All Branch Topic (ABT) Non-physician in charge of physician?

DD214_DOC

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    Does this ever happen anywhere outside of the .mil? I was acting chief of my clinic/section for about a year and the previous chief I replaced was also a physician. During my tenure, I was able to really change the environment of the clinic, morale increased, people enjoyed coming to work for a change, a lot of the BS stopped, etc., etc.

    The workload sucked so I was grateful when the permanent chief came on board and I could step down. However, the new chief is a civilian PhD. He makes decisions now regarding my schedule, workflow, and even does the triage for referrals to me.

    The environment here has significantly changed to the point that I and many others no longer enjoy working here. I have a constant deluge of nonsense referrals and absolutely zero say in the triage process. Admin staff have also been both encouraged and supported by the new chief to independently and liberally schedule patients outside of my appointment template for patient convenience, such as merging two follow-up sessions to create an intake evaluation, even though I have two open intake slots on other days that same week. They ignore my instructions of when to schedule a f/u and which apt type to schedule someone in, so I am routinely seeing complex high-acuity patients in 30 minute apt slots (which actually end up being about 15 minutes actual face to face time), or 10 minute f/u patients being scheduled in my 60-minute apt times.

    I realize this is more a venting session for me, but I'm guessing this is pretty common for the .mil? Any recourse I may have? I have talked with the chief already as a first step which was pretty useless. I don't expect him to understand physician workload and why certain things are important since he's not a physician, but I was a bit surprised that he really wasn't willing to listen.
     

    HighPriest

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      I would recommend being very passive aggressive. Mention regularly about how things are "ok now, but it just seems like they could be better," or "yeah....that's one way of doing it..." Always stop talking when your new chief walks in the room. Never answer your cell when he calls you, but always answer on the first ring when anyone else does. Leave little hints around the office, like stacks of unfinished charts or empty scotch bottles or anthrax bombs.
       
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      DD214_DOC

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        Have you tried talking to your new chief?

        Yes, of course, during which I was pretty much dismissed. He speaks as though he himself understands what it's like to be a physician. The cherry on top was recently learning that both of my nurses -- so my entire clinical support staff -- were approved by him to take two weeks of leave at the same time with no other backup arranged.
         

        DD214_DOC

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          I would recommend being very passive aggressive. Mention regularly about how things are "ok now, but it just seems like they could be better," or "yeah....that's one way of doing it..." Always stop talking when your new chief walks in the room. Never answer your cell when he calls you, but always answer on the first ring when anyone else does. Leave little hints around the office, like stacks of unfinished charts or empty scotch bottles or anthrax bombs.

          Already ahead on the chart thing. When he tries to have conversations with me about medical stuff and honestly believing that he knows as much or nearly as much as physicians, I try my best to find a way to weave into the discussion some type of reference to the Dunning-Kruger Effect. So far, I don't think he's caught on to the fact I'm actually alluding to him.
           
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          HighPriest

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            I always found that there were three types of people in milmed leadership:

            1 - Young go getters who really wanted to make a change and shake up the establishment because they know what it's like to be on the front line of mildmed. They usually last somewhere between 2 months - 1 year before the constant tide of bull$#!t causes them to separate or dissolve into one of the next two categories.

            2 - Senior "clinical" leadership who haven't actually touched a patient in years - or worse, they treat patients with just enough frequency to maintain their licensure, meaning that they're terrifying in a clinical setting. They have absolutely no recollection what it's like to see clinic in milmed, and their recollection of being a clinician has been supplanted by the arbitrary metrics that OTSG hands down from the plinko board that determines policy. They want to provide good care, but they don't know what that is, so they have to assume that meeting metrics means good clinical care - even when it is totally unrelated. If nothing else, meeting metrics means more funding, and as we all know throwing money at a problem is the surest way to fix it.

            3 - Non-clinical staff (and this absolutely includes nurses and PhDs.) Some of them still fall into category 2, but category 3 is reserved for the gunners who just hate physicians. They're as good as you - no, BETTER than you because they care about the patient and all you care about is (insert bad thing). They're here to make sure you stay in line, and the military gives them the power to crush you if they see fit. Step out of line clinically and they'll crucify you. Step out of line with regards to your military commitment and they'll crucify you simply because physicians need to pay for their grievous sins. They love to come up with completely nonsensical, arbitrary guidelines that you must and will follow and they especially like it when those guidelines are based upon absolutely no clinical evidence. But if you complain about them, they'll crucify you because you think you're better than them you SOB. So you'd better learn to dance, monkey.

            Now, each of these categories has a wide variety of zeal (or lack thereof), but ultimately I always found it to be accurate.

            Which is your guy?
             
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            DD214_DOC

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              I always found that there were three types of people in milmed leadership:

              1 - Young go getters who really wanted to make a change and shake up the establishment because they know what it's like to be on the front line of mildmed. They usually last somewhere between 2 months - 1 year before the constant tide of bull$#!t causes them to separate or dissolve into one of the next two categories.

              2 - Senior "clinical" leadership who haven't actually touched a patient in years - or worse, they treat patients with just enough frequency to maintain their licensure, meaning that they're terrifying in a clinical setting. They have absolutely no recollection what it's like to see clinic in milmed, and their recollection of being a clinician has been supplanted by the arbitrary metrics that OTSG hands down from the plinko board that determines policy. They want to provide good care, but they don't know what that is, so they have to assume that meeting metrics means good clinical care - even when it is totally unrelated. If nothing else, meeting metrics means more funding, and as we all know throwing money at a problem is the surest way to fix it.

              3 - Non-clinical staff (and this absolutely includes nurses and PhDs.) Some of them still fall into category 2, but category 3 is reserved for the gunners who just hate physicians. They're as good as you - no, BETTER than you because they care about the patient and all you care about is (insert bad thing). They're here to make sure you stay in line, and the military gives them the power to crush you if they see fit. Step out of line clinically and they'll crucify you. Step out of line with regards to your military commitment and they'll crucify you simply because physicians need to pay for their grievous sins. They love to come up with completely nonsensical, arbitrary guidelines that you must and will follow and they especially like it when those guidelines are based upon absolutely no clinical evidence. But if you complain about them, they'll crucify you because you think you're better than them you SOB. So you'd better learn to dance, monkey.

              Now, each of these categories has a wide variety of zeal (or lack thereof), but ultimately I always found it to be accurate.

              Which is your guy?

              Yep, 3.
               

              Atlas Shrugged

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                I think it's time you set up a gin distillery and work on your sarcasm game.

                I wish I could actually help, but I haven't been in the game long enough. This is one of my big fears.
                 
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                HighPriest

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                  Dealing with them was always troublesome. Category 1 guys are usually pretty easy to deal with. You just let them know you have a problem, and they'll legitimately try to fix it. They'll probably fail, but they'll try. Category 2 guys are usually receptive to your concerns, but not even in the ballpark as much as they are concerned with things coming down the pipe from MEDCOM. It's not that they don't want to fix your problem, usually. It's just that your problem isn't very important and doesn't require a lot of attention. In fact, I posit that they literally forget what your problem was within 2 minutes of having ended a conversation with you. There are two ways of dealing with them: 1 - Become enough of a problem that they can't ignore you. That works only if the issue you're having effects a lot of people. If it's just you, they'll squash you for making noise. You have to make fixing the problem a better deal than just crushing you. 2 - Become productive enough that you can convince them that not fixing the problem will effect your productivity and thereby effect their precious metrics. That way tends to be very effective, but you've got to clearly stand out as a high performer and you have to be able to convince them that the issue you're having really is a threat to your performance.

                  Dealing with type 3 is much harder. Type 3s tend to wander in packs like hyenas, so you can't go at them head on or in a manner that seems threatening to the pack, otherwise they'll all pounce on you from different angles. And even if you think they're a lone wolf, they're not. There are packmates hiding in the weeds, waiting to hop out - not even necessarily to help their friends, but simply to put a boot on your filthy doctor neck. You might go after the nurse OIC of the pediatrics floor when suddenly the nurse OIC of L&D comes out of the woodwork with a complaint about you that you'd never see coming. So you have lure them out and let them hang themselves, or you have to bypass them completely. If your goal is to damage them, you have to do the former. Give them enough rope to hang themselves, and make sure it's obvious and out in the open enough that other people see it. It's not easy to do, because they're very good at passing blame. I think it would actually take quite a bit of careful planning, unless they're careless. I've never gone this route. But if what you really want is to just fix the problem, you have to accept that they will probably end up entirely unaware that they were screwing the pooch to begin with. You go over their head until you find a type 1 or a type 2 that you can work with, and you fix the problem without letting the type 3 in the loop. If the type 3 finds out about it, they'll resent you for it, but you just have to make sure they don't find out about it until after the problem has been fixed.

                  So in your case, best case scenario is to find a type 1 or a type 2 in hospital command, and present a case to him or her as to why this guy's performance is resulting in a decrease in performance metrics.
                   

                  Cooperd0g

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                    Then bring your concerns to the next level up.

                    This next comment isn't aimed at you in particular, but physicians in general. Many don't want the extra burden of admin roles, but then are very quick to complain about how a non-physician runs things.
                     
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                    HighPriest

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                      Then bring your concerns to the next level up.

                      This next comment isn't aimed at you in particular, but physicians in general. Many don't want the extra burden of admin roles, but then are very quick to complain about how a non-physician runs things.

                      This is true, to be sure - especially in MEDCOM where sometimes leadership positions means giving up your clinical practice. It sucks. It isn't fair. It is in fact total BS, but at the same time we let these people get into leadership positions...
                       

                      DD214_DOC

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                        Plot twist, I actually occupied his position for almost a year. I decided to be none of the 3 types above and instead ignored all the nonsense and pointless metrics and simply focused on supporting my providers and providing good clinical care -- which usually happens when providers are happy. In the end, senior leaders didn't make the connection that the person who ignored the nonsense also had the section with the highest morale and both staff and patient satisfaction.

                        Oh well.


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                        Plot twist, I actually occupied his position for almost a year. I decided to be none of the 3 types above and instead ignored all the nonsense and pointless metrics and simply focused on supporting my providers and providing good clinical care -- which usually happens when providers are happy. In the end, senior leaders didn't make the connection that the person who ignored the nonsense also had the section with the highest morale and both staff and patient satisfaction.

                        Oh well.


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                        Sounds awful. This is why I stayed operational during my commitment. Then again you're residency trained so you don't have the luxury of playing flight doc for a few years.

                        My advice would be to just put your head down and work your ass off. The harder you work the more unassailable you become from admin types, in my limited experience. It will also make you a better clinician. Plus, good chance this douche won't be your boss in a year or two anyways.

                        Teachable moment for the med students here...

                        ex 61N
                         

                        DD214_DOC

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                          Sounds awful. This is why I stayed operational during my commitment. Then again you're residency trained so you don't have the luxury of playing flight doc for a few years.

                          My advice would be to just put your head down and work your ass off. The harder you work the more unassailable you become from admin types, in my limited experience. It will also make you a better clinician. Plus, good chance this douche won't be your boss in a year or two anyways.

                          Teachable moment for the med students here...

                          ex 61N

                          Yep. To my credit though, I wasn't removed from the position; it was only interim to begin with. I was recognized for doing a pretty good job, which was possible by protecting my staff from nonsense and metric-driven hell. It's the last part everyone seemed to ignore, and now the clinic is back to the status quo and everyone miserable.


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                          HighPriest

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                            Plot twist, I actually occupied his position for almost a year. I decided to be none of the 3 types above and instead ignored all the nonsense and pointless metrics and simply focused on supporting my providers and providing good clinical care -- which usually happens when providers are happy. In the end, senior leaders didn't make the connection that the person who ignored the nonsense also had the section with the highest morale and both staff and patient satisfaction.

                            Oh well.


                            Sent from my iPhone using SDN mobile
                            No, you were type 1. Maybe a bit more or less zealous, but still type 1. That's ok. They're good people, they just dont last long. Type 1 is the best you can hope for.
                             
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