For those times when you just need to vent a bit

[Guyton]

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Simple. You're a technician with Rx rights. Tech's don't get any respect.

The relegation of the psychiatrist to "prescriber" obviates his or her role as a professional and engenders the "technician" mindset. It is incumbent on the physician to set professional boundaries with their colleagues and educate them on appropriate practice standards. If we do not set the standard, then others with less training, competing motives, and often different priorities will.

 

[sunlioness]

He thanked me.

True story. I apologized to the patient for wasting his time. I told him I had only become aware of the situation today and that he had been scheduled for fifteen minutes. I said I didn't have time in fifteen minutes to ferret out the truth of who did what and thus I could not in good conscience prescribe a controlled substance. I told him I I was leaving the clinic in two months. I encouraged him to try to work things out wth his original doc, but barring that he needed to schedule an eval with someone new.

And he thanked me.


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[nancysinatra]

He thanked me.

True story. I apologized to the patient for wasting his time. I told him I had only become aware of the situation today and that he had been scheduled for fifteen minutes. I said I didn't have time in fifteen minutes to ferret out the truth of who did what and thus I could not in good conscience prescribe a controlled substance. I told him I I was leaving the clinic in two months. I encouraged him to try to work things out wth his original doc, but barring that he needed to schedule an eval with someone new.

And he thanked me.


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Sometimes it works to be direct. But not always. I work in a rural area that has a meth/adderall epidemic along with a high unemployment rate. All the time I get screamed at, sometimes by whole families, if I won't continue whatever crazy combination or dose of stimulants they are on, not to mention benzos. I have gotten very good at telling people that if all they want is Adderall (preferably TID), I can't help them but they are certainly free to get a second opinion. Then they yell at me because there are "no other doctors around here so who am I supposed to go to?" (Which is true. There is a dire physician and nurse shortage in this area. Psych is the worst.) Then when I tell them I'M leaving in a month, they yell at me because it means "I have to see another doctor again now? What's wrong with this place?"

Once I had a mom who was selling her son's vyvanse and her own xanax. They were both my patients. They scheduled appointments together. When I insisted on splitting them up, they'd show up together. They would both threaten me and the rest of the staff. Let me just tell you how fun that was. They got kicked out of the town ER once for doing the same thing.

It's gotten better though, from when I started. I've weeded out some of the worst cases. But I work at a clinic that is supportive. We don't see late arrivals if they more than 5 minutes late unless we have an opening. Follow ups are 20 min. No one on the staff pressures me to prescribe anything.

 

[clausewitz2]

He thanked me.

True story. I apologized to the patient for wasting his time. I told him I had only become aware of the situation today and that he had been scheduled for fifteen minutes. I said I didn't have time in fifteen minutes to ferret out the truth of who did what and thus I could not in good conscience prescribe a controlled substance. I told him I I was leaving the clinic in two months. I encouraged him to try to work things out wth his original doc, but barring that he needed to schedule an eval with someone new.

And he thanked me.


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[sunlioness]

Do you guys know what the legalities are around working with students?

At my old job, I wasn't allowed to precept medical students until I had a faculty appointment. They said that without the faculty appointment, my liability insurance wouldn't cover the student. This was on the CL service, so that was kinda important.

Here, I don't have a faculty appointment. But yesterday after the benzo guy thanked me, I got a call that said my first intake was here. I don't do intake on Tuesday and no one told me I was being pulled to intake. Also, I really hate intake. So I wasn't terribly happy.

And then I get down there and not only was I pulled to intake, there was a student down there whom I was apparently responsible for.

Well . . . I refused to take on the student. I told the coordinator that it just flat out was not going to happen. And that I needed a minute before I could see the patient (who was a polysubstance abusing survivor of childhood sexual abuse trying to get on disability).

The students here just basically shadow. Like I said, it's a waste of their time and money. So it's not like they actually do anything they could get sued over. But I'm not faculty. And I don't want to be saddled with students anymore when I already am not given the time to do what needs to be done. So I'm wondering if I could refuse because I'm not faculty? Then again, I don't want to make waves. 🙁

I feel like Sansa Stark. "My father was a traitor. My brother is a traitor. I love King Joffrey. I am His Grace's most loyal subject."

And the thing I can't get over . . . Last week before calling in sick for two days, I kinda lost it on a case manager. Not yelling at him, but going on a mini rant about something and blinking back tears. Then I call out two days in a row. Then I come back. And yesterday afternoon happens and I go on a mini rant in intake and blink back tears again.

And I've been nervously waiting for the clinic manager or the medical director to ask to talk to me about it.

And they haven't. I have to say that I genuinely don't want to talk with them about it. But it doesn't make me feel particularly valued either.

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[Shikima]

Do you guys know what the legalities are around working with students?

At my old job, I wasn't allowed to precept medical students until I had a faculty appointment. They said that without the faculty appointment, my liability insurance wouldn't cover the student. This was on the CL service, so that was kinda important.

Here, I don't have a faculty appointment. But yesterday after the benzo guy thanked me, I got a call that said my first intake was here. I don't do intake on Tuesday and no one told me I was being pulled to intake. Also, I really hate intake. So I wasn't terribly happy.

And then I get down there and not only was I pulled to intake, there was a student down there whom I was apparently responsible for.

Well . . . I refused to take on the student. I told the coordinator that it just flat out was not going to happen. And that I needed a minute before I could see the patient (who was a polysubstance abusing survivor of childhood sexual abuse trying to get on disability).

The students here just basically shadow. Like I said, it's a waste of their time and money. So it's not like they actually do anything they could get sued over. But I'm not faculty. And I don't want to be saddled with students anymore when I already am not given the time to do what needs to be done. So I'm wondering if I could refuse because I'm not faculty? Then again, I don't want to make waves. 🙁

I feel like Sansa Stark. "My father was a traitor. My brother is a traitor. I love King Joffrey. I am His Grace's most loyal subject."

And the thing I can't get over . . . Last week before calling in sick for two days, I kinda lost it on a case manager. Not yelling at him, but going on a mini rant about something and blinking back tears. Then I call out two days in a row. Then I come back. And yesterday afternoon happens and I go on a mini rant in intake and blink back tears again.

And I've been nervously waiting for the clinic manager or the medical director to ask to talk to me about it.

And they haven't. I have to say that I genuinely don't want to talk with them about it. But it doesn't make me feel particularly valued either.

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You're ok. Don't need to justify anything. You're on your way out and they're already dumping work on you because of this. If they have a problem with you setting boundaries, then it's on them, not you. And they will get over it - besides, it's not like you can't find another job, oh wait... you do have one lined up. 😉

 

[Bartelby]

...
And I've been nervously waiting for the clinic manager or the medical director to ask to talk to me about it.

And they haven't. I have to say that I genuinely don't want to talk with them about it. But it doesn't make me feel particularly valued either.

I'm guessing they don't care because you're on the way out. It sounds like a really toxic environment. As for the student issue I would ask a supervisor and/or any legal consultant that the clinic has. Someone higher up than a clinical attending should be making sure that the student has appropriate malpractice insurance in place. Once you confirm that someone else is handling it you can work with students with a clear conscience.

 

[thoffen]

I am wondering if it might be construed to have a treatment relationship with a person. Sounds unlikely given the scenario.

 

[Doctor Bagel]

I'm guessing they don't care because you're on the way out. It sounds like a really toxic environment. As for the student issue I would ask a supervisor and/or any legal consultant that the clinic has. Someone higher up than a clinical attending should be making sure that the student has appropriate malpractice insurance in place. Once you confirm that someone else is handling it you can work with students with a clear conscience.

Also you'd hope they make sure that the student has had the appropriate HIPAA training, infectious disease screening, background check, etc.. I'd also demand to be given more administrative time if I had to supervise students. Jeez, Sunlioness, your job sounds ridiculous. Good for you for getting out of there.

 

[sunlioness]

Yeah. And I've been sending emails asking for a copy of my liability insurance certificate as it's needed for credentialing at the new place and just getting crickets.

Just out of curiosity, I took the Maslach Burnout Inventory. It was .... Not good. But apparently, I got a 58% on personal accomplishment. So that's something.

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[finalpsychyear]

Yeah. And I've been sending emails asking for a copy of my liability insurance certificate as it's needed for credentialing at the new place and just getting crickets.

Just out of curiosity, I took the Maslach Burnout Inventory. It was .... Not good. But apparently, I got a 58% on personal accomplishment. So that's something.

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Proud to hear you took two days in a row. Not sure how many sick days/vaca days you have left. I would def max them out and have a few 4 day weeks or 3 days wknds to help manage your stress there. They seem to be taking advantage of you and don't even bother to even ask how your doing when your out a few days. Sounds like you have made them a ton of money with the volume you see. You earned those sick days. Use them all before your outta there. This job is a recurring scenerio when i think of CMHC jobs. Part of the reason Im considering putting up my own shingle but who knows.

 

[MLT2MT2DO]

Do you guys know what the legalities are around working with students?

At my old job, I wasn't allowed to precept medical students until I had a faculty appointment. They said that without the faculty appointment, my liability insurance wouldn't cover the student. This was on the CL service, so that was kinda important.

Here, I don't have a faculty appointment. But yesterday after the benzo guy thanked me, I got a call that said my first intake was here. I don't do intake on Tuesday and no one told me I was being pulled to intake. Also, I really hate intake. So I wasn't terribly happy.

And then I get down there and not only was I pulled to intake, there was a student down there whom I was apparently responsible for.

Well . . . I refused to take on the student. I told the coordinator that it just flat out was not going to happen. And that I needed a minute before I could see the patient (who was a polysubstance abusing survivor of childhood sexual abuse trying to get on disability).

The students here just basically shadow. Like I said, it's a waste of their time and money. So it's not like they actually do anything they could get sued over. But I'm not faculty. And I don't want to be saddled with students anymore when I already am not given the time to do what needs to be done. So I'm wondering if I could refuse because I'm not faculty? Then again, I don't want to make waves. 🙁

I feel like Sansa Stark. "My father was a traitor. My brother is a traitor. I love King Joffrey. I am His Grace's most loyal subject."

And the thing I can't get over . . . Last week before calling in sick for two days, I kinda lost it on a case manager. Not yelling at him, but going on a mini rant about something and blinking back tears. Then I call out two days in a row. Then I come back. And yesterday afternoon happens and I go on a mini rant in intake and blink back tears again.

And I've been nervously waiting for the clinic manager or the medical director to ask to talk to me about it.

And they haven't. I have to say that I genuinely don't want to talk with them about it. But it doesn't make me feel particularly valued either.

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At this point what are you afraid of? I know it isn't good to burn bridges but I don't see any real reason you're walking on egg shells.

Let me know if you're in need of more metaphors

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[keifernny2]

The best thing about this forum is that it helps us all realize that we're not alone.

I really don't get how these places stay in business when doctors keep quitting. ( including the ones that I work at). The turnover costs them a fortune.

While there may be a line up of nps looking for jobs, it's clear that if they were looking for more of them, they would be hiring them.



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[Trismegistus4]

Oh, man, you people are scaring me. I'm starting my first permanent job in August, working in an outpatient clinic for a large, "non-profit" hospital system. I dread the idea of being an employee, since I hated the corporate world so much in my previous, non-medical career. Reading all the legalese I have to sign just gives me the feeling that I'm signing my life away. And of course, they wouldn't be hiring doctors as employees if it weren't financially advantages to them. They're going to be making money off of me, skimming off the top of my collections. That's a pretty defeating feeling. I could have made almost twice as much as this job will pay, had I stayed on permanently at my last locums gig.

The big disadvantage of this new job is that new evals are only 30 minutes. Supposedly they have MA's taking all the history beforehand, making a 30 minute visit feasible. With a full schedule, I could theoretically have 22 patients a day, though on interview day one of the psychiatrists already there told me the average is 16-20. But it never really occurred to me before this thread that they could change appointment times (30 minute new, 20 minute follow ups) on me, since I don't think they're made explicit in the contract. I hope the next 2 years of my life aren't hell!

 

[cookymonster]

Oh, man, you people are scaring me. I'm starting my first permanent job in August, working in an outpatient clinic for a large, "non-profit" hospital system. I dread the idea of being an employee, since I hated the corporate world so much in my previous, non-medical career. Reading all the legalese I have to sign just gives me the feeling that I'm signing my life away. And of course, they wouldn't be hiring doctors as employees if it weren't financially advantages to them. They're going to be making money off of me, skimming off the top of my collections. That's a pretty defeating feeling. I could have made almost twice as much as this job will pay, had I stayed on permanently at my last locums gig.

The big disadvantage of this new job is that new evals are only 30 minutes. Supposedly they have MA's taking all the history beforehand, making a 30 minute visit feasible. With a full schedule, I could theoretically have 22 patients a day, though on interview day one of the psychiatrists already there told me the average is 16-20. But it never really occurred to me before this thread that they could change appointment times (30 minute new, 20 minute follow ups) on me, since I don't think they're made explicit in the contract. I hope the next 2 years of my life aren't hell!

Just wondering why you decided to take an employed gig instead of stick with locums work?
Your posts in another thread made it sound like a solid option.
I have a very good employed inpatient position, but the institutional inflexibility is a drag, as is paying over a third of my income in taxes. I have to wait a few years to get benefits vested, otherwise I'd probably go ahead and cut the cord.

 

[nexus73]

masters level intakes are okay when the presentation is straightforward.

 

[Trismegistus4]

Just wondering why you decided to take an employed gig instead of stick with locums work?
Your posts in another thread made it sound like a solid option.
I have a very good employed inpatient position, but the institutional inflexibility is a drag, as is paying over a third of my income in taxes. I have to wait a few years to get benefits vested, otherwise I'd probably go ahead and cut the cord.

Honestly, the biggest reason I chose to bite the bullet at this time is that, with all my belongings in storage and me living out of locums-provided housing, it was becoming a logistical nightmare not to have a permanent residence.

masters level intakes are okay when the presentation is straightforward.

Heh. I meant Medical Assistants, not Masters of Arts.

 

[splik]

Heh. I meant Medical Assistants, not Masters of Arts.

This sounds like a terrible job. a masters levels counselor at least has some mental health training and can take something that resembles a psychiatric history (and potentially a good social and developmental and family history). However I cannot imagine a medical assistant (who has no training in medicine, psychiatry, or history taking - we have them in our dementia clinic and they can barely complete a MOCA correctly with the instructions in front of them). This sounds like a train wreck cant imagine you'll last long in this job....

 

[Trismegistus4]

This sounds like a terrible job. a masters levels counselor at least has some mental health training and can take something that resembles a psychiatric history (and potentially a good social and developmental and family history). However I cannot imagine a medical assistant (who has no training in medicine, psychiatry, or history taking - we have them in our dementia clinic and they can barely complete a MOCA correctly with the instructions in front of them). This sounds like a train wreck cant imagine you'll last long in this job....

We shall see. I signed a 2 year contract with a signing bonus that I'd have to repay on a pro-rated basis if I left early. There is 1 afternoon off a week, and the vacation time starts at 4 weeks and goes up by 1 week per year for the first few years, so that's not bad. What I'm hoping will happen is that I'll make some contacts in the area and find out about some private practice opportunities, since the non-compete clause isn't restrictive against those.

 

[notdeadyet]

What I'm hoping will happen is that I'll make some contacts in the area and find out about some private practice opportunities, since the non-compete clause isn't restrictive against those.

How so? What does your mom-compete clause include?


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[Trismegistus4]

How so? What does your mom-compete clause include?


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For a period of 2 years after I leave, no other older woman may text me as soon as my plane lands to make sure I'm OK, keep trying to feed me extra food, or throw up her hands in exasperation as I try to teach her how to use her computer.

But seriously, it's 1 year long and it restricts me only from working within a 15 mile radius for one of three competitors (or their subsidiaries) named in the contract. There's no restriction against me working for any other entity, or starting a private practice, or joining a group private practice. I could be wrong, but I thought that was pretty good, because I thought a lot of non-compete clauses sought to bar the physician completely from practicing his specialty at all within a certain radius and a certain time period.

 

[notdeadyet]

That's not bad.

Re: the "mom-compete clause": I will blame my iPhone, but I do notice I've had a disproportionate number of typos after SDNing in the company of a couple of Little Sumpin's in my local after a particularly grueling week. Mea culpa...

 

[keifernny2]

suggestion: Save the signing bonus in your savings account for the first few months until you're sure whether you like the job. That way, if you decide to leave early, you aren't underwater and trying to save up to buy your way out of the contract.

 

[nexus73]

Heh. I meant Medical Assistants, not Masters of Arts.

Dear god

 

[Doctor Bagel]

My job has some real downsides, don't get me wrong, but can I vent that I'm sad that it's ending because our unit is closing. Today, I got a free loaf of high quality bread from the friendly janitor lady just because and then bought some vegetarian tacos for $2.50 at the cafeteria where I was greeted by the very friendly elderly lady cashier who always wishes me a truly enthusiastic good day. Then I left and walked 50 feet to my car parked in the free parking lot and drove against traffic to get home. 8 more months ... 🙁

 

[sunlioness]

At this point what are you afraid of? I know it isn't good to burn bridges but I don't see any real reason you're walking on egg shells.

Let me know if you're in need of more metaphors

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I care because it's in me to care. I want to be seen as professional. A good worker. Someone who willingly does what is required.

I think a lot of docs feel the same way and it's part of why we're so easy to dick over.

Did you hear what the surgeon general said recently? He is very concerned by physician burnout in medicine. And we all need to take up yoga and not worry about eating dessert if we want to.

Why did I not know these things? It seems so simple now . . . I shall raise a creme brûlée in his honor while seated in lotus position.

The office manager sent me an email specifically to forward me the email she sent letting me know my schedule had changed. I don't check my work email because every time I turn the computer on, it sounds like a 747 coming in for a landing. It also has a DVD-ROM, a floppy drive, and a sticker than says "Now with Windows XP!"

So, not to say "hey I heard you kinda freaked out down in intake, what's up? You okay?"

But something that felt more like "I heard you told lies about me and if you just checked your damn email once in a while you'd know that."

So what did I do?

I apologized for not checking my damn email.

I also went to bed at 6:30pm last "night". Alright. Gotta go do this prior authorization for a medication initially prescribed by another doc for this patient I only saw once and for fifteen minutes. And my phone's ringing . . .

TGIF.

 

[thoffen]

Sorry sunlioness. Best of luck to you wherever you end up out of that place. Hard enough to deal with the projections of our patients, dealing with it from our staff is another story. And sometimes the more professional you actually act, the more people think that it's OK to dump on you.

 

[sunlioness]

Thank you.

And I'll be okay. I'm going somewhere so much better. The boss likes me. Thinks of me as a person, a colleague, and a friend. We're on a first name basis. He works as hard or harder than any of us and does amazing work with his patients.

Here I'm just a widget to a guy who drives a Lexus, attends Very Important Meetings while we see patients, and insists on being called "Doctor".


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[Trismegistus4]

suggestion: Save the signing bonus in your savings account for the first few months until you're sure whether you like the job. That way, if you decide to leave early, you aren't underwater and trying to save up to buy your way out of the contract.

Oh, that won't be a problem; if anything I'm overly financially conservative. I can't stand not having a large rainy day fund, to the point where a more financially shrewd person would probably say I'm missing out on investment opportunities by keeping so much of my money in cash. My checking account balance is already several times the amount of the singing bonus, and climbing.

A big part of the reason I took this particular job is that it was the only seemingly decent job offer I had in a desirable city. If I were married with kids (or ready to give up on finding a wife and resign myself to being single for life,) I'd have no problem living in a smaller town, but as a single guy who still wants a family, I still feel I need to live in an urban area. Of course, as sunlioness's example shows us, being picky about location can certainly backfire...

My biggest fear is that I'll get "stuck" in this job because despite what I wrote about about hoping to find other local opportunities once I'm there, I'm an introvert who doesn't really like networking, and am always going to be limited to finding jobs through recruiters and job postings.

 

[sunlioness]

So I asked to speak with the medical director. I wanted her to know how burnt out I am and to ask for her help to brainstorm ways to get us all to my last day.

She showed up with my production data from a few months ago. My utilization was at 58%. She seemed perplexed as to why I would be feeling so drained when my numbers were so bad. She said that with 58% utilization, I actually could spend 20 minutes with patients (apparently because my utilization numbers for an entire month are consistently reflected day-to-day and people kindly no show on a scheduled basis that can be predicted). She encouraged me to take more time with patients to "reconnect to what's fun about psychiatry" even if it meant I ran late.

I asked if certain schedule tweaks were possible. They're not. I asked if I could not see patients who showed up so late that they actually missed their appointment. Nope. But I could tell them they may have to wait a while.

Yet she seemed so earnest, and sincere, and trying to be compassionate and helpful.

But the end of our discussion, I felt that one of us had to be crazy. And I wasn't entirely certain as to which one of us it was. The message seemed to be, "Here are the reasons why you shouldn't be feeling as you do. And if you spent more time with patients, you would reconnect to the joy of it."

In the end it doesn't matter which of us is crazy. Because it clearly isn't working for me. And it clearly isn't working for them either.

I just wish she had suggested an earlier end date.

 

[smalltownpsych]

So I asked to speak with the medical director. I wanted her to know how burnt out I am and to ask for her help to brainstorm ways to get us all to my last day.

She showed up with my production data from a few months ago. My utilization was at 58%. She seemed perplexed as to why I would be feeling so drained when my numbers were so bad. She said that with 58% utilization, I actually could spend 20 minutes with patients (apparently because my utilization numbers for an entire month are consistently reflected day-to-day and people kindly no show on a scheduled basis that can be predicted). She encouraged me to take more time with patients to "reconnect to what's fun about psychiatry" even if it meant I ran late.

I asked if certain schedule tweaks were possible. They're not. I asked if I could not see patients who showed up so late that they actually missed their appointment. Nope. But I could tell them they may have to wait a while.

Yet she seemed so earnest, and sincere, and trying to be compassionate and helpful.

But the end of our discussion, I felt that one of us had to be crazy. And I wasn't entirely certain as to which one of us it was. The message seemed to be, "Here are the reasons why you shouldn't be feeling as you do. And if you spent more time with patients, you would reconnect to the joy of it."

In the end it doesn't matter which of us is crazy. Because it clearly isn't working for me. And it clearly isn't working for them either.

I just wish she had suggested an earlier end date.

The message from the more malignant narcissistic administrators is always going to be along the lines of: "How can you complain when we have documentation to prove how badly you suck. I just can't believe that you can't see that the sky is green and the trees are blue. What is wrong with you?" As you might have guessed, I had a conversation with an admin type just the other day.

 

[deleted736562]

So I asked to speak with the medical director. I wanted her to know how burnt out I am and to ask for her help to brainstorm ways to get us all to my last day.

She showed up with my production data from a few months ago. My utilization was at 58%. She seemed perplexed as to why I would be feeling so drained when my numbers were so bad. She said that with 58% utilization, I actually could spend 20 minutes with patients (apparently because my utilization numbers for an entire month are consistently reflected day-to-day and people kindly no show on a scheduled basis that can be predicted). She encouraged me to take more time with patients to "reconnect to what's fun about psychiatry" even if it meant I ran late.

I asked if certain schedule tweaks were possible. They're not. I asked if I could not see patients who showed up so late that they actually missed their appointment. Nope. But I could tell them they may have to wait a while.

Yet she seemed so earnest, and sincere, and trying to be compassionate and helpful.

But the end of our discussion, I felt that one of us had to be crazy. And I wasn't entirely certain as to which one of us it was. The message seemed to be, "Here are the reasons why you shouldn't be feeling as you do. And if you spent more time with patients, you would reconnect to the joy of it."

In the end it doesn't matter which of us is crazy. Because it clearly isn't working for me. And it clearly isn't working for them either.

I just wish she had suggested an earlier end date.

Making you feel that something is wrong with you seems like a classic manipulative maneuver. Although this is just a hunch from afar.

Just a question: does spending more time with patients to discover the "fun in psychiatry" mean you get to leave work later with no extra payment?

 

[sunlioness]

Making you feel that something is wrong with you seems like a classic manipulative maneuver. Although this is just a hunch from afar.

Just a question: does spending more time with patients to discover the "fun in psychiatry" mean you get to leave work later with no extra payment?

It would, yes.

I had 26 scheduled today. It wasn't fun.

 

[MacDonaldTriad]

Are you sure you don't work for the VA?

 

[Doctor Bagel]

Are you sure you don't work for the VA?

Nobody at my local VA works that hard. Change sun lioness's 16 to 6, and you'd be talking.

 

[Doctor Bagel]

So I asked to speak with the medical director. I wanted her to know how burnt out I am and to ask for her help to brainstorm ways to get us all to my last day.

She showed up with my production data from a few months ago. My utilization was at 58%. She seemed perplexed as to why I would be feeling so drained when my numbers were so bad. She said that with 58% utilization, I actually could spend 20 minutes with patients (apparently because my utilization numbers for an entire month are consistently reflected day-to-day and people kindly no show on a scheduled basis that can be predicted). She encouraged me to take more time with patients to "reconnect to what's fun about psychiatry" even if it meant I ran late.

I asked if certain schedule tweaks were possible. They're not. I asked if I could not see patients who showed up so late that they actually missed their appointment. Nope. But I could tell them they may have to wait a while.

Yet she seemed so earnest, and sincere, and trying to be compassionate and helpful.

But the end of our discussion, I felt that one of us had to be crazy. And I wasn't entirely certain as to which one of us it was. The message seemed to be, "Here are the reasons why you shouldn't be feeling as you do. And if you spent more time with patients, you would reconnect to the joy of it."

In the end it doesn't matter which of us is crazy. Because it clearly isn't working for me. And it clearly isn't working for them either.

I just wish she had suggested an earlier end date.

Sounds like gas lighting to me.

 

[keifernny2]

Your other alternative is to start billing all level 1 follow ups, putting a kitchen bell-timer on your desk, and ushering everyone out after 5 minutes. Admin will get the hint once they start seeing your reimbursements coming back.

 

[watto]

Ha on the level 1s...my favorite passive-aggressive expression of anger used to be flooding the insurance companies with prior authorization requests for drugs that didn't need to have prior authorization. When I had extra time, I was like, "why not waste some of their time." They had to read the authorization, look of the info, and send me back a fax that the patient didn't need it.

It was a very mild form of subversion, I admit.

 

[F0nzie]

So I asked to speak with the medical director. I wanted her to know how burnt out I am and to ask for her help to brainstorm ways to get us all to my last day.

She showed up with my production data from a few months ago. My utilization was at 58%. She seemed perplexed as to why I would be feeling so drained when my numbers were so bad. She said that with 58% utilization, I actually could spend 20 minutes with patients (apparently because my utilization numbers for an entire month are consistently reflected day-to-day and people kindly no show on a scheduled basis that can be predicted). She encouraged me to take more time with patients to "reconnect to what's fun about psychiatry" even if it meant I ran late.

I asked if certain schedule tweaks were possible. They're not. I asked if I could not see patients who showed up so late that they actually missed their appointment. Nope. But I could tell them they may have to wait a while.

Yet she seemed so earnest, and sincere, and trying to be compassionate and helpful.

But the end of our discussion, I felt that one of us had to be crazy. And I wasn't entirely certain as to which one of us it was. The message seemed to be, "Here are the reasons why you shouldn't be feeling as you do. And if you spent more time with patients, you would reconnect to the joy of it."

In the end it doesn't matter which of us is crazy. Because it clearly isn't working for me. And it clearly isn't working for them either.

I just wish she had suggested an earlier end date.

You are at a huge disadvantage because your departure gives your boss no reason to invest in your needs. She was clearly unable or unwilling to see the problem from your perspective or empathize with your distress. It was a superficial interaction and a "we win you lose paradigm". But the reality is you both lose. If the problem is not entirely yours, how would that reflect on her? She is tagging you with inadequacies but if she were to accept any responsibility in the matter she would also have to accept the major company financial loss of your departure. If this is how she operates with employees think of how much of a disaster it would be to have someone like this manage your company. With you on the way out the door, she is protecting her own interests until you are gone. You cannot fix anybody's insanity, but you can ask questions to see just how far down the rabbit hole they are.

A few questions I would have like to ask:

What are the average utilization percentages of other psychiatrists? How have other psychiatrists addressed the issue?

If such a significant discrepancy still exists what do you believe the cause of the problem is?

How does a permissive and accommodating appointment no show policy have an impact on utilization long term?








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[nexus73]

That sucks.

But ultimately you're leaving the place because it sucks. I vote for keeping your head down grinding the last bit out. They can make it hurt but they can't stop time. Soon enough you will be free.

 

[WingedOx]

The message from the more malignant narcissistic administrators is always going to be along the lines of: "How can you complain when we have documentation to prove how badly you suck. I just can't believe that you can't see that the sky is green and the trees are blue. What is wrong with you?" As you might have guessed, I had a conversation with an admin type just the other day.

my co-chief resident used to do that type of thing. Made for a fun year of leadership.

 

[WingedOx]

Nobody at my local VA works that hard. Change sun lioness's 16 to 6, and you'd be talking.

This thread has almost given me a sense of guilt about the fact I'm given a full 30 min for followups in my VA clinic... then I have a week like I had this week. The acuity in my outpatient clinic is off the charts. I'm honestly wondering who is going to snap first... and when they do will it be self-directed violence, or a wife that gets attacked/killed.

 

[Shikima]

This thread has almost given me a sense of guilt about the fact I'm given a full 30 min for followups in my VA clinic... then I have a week like I had this week. The acuity in my outpatient clinic is off the charts. I'm honestly wondering who is going to snap first... and when they do will it be self-directed violence, or a wife that gets attacked/killed.

I've been having the same thing. In addition, the therapists are "too busy" and are offended that I instruct the patient to attend weekly psychotherapy due to crisis.

 

[sunlioness]

Yeah. It did help in that my perspective has changed from "I need to do a decent job and try to help people" to "I need to do an acceptable job so as not to kill anybody or get myself sued." Sucks for the patients, but it sucks for them anyway.

My lawyer friend (who isn't my lawyer, just a lawyer friend) said I should directly ask for an earlier end date. I just don't see that ending well. :-/. Especially since the only place my current end date is in writing is an email and I'm trying to figure what to do about that. Should I have my actual lawyer draw up papers? Should I ask them about it? She suggested asking them about it and casually mentioning that I'm happy to have my atty draft the relevant paperwork.


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[splik]

how long have you got left? I would go on sick leave for as long as you can - you are clearly burnt out working in this toxic environment and it's not good for you or your patients to continue.

 

[sunlioness]

A few questions I would have like to ask:

What are the average utilization percentages of other psychiatrists? How have other psychiatrists addressed the issue?

We got a print out of everyone's numbers at a staff meeting a month or so ago. At that point I was in the upper 60s, which was low average for the department. Not the worst. Not the best. Target is 75%. Only one doc was at target. I think it's understandable that I'm low . . . I'm still new and am seeing mostly patients who are assigned to other docs they can't get in with. A patient is more inclined to show up for an appointment with someone they have a relationship with than someone they don't know and whose appointment was made by a case manager because the treatment plan is out of compliance.

It's interesting to me that she chose to bring February's numbers to our chat. I remember the February staff meeting where she said, "Our utilization is down across the board. We're scheduling people for evals if they haven't had one in a while just to try to get our numbers back up."

such a significant discrepancy still exists what do you believe the cause of the problem is?

How does a permissive and accommodating appointment no show policy have an impact on utilization long term?

It sure as hell doesn't help. Case in point. The other day I was running down to intake. A case manager flagged me down because she wanted me to write meds for a patient who had missed her appointment in the morning. She showed up for it in the afternoon after her doc had left the building. I said I couldn't. I was late down in intake. The patient (again, not my patient) asked how long I'd be down there. "Two hours." And this woman I'd never seen before in my life and who had shown up hours late for her appt flipped out on me. "That's unacceptable! I need my meds! You need to write them for me NOW." So because of our loosey policy, patients are entitled. The morning doc's numbers go down. And I get yelled at.

I asked to speak to the medical director because earlier this week a patient yelled at me for being late. I was late. That was true. The patient was being inappropriate, but her frustration was justified. Instead of apologizing and trying to deescalate the situation, I got defensive and kinda yelled at her back. I am quiet. I am shy. I am conflict avoidant. I have NEVER done anything like that in my life. "This is bad" I say to myself and ask for the meeting. She told me, "Oh that happens to all of us from time to time. It's not big deal. It only matters that you take that experience and learn from it." Again, that had never happened to me before. And I am not some young doc fresh out of residency.

I've thought about sick leave. It kinda pleases me on the "I asked to get out quickly and you said no. So instead of paying me nothing, you get to pay me 60% of my salary for the next month or so." But I don't want that on my record. People ask about that stuff during licensing and credentialing and I don't want to have to explain it for the rest of my career. Though I guess using up my sick days wouldn't do that. It's short term disability that would do that.

I have one month, nineteen days, five hours, twenty-five minutes,and twenty-one seconds to go.

Not that I'm counting.

Today is my short day. Only 23 scheduled . . ..








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[sunlioness]

And you know, there were things I could do at other jobs to improve numbers. At my last job I was on RVU and I felt no shows directly. But I had more control over it. Plus patients there got reminder calls. If they didn't come, I could bill them and recoup some of the credit. And if they didn't come consistently (3 no shows within a year), I could discharge them.

Here, no reminder calls unless they have an ICM who takes it upon herself to do it. No billing. No discharging. So I'm being held accountable for something over which I am completely powerless. Unless I'm missing something. It's probably that I need to reconnect to the joy of psychiatry. And if I did that, my joy would be infectious and patients would show.


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[nexus73]

Can you use vacation to take a day off each week. If you can, take every Wednesday off. That way each day is either the first day back or your last day before time off.

 

[WingedOx]

I've been having the same thing. In addition, the therapists are "too busy" and are offended that I instruct the patient to attend weekly psychotherapy due to crisis.

Thankfully I have a good team of therapists (one of the reasons I'm happy here so far) and we're all usually in agreement that me trying to manage these people from just my MedMon clinic is a seriously bad idea, but the patients don't want to show up for therapy, don't want to commit to an IOP or higher level of care, refuse to be admitted, etc. Plus, the splitting and other cluster B bull**** out of these rural vets is off the charts.

Despite this, the line "this is why so many of us kill ourselves!" has been thrown around like candy at a parade any time we do or say something they don't like, despite their frequent non-adherence. One of my therapists yesterday got told that "I'm going to report you to Senator ____ and Fox News!" after we called our second safety check on him in a month after he screamed into the phone that he was suicidal and refused to answer his phone after that.

I've got a guy in his early 30s coming in as my last patient this afternoon who is already loaded up on opiates because of chronic back pain. Still refuses to go to the vet center for therapy, then spends the whole half hour frustrated at me because I won't start him on xanax. "So what are vets who are in pain and anxious supposed to do!? Are you supposed to just let us suffer!?"

 

[sunlioness]

He's gonna have to get Xanax on the street and he'll have to go to a bad neighborhood for that. And he might get beat up, robbed, or murdered. Do you want that on your conscience, doc?

I had a vet tell me that in residency in a similar situation to yours. Fortunately back then, the suicide thing wasn't in the news as much.

I remember when a bunch of my non medical friends were posting stuff on social media. One of those "share if you agree!" things saying vets should be allowed to see private docs if the VA wait was too long. And I'm like, do out know how many orders of magnitude longer wait it is to see a private psychiatrist?! I was scheduling four months out for a new eval at the time.

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