Bad management

[Attending1985]

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Any tips for coping with bad management? I have worked at my outpatient clinic for the past nine years and it’s overall been ideal. I work part time, can do therapy have no call and am reimbursed well. Management has been for the most part benign. Unfortunately, my manager left about a year ago and a new psychologist took over as clinical lead. Personally, I don’t jive with this person and I find her inauthentic and I get a bad gut feeling. One example is asking me to take over patients from a new psychiatrist that was hired and instead of saying something generic like patient wants to switch or not a good fit she tells me specific negative things the patient said about the psychiatrist. This has happened multiple times. Overall, my impression is she inflates herself and admonishes others while putting on a saccharin sweet demeanor. I dread interacting with her and I find myself more stressed at my job knowing any issues that arise will go through her. At the same time the other favorable aspects of my job have not changed which makes me hesitant to leave. Any advice on ways to cope with this? My tendency is to keep my head down and focus on my own practice as clinic drama has ebbed and flowed over the years. I’m wondering if it’s time to speak up more about this situation but knowing how things work don’t want to create a worse situation for myself.

 

[FlowRate]

Maybe I'm missing something but this doesn't sound like the level of manager issue that's IMO worth leaving an otherwise good job. Do you have to interact with her frequently and for extended periods of time? I'm not hearing examples of objective bad management as much as a lack of personality fit. What is there to "speak up" about? Sounds like the vibe of how she delivers the reason the patients decided to transfer makes you feel like it's for nefarious purposes, but sometimes it's helpful to know what patients found to not be a good fit with their last psychiatrist (either because it's something I can appropriately work around or to anticipate the patient eventually firing me, as well.)

 

[randomdoc1]

as someone who's been on both ends of the table, I have some understanding of the situation. Obviously, every situation is so unique! Yes, if you personally do not jive with the person, I'd try to figure out what will be tolerable for me. And as you indicated, decide which battles you want to pick. It does feel like a situation of trying to stay in your own lane best as you can without other crap flowing into it. Because probably people involved will not be interested in changing their minds, so it's finding what's the most peaceful way to agree to disagree. It's good to know what your breaking/leaving point is and be self aware of that, although it does not seem to be you are very near it. Which is good. I thought being an employer would keep me away from these situations but learned you can never full get away from it. I regularly have to determine what is tolerable enough for me and the practice collectively and at what point *gulp* do I have to let someone go. The deciding point is how disruptive is it to all of us collectively, not just purely how much I personally dislike someone. So I think as long as whether you are an employee or employer, if the mindset is of the collective, that may help guide your decisions too. I have realized that without saying anything, other people already notice what we may be noticing and saying less can be more. Because you are demonstrating that you all know but you are not trying to stir the pot in a way that can increase adverse events. I've learned as an employer, there's always so much drama and it's a massive headache. So there may be more things going on that people are willing to share and understandably so. You just never know! In your situation I'd be thinking about, putting my best self forward but with healthy boundaries and specific clear expectations. Navigating office politics carefully and being mindful of what I say. Once said, it cannot be taken back. And if things escalate, be prepared to have specific examples and observe if others are observing the same. It's really hard to discipline or fire anyone. No one enjoys and it is full of legal hoops and rightfully so. But concrete and specific content is where it is at. Continue to form allies and emotional support with colleagues. But also be careful who you confide in. I realized you never know what anyone's agenda is these days. Nothing is a surprise anymore.

 

[Attending1985]

as someone who's been on both ends of the table, I have some understanding of the situation. Obviously, every situation is so unique! Yes, if you personally do not jive with the person, I'd try to figure out what will be tolerable for me. And as you indicated, decide which battles you want to pick. It does feel like a situation of trying to stay in your own lane best as you can without other crap flowing into it. Because probably people involved will not be interested in changing their minds, so it's finding what's the most peaceful way to agree to disagree. It's good to know what your breaking/leaving point is and be self aware of that, although it does not seem to be you are very near it. Which is good. I thought being an employer would keep me away from these situations but learned you can never full get away from it. I regularly have to determine what is tolerable enough for me and the practice collectively and at what point *gulp* do I have to let someone go. The deciding point is how disruptive is it to all of us collectively, not just purely how much I personally dislike someone. So I think as long as whether you are an employee or employer, if the mindset is of the collective, that may help guide your decisions too. I have realized that without saying anything, other people already notice what we may be noticing and saying less can be more. Because you are demonstrating that you all know but you are not trying to stir the pot in a way that can increase adverse events. I've learned as an employer, there's always so much drama and it's a massive headache. So there may be more things going on that people are willing to share and understandably so. You just never know! In your situation I'd be thinking about, putting my best self forward but with healthy boundaries and specific clear expectations. Navigating office politics carefully and being mindful of what I say. Once said, it cannot be taken back. And if things escalate, be prepared to have specific examples and observe if others are observing the same. It's really hard to discipline or fire anyone. No one enjoys and it is full of legal hoops and rightfully so. But concrete and specific content is where it is at. Continue to form allies and emotional support with colleagues. But also be careful who you confide in. I realized you never know what anyone's agenda is these days. Nothing is a surprise anymore.

Thanks. I appreciate that feedback. I know this person is not well liked but has climbed the management ladder as no one else wants these positions. She also wants a bigger presence than past managers and tends to push for a personal relationship which I don’t want. Unfortunately most of my allies have left the clinic over the past few years but I do have a colleague I’m close to that is very supportive and feels the same.

 

[Candidate2017]

Management positions tend to attract narcissists. Probably more so with psychologists and psychiatrists, as those professions are held to be some kind of authority on the human condition. What else is there to do to cope with your clinic manager other than some combination of ignore, confront, or assert yourself depending on the conflict at hand and whether or not you feel the energy is worth it?

A fake person is going to be fake, and hopefully every psychiatrist at your clinic should be able to see it. Certainly, your manager isn't that great at therapy if they are repeating the patient's badmouthing of their psychiatrist. Some would say they're a terrible therapist to allow patients to switch psychiatrists in the same clinic. Personally, I would speak to the new psychiatrist regarding your experience and get some insight into all parties involved, as well as increase transparency among physicians.

I'd also wonder if your manager is splitting the psychiatric staff. Newly hired psychiatrists tend to have their own way of doing things, which may butthurt managers who are used to their clinic psychiatrists keeping their mouths shut. Physicians often remain silent about management's stupidity, which reinforces management's stupidity. In reality most physicians know there isn't enough time (and no money) to correct every stupid thing that comes out a manager's mouth while grinding out 99214s/RVUs.

 

[Attending1985]

Management positions tend to attract narcissists. Probably more so with psychologists and psychiatrists, as those professions are held to be some kind of authority on the human condition. What else is there to do to cope with your clinic manager other than some combination of ignore, confront, or assert yourself depending on the conflict at hand and whether or not you feel the energy is worth it?

A fake person is going to be fake, and hopefully every psychiatrist at your clinic should be able to see it. Certainly, your manager isn't that great at therapy if they are repeating the patient's badmouthing of their psychiatrist. Some would say they're a terrible therapist to allow patients to switch psychiatrists in the same clinic. Personally, I would speak to the new psychiatrist regarding your experience and get some insight into all parties involved, as well as increase transparency among physicians.

I'd also wonder if your manager is splitting the psychiatric staff. Newly hired psychiatrists tend to have their own way of doing things, which may butthurt managers who are used to their clinic psychiatrists keeping their mouths shut. Physicians often remain silent about management's stupidity, which reinforces management's stupidity. In reality most physicians know there isn't enough time (and no money) to correct every stupid thing that comes out a manager's mouth while grinding out 99214s/RVUs.

Completely agree about the management narcissist piece. It’s very discomforting knowing that someone with this personality structure has an impact on my life. I think it just makes me feel powerless knowing that if it were to be me she’d choose to mistreat as I’ve seen her mistreat this other clinician I don’t see myself having any recourse as management protects management.

 

[comp1]

My first thought reading the OP's post was...that is not so bad. I've definitely worked for much, much worse although things are pretty darn good now. If they otherwise like the job, I'm not sure that kind of manager is a good enough reason to leave. The risk for worse is quite high. It sounds like the OP might be more grieving the loss of their previous manager. I get being uncomfortable with the boss badmouthing colleagues and it's indeed a dangerous road for the manager to tread. The social cohesiveness theory of gossip is that it strengthens in-group bonds and that is pretty well supported in research, but it certainly can be horrifically maladaptive in splitting situations.

 

[Attending1985]

My first thought reading the OP's post was...that is not so bad. I've definitely worked for much, much worse although things are pretty darn good now. If they otherwise like the job, I'm not sure that kind of manager is a good enough reason to leave. The risk for worse is quite high. It sounds like the OP might be more grieving the loss of their previous manager.

I think I’ve been lucky throughout residency and attendinghood for the most part to be surrounded by good, supportive people. I think that’s a big reason why I’ve been able to thrive and do good work. Her position was offered to me but I didn’t want it. In hindsight, I probably should’ve taken it to avoid this.

 

[comp1]

That's a really good lesson. Even for people who hate being a manager, it can be worlds better to put up with managerial responsibilities than put up with being under a bad manager. I know I've certainly made that decision. MDs typically make only a tiny bit more money (relatively) for being a manager. This is why managers are mostly RNs and psychologists, but there are a lot of reasons to take a managerial job beyond money. Fortunately it sounds like the new manager might not stick around that long, so you might get another chance and you'll be an even better manager yourself for having had this experience.

 

[Attending1985]

That's a really good lesson. Even for people who hate being a manager, it can be worlds better to put up with managerial responsibilities than put up with being under a bad manager. I know I've certainly made that decision. MDs typically make only a tiny bit more money (relatively) for being a manager. This is why managers are mostly RNs and psychologists, but there are a lot of reasons to take a managerial job beyond money. Fortunately it sounds like the new manager might not stick around that long, so you might get another chance and you'll be an even better manager yourself for having had this experience.

Yeah lesson learned. Would’ve been better off with that headache than this one. Unfortunately this person has big admin goals and I don’t see her leaving anytime soon.

 

[Wilf]

One of the disappointments I’ve had with psychiatry is that we so often let ourselves be ruled by people much less educated and qualified or competent than us. The current CEO of my hospital is a dumb MBA (his whole reputation is being dumb) and he has not been shy about changing policies affecting us negatively. I’ve interviewed at places where the CEO is a social worker or nurse or in one case, a pharmacist. That being said, some of the psychiatrists I’ve worked under weren’t much better.

The current CEO talks down to me about management and business issues and it’s ironic and annoying because he’s often incorrect, plus I have an MBA from a school just as good as his 🙄

 

[futureapppsy2]

sometimes it's helpful to know what patients found to not be a good fit with their last psychiatrist (either because it's something I can appropriately work around or to anticipate the patient eventually firing me, as well.)

My thoughts exactly--this could help avoid multiple "patient bounces" between psychiatrists.

 

[comp1]

We definitely all need to take more management positions.

 

[Attending1985]

We definitely all need to take more management positions.

Agreed.

 

[FlowRate]

We definitely all need to take more management positions.

And if someone isn't the type who wants to be a manger, it can also help to push colleagues who you think would be a good manager to apply for those positions when they open.

 

[randomdoc1]

Agreed.

I hate managing people. But I learned I either do managing or I end up managed....
Would not have issues with the latter if the management was good but that's so rare.

They say those who do not wish for power are the ones most fit to hold it. So true.