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New attending!! Having doubts about my job choice.

Discussion in 'Internal Medicine and IM Subspecialties' started by bananas85, Aug 25, 2015.

  1. bananas85

    5+ Year Member

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    I recently finished internal medicine training and moved to rural area to start my first job as a hospitalist. Although I like the patient population and the people I'm working with I feel like I feel like the hospital is ancient compared to what I Trained in. The EMR they uses Is all scripts/ sunrise/ apollo and it is terrible compared to epic, which is what I used.

    I was expecting a initial period of getting used to things because every hospital has a different way of doing things, i'm getting frustrated with my lack of skills navigating the EMR. The problem is the response time of the EMR is extremely slow, after a single mouse click it takes about three seconds for the EMR to respond. You can imagine that this adds up while you are when you are doing things like med rec or simply navigating the notes of consultants.

    Can someone give me some words of wisdom or pearls.. I know getting to know the consultants and the hospital staff will come with time, but the EMR is not going to change. If you have used inpatient Apollo/all scripts can you tell me if you were able to get efficient at it?
     
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  3. ThoracicGuy

    Physician 5+ Year Member

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    Allscripts is horrible. It is slow. It's cumbersome. Epic is much nicer compared to this. Unfortunately you don't get to pick your EMR. If everything else is going well, don't let the hospital EMR choice make or break your job. It'll get a bit better while you get used to it, though you'll always want the hospital to change to something better...
     
    Gpan likes this.
  4. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Perfect your craft and cash your pay checks. Re evaluate in three years.
     
  5. gutonc

    gutonc No Meat, No Treat
    Administrator Physician PhD 10+ Year Member

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    I was going to say 2. But otherwise I agree.
     
  6. bananas85

    5+ Year Member

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    Thanks all good advice and I appreciate it.

    I was there from seven in the morning till 1030 at night these past 3 days. (Just started). I was so exhausted last night and the computer was giving me trouble I just wanted to smash it LOL. I've been in bed all day till 5 PM. And still recovering ..
     
    #5 bananas85, Aug 25, 2015
    Last edited: Aug 25, 2015
  7. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Or two. Most contracts seem like three these days I was assuming.
     
  8. Gpan

    10+ Year Member

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    That is why I ALWAYS ask about what EMR they use in the hospitals on my initial interview with prospective employments. Don't underestimate the power of EMR or the negative influence of it on how sufficient you can be as a Doctor. One of my friends is in the same situation. He/She c/o about the emr the first day on the job and still complains about it now.

    I would ask around and see if anyone has tips or tricks on how to circumvent around that emr. Otherwise, you're stuck for the length of the contract. Sorry!
     
  9. bananas85

    5+ Year Member

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    Well
    My Contract is such that I can break it, I just have to give 3 months notice and my sign on bonus back. So it's not a huge deal, you know.

    I didn't realize emr would effect my job THAT much, i will give it a shot for 2-3 months if I am still getting frustrated I will leave. And go back to my reaidency institution or one of its sister branches if they will have me.
     
  10. Nivakia

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    Talk to the IT people and see if they are willing to buy a cheaper EMR that is more user friendly.
     
  11. instatewaiter2

    instatewaiter2 But...there's a troponin

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    Is it one computer/location. Perhaps they didn't give you enough bandwidth and it would be an easy enough fix.
     
  12. ThoracicGuy

    Physician 5+ Year Member

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    No, allscripts really is that slow...
     
  13. bananas85

    5+ Year Member

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    It runs better on my home laptop 16gb RAM, and i7 processor. But I also have 50mbps internet at home and was hardwired. What do you think is the most efficient way to do rounds now that I am out of residency.

    1. Computer round on all 2. Physically round on all 3. Do Notes 4. Do IM bills

    the cons of this is I may forget something since there are 18-22 patients to remember about

    or

    break them into clusters of 5 patients and do each of the above step 1 cluster at a time.

    the cons of this would be possibly not coming across something that should have been addressed sooner until its later in the day..
     
  14. rokshana

    rokshana Member
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    my first mind blown concept while 1st worked as a hospitalist was that I did not have to see everyone (and have notes written) by 9am...there is no attending's schedule that has to be met...you have 12 hours to see your pts, and get the paperwork done...

    everyone has a different way to do things, but when I was at a place where I had floor pts as well as admissions, i would prioritize the pts that needed to be seen early in the day...those that need to be discharged and those that were fairly active (i.e. needed tests, procedures, consults, etc) or needed things to help get them d/c...then those that were hanging out...placement issues, getting treatment that can't be done at home, so forth...paperwork was last on my priority (other than paperwork that was time sensitive... d/c summaries that needed to go with the pt or consults that needed to be available to the team that requested them, etc., and would either do them as i saw the pt (if i had a COW with me) or grouped with the floor i saw them...if billing was in an em that was integrated (like Epic) I would do it as i finished the note, otherwise did it a the end of the day. There would be a pause for an admission, so would try to get discharges tied up fairly early so they wouldn't be inadvertently delayed if there a lot of admissions or an icu pt started to crump...

    and sorry, nothing makes all scripts faster or efficient...
     
  15. FutureInternist

    10+ Year Member

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    Like rokshana said, everyone has a different way of doing things

    I see on average 15-16 pts (counting new pts I got from overnight admits) & then we get a max of 2 admits per day

    The biggest thing I do is get there an hour before anyone i.e 7 am
    This allows me to computer round on everyone by 8 & then leave for physical rounds while others are still parking their cars. That first golden hour w/o any pages etc is extremely useful for getting your day off to a good start
    Lots of times the nurses will be doing bedside handoffs at that time & I can get first hand reports from the night nurse as to the major events of the night

    The previous day, I would have made a list of potential d/c's the next day & those are the only pts I examine in the morning (I see everyone but not examine)
    This allows me to finish rounds earlier & then do all my d/c's prior to our unit based rounds (with the nurses, charge nurse & case managers etc)
    The d/c summary, to me, is very important to hand to the pt before they leave since that is, in a lot of cases, the only link for the PCP to the hospitalist. I hated it when I saw pts as their PCP & they told me they were in the hospital, since now you have to stop everything & try to get the d/c summary faxed over to you so you what happened, what meds they were d/c'd on, what you need to follow up on etc, so I try to avoid being the dickwad hospitalist that doesn't send d/c summaries with the pt
    The early d/c's also allow for unforseen issues (sister can't pick me up today, can I get a refill on this med even though you asked me if I needed any refills & I said no an hour ago etc) to crop up earlier in the day & can be dealt with a lot quicker/easier
    After d/c's & unit based rounds, I type up my notes (copy/past the physical exams from the day before) & once that is done (usually 2 hours for all the notes) then I go to my afternoon rounds where I update the pts on any new labs that may have come in since the morning & what the plan is. This is the time that I examine the remaining pts & if anything causes me to change my plan, I just update the finding & note accordingly

    There are many time sensitive issues, & if you can get those taken care of ahead of time then you will be a rock star & be home earlier than everyone else

    I always get the PCP appts, coumadin clinic appts, HHC orders, O2 orders etc done a day or two ahead of time so on the day of d/c you really just have to say Hi, put the steth on for a second & then spend 5-10 minutes reviewing the d/c plan
    Doing it ahead of time has the added benefit of all the appts showing up on the pt's d/c summary (rather than a list of phone numbers that will call them to make such appts)
     
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  16. bananas85

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    I feel like a quitter but I jsut cannot do this anymore. I JUST CANT.. I wanna roll up into a ball and cry. OVER and OVER AGAIN IT is taking double the time for everything


    .. I am depressed.
     
  17. Imdur

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    I don't have any experience with this as I am still a resident. But something tells me it will get better with time.
     
  18. bananas85

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    I placed my 90 days resignation notice. Now I know of what to look or going forward
     
  19. FutureInternist

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    Well guess you made your decision

    Things to ask about at your next job interview
    EMR (obviously) :)
    # of pts on average that each team has
    # of admissions that each team has to do
    Any caps on pts
    Open or closed ICU
    Any procedures that you are required/expected to do
    How are overnight pts distributed to the teams (does everyone get the same # or they pick on the efficient ones who have a low census & give them more)
    How long are you expected to stay at the hospital - some places require you stay on site till the end of your shift
    On admit (or overnight) shifts is there a minimum # of admissions that you are expected to do
    Do you call consultants directly or just put in the order in EMR
    How much of the 'scut' work are you expected to do - Calling rehab facilities, arranging for outpt infusion center appts etc etc

    Good Luck
     
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