Office Manager Issues

[William Sparrow]

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Long post. Apologies in advance for the length and thanks for your insight, folks:

So I joined a large, multidisciplinary, private practice of >140 docs last year. The practice has a pain department based out of their main office an hour away, and hired me out of fellowship to grow a new pain practice from the ground up in a satellite office an hour away. The clinic has essentially assigned the office manager in the main office to manage my practice as well, although the majority of the time she's not physically here. She's probably in my office maybe 2 hours or so a week give or take. Been having some issues and want insight from some of you veterans as to how you would handle this:

1. Whenever I make requests on how I want the clinic to run, I've found the answer is "no" if it requires any additional work on the part of this manager. For example, I asked her to add more clinic patient slots to my schedule so that I can fit more patients visits into a day. Managers response was "that is not necessary because your schedule isn't full yet. We can book office visits in procedure slots if your clinic days are full." I actually ran an analysis based on my previous 6 months and found that given my no-show/reschedule rate/current payor mix, it'd be almost mathematically impossible to break even under this manager's current model structure even if my clinic was entirely booked out. I pointed this out to her and instead of expanding my schedule as I asked, she kind of huffed and puffed and agreed to add a couple of double book slots during the day to account for the inevitable no shows.

2. Questioning my medical judgement. During a meeting with the director of operations a few weeks ago she implied that my opiate prescribing habits were slowing practice growth. Basically said that I should consider starting more new patients on tramadol "or something" while I work them up so that they are required to continually follow up for medication refills. Mind you she has zero medical training.

3. Getting snippy with me over things that I thought were pretty standard. For example, whenever I get a new consult for a patient on chronic opiates from another prescriber, I ask for the previous prescribers notes as well as the reason the patient is leaving that practice (dismissed? moving? second opinion? etc). I've gotten multiple consults for "chronic severe pain" in patients with no accompanying notes. I was told it's clinic policy to obtain pertinent records prior to working through a consult. The most recent time I responded and asked her to obtain records she sent me a passive aggressive response "the patient is in severe pain and has been calling us all day. We do not have records. Please advise." This has become a recurring theme. She also once told me "we don't need it" when I asked for a copy of a lumbar MRI for a consult on a patient that recently had it done at an outside facility.

4. Staff making little mistakes/scheduling errors, mostly due to lack of leadership presence in the office while I'm focused on seeing patients during the day (ex. booking a bilateral 3 level lumbar RFA in a 15 minute procedure slot).

5. Not communicating. Scheduling me for meetings without telling me beforehand. Staff calling out and her not telling me, etc.

6. Probably most bothersome, I once overheard her making disparaging remarks about me to a physician colleague. She didn't realize I could hear her, and then saw me and immediately proceeded to address me in this sweet, ultra-friendly voice as if she hadn't just been talking crap about me seconds prior. I called her out on it, telling her I heard everything she just said. She panicked, ended up pulling me aside, tearfully apologizing, and blamed it on stress, family troubles, covid, etc. I didn't really feel like making a big thing out of it. We all have our moments. So I told her I accepted her apology and haven't brought it up since. I didn't really want to dwell on it, but I've had a hard time forgetting that moment as I feel that she showed her true colors when she felt I wasn't around to hear her. This happened maybe 7-8 months ago. Maybe I did the wrong thing by not raising a stink over this. I think if it wasn't for the continued passive aggressiveness I would have gotten over it by now.

Long and short of it, this lady thinks she's my attending/superior, and she's only doing the bare minimum remotely to actually manage the satellite clinic. Because of this, I'm finding it increasingly difficult to grow this practice to it's full potential. I'm new to the private practice world, but I always thought it was the practice manager's job to ensure the practice is running smoothly and to my liking? Not to dictate patient management or my workflow. I've kept a record of everything that's been going on in the event I need to to escalate this to leadership. Was really hoping to not have to do that though as I'm worried she would make my life hell afterwards. How would you guys approach this?

 

[specepic]

You need to talk to whoever oversees her. She sounds toxic

 

[nvrsumr]

I had a similar toxic office manager working for spine surgeon. Had been with the founding surgeon since day one and thought she was my boss. Truth of the matter she was...

 

[deleted131481]

You need to talk to whoever oversees her. She sounds toxic

Yes, and have the conversation over phone on person rather than email.

See if you can get assigned a different practice manager as this one is clearly not working out.

 

[Cholula]

You sound like you want to be your own boss and make all the decisions yourself. There is nothing an office manager does that you can't do yourself. Get out as fast as you can. Build up and manage your own clinic. You don't need an office manager and you don't need to be an employee.

 

[Ferrismonk]

A toxic employee can ruin the business, especially an office manager. Talk to the leadership and let them know that you don't meet eye to eye with the current practice manager and that you would like a new manager assigned. There is no benefit have her disciplined unless they're looking to fire her anyway. Realize that the answer may be "no", especially if she's been there a while.

Either way, start looking for a new job.

I used to work in a practice similar to yours and while my local staff was great, corporate held a lot of control and put up barriers similar to what you're experiencing. I fought for 3 years slowly growing the clinic before I decided to leave. Once I left the practice died.

 

[Agast]

So, I think having this as your first job straight out of fellowship worked against you a bit. You still have the mindset that Admin should have some power/control over you...in private practice this really should not be the case.

You are the money maker. You are bringing in the money that becomes her salary. She is essentially a parasite whose one goal should be DO NOT KILL THE MONEY MAKER. The fact that she is being petty and shady just indicates she is a *****. Call her out when she's being an idiot. What are they going to do, fire you? Then it's a dumb job anyways.

 

[Pain Applicant1]

You sound like you want to be your own boss and make all the decisions yourself. There is nothing an office manager does that you can't do yourself. Get out as fast as you can. Build up and manage your own clinic. You don't need an office manager and you don't need to be an employee.

This.

You generate revenue and are considered an asset. She is considered a liability. You are in charge and are her boss but somehow the roles got reversed. She's taking advantage of you because you're relatively new and I assume relatively young. She's bullying you and the more weakness you show the more she will dig in.

I would tell her bluntly that she's not your boss and she works for you, not the other way around. I would fight. Stand up for yourself. Like a typical bully, I bet once you do this she'll respect you more and you won't hear a peep from her any further.

Don't worry about retribution from the practice. It is much more difficult to hire doctors than it is to hire an office manager. Don't ever forget the power you hold. If they respect her more than they respect you, you shouldn't be there to begin with.

 

[nvrsumr]

I agree with most of the above but an established office manager for 140 doc practice may have more leverage than you. Sounds like u are probably going to be getting another job soon anyway as the numbers aren't pencilling in for you.

 

[geauxg8rs]

Long post. Apologies in advance for the length and thanks for your insight, folks:

So I joined a large, multidisciplinary, private practice of >140 docs last year. The practice has a pain department based out of their main office an hour away, and hired me out of fellowship to grow a new pain practice from the ground up in a satellite office an hour away. The clinic has essentially assigned the office manager in the main office to manage my practice as well, although the majority of the time she's not physically here. She's probably in my office maybe 2 hours or so a week give or take. Been having some issues and want insight from some of you veterans as to how you would handle this:

1. Whenever I make requests on how I want the clinic to run, I've found the answer is "no" if it requires any additional work on the part of this manager. For example, I asked her to add more clinic patient slots to my schedule so that I can fit more patients visits into a day. Managers response was "that is not necessary because your schedule isn't full yet. We can book office visits in procedure slots if your clinic days are full." I actually ran an analysis based on my previous 6 months and found that given my no-show/reschedule rate/current payor mix, it'd be almost mathematically impossible to break even under this manager's current model structure even if my clinic was entirely booked out. I pointed this out to her and instead of expanding my schedule as I asked, she kind of huffed and puffed and agreed to add a couple of double book slots during the day to account for the inevitable no shows.

2. Questioning my medical judgement. During a meeting with the director of operations a few weeks ago she implied that my opiate prescribing habits were slowing practice growth. Basically said that I should consider starting more new patients on tramadol "or something" while I work them up so that they are required to continually follow up for medication refills. Mind you she has zero medical training.

3. Getting snippy with me over things that I thought were pretty standard. For example, whenever I get a new consult for a patient on chronic opiates from another prescriber, I ask for the previous prescribers notes as well as the reason the patient is leaving that practice (dismissed? moving? second opinion? etc). I've gotten multiple consults for "chronic severe pain" in patients with no accompanying notes. I was told it's clinic policy to obtain pertinent records prior to working through a consult. The most recent time I responded and asked her to obtain records she sent me a passive aggressive response "the patient is in severe pain and has been calling us all day. We do not have records. Please advise." This has become a recurring theme. She also once told me "we don't need it" when I asked for a copy of a lumbar MRI for a consult on a patient that recently had it done at an outside facility.

4. Staff making little mistakes/scheduling errors, mostly due to lack of leadership presence in the office while I'm focused on seeing patients during the day (ex. booking a bilateral 3 level lumbar RFA in a 15 minute procedure slot).

5. Not communicating. Scheduling me for meetings without telling me beforehand. Staff calling out and her not telling me, etc.

6. Probably most bothersome, I once overheard her making disparaging remarks about me to a physician colleague. She didn't realize I could hear her, and then saw me and immediately proceeded to address me in this sweet, ultra-friendly voice as if she hadn't just been talking crap about me seconds prior. I called her out on it, telling her I heard everything she just said. She panicked, ended up pulling me aside, tearfully apologizing, and blamed it on stress, family troubles, covid, etc. I didn't really feel like making a big thing out of it. We all have our moments. So I told her I accepted her apology and haven't brought it up since. I didn't really want to dwell on it, but I've had a hard time forgetting that moment as I feel that she showed her true colors when she felt I wasn't around to hear her. This happened maybe 7-8 months ago. Maybe I did the wrong thing by not raising a stink over this. I think if it wasn't for the continued passive aggressiveness I would have gotten over it by now.

Long and short of it, this lady thinks she's my attending/superior, and she's only doing the bare minimum remotely to actually manage the satellite clinic. Because of this, I'm finding it increasingly difficult to grow this practice to it's full potential. I'm new to the private practice world, but I always thought it was the practice manager's job to ensure the practice is running smoothly and to my liking? Not to dictate patient management or my workflow. I've kept a record of everything that's been going on in the event I need to to escalate this to leadership. Was really hoping to not have to do that though as I'm worried she would make my life hell afterwards. How would you guys approach this?

You should have done more when she disparaged you. She has no respect for you. Either she is gone or you are.

 

[William Sparrow]

Thanks for the feedback, everyone. Agree, came in naïve and too passive. Wanted to make friends with everyone, and wasn't sure I had any weight to throw around since she's been around a while (apparently very well liked by the other pain docs at the main clinic) and I was a new doc with an immature practice that isn't yet profitable.

I have no problem confronting bullies. Especially since I'm the one generating the revenue. Was just trying to figure out the best way to do it in a professional manner without coming across as arrogant or giving her ammo to accuse me of verbal abuse/creating a hostile work environment.

Would love to break off and start my own practice. Didn't have the guts to do it straight out of training.

 

[Doctodd]

ill be the slight contrarian here.....

1. ask for more autonomy on scheduling more patients. Not sure why they wouldnt want to book more patients. That should be an easy sell. Your argument is you should capture the business now by squeezing in more patients now, not later. Tell the scheduler/secretary, not her.

2 and 3. What's wrong with patients being on a short leash? If you dont have records, which is sometimes the fault of the referring office, i dont see anything wrong with a little tramadol to hold them over. You can still make medical decisions without other records. Do you have an in office fluoro or ultrasound?

4. Most of us only do 1 side RF anyway. Make an executive decision there. Have patient come back to discuss success/failure of one side and schedule the other side next visit. This also satisfies #1 and #2.

5. meh

6. Biggie.....remind her whenever the opportunity arises. Hit her over the head with it whenever she pisses you off, but nicely...kill her with kindness. Make your colleagues aware of it.

 

[Orin]

If you can find a better job, go for it. Most people leave their first job.
If not, decide how you want to make things work. Raising a stink about someone who is well established as the new person is not going to go well.

Now that you have some idea of what you want, see if you can do this without her involvement. If you have direct reports in your clinic, deal with them directly and cut her out of that. Establish that as the workflow. You'll do more unpaid work, but you'll have more control. She'll likely be happy to not take the trip out to see you.

Some of this is probably because your practice parameters are different from the people she has learned with.
Some of this is because you are not her priority.

 

[drusso]

Long post. Apologies in advance for the length and thanks for your insight, folks:

So I joined a large, multidisciplinary, private practice of >140 docs last year. The practice has a pain department based out of their main office an hour away, and hired me out of fellowship to grow a new pain practice from the ground up in a satellite office an hour away. The clinic has essentially assigned the office manager in the main office to manage my practice as well, although the majority of the time she's not physically here. She's probably in my office maybe 2 hours or so a week give or take. Been having some issues and want insight from some of you veterans as to how you would handle this:

1. Whenever I make requests on how I want the clinic to run, I've found the answer is "no" if it requires any additional work on the part of this manager. For example, I asked her to add more clinic patient slots to my schedule so that I can fit more patients visits into a day. Managers response was "that is not necessary because your schedule isn't full yet. We can book office visits in procedure slots if your clinic days are full." I actually ran an analysis based on my previous 6 months and found that given my no-show/reschedule rate/current payor mix, it'd be almost mathematically impossible to break even under this manager's current model structure even if my clinic was entirely booked out. I pointed this out to her and instead of expanding my schedule as I asked, she kind of huffed and puffed and agreed to add a couple of double book slots during the day to account for the inevitable no shows.

2. Questioning my medical judgement. During a meeting with the director of operations a few weeks ago she implied that my opiate prescribing habits were slowing practice growth. Basically said that I should consider starting more new patients on tramadol "or something" while I work them up so that they are required to continually follow up for medication refills. Mind you she has zero medical training.

3. Getting snippy with me over things that I thought were pretty standard. For example, whenever I get a new consult for a patient on chronic opiates from another prescriber, I ask for the previous prescribers notes as well as the reason the patient is leaving that practice (dismissed? moving? second opinion? etc). I've gotten multiple consults for "chronic severe pain" in patients with no accompanying notes. I was told it's clinic policy to obtain pertinent records prior to working through a consult. The most recent time I responded and asked her to obtain records she sent me a passive aggressive response "the patient is in severe pain and has been calling us all day. We do not have records. Please advise." This has become a recurring theme. She also once told me "we don't need it" when I asked for a copy of a lumbar MRI for a consult on a patient that recently had it done at an outside facility.

4. Staff making little mistakes/scheduling errors, mostly due to lack of leadership presence in the office while I'm focused on seeing patients during the day (ex. booking a bilateral 3 level lumbar RFA in a 15 minute procedure slot).

5. Not communicating. Scheduling me for meetings without telling me beforehand. Staff calling out and her not telling me, etc.

6. Probably most bothersome, I once overheard her making disparaging remarks about me to a physician colleague. She didn't realize I could hear her, and then saw me and immediately proceeded to address me in this sweet, ultra-friendly voice as if she hadn't just been talking crap about me seconds prior. I called her out on it, telling her I heard everything she just said. She panicked, ended up pulling me aside, tearfully apologizing, and blamed it on stress, family troubles, covid, etc. I didn't really feel like making a big thing out of it. We all have our moments. So I told her I accepted her apology and haven't brought it up since. I didn't really want to dwell on it, but I've had a hard time forgetting that moment as I feel that she showed her true colors when she felt I wasn't around to hear her. This happened maybe 7-8 months ago. Maybe I did the wrong thing by not raising a stink over this. I think if it wasn't for the continued passive aggressiveness I would have gotten over it by now.

Long and short of it, this lady thinks she's my attending/superior, and she's only doing the bare minimum remotely to actually manage the satellite clinic. Because of this, I'm finding it increasingly difficult to grow this practice to it's full potential. I'm new to the private practice world, but I always thought it was the practice manager's job to ensure the practice is running smoothly and to my liking? Not to dictate patient management or my workflow. I've kept a record of everything that's been going on in the event I need to to escalate this to leadership. Was really hoping to not have to do that though as I'm worried she would make my life hell afterwards. How would you guys approach this?

Can you fire her or discipline her? When do you do her evaluation?

 

[SSdoc33]

just change the practice the way you see fit. have her react to you, rather than vice-versa. also, dont involve her in the minutiae of the practice. talk to the schedulers, dont show for meeting that you dont schedule yourself, discus issue with her superiors/partners if needed, simply don't see patients that dont have records in place or are not reasonable. these issues and problems will fall on HER shoulders, not yours as you should be the one setting your practice parameters.

if you can demonstrate that you can bring in $$$ practicing the way you want, all else will fall by the wayside. do not undervalue yourself or overvalue her role

it is very easy for those on this board to say "just find a new job". in reality, it isnt that easy, with family/schools/house, etc. you can make this work without being the b$tch to the office manager

 

[Pain Applicant1]

Thanks for the feedback, everyone. Agree, came in naïve and too passive. Wanted to make friends with everyone, and wasn't sure I had any weight to throw around since she's been around a while (apparently very well liked by the other pain docs at the main clinic) and I was a new doc with an immature practice that isn't yet profitable.

I have no problem confronting bullies. Especially since I'm the one generating the revenue. Was just trying to figure out the best way to do it in a professional manner without coming across as arrogant or giving her ammo to accuse me of verbal abuse/creating a hostile work environment.

Would love to break off and start my own practice. Didn't have the guts to do it straight out of training.

You are spot on here with everything. The confrontation, if it occurs, has to be done artfully. Keep us posted on how it turns out. Also, don't be afraid of starting your own practice. The worst thing that can happen is it fails and failure is no big deal.

IMO, income is a far second to autonomy and having your own practice grants you this.

There is nothing worse than going to work miserable every day.

 

[drusso]

Thanks for the feedback, everyone. Agree, came in naïve and too passive. Wanted to make friends with everyone, and wasn't sure I had any weight to throw around since she's been around a while (apparently very well liked by the other pain docs at the main clinic) and I was a new doc with an immature practice that isn't yet profitable.

I have no problem confronting bullies. Especially since I'm the one generating the revenue. Was just trying to figure out the best way to do it in a professional manner without coming across as arrogant or giving her ammo to accuse me of verbal abuse/creating a hostile work environment.

Would love to break off and start my own practice. Didn't have the guts to do it straight out of training.

How well do you know this person? Have you considered taking her out for a cup of coffee or inviting her and her spouse over for dinner. If you can glean a sense of what her commitments are organizationally, financially (how she makes her bonus), and personally you can gain leverage in steering her behavior in a direction that is more consistent with your needs.

 

[William Sparrow]

Can you fire her or discipline her? When do you do her evaluation?

I have my scheduled quarterly meeting with the CEO and clinic leadership next week. I'm going to show them some of her oppositional emails and the numbers from the analysis I ran and gently/professionally tell them I think she's been dropping the ball and losing them money. It'll make her look bad, and when it gets back to her I'm sure she'll be upset. Not sure any disciplinary action will take place, but I can't imagine they'll take kindly to her denying my request to see more patients and generate more revenue for them.

How well do you know this person? Have you considered taking her out for a cup of coffee or inviting her and her spouse over for dinner. If you can glean a sense of what her commitments are organizationally, financially (how she makes her bonus), and personally you can gain leverage in steering her behavior in a direction that is more consistent with your needs.

I actually really like this! I wish I would have thought to do this when I joined last year. I'm kind of hesitant to go that route now as I don't want her to feel like the way she's been behaving has been reasonable or acceptable.

Thanks again, everyone! I'll keep you all posted

 

[William Sparrow]

Had my quarterly meeting with the CEO and CMO. The CFO and COO didn't make it.

Long and short, they were very professional and supportive. I could tell they were confused, surprised, and pissed when I told them how the office manager was refusing to open up my schedule more. However, they also made a couple of comments that implied to me that they think part of the issue could be conservative opioid prescribing habits (for the record, my opiate prescribing habits aren't that conservative. I just don't believe in utilizing a "pills for shots" practice model and rarely prescribe opioids as a first-line agent for chronic, non-malignant, pain). They didn't come outright and say "write more narcotics" but they kept asking me questions implying they felt lagging productivity would magically improve with extra hydrocodone.

They looked shocked when I showed them the numbers from my clinical analysis and said they were going to run it by the CFO to confirm the accuracy of my calculations and also reach out to my manager about the refusal to fix the schedule. Overall, I left feeling kind of meh. I did feel they were trying to be genuine and supportive, although judging by how surprised they were by the data I provided them it was also apparent to me that no one has ever done a financial analysis of my clinic on a granular level before which is disturbing. Makes me wonder how they decided there was a need in this location if they never ran the numbers beforehand.

I'm almost certain the practice manager's going to get upset when leadership approaches her. I wouldn't be surprised if her attitude towards me worsens in the upcoming days. She hasn't said anything out of line in a while, but if I have any more issues I'm going to check her immediately. I have another year on my contract, but I'm going to start exploring new gigs and make sure I have an exit strategy ready.

 

[Crybaby]

Had my quarterly meeting with the CEO and CMO. The CFO and COO didn't make it.

Long and short, they were very professional and supportive. I could tell they were confused, surprised, and pissed when I told them how the office manager was refusing to open up my schedule more. However, they also made a couple of comments that implied to me that they think part of the issue could be conservative opioid prescribing habits (for the record, my opiate prescribing habits aren't that conservative. I just don't believe in utilizing a "pills for shots" practice model and rarely prescribe opioids as a first-line agent for chronic, non-malignant, pain). They didn't come outright and say "write more narcotics" but they kept asking me questions implying they felt lagging productivity would magically improve with extra hydrocodone.

They looked shocked when I showed them the numbers from my clinical analysis and said they were going to run it by the CFO to confirm the accuracy of my calculations and also reach out to my manager about the refusal to fix the schedule. Overall, I left feeling kind of meh. I did feel they were trying to be genuine and supportive, although judging by how surprised they were by the data I provided them it was also apparent to me that no one has ever done a financial analysis of my clinic on a granular level before which is disturbing. Makes me wonder how they decided there was a need in this location if they never ran the numbers beforehand.

I'm almost certain the practice manager's going to get upset when leadership approaches her. I wouldn't be surprised if her attitude towards me worsens in the upcoming days. She hasn't said anything out of line in a while, but if I have any more issues I'm going to check her immediately. I have another year on my contract, but I'm going to start exploring new gigs and make sure I have an exit strategy ready.

Best of luck to you. I hope things don't get too rocky.

Out of curiosity. Is your group physician run, or all of the "chiefs" (CEO, CMO, CFO, COO) strictly business/ non medical?

From my limited experience, interactions with management or " non medical business partners" seem unfruitful or I get a creepy vibe that values $$ > patient care.

 

[SSdoc33]

lets be honest, you can't ignore the finances. everybody want more $$ - docs as well as management. you have to be productive.

but the pressure to prescribe opioids is a non-starter. they can go pound sand. if you are productive without being a liberal opioid prescriber, everyone will be happy enough in the end.

 

[Pain Applicant1]

I once overheard her making disparaging remarks about me to a physician colleague. She didn't realize I could hear her, and then saw me and immediately proceeded to address me in this sweet, ultra-friendly voice as if she hadn't just been talking crap about me seconds prior. I called her out on it, telling her I heard everything she just said. She panicked, ended up pulling me aside, tearfully apologizing, and blamed it on stress, family troubles, covid, etc.

. I wouldn't be surprised if her attitude towards me worsens in the upcoming days.

Are you sure about this? Usually bullies back down when confronted. Look at the first quote and what happened when you confronted her the first time.

 

[William Sparrow]

Best of luck to you. I hope things don't get too rocky.

Out of curiosity. Is your group physician run, or all of the "chiefs" (CEO, CMO, CFO, COO) strictly business/ non medical?

From my limited experience, interactions with management or " non medical business partners" seem unfruitful or I get a creepy vibe that values $$ > patient care.

Thanks! It's a mixture. The CMO is an MD/MBA but I don't think has practiced for a while. The COO has a nursing background. It think the other two are strictly business. The clinic itself is physician owned. There's a medical board of directors comprised of peer-elected physician partners that oversees everything.

lets be honest, you can't ignore the finances. everybody want more $$ - docs as well as management. you have to be productive.

but the pressure to prescribe opioids is a non-starter. they can go pound sand. if you are productive without being a liberal opioid prescriber, everyone will be happy enough in the end.

Yup. I get it. Gotta keep the lights on. I could understand their concern if I was just booting everyone on tramadol and refusing to prescribe even when indicated, or if I was too slow to handle the volume needed to keep things afloat, but it's just not the case. I'm literally begging them to give me more volume, but was told no essentially because it would create a minor nuisance to change the schedule template in the EMR. Just kind of baffling that this wasn't step one instead of indirectly pressuring me to hand out more percs to boost follow up visits.

 

[Sushirolls]

I agree with most of the above but an established office manager for 140 doc practice may have more leverage than you. Sounds like u are probably going to be getting another job soon anyway as the numbers aren't pencilling in for you.

This place is large enough to be corporate. They just want to churn the opioids for patient volume and to satisfy their PCPs. This office manager carries more weight than you. You are a mere cog and widget, and they don't care about your or your professionalism or standards.

They fact that they even encouraged you in a meeting to prescribe more opioids even slightly, IS A GIANT RED MASSIVE RUN THE HECK AWAY flag. Leave before your contract is up, and take the penalties of that. Get out of there now. Only worse days are ahead of you. Can tread lighly when you are swimming in a toxic acidic vat. Jump out dear frog, jump out.

 

[Baron Samedi]

What do you lose by breaking contract? A small signing bonus, non-vested 401k match amounting to a couple thousand bucks, and subject to a non-enforcable no compete clause?

 

[SSdoc33]

This place is large enough to be corporate. They just want to churn the opioids for patient volume and to satisfy their PCPs. This office manager carries more weight than you. You are a mere cog and widget, and they don't care about your or your professionalism or standards.

They fact that they even encouraged you in a meeting to prescribe more opioids even slightly, IS A GIANT RED MASSIVE RUN THE HECK AWAY flag. Leave before your contract is up, and take the penalties of that. Get out of there now. Only worse days are ahead of you. Can tread lighly when you are swimming in a toxic acidic vat. Jump out dear frog, jump out.

i dont know if the situation is THIS dire, but the next time you have a meeting like this, turn your phone on to record what is told to you. if there are legal problems down the road it may help (IE: a contract may become void if they violate any of the terms or try to persuade you to Rx more opioids)

 

[Sushirolls]

Some states don't permit recordings without all parties consenting. Non consenting recordings mean nothing, get thrown out.

 

[Agast]

Recording laws by state

 

[BobBarker]

Didn’t read the entire thread.

more often than you should in medicine, you will have to remind these types who is the boss.

Schedule the patients this way, appeal that denial, forgive that patient balance… why? Because I said so and I am the doctor and the only reason that you and everyone else here is employed.

 

[drusso]

Didn’t read the entire thread.

more often than you should in medicine, you will have to remind these types who is the boss.

Schedule the patients this way, appeal that denial, forgive that patient balance… why? Because I said so and I am the doctor and the only reason that you and everyone else here is employed.

You will be branded a "disruptive physician" and forced to undergo re-education:

DEFINE_ME

"The know-it-all is a high achiever with great clinical acumen. They may have been the valedictorian of their medical school, or the best fellow in their class. When you attempt to talk to them, they condescend to you about your ideas, using adverbs like “obviously” and “clearly” to describe their approach in contrast to yours. The know-it-all is often intimidating and unapproachable, and they may even take pride in those characteristics. This can make negotiating with the know-it-all difficult; they can make you question your own convictions and beliefs and make you feel small by comparison. Much of the know-it-all’s approach comes from a need for control and respect."

 

[BobBarker]

You will be branded a "disruptive physician" and forced to undergo re-education:

DEFINE_ME

"The know-it-all is a high achiever with great clinical acumen. They may have been the valedictorian of their medical school, or the best fellow in their class. When you attempt to talk to them, they condescend to you about your ideas, using adverbs like “obviously” and “clearly” to describe their approach in contrast to yours. The know-it-all is often intimidating and unapproachable, and they may even take pride in those characteristics. This can make negotiating with the know-it-all difficult; they can make you question your own convictions and beliefs and make you feel small by comparison. Much of the know-it-all’s approach comes from a need for control and respect."

Clearly, this is for the most part accurate. Obviously, I was the best fellow in my class.

 

[anonperson]

Had my quarterly meeting with the CEO and CMO. The CFO and COO didn't make it.

Long and short, they were very professional and supportive. I could tell they were confused, surprised, and pissed when I told them how the office manager was refusing to open up my schedule more. However, they also made a couple of comments that implied to me that they think part of the issue could be conservative opioid prescribing habits (for the record, my opiate prescribing habits aren't that conservative. I just don't believe in utilizing a "pills for shots" practice model and rarely prescribe opioids as a first-line agent for chronic, non-malignant, pain). They didn't come outright and say "write more narcotics" but they kept asking me questions implying they felt lagging productivity would magically improve with extra hydrocodone.

They looked shocked when I showed them the numbers from my clinical analysis and said they were going to run it by the CFO to confirm the accuracy of my calculations and also reach out to my manager about the refusal to fix the schedule. Overall, I left feeling kind of meh. I did feel they were trying to be genuine and supportive, although judging by how surprised they were by the data I provided them it was also apparent to me that no one has ever done a financial analysis of my clinic on a granular level before which is disturbing. Makes me wonder how they decided there was a need in this location if they never ran the numbers beforehand.

I'm almost certain the practice manager's going to get upset when leadership approaches her. I wouldn't be surprised if her attitude towards me worsens in the upcoming days. She hasn't said anything out of line in a while, but if I have any more issues I'm going to check her immediately. I have another year on my contract, but I'm going to start exploring new gigs and make sure I have an exit strategy ready.

This reeks of bad leadership.

The guys at the top are fat and happy collecting $750k+ salaries and have no interest in improving things in a meaningful way. The CEO is probably pulling in seven figures as well.

Health systems have a way of attracting this type of leadership in general.

The reason I bring this up is because for all of the cash compensation they "earn" they really aren't that busy. Their days are filled with a couple of random meetings and then not much else. You'd think they would do a deep dive in all of their clinics etc to figure out how to improve the financials/ patient throughput etc.

This rarely happens because unless there is a major issue, they are happy collecting the facility fee/professional fee/ random government subsidy and then calling it a day.

Look at how they are trying to suggest that you are the problem. They won't outright say write more narcotics because they aren't that dumb but the implications are clear.

Do your year and probably find a new gig.

 

[promethius]

Thanks for the feedback, everyone. Agree, came in naïve and too passive. Wanted to make friends with everyone, and wasn't sure I had any weight to throw around since she's been around a while (apparently very well liked by the other pain docs at the main clinic) and I was a new doc with an immature practice that isn't yet profitable.

I have no problem confronting bullies. Especially since I'm the one generating the revenue. Was just trying to figure out the best way to do it in a professional manner without coming across as arrogant or giving her ammo to accuse me of verbal abuse/creating a hostile work environment.

Would love to break off and start my own practice. Didn't have the guts to do it straight out of training.

Hey I know how it is and just wanted to say your first job will probably not be your last job. I finished my fellowship about 7 years ago now and had similar issues with my last employed position. After 3 years, I ended up starting my own practice and have not looked back since. I work more now than I did when I was working for someone else and make less money because I am still growing my practice in a competitive environment, but the only people I have to answer to is myself and my patients. I am fortunate in that I can say money has and never will be the end-all-be-all for me.

The only benefits for working for someone else is if you do not want to deal with any administrative work, if you are fresh out of training and work in a practice with other colleagues who you can bounce ideas off of, and/or if you have a family or are deeply in debt and depend on a steady source of income. Otherwise, I agree that the autonomy you get working for yourself far outweigh any compensation you receive.

My advice for starting your own practice. Do it before you turn 40. The earlier you do it, the more time you get to reap the benefits later when your practice finally matures. And don't listen to all the naysayers who say private practice is dying. The best time to do something is when everyone else is jumping ship. Good luck!

 

[drusso]

Hey I know how it is and just wanted to say your first job will probably not be your last job. I finished my fellowship about 7 years ago now and had similar issues with my last employed position. After 3 years, I ended up starting my own practice and have not looked back since. I work more now than I did when I was working for someone else and make less money because I am still growing my practice in a competitive environment, but the only people I have to answer to is myself and my patients. I am fortunate in that I can say money has and never will be the end-all-be-all for me.

The only benefits for working for someone else is if you do not want to deal with any administrative work, if you are fresh out of training and work in a practice with other colleagues who you can bounce ideas off of, and/or if you have a family or are deeply in debt and depend on a steady source of income. Otherwise, I agree that the autonomy you get working for yourself far outweigh any compensation you receive.

My advice for starting your own practice. Do it before you turn 40. The earlier you do it, the more time you get to reap the benefits later when your practice finally matures. And don't listen to all the naysayers who say private practice is dying. The best time to do something is when everyone else is jumping ship. Good luck!

Congratulations! Once you get a taste of being on your own, you're basically unemployable for the rest of your life...

 

[William Sparrow]

Long post. Apologies in advance for the length and thanks for your insight, folks:

So I joined a large, multidisciplinary, private practice of >140 docs last year. The practice has a pain department based out of their main office an hour away, and hired me out of fellowship to grow a new pain practice from the ground up in a satellite office an hour away. The clinic has essentially assigned the office manager in the main office to manage my practice as well, although the majority of the time she's not physically here. She's probably in my office maybe 2 hours or so a week give or take. Been having some issues and want insight from some of you veterans as to how you would handle this:

1. Whenever I make requests on how I want the clinic to run, I've found the answer is "no" if it requires any additional work on the part of this manager. For example, I asked her to add more clinic patient slots to my schedule so that I can fit more patients visits into a day. Managers response was "that is not necessary because your schedule isn't full yet. We can book office visits in procedure slots if your clinic days are full." I actually ran an analysis based on my previous 6 months and found that given my no-show/reschedule rate/current payor mix, it'd be almost mathematically impossible to break even under this manager's current model structure even if my clinic was entirely booked out. I pointed this out to her and instead of expanding my schedule as I asked, she kind of huffed and puffed and agreed to add a couple of double book slots during the day to account for the inevitable no shows.

2. Questioning my medical judgement. During a meeting with the director of operations a few weeks ago she implied that my opiate prescribing habits were slowing practice growth. Basically said that I should consider starting more new patients on tramadol "or something" while I work them up so that they are required to continually follow up for medication refills. Mind you she has zero medical training.

3. Getting snippy with me over things that I thought were pretty standard. For example, whenever I get a new consult for a patient on chronic opiates from another prescriber, I ask for the previous prescribers notes as well as the reason the patient is leaving that practice (dismissed? moving? second opinion? etc). I've gotten multiple consults for "chronic severe pain" in patients with no accompanying notes. I was told it's clinic policy to obtain pertinent records prior to working through a consult. The most recent time I responded and asked her to obtain records she sent me a passive aggressive response "the patient is in severe pain and has been calling us all day. We do not have records. Please advise." This has become a recurring theme. She also once told me "we don't need it" when I asked for a copy of a lumbar MRI for a consult on a patient that recently had it done at an outside facility.

4. Staff making little mistakes/scheduling errors, mostly due to lack of leadership presence in the office while I'm focused on seeing patients during the day (ex. booking a bilateral 3 level lumbar RFA in a 15 minute procedure slot).

5. Not communicating. Scheduling me for meetings without telling me beforehand. Staff calling out and her not telling me, etc.

6. Probably most bothersome, I once overheard her making disparaging remarks about me to a physician colleague. She didn't realize I could hear her, and then saw me and immediately proceeded to address me in this sweet, ultra-friendly voice as if she hadn't just been talking crap about me seconds prior. I called her out on it, telling her I heard everything she just said. She panicked, ended up pulling me aside, tearfully apologizing, and blamed it on stress, family troubles, covid, etc. I didn't really feel like making a big thing out of it. We all have our moments. So I told her I accepted her apology and haven't brought it up since. I didn't really want to dwell on it, but I've had a hard time forgetting that moment as I feel that she showed her true colors when she felt I wasn't around to hear her. This happened maybe 7-8 months ago. Maybe I did the wrong thing by not raising a stink over this. I think if it wasn't for the continued passive aggressiveness I would have gotten over it by now.

Long and short of it, this lady thinks she's my attending/superior, and she's only doing the bare minimum remotely to actually manage the satellite clinic. Because of this, I'm finding it increasingly difficult to grow this practice to it's full potential. I'm new to the private practice world, but I always thought it was the practice manager's job to ensure the practice is running smoothly and to my liking? Not to dictate patient management or my workflow. I've kept a record of everything that's been going on in the event I need to to escalate this to leadership. Was really hoping to not have to do that though as I'm worried she would make my life hell afterwards. How would you guys approach this?

7. Unvaccinated nurse comes in to work on Tues with a cough and low grade fever. Told the office manager she was sick via text first thing in the AM. Manager didn't respond. Nurse sends an email asking if she got the text. She emails back "yes, didn't have time to respond. Let me know if you need to go home but we're really short staffed." I find out about this shortly after finishing a morning of procedures, around lunch time. Immediately text the manager like hey, shouldn't she go home and get covid tested (this is the clinic policy)? Literally seconds later she calls the nurses station, not knowing I was already standing right there and mockingly says "Sparrow thinks you have covid *snicker* *snicker*" Didn't bother to call me back or respond to my text. So then I called employee health and reported it. They, of course, made the nurse go home immediately and they escalated it to the higher ups to help find coverage. A few minutes after I called employee health and she received a "what is going on?" call from the CMO, she responds to my text and says "I'm sending someone."

Next day, she walks into my office and tells me I didn't have to escalate this because she was already aware of what was going on for the whole day and had it under control and was preparing to send someone over to cover and that she "doesn't think she has covid because she's done stuff like this before." Basically tried to confront me for getting higher ups involved even though she failed to notify me of what was going on or respond to my text until after I escalated it. Also heavily implied that I was overreacting and that the nurse "likely didn't have covid."

Fast forward to today, we get the call, nurse has covid. Whoops. I reported the incident to risk management and they basically stated that my manager failed to adhere to protocol. I'm vaccinated, but none of my office staff are (rural area, lots of anti-vaxxers/Facebook scholars) so who knows if she managed to infect some other people while she was here for the entire morning. I thought about being petty and sliding in an "I told you so" or a "guess I didn't overreact after all, did I?" but decided to let risk worry about it and just focus on being a good doctor... Still, so tempting to rub her face in this especially since she came to my office yesterday criticizing how I handled things after she failed to act.

Anywho. Just venting. I know what the next step has to be. Looking around now.

 

[RoloTomassi]

Geez what a B. That's unbearable. Sucks that she's not getting the boot but you have to leave, though I know it's not just her that's an issue

 

[JelloIsJigglin]

7. Unvaccinated nurse comes in to work on Tues with a cough and low grade fever. Told the office manager she was sick via text first thing in the AM. Manager didn't respond. Nurse sends an email asking if she got the text. She emails back "yes, didn't have time to respond. Let me know if you need to go home but we're really short staffed." I find out about this shortly after finishing a morning of procedures, around lunch time. Immediately text the manager like hey, shouldn't she go home and get covid tested (this is the clinic policy)? Literally seconds later she calls the nurses station, not knowing I was already standing right there and mockingly says "Sparrow thinks you have covid *snicker* *snicker*" Didn't bother to call me back or respond to my text. So then I called employee health and reported it. They, of course, made the nurse go home immediately and they escalated it to the higher ups to help find coverage. A few minutes after I called employee health and she received a "what is going on?" call from the CMO, she responds to my text and says "I'm sending someone."

Next day, she walks into my office and tells me I didn't have to escalate this because she was already aware of what was going on for the whole day and had it under control and was preparing to send someone over to cover and that she "doesn't think she has covid because she's done stuff like this before." Basically tried to confront me for getting higher ups involved even though she failed to notify me of what was going on or respond to my text until after I escalated it. Also heavily implied that I was overreacting and that the nurse "likely didn't have covid."

Fast forward to today, we get the call, nurse has covid. Whoops. I reported the incident to risk management and they basically stated that my manager failed to adhere to protocol. I'm vaccinated, but none of my office staff are (rural area, lots of anti-vaxxers/Facebook scholars) so who knows if she managed to infect some other people while she was here for the entire morning. I thought about being petty and sliding in an "I told you so" or a "guess I didn't overreact after all, did I?" but decided to let risk worry about it and just focus on being a good doctor... Still, so tempting to rub her face in this especially since she came to my office yesterday criticizing how I handled things after she failed to act.

Anywho. Just venting. I know what the next step has to be. Looking around now.

wow. it's amazing how delusional or manipulative people can be.
Workplace environment is equally as important as the work itself.
God Speed

 

[geauxg8rs]

7. Unvaccinated nurse comes in to work on Tues with a cough and low grade fever. Told the office manager she was sick via text first thing in the AM. Manager didn't respond. Nurse sends an email asking if she got the text. She emails back "yes, didn't have time to respond. Let me know if you need to go home but we're really short staffed." I find out about this shortly after finishing a morning of procedures, around lunch time. Immediately text the manager like hey, shouldn't she go home and get covid tested (this is the clinic policy)? Literally seconds later she calls the nurses station, not knowing I was already standing right there and mockingly says "Sparrow thinks you have covid *snicker* *snicker*" Didn't bother to call me back or respond to my text. So then I called employee health and reported it. They, of course, made the nurse go home immediately and they escalated it to the higher ups to help find coverage. A few minutes after I called employee health and she received a "what is going on?" call from the CMO, she responds to my text and says "I'm sending someone."

Next day, she walks into my office and tells me I didn't have to escalate this because she was already aware of what was going on for the whole day and had it under control and was preparing to send someone over to cover and that she "doesn't think she has covid because she's done stuff like this before." Basically tried to confront me for getting higher ups involved even though she failed to notify me of what was going on or respond to my text until after I escalated it. Also heavily implied that I was overreacting and that the nurse "likely didn't have covid."

Fast forward to today, we get the call, nurse has covid. Whoops. I reported the incident to risk management and they basically stated that my manager failed to adhere to protocol. I'm vaccinated, but none of my office staff are (rural area, lots of anti-vaxxers/Facebook scholars) so who knows if she managed to infect some other people while she was here for the entire morning. I thought about being petty and sliding in an "I told you so" or a "guess I didn't overreact after all, did I?" but decided to let risk worry about it and just focus on being a good doctor... Still, so tempting to rub her face in this especially since she came to my office yesterday criticizing how I handled things after she failed to act.

Anywho. Just venting. I know what the next step has to be. Looking around now.

Just give her a wink and a nod and she’ll know her place

 

[jsaul]

7. Unvaccinated nurse comes in to work on Tues with a cough and low grade fever. Told the office manager she was sick via text first thing in the AM. Manager didn't respond. Nurse sends an email asking if she got the text. She emails back "yes, didn't have time to respond. Let me know if you need to go home but we're really short staffed." I find out about this shortly after finishing a morning of procedures, around lunch time. Immediately text the manager like hey, shouldn't she go home and get covid tested (this is the clinic policy)? Literally seconds later she calls the nurses station, not knowing I was already standing right there and mockingly says "Sparrow thinks you have covid *snicker* *snicker*" Didn't bother to call me back or respond to my text. So then I called employee health and reported it. They, of course, made the nurse go home immediately and they escalated it to the higher ups to help find coverage. A few minutes after I called employee health and she received a "what is going on?" call from the CMO, she responds to my text and says "I'm sending someone."

Next day, she walks into my office and tells me I didn't have to escalate this because she was already aware of what was going on for the whole day and had it under control and was preparing to send someone over to cover and that she "doesn't think she has covid because she's done stuff like this before." Basically tried to confront me for getting higher ups involved even though she failed to notify me of what was going on or respond to my text until after I escalated it. Also heavily implied that I was overreacting and that the nurse "likely didn't have covid."

Fast forward to today, we get the call, nurse has covid. Whoops. I reported the incident to risk management and they basically stated that my manager failed to adhere to protocol. I'm vaccinated, but none of my office staff are (rural area, lots of anti-vaxxers/Facebook scholars) so who knows if she managed to infect some other people while she was here for the entire morning. I thought about being petty and sliding in an "I told you so" or a "guess I didn't overreact after all, did I?" but decided to let risk worry about it and just focus on being a good doctor... Still, so tempting to rub her face in this especially since she came to my office yesterday criticizing how I handled things after she failed to act.

Anywho. Just venting. I know what the next step has to be. Looking around now.

what kind of private practice do you work in? so much bureaucracy!!!there is a manager for you, employee health department, CMO, risk management department? damn thats a lot of staff and departments for a private practice

 

[Crybaby]

Kudos to you for taking the high road. As much grief as she has given you, I would have been all too eager to rub her nose in her mess. Hope you can get out of there without becoming too jaded.

 

[Pain Applicant1]

7. Unvaccinated nurse comes in to work on Tues with a cough and low grade fever. Told the office manager she was sick via text first thing in the AM. Manager didn't respond. Nurse sends an email asking if she got the text. She emails back "yes, didn't have time to respond. Let me know if you need to go home but we're really short staffed." I find out about this shortly after finishing a morning of procedures, around lunch time. Immediately text the manager like hey, shouldn't she go home and get covid tested (this is the clinic policy)? Literally seconds later she calls the nurses station, not knowing I was already standing right there and mockingly says "Sparrow thinks you have covid *snicker* *snicker*" Didn't bother to call me back or respond to my text. So then I called employee health and reported it. They, of course, made the nurse go home immediately and they escalated it to the higher ups to help find coverage. A few minutes after I called employee health and she received a "what is going on?" call from the CMO, she responds to my text and says "I'm sending someone."

Next day, she walks into my office and tells me I didn't have to escalate this because she was already aware of what was going on for the whole day and had it under control and was preparing to send someone over to cover and that she "doesn't think she has covid because she's done stuff like this before." Basically tried to confront me for getting higher ups involved even though she failed to notify me of what was going on or respond to my text until after I escalated it. Also heavily implied that I was overreacting and that the nurse "likely didn't have covid."

Fast forward to today, we get the call, nurse has covid. Whoops. I reported the incident to risk management and they basically stated that my manager failed to adhere to protocol. I'm vaccinated, but none of my office staff are (rural area, lots of anti-vaxxers/Facebook scholars) so who knows if she managed to infect some other people while she was here for the entire morning. I thought about being petty and sliding in an "I told you so" or a "guess I didn't overreact after all, did I?" but decided to let risk worry about it and just focus on being a good doctor... Still, so tempting to rub her face in this especially since she came to my office yesterday criticizing how I handled things after she failed to act.

Anywho. Just venting. I know what the next step has to be. Looking around now.

Sorry about being politically incorrect and I don't mean to inject race into this but by any chance is she a fat white woman, lol? I find that this particular demographic for some reason enjoys power struggles with men. I wonder if there is any correlation, lol. Apologies to those in this demographic who aren't this way. I can't really figure out why this would be although I could probably come up with a hypothesis or two if I thought about it for a second.

I've noticed it from nurses when I was a student and I'm also dealing with one now. I literally had a tree fall through one of my properties during a recent storm and she, as the adjuster, is giving me a hard time. I've never had an issue with any other adjuster in the past and was able to get properties fixed up quickly after the damage occurred. But no, not this time.

 

[Pain Applicant1]

Congratulations! Once you get a taste of being on your own, you're basically unemployable for the rest of your life...

Couldn't agree more. Once you taste freedom, it's way too hard to give up.

 

[gazzer]

what kind of private practice do you work in? so much bureaucracy!!!there is a manager for you, employee health department, CMO, risk management department? damn thats a lot of staff and departments for a private practice

Yes. I would like to know as well. Sounds like a big operation with tons of built-in referral sources.

 

[William Sparrow]

what kind of private practice do you work in? so much bureaucracy!!!there is a manager for you, employee health department, CMO, risk management department? damn thats a lot of staff and departments for a private practice

A huge multidisciplinary one

Yes. I would like to know as well. Sounds like a big operation with tons of built-in referral sources.

I thought the same when I signed on. I think the fact that I'm in a small satellite office an hour away from most of the referring providers (there's a large pain department in the main clinic) coupled with the pandemic and poor management/oversight has all made growth more challenging than I anticipated.

Kudos to you for taking the high road. As much grief as she has given you, I would have been all too eager to rub her nose in her mess. Hope you can get out of there without becoming too jaded.

I spent a solid 15 minutes going back and forth about texting her, "So I heard that covid test was positive after all" with this meme:

 

[William Sparrow]

Been a while, but I promised I'd keep you guys in the loop.

I didn't know this at the time I was posting, but it wasn't just me having issues. This manager made enemies out of the staff and the pain docs at the flagship location due to similar toxic behavior in the main office. The main clinic started hemorrhaging staff who cited her behavior as their reason for quitting. Apparently things snowballed and she got into a shouting match with one of the partners in the middle of a clinic hallway during the work day (yikes). HR got involved, launched an investigation, caught her lying about a multitude of issues, and they terminated her the next day.

My productivity exploded the moment she left. The jump has been drastic enough that it's become clear that she was sitting on referrals to me which was stifling my clinic volume. There's even been some speculation that she was doing it intentionally as retaliation for me irritating her in an attempt to prevent me from making partner.

Unfortunately for my employer, I started looking for other gigs months prior to the manager getting axed, and I received an offer that pays substantially more, is closer to my home, requires less med management, and offers partnership. I turned in my notice a couple of weeks ago and I'm starting with the new practice this summer.

It feels pretty good to see how things have turned out. There were definitely fingers of blame being pointed at me, but the numbers don't lie, and it's obvious now where the issue was. I think if the leadership team had the stones to approach me, own that they screwed up, and apologize for letting this fester as long as it did and for blaming me for it, I would have considered giving them another chance. But they never did. No one reached out to apologize or acknowledge that I was right other than one of the partnered pain docs. Oh well. I feel vindicated and now they're going to lose an entire region of pain patients. Cheers

 

[Doctodd]

You don’t need an apology…..but you did receive it from the partner. Nevertheless, glad it worked out.