question would be more like if a patient under the care of another resident that you have never seen or cared for had an adverse outcomes, you're unlikely to be named. Otherwise every resident would be and that's just not how that happens.

Yes, you CAN be named but the post I responded to said it was likely.

 

[SLC]

There's the catch - a patient under your care. Its not surprisingly to me that you were named in that case.

My question would be more like if a patient under the care of another resident that you have never seen or cared for had an adverse outcomes, you're unlikely to be named. Otherwise every resident would be and that's just not how that happens.

Yes, you CAN be named but the post I responded to said it was likely.

Oh I wasn’t named. The ED resident, the attending, the hospital, and the ED doc’s group were named.

I was just asked for a deposition.

But my lawyer said in no uncertain terms that all it takes to be named in a Med-mal suit is the plaintiff wanting to sue you. There’s no requirement other than that.

 

[VA Hopeful Dr]

Oh I wasn’t named. The ED resident, the attending, the hospital, and the ED doc’s group were named.

I was just asked for a deposition.

But my lawyer said in no uncertain terms that all it takes to be named in a Med-mal suit is the plaintiff wanting to sue you. There’s no requirement other than that.

I'm not arguing that. I'm arguing how likely it is if you have never had any kind of contact with the patient.

 

[B1GM0N3Y86]

Appreciate the input. From what administrators here and the office mgr has stated, the supervisory physician has to be easily reachable if not in the office. The part time physician that signed up for that has stated the same. If midlevel asks me something on a Friday, Ill simply state that I want no part in being documented as the MD he/she sought counsel from since the other MD is that.

It isnt all bad, there are a couple decent bonuses about this place
- 8 hr work day includes your 1 hour lunch, so in by 8am and done at 4pm
- all results reviewed --> i review them, nurses do all phone calls
- any orders i want to place on a patient outside of a patient visit --> i start a telephone note and mark it to nursing --> nurses order meds/labs/imaging for the pt, informs the pt why i order them --> and then all i do is cosign the orders

This makes managing patients easier with the nurses doing all the calls and placing orders outside the visits for us providers


In all, I believe this Job if anything will give me experience of what I def will want or not want in next position. Last thing I want to show is that I lasted only weeks to a few months at my first attending job and having to explain it. For now tho, I think I am willing to give it a shot. If things start to go downhill after a few months of having only a part time doc w/ me and midlevels --> start search in my hometown area which is a few hours away, sign a new agreement, and give my notice to current employer. All while not having any down time between Jobs.

 

[SLC]

I'm not arguing that. I'm arguing how likely it is if you have never had any kind of contact with the patient.

Yeah, Obviously unlikely then.

 

[BigSib]

...During my first day, I find out the one Full Time position doctor was actually going PART TIME on my 1st Day. He now does not work any Fridays.
- I also found out that the other doctor in the office works 4 ten hour days (Mon-Thursday) essentially leaving me with 2 mid-levels on Fridays to hold down the fort
...

Sounds like you got f**ked over and were not aware of the responsibilities that were expected. You should talk with your colleagues and whomever is your 'boss' about this especially if you were not expecting it.

 

[d2305]

The bad thing is that your malpractice insurer may settle the case despite your protest. You will have to report it at every license application. The good news is that FM isn't a litigious specialty.