Performance improvement plan, may get fired? Advice.

[Osteoth]

Am IM hospitalist rural midwest. Have not been at my job very long but have been having constant issues with nurses, APPs, to the point that two nurses were recently fired and I was placed on a performance improvement plan (PIP).

The goals seem reasonable, but doing some research it seems as though a PIP is the first step toward being fired, so I want to know if anyone has experience in having a PIP, if this means I am for certain going to get fired or if I can come back from this, and general tips if you have been fired.

I am going to try and get a lawyer to review the PIP before signing, and to negotiate some of the aspects of the PIP to make it more quantitative in regards to goals, etc. I also am going to be saving most of my paychecks in the next few months on the PIP incase I need to find a new job.

I have also been reading it is smart if you are going to get fired to ask to resign in order to avoid having that stain when you apply for other jobs.

Anything else I should be doing? Thanks so much.

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[Gastrapathy]

Leave

 

[CCM-MD]

Am IM hospitalist rural midwest. Have not been at my job very long but have been having constant issues with nurses, APPs, to the point that two nurses were recently fired and I was placed on a performance improvement plan (PIP).

The goals seem reasonable, but doing some research it seems as though a PIP is the first step toward being fired, so I want to know if anyone has experience in having a PIP, if this means I am for certain going to get fired or if I can come back from this, and general tips if you have been fired.

I am going to try and get a lawyer to review the PIP before signing, and to negotiate some of the aspects of the PIP to make it more quantitative in regards to goals, etc. I also am going to be saving most of my paychecks in the next few months on the PIP incase I need to find a new job.

I have also been reading it is smart if you are going to get fired to ask to resign in order to avoid having that stain when you apply for other jobs.

Anything else I should be doing? Thanks so much.

I would resign now and find a new job asap. They are establishing a paper trail to fire you. Sorry you are going through this.

 

[sloh]

Start looking for a new job asap. PIP is largely just a perfunctory process employers put you through to cover their asses. But make no mistake, they want you gone and will be successful in doing so. No point in hiring a lawyer. Find a new job asap.

 

[Osteoth]

Is there any chance I make it through this?

 

[DrMetal]

Is there any chance I make it through this?

Sure there's a chance, but why risk it? Do you need to stay (family, geography, good golf courses nearby)?

Nurses were fired because of your complaints? That's why you got in trouble?

 

[Ubba]

Even if you were to "make it through"... why would you want to stay at a place that views you as a sort remedial student? What are you going to do, tiptoe around the place sheepishly for years and years, jumping at the slightest proverbial sound from admin? Entire relationship has been soured.
Leave and be free, hospitalists are in great demand.

 

[chessknt]

You need to leave. If they actually terminate you that has to be reported forever. Signing this PIP has to be reported forever. Just ask to resign instead and start looking now, long term your life will be much better and youll be glad you did it.

 

[Ubba]

Question: If an employer called a physician into the office and let him know that he was being fired, would the employer be willing to play ball if the doc floated the idea of resignation at that point? Doesn't the employer gain a lot more from a resignation than from a termination (eg, no severance)? Or have the papers already generally been signed at that point, making it too late to change it to resignation?

 

[Osteoth]

Sure there's a chance, but why risk it? Do you need to stay (family, geography, good golf courses nearby)?

Nurses were fired because of your complaints? That's why you got in trouble?

I have a big signing bonus I would want to keep if I have the option lol.

The same nurse submitted half a dozen formal complaints against me, among them
-I do not assess my patients because I do not listen to the heart and lungs of every patient awaiting placement
-I do not spend enough time with my patients
-My clinical practice is poor, when case was reviewed my director said my management was fine
-I do not answer my phone when I literally have it on me the entire day

She has pushed out several other people and was let go because of the combination of all these thing

You need to leave. If they actually terminate you that has to be reported forever. Signing this PIP has to be reported forever. Just ask to resign instead and start looking now, long term your life will be much better and youll be glad you did it.

So I've been reading and saw places that say a PIP is not reportable?

Also if I leave wouldn't I still have to report because it was "to avoid an investigation"?

 

[chessknt]

I have a big signing bonus I would want to keep if I have the option lol.

The same nurse submitted half a dozen formal complaints against me, among them
-I do not assess my patients because I do not listen to the heart and lungs of every patient awaiting placement
-I do not spend enough time with my patients
-My clinical practice is poor, when case was reviewed my director said my management was fine
-I do not answer my phone when I literally have it on me the entire day

She has pushed out several other people and was let go because of the combination of all these thing

So I've been reading and saw places that say a PIP is not reportable?

Also if I leave wouldn't I still have to report because it was "to avoid an investigation"?

A PIP isn't an investigation, it is a disciplinary action but only if you agree to it. Hospitals can and do ask about this and you would have to say yes unless you have a lawyer look at it and prove it is sealed and undiscoverable. If you tell your boss you're going to resign instead and if they want yo waive the time period required for notice it could be effective immediately that would be a much better move and allow you to start looking.

It isn't worth it dude, like at all. I know that signing bonus is going to sting but your goose is cooked. The way the system is rigged, you 100% you will be fired.

 

[Osteoth]

A PIP isn't an investigation, it is a disciplinary action but only if you agree to it. Hospitals can and do ask about this and you would have to say yes unless you have a lawyer look at it and prove it is sealed and undiscoverable. If you tell your boss you're going to resign instead and if they want yo waive the time period required for notice it could be effective immediately that would be a much better move and allow you to start looking.

It isn't worth it dude, like at all. I know that signing bonus is going to sting but your goose is cooked. The way the system is rigged, you 100% you will be fired.

I had a conversation with my boss today, and I was told that because I am employed by a staffing company that subcontracts through the hospital to provide hospitalist coverage, that the PIP is not NPDB reportable, and even if I was fired it would not be a reportable offense unless it was to go through the medical staff at the hospital and lead to a revocation of privileges. Anyone have any experience with this?

 

[chessknt]

I had a conversation with my boss today, and I was told that because I am employed by a staffing company that subcontracts through the hospital to provide hospitalist coverage, that the PIP is not NPDB reportable, and even if I was fired it would not be a reportable offense unless it was to go through the medical staff at the hospital and lead to a revocation of privileges. Anyone have any experience with this?

Besides the signing bonus why would you want to thread that needle? Did you buy a house and have to sell and relocate? I don't understand why you are trying so hard to stay when it clearly isn't going to happen--you are still in the denial stage but you need to hurry up to acceptance...

 

[end stage fibro]

Dude just leave

 

[Crayola227]

Besides the signing bonus why would you want to thread that needle? Did you buy a house and have to sell and relocate? I don't understand why you are trying so hard to stay when it clearly isn't going to happen--you are still in the denial stage but you need to hurry up to acceptance...

Yeah I mean to be fair, if a house is tied up in all this, at least trying to put it off without a reportable action, even by a couple months, is understandable.

Most PIPs have a certain timeframe "for you to improve" before you get "reassessed" and generally unless you do something in that time that justifies immediate termination (which if they wanted to do that, you would think they would have done it already), then they will wait until then to let you know they are firing you. As part of the "box-checking" "but we gave you a fair chance."

I would look at this timetable they set out. Because if you are looking at a signing bonus that is up in the air, I bet your employer is too. Meaning it sounds like they are trying to push you out so you lose the bonus.

If that's their goal and the PIP timeline will achieve that for them... then consider it gone already.

That said, you know, if the timetable is 2 months let's say, I can understand how 2 months salary and to sell your house could be important.

So the question about looking the PIP over, dragging this out, and can you still resign then cleanly, does make sense.

I agree with others, everything in your planning has to assume the end goal of the hospital is to fire you and this job should be assumed 100% toast. This isn't like a residency PIP where there is a *tiny* chance they still want your cheap slave labor if the issues they have with you are legitimate AND you can solve them to their satisfaction in tiny window, while under the microscope, against all bias, and they just want the door open to fire you but don't have their heart set on it quite yet.

This is a different game, you cost full price and finding more like you to slot in is easier.

So it's very easy for everyone to tell you to go down there tomorrow and ask to resign, but I think it's worth discussing reportability, what your barriers to relocation and a new job are, your financials, and if there is a narrow path you can tread between now and your inevitable break with this place, that is better than alternatives assuming more than one path can even be carved.

Without all the details, it's hard to advise you of anything but the fact no matter what they say, this is not salvageable as far as keeping the job, and there is a good chance if possible the timing is purposefully being done to take away the signing bonus. So there is likely nothing you can do there as well. And that resigning is always cleaner than other paths.

Also your resignation means less to them than it would if you were a resident. Residents there is more red tape and appeals in the firing process, so the desire for a resignation and a waiver of various rights and dragging it out is more appealing to the hospital. This gives your resignation more value as a negotiating chip.

I'm really bringing that up, because these things come up on the board all the time, and the people to whom it applies are typically reading all they can on the site about it all. So it's important to distinguish how the two situations with a PIP are different.

One thing that can give more value to a resignation, is if you are in a position to make noise or sue for discrimination of some sort. But it doesn't sound like you have any case for that or you would have already brought that up. And it really depends on a lot of factors I'm not familiar with, if that would even be a good idea or not in such a case as this, or not. It does make things go nuclear though, and in this situation I doubt it gets you anywhere.

Having an experienced attorney that represents physicians in employment contracts advise you can't hurt, except your pocketbook and it sounds like you might need the money more.

I'm guessing the nursing union is quite strong here or nurses are harder to keep on staff? Because it seems absurd to let a physician go over this otherwise. But that would change the equation. You also have to wonder if she has her own case to cause pain to the hospital. Which could explain a lot.

I wonder if there is any way to negotiate a resignation in exchange for keeping the signing bonus? This is a question I have for others.

 

[dozitgetchahi]

Am IM hospitalist rural midwest. Have not been at my job very long but have been having constant issues with nurses, APPs, to the point that two nurses were recently fired and I was placed on a performance improvement plan (PIP).

The goals seem reasonable, but doing some research it seems as though a PIP is the first step toward being fired, so I want to know if anyone has experience in having a PIP, if this means I am for certain going to get fired or if I can come back from this, and general tips if you have been fired.

I am going to try and get a lawyer to review the PIP before signing, and to negotiate some of the aspects of the PIP to make it more quantitative in regards to goals, etc. I also am going to be saving most of my paychecks in the next few months on the PIP incase I need to find a new job.

I have also been reading it is smart if you are going to get fired to ask to resign in order to avoid having that stain when you apply for other jobs.

Anything else I should be doing? Thanks so much.

You need to leave.

I agree with the others…the entire relationship has been soured at this point. They are not only putting down a paper trail to fire you…things like this can even be put in your personnel file, and they could say you were “under investigation” and in some circumstances that could have to be reported to the medical board and/or credentialing etc.

Don’t sign this thing. Just leave. This isn’t residency or something where you need to make nice and play their game until the end because you’re going to be hosed if you leave without finishing training. I have actually been in a situation somewhat similar to this at my very first (abusive) job…looking back if there’s anything I wish I had done, it would have been to leave faster. These types of places are unreasonable, and believe me, you haven’t yet seen the types of reindeer games that are about to start coming at you from admin. Just get out. Get set up with locums or something if you need to bridge a gap until your next stable gig.

 

[dozitgetchahi]

I had a conversation with my boss today, and I was told that because I am employed by a staffing company that subcontracts through the hospital to provide hospitalist coverage, that the PIP is not NPDB reportable, and even if I was fired it would not be a reportable offense unless it was to go through the medical staff at the hospital and lead to a revocation of privileges. Anyone have any experience with this?

Don’t trust anything your boss tells you, especially in a situation like this. Assume you are being lied to. Just imagine if you get to the end and get reported to NPDB and all this jazz…it’s really bad news. You want to avoid this at all possible costs.

 

[Crayola227]

You need to leave.

I agree with the others…the entire relationship has been soured at this point. They are not only putting down a paper trail to fire you…things like this can even be put in your personnel file, and they could say you were “under investigation” and in some circumstances that could have to be reported to the medical board and/or credentialing etc.

Don’t sign this thing. Just leave. I have actually been in a situation somewhat similar to this at my very first (abusive) job…looking back if there’s anything I wish I had done, it would have been to leave faster. These types of places are unreasonable, and believe me, you haven’t yet seen the types of reindeer games that are about to start coming at you from admin. Just get out. Get set up with locums or something if you need to bridge a gap until your next stable gig.

Well I revise any of my musings above. If there is even a chance this becomes something that a medical board would ever get a whiff of, it's 100% no worth it and you should leave. Hassle with the board never worth it. If you consider what an attorney to represent you to a medical board could cost (and you should always have one if you come under scrutiny), the signing bonus is irrelevant.

You can get some kind of a gig if the mortgage and house sale is an issue.

 

[dozitgetchahi]

Question: If an employer called a physician into the office and let him know that he was being fired, would the employer be willing to play ball if the doc floated the idea of resignation at that point? Doesn't the employer gain a lot more from a resignation than from a termination (eg, no severance)? Or have the papers already generally been signed at that point, making it too late to change it to resignation?

It depends on a variety of factors, including terms of the contract, laws of your state etc. There are absolutely people that get “asked to resign”. If you offer to resign at this point, they may agree.

 

[dozitgetchahi]

I have a big signing bonus I would want to keep if I have the option lol.

The same nurse submitted half a dozen formal complaints against me, among them
-I do not assess my patients because I do not listen to the heart and lungs of every patient awaiting placement
-I do not spend enough time with my patients
-My clinical practice is poor, when case was reviewed my director said my management was fine
-I do not answer my phone when I literally have it on me the entire day

She has pushed out several other people and was let go because of the combination of all these thing

So I've been reading and saw places that say a PIP is not reportable?

Also if I leave wouldn't I still have to report because it was "to avoid an investigation"?

Biggest piece of advice I would give you is to make sure that you read the contract closely and understand how much of the signon you’d have to pay back, and under what terms.

One of the reasons I didn’t leave my first crappy job sooner is that I initially misunderstood the contract and thought I’d be having to repay some portion of the entire bonus ($60k), which would have been very difficult. However, in reality 2/3 of the bonus was automatically forgiven and only 1/3 of the bonus was repayable ($20k), and a portion of this was forgiven each month I worked there. By the time I actually left after understanding the contract better, the amount due was only like $5k, which was not a big deal.

Furthermore, it sounds like you did the smart thing and basically kept the bonus in savings…if that is the case, just give them the bonus back and GTFO. Trust me, it is absolutely not worth the risk of them ****ing with your credentialing and employment record if you hang around. Jobs with good bonuses are fairly plentiful out there right now. Just get out of this place and find something better.

 

[NotAProgDirector]

I agree with others that a PIP is a step along the road to being fired. I think some places will give you a "real shot" at improvement, and others are just getting ducks in a row. Even if this is a fair place that wants you to improve, the question is whether you can make a big enough change in time. If the nurses really dislike you, any small infraction is likely to get reported. Once you're under the microscope, everything gets magnified.

All that said, I worry that part of the problem is you, and you could run into issues elsewhere. You posted this thread in the past: Bad MSPE If you had "professionalism" problems in medical school that were serious enough to include in your MSPE, I worry that what's happening now is more of the same. From that thread, sounds like when you thought things were not important, you created problems enough to run into trouble. The same may be happening here. No matter what you decide to do, best to look in the mirror and figure out what part you may be playing in all of this.

 

[Osteoth]

Most PIPs have a certain timeframe "for you to improve" before you get "reassessed" and generally unless you do something in that time that justifies immediate termination (which if they wanted to do that, you would think they would have done it already), then they will wait until then to let you know they are firing you. As part of the "box-checking" "but we gave you a fair chance."

So the question about looking the PIP over, dragging this out, and can you still resign then cleanly, does make sense.

So it's very easy for everyone to tell you to go down there tomorrow and ask to resign, but I think it's worth discussing reportability, what your barriers to relocation and a new job are, your financials, and if there is a narrow path you can tread between now and your inevitable break with this place, that is better than alternatives assuming more than one path can even be carved.

Having an experienced attorney that represents physicians in employment contracts advise you can't hurt, except your pocketbook and it sounds like you might need the money more.

I'm guessing the nursing union is quite strong here or nurses are harder to keep on staff? Because it seems absurd to let a physician go over this otherwise. But that would change the equation. You also have to wonder if she has her own case to cause pain to the hospital. Which could explain a lot.

I wonder if there is any way to negotiate a resignation in exchange for keeping the signing bonus? This is a question I have for others.

This is my thinking. I can give back the signing bonus, but this would pretty much wipe me out savings wise, and I would still need $ for moving costs, to pay for another place to live etc.

If I were to lets say stay for 2 months, then resign, my contract gives a 3 month no fault termination period, so that would give me 5 months to save up the money to move.

You need to leave.

I agree with the others…the entire relationship has been soured at this point. They are not only putting down a paper trail to fire you…things like this can even be put in your personnel file, and they could say you were “under investigation” and in some circumstances that could have to be reported to the medical board and/or credentialing etc.

Don’t sign this thing. Just leave. This isn’t residency or something where you need to make nice and play their game until the end because you’re going to be hosed if you leave without finishing training. I have actually been in a situation somewhat similar to this at my very first (abusive) job…looking back if there’s anything I wish I had done, it would have been to leave faster. These types of places are unreasonable, and believe me, you haven’t yet seen the types of reindeer games that are about to start coming at you from admin. Just get out. Get set up with locums or something if you need to bridge a gap until your next stable gig.

I was told that because this is coming from the company, not the hospital or the peer review committee, that this would not be a NPDB reportable event, but of course I have an appointment with a lawyer coming up to iron this stuff out.

Well I revise any of my musings above. If there is even a chance this becomes something that a medical board would ever get a whiff of, it's 100% no worth it and you should leave. Hassle with the board never worth it. If you consider what an attorney to represent you to a medical board could cost (and you should always have one if you come under scrutiny), the signing bonus is irrelevant.

You can get some kind of a gig if the mortgage and house sale is an issue.

Yes, I have to discuss with a lawyer if this is truly a non reportable event, and I have an appointment.

It depends on a variety of factors, including terms of the contract, laws of your state etc. There are absolutely people that get “asked to resign”. If you offer to resign at this point, they may agree.

That is what they told me, if the "PIP" does not work they will let me resign, but I of course assume that's a lie.

Biggest piece of advice I would give you is to make sure that you read the contract closely and understand how much of the signon you’d have to pay back, and under what terms.

One of the reasons I didn’t leave my first crappy job sooner is that I initially misunderstood the contract and thought I’d be having to repay some portion of the entire bonus ($60k), which would have been very difficult. However, in reality 2/3 of the bonus was automatically forgiven and only 1/3 of the bonus was repayable ($20k), and a portion of this was forgiven each month I worked there. By the time I actually left after understanding the contract better, the amount due was only like $5k, which was not a big deal.

Furthermore, it sounds like you did the smart thing and basically kept the bonus in savings…if that is the case, just give them the bonus back and GTFO. Trust me, it is absolutely not worth the risk of them ****ing with your credentialing and employment record if you hang around. Jobs with good bonuses are fairly plentiful out there right now. Just get out of this place and find something better.

Unfortunately I tried to negotiate this when i started, but I would have to give back the whole $40k if I leave.

I agree with others that a PIP is a step along the road to being fired. I think some places will give you a "real shot" at improvement, and others are just getting ducks in a row. Even if this is a fair place that wants you to improve, the question is whether you can make a big enough change in time. If the nurses really dislike you, any small infraction is likely to get reported. Once you're under the microscope, everything gets magnified.

All that said, I worry that part of the problem is you, and you could run into issues elsewhere. You posted this thread in the past: Bad MSPE If you had "professionalism" problems in medical school that were serious enough to include in your MSPE, I worry that what's happening now is more of the same. From that thread, sounds like when you thought things were not important, you created problems enough to run into trouble. The same may be happening here. No matter what you decide to do, best to look in the mirror and figure out what part you may be playing in all of this.

That is my worry, that thing will not change without my control.

Absolutely I worry about myself being the issue. I will be the first person to say I was a bad medical student, honestly probably bottom 10% of medical students and one of the only reasons I matched was because I was a USMD who matched to a no-name IMG-heavy IM program lusting after the names on their roster.

That being said, I think I was a good resident, never had any issues during residency, and thought through significant self-reflection and self-improvement that I had moved past these issues.

All any of us can do is try to be better, and at every turn in this situation I have done what was asked of me and tried to change my behavior to match what was expected of me. I have asked for feedback from a multitude of sources during this situation, and no one has really been able to give me concrete things that I could do to fix the situation. That being said I will continue to meditate on these factors and try to pinpoint weaknesses in myself I can change.

 

[AlbinoHawk DO]

Simply leave or have a lawyer neutralize this. Never accept a "performance improvement" plan

 

[dozitgetchahi]

This is my thinking. I can give back the signing bonus, but this would pretty much wipe me out savings wise, and I would still need $ for moving costs, to pay for another place to live etc.

If I were to lets say stay for 2 months, then resign, my contract gives a 3 month no fault termination period, so that would give me 5 months to save up the money to move.

I was told that because this is coming from the company, not the hospital or the peer review committee, that this would not be a NPDB reportable event, but of course I have an appointment with a lawyer coming up to iron this stuff out.

Yes, I have to discuss with a lawyer if this is truly a non reportable event, and I have an appointment.

That is what they told me, if the "PIP" does not work they will let me resign, but I of course assume that's a lie.

Unfortunately I tried to negotiate this when i started, but I would have to give back the whole $40k if I leave.

That is my worry, that thing will not change without my control.

Absolutely I worry about myself being the issue. I will be the first person to say I was a bad medical student, honestly probably bottom 10% of medical students and one of the only reasons I matched was because I was a USMD who matched to a no-name IMG-heavy IM program lusting after the names on their roster.

That being said, I think I was a good resident, never had any issues during residency, and thought through significant self-reflection and self-improvement that I had moved past these issues.

All any of us can do is try to be better, and at every turn in this situation I have done what was asked of me and tried to change my behavior to match what was expected of me. I have asked for feedback from a multitude of sources during this situation, and no one has really been able to give me concrete things that I could do to fix the situation. That being said I will continue to meditate on these factors and try to pinpoint weaknesses in myself I can change.

Look, I don’t think any of us can judge from here if there’s a genuine performance issue or not, or whether the workplace just sucks, or whether both issues are present at once here. What I can say is that there are definitely jobs out there where the staff are horrible and where the deck is stacked against you by admin, culture, etc. You’re telling us that some nurse at this job has managed to force out at least 3 other docs in the past. This certainly has the vibe of a hostile workplace, and one where nurses are allowed to make petty complaints and beefs against doctors. This is not a place you want to work, regardless of how good of a doctor you are or aren’t.

Also, on the “giving back the bonus” thing: I am friends with a CFO for the hospital across town. He has talked about how much of a pain in the ass it is for them, both legally and logistically, to try to chase down a doctor to pay back bonuses after they leave. Apparently their success rate on this is pretty low, and among their docs that have left (and there are many, because the system is not a pleasant place to work), very few of them have ever paid the bonuses back. The local courts have not been willing to enforce the bonus payback portion of their contracts.

I wouldn’t bank on that without legal advice, but if you’re talking to a lawyer, it may be an interesting thing to run by them.

 

[anonperson]

Am IM hospitalist rural midwest. Have not been at my job very long but have been having constant issues with nurses, APPs, to the point that two nurses were recently fired and I was placed on a performance improvement plan (PIP).

The goals seem reasonable, but doing some research it seems as though a PIP is the first step toward being fired, so I want to know if anyone has experience in having a PIP, if this means I am for certain going to get fired or if I can come back from this, and general tips if you have been fired.

I am going to try and get a lawyer to review the PIP before signing, and to negotiate some of the aspects of the PIP to make it more quantitative in regards to goals, etc. I also am going to be saving most of my paychecks in the next few months on the PIP incase I need to find a new job.

I have also been reading it is smart if you are going to get fired to ask to resign in order to avoid having that stain when you apply for other jobs.

Anything else I should be doing? Thanks so much.

Try to get an employment lawyer to review.

If you are a part of some protected class you can use that to claim some type of discrimination in order to leave the job without any official negative marks

Don't with sign any PIP.

Like everyone else is saying. This job is toast and find something else.

Don't feel bad. My first job out of fellowship lasted 6 miserable months before the group went out of business. I also paid back a signing bonus when this group imploded even though I probably could have screwed with them and kept it.

How much is the bonus for?

Please clarify this for me. A power tripping nurse was going after you and various other staff members. Some people got fired. You are being placed on a PIP. And said nurse also got fired?

Was she complaining to the department chair or chief of staff?

Sounds like a bizarre situation. Most hospitals with a half way decent medical staff initially handle these complaints within the department first and they escalate to the med exec committee etc.

 

[Osteoth]

Simply leave or have a lawyer neutralize this. Never accept a "performance improvement" plan

Yup, I have a lawyer reviewing it and will not sign the PIP. If they force me to I will resign.

Look, I don’t think any of us can judge from here if there’s a genuine performance issue or not, or whether the workplace just sucks, or whether both issues are present at once here. What I can say is that there are definitely jobs out there where the staff are horrible and where the deck is stacked against you by admin, culture, etc. You’re telling us that some nurse at this job has managed to force out at least 3 other docs in the past. This certainly has the vibe of a hostile workplace, and one where nurses are allowed to make petty complaints and beefs against doctors. This is not a place you want to work, regardless of how good of a doctor you are or aren’t.

Also, on the “giving back the bonus” thing: I am friends with a CFO for the hospital across town. He has talked about how much of a pain in the ass it is for them, both legally and logistically, to try to chase down a doctor to pay back bonuses after they leave. Apparently their success rate on this is pretty low, and among their docs that have left (and there are many, because the system is not a pleasant place to work), very few of them have ever paid the bonuses back. The local courts have not been willing to enforce the bonus payback portion of their contracts.

I wouldn’t bank on that without legal advice, but if you’re talking to a lawyer, it may be an interesting thing to run by them.

That is a good question, I never really thought about that because everyone talks about having to give the bonus back.

Try to get an employment lawyer to review.

If you are a part of some protected class you can use that to claim some type of discrimination in order to leave the job without any official negative marks

Don't with sign any PIP.

Like everyone else is saying. This job is toast and find something else.

Don't feel bad. My first job out of fellowship lasted 6 miserable months before the group went out of business. I also paid back a signing bonus when this group imploded even though I probably could have screwed with them and kept it.

How much is the bonus for?

Please clarify this for me. A power tripping nurse was going after you and various other staff members. Some people got fired. You are being placed on a PIP. And said nurse also got fired?

Was she complaining to the department chair or chief of staff?

Sounds like a bizarre situation. Most hospitals with a half way decent medical staff initially handle these complaints within the department first and they escalate to the med exec committee etc.

$40k.

No, this PIP is through the staffing agency I work for, not the medical staff, so it would not be NPDB reportable is my understanding, but of course I will have a lawyer confirm this.

The nurse got her manager fired for not controlling her, and she was so crazy so that a bunch of other nurses resigned. No other medical staff was fired.

 

[dozitgetchahi]

Yup, I have a lawyer reviewing it and will not sign the PIP. If they force me to I will resign.

That is a good question, I never really thought about that because everyone talks about having to give the bonus back.

$40k.

No, this PIP is through the staffing agency I work for, not the medical staff, so it would not be NPDB reportable is my understanding, but of course I will have a lawyer confirm this.

The nurse got her manager fired for not controlling her, and she was so crazy so that a bunch of other nurses resigned. No other medical staff was fired.

I also find it bizarre that a staffing company - who is presumably disconnected from the petty politics of this particular hospital - is trying to put you on a PIP etc.

Have you started lining up interviews for your next job? Personally I would also get connected with a locums agency and start that credentialing process.

 

[Osteoth]

I also find it bizarre that a staffing company - who is presumably disconnected from the petty politics of this particular hospital - is trying to put you on a PIP etc.

Have you started lining up interviews for your next job? Personally I would also get connected with a locums agency and start that credentialing process.

My thoughts exactly, but my boss told me she “felt like she had to do something”.

Luckily I believe in being antifragile so I’m in the final stages of signing a contract with a local private group and am working on credentialing for internal Locums of a hospital nearby. Luckily.

 

[end stage fibro]

For 40k(~26k after taxes?), I don't think it worth the chance of wearing a scarlet letter for the rest of your career. I agree with dozitgetchahi - this is such a roundabout way of "disciplining" you. Furthermore, if we take you at face value, you didn't do anything to get into this mess. How can you guarantee you can do something to get yourself out?

anyways, congrats on the new job!

 

[rockstar88]

I have a big signing bonus I would want to keep if I have the option lol.

The same nurse submitted half a dozen formal complaints against me, among them
-I do not assess my patients because I do not listen to the heart and lungs of every patient awaiting placement
-I do not spend enough time with my patients
-My clinical practice is poor, when case was reviewed my director said my management was fine
-I do not answer my phone when I literally have it on me the entire day

She has pushed out several other people and was let go because of the combination of all these thing

So I've been reading and saw places that say a PIP is not reportable?

Also if I leave wouldn't I still have to report because it was "to avoid an investigation"?

Are these complaints considered appropriate if the outcome is good? I mean, does it matter how much time you spend in a patient's room when they're doing better? Does it matter whether or not someone is auscultating when someone is there for placement?

 

[dozitgetchahi]

My thoughts exactly, but my boss told me she “felt like she had to do something”.

Luckily I believe in being antifragile so I’m in the final stages of signing a contract with a local private group and am working on credentialing for internal Locums of a hospital nearby. Luckily.

The other thing you need to make sure of when leaving is your tail coverage. That may be an even bigger (and more expensive) issue than the bonus. What does your contract say about tail coverage? They (or you) may always pay it based on the contract, but there are contracts where you pay it if you resign but they pay it if they fire you, etc etc…definitely something to be aware of here, especially if there are negotiations about exiting.

Also, out of curiosity…what are the “goals” on this PIP?

 

[Crayola227]

Are these complaints considered appropriate if the outcome is good? I mean, does it matter how much time you spend in a patient's room when they're doing better? Does it matter whether or not someone is auscultating when someone is there for placement?

Eh, because of notes, billing, medicolegal, things like time with the patient and did you do relevant portions of an exam you wrote and billed for or not, then having a paper record of someone essentially accusing you of fraud, which could establish any number of cases against you or the hospital.... yeah from that perspective it matters. It always matters if it seems like a discrepancy between documentation/billing and reality can be alleged credibly.

The way all of this works for us is, the Emperor is wearing clothes. No one talks about the bull**** or any discrepancy. This nurse is basically saying the Emperor isn't wearing clothes. Usually that's the person who gets the boot. It's too easy for "truth telling" like this to collapse the entire hospital, if every nurse ran around narcing on every doc creating a paper trail "truth it could collapse the entire system... I can't believe they aren't trying to keep her mouth shut.

 

[dozitgetchahi]

Eh, because of notes, billing, medicolegal, things like time with the patient and did you do relevant portions of an exam you wrote and billed for or not, then having a paper record of someone essentially accusing you of fraud, which could establish any number of cases against you or the hospital.... yeah from that perspective it matters. It always matters if it seems like a discrepancy between documentation/billing and reality can be alleged credibly.

The way all of this works for us is, the Emperor is wearing clothes. No one talks about the bull**** or any discrepancy. This nurse is basically saying the Emperor isn't wearing clothes. Usually that's the person who gets the boot. It's too easy for "truth telling" like this to collapse the entire hospital, if every nurse ran around narcing on every doc creating a paper trail "truth it could collapse the entire system... I can't believe they aren't trying to keep her mouth shut.

Well, the question is this: is anything this nurse complaining about actually true? Also, unless she is shadowing you every second of every shift, how does she actually know any of this?

“Doctor doesn’t spend enough time with patients”…how does she know if you did or didn’t come back to see the patient again? Is she in the room with you when you see the patient? As a resident I can remember quite a few patients where I came back later for one reason or another…also, is there a minimum amount of time a doctor must spend with an inpatient per day? Are the patients complaining? Is the doctor billing 60 min of care time and spending 5 min with the pt? Who knows…

“Doctor doesn’t auscultate patients waiting for placement” - is the doctor charting that they did auscultate? That would be potential fraud…but if the doctor is writing a sort of “express note” for the rocks awaiting placement, maybe he/she isn’t doing or documenting a full physical exam, and maybe that’s ok…

“Doctor does not answer phone”…this can be tracked easily in the hospital phone system, and easily disproven if it isn’t true…and there are times where you’re not going to be able to pick up the phone right away, too.

“Clinical practice is poor”…outside of horrific situations like Christopher Duntsch etc, nurses tend to be really poor judges of this in my experience…IMHO nurses try to call anything “poor practice” that makes their lives harder or that doesn’t fit their own uneducated idea of what should be done, even if it’s actually the right thing…plus if you haven’t been there long it would take you having made some really egregious and outrageous errors for anyone to try to put you on a PIP already…

IMHO the whole thing smells more like “hostile work environment” than bad doctor…and I’ve seen bad docs (and the things they get away with) at a lot of hospitals…generally nobody is putting them on PIPs or filing complaints after a few months, even if they probably deserve it…

From my experience at my first awful job, my suspicion here is that the “troublemaker nurse” is somehow well connected or otherwise politically powerful. I had an MA in my office at that first job who was an awful, lazy employee (she had lost her license as a nurse and was working as an MA)…basically she was nasty to patients and everyone else and tried to get away with doing as little as possible at work, and the office manager and her were apparently best buddies in high school. The office manager was really good friends with the higher up hospital admins, and she had convinced them all that this person was a “really good employee”, so basically this person was untouchable even though she was completely incompetent and shiftless and nasty to deal with. To keep the MA there, the office manager’s strategy was apparently to try to make the doc look as bad as possible…so they tried to claim i was late to work when I wasn’t, and all this other silly BS. The hospital was apparently willing to lose a doctor they had invested hundreds of thousands of dollars into in favor of some lazy MA and an office manager who “had her back”…that’s how politically stupid all of this gets.

In your situation, note that this crazy nurse lobbing accusations isn’t the one who got fired…it’s the people around her…

 

[Osteoth]

For 40k(~26k after taxes?), I don't think it worth the chance of wearing a scarlet letter for the rest of your career. I agree with dozitgetchahi - this is such a roundabout way of "disciplining" you. Furthermore, if we take you at face value, you didn't do anything to get into this mess. How can you guarantee you can do something to get yourself out?

anyways, congrats on the new job!

I think I would have to pay back the full $40k after tax right?

Are these complaints considered appropriate if the outcome is good? I mean, does it matter how much time you spend in a patient's room when they're doing better? Does it matter whether or not someone is auscultating when someone is there for placement?

That's what I'm saying. Not every patient awaiting placement needs me to spend an hour with them chatting about their dementia...

The other thing you need to make sure of when leaving is your tail coverage. That may be an even bigger (and more expensive) issue than the bonus. What does your contract say about tail coverage? They (or you) may always pay it based on the contract, but there are contracts where you pay it if you resign but they pay it if they fire you, etc etc…definitely something to be aware of here, especially if there are negotiations about exiting.

Also, out of curiosity…what are the “goals” on this PIP?

Just looked luckily my tail is covered even if I'm fired.
They want me to round bedside with every nurse every day, which isn't that bad it's a small hospital.
They also want me to beef up my notes so they can bill the maximum DRG nonsense

Eh, because of notes, billing, medicolegal, things like time with the patient and did you do relevant portions of an exam you wrote and billed for or not, then having a paper record of someone essentially accusing you of fraud, which could establish any number of cases against you or the hospital.... yeah from that perspective it matters. It always matters if it seems like a discrepancy between documentation/billing and reality can be alleged credibly.

The way all of this works for us is, the Emperor is wearing clothes. No one talks about the bull**** or any discrepancy. This nurse is basically saying the Emperor isn't wearing clothes. Usually that's the person who gets the boot. It's too easy for "truth telling" like this to collapse the entire hospital, if every nurse ran around narcing on every doc creating a paper trail "truth it could collapse the entire system... I can't believe they aren't trying to keep her mouth shut.

Dude the thing is, I've worked at bigger places before and some of the private doctors there would literally committ malpractice on a daily basis and would never get in trouble.

We had one guy who was infamous for this. Have a heart? Cardio. Have lungs? Pulm. For every patient and he had like 4,000 pts in his outpatient practice. He would literally never see some of his pts. Of course everyone was happy in a FFS world though.

Well, the question is this: is anything this nurse complaining about actually true? Also, unless she is shadowing you every second of every shift, how does she actually know any of this?

“Doctor doesn’t spend enough time with patients”…how does she know if you did or didn’t come back to see the patient again? Is she in the room with you when you see the patient? As a resident I can remember quite a few patients where I came back later for one reason or another…also, is there a minimum amount of time a doctor must spend with an inpatient per day? Are the patients complaining? Is the doctor billing 60 min of care time and spending 5 min with the pt? Who knows…

“Doctor doesn’t auscultate patients waiting for placement” - is the doctor charting that they did auscultate? That would be potential fraud…but if the doctor is writing a sort of “express note” for the rocks awaiting placement, maybe he/she isn’t doing or documenting a full physical exam, and maybe that’s ok…

“Doctor does not answer phone”…this can be tracked easily in the hospital phone system, and easily disproven if it isn’t true…and there are times where you’re not going to be able to pick up the phone right away, too.

“Clinical practice is poor”…outside of horrific situations like Christopher Duntsch etc, nurses tend to be really poor judges of this in my experience…IMHO nurses try to call anything “poor practice” that makes their lives harder or that doesn’t fit their own uneducated idea of what should be done, even if it’s actually the right thing…plus if you haven’t been there long it would take you having made some really egregious and outrageous errors for anyone to try to put you on a PIP already…

IMHO the whole thing smells more like “hostile work environment” than bad doctor…and I’ve seen bad docs (and the things they get away with) at a lot of hospitals…generally nobody is putting them on PIPs or filing complaints after a few months, even if they probably deserve it…

From my experience at my first awful job, my suspicion here is that the “troublemaker nurse” is somehow well connected or otherwise politically powerful. I had an MA in my office at that first job who was an awful, lazy employee (she had lost her license as a nurse and was working as an MA)…basically she was nasty to patients and everyone else and tried to get away with doing as little as possible at work, and the office manager and her were apparently best buddies in high school. The office manager was really good friends with the higher up hospital admins, and she had convinced them all that this person was a “really good employee”, so basically this person was untouchable even though she was completely incompetent and shiftless and nasty to deal with. To keep the MA there, the office manager’s strategy was apparently to try to make the doc look as bad as possible…so they tried to claim i was late to work when I wasn’t, and all this other silly BS. The hospital was apparently willing to lose a doctor they had invested hundreds of thousands of dollars into in favor of some lazy MA and an office manager who “had her back”…that’s how politically stupid all of this gets.

In your situation, note that this crazy nurse lobbing accusations isn’t the one who got fired…it’s the people around her…

That's wild. The crazy nurse is getting fired, but the problem the hospital is in right now is they have literally 0 ICU nurses for the next 3 days lol. This is the **** that rural america deals with...so they need her for at least a few more weeks.

 

[wholeheartedly]

My thoughts exactly, but my boss told me she “felt like she had to do something”.

This is an epically stupid reason for the staffing company to put you on a PIP, especially if the facility doesn’t want to.

Ditch them.

 

[dozitgetchahi]

I think I would have to pay back the full $40k after tax right?

That's what I'm saying. Not every patient awaiting placement needs me to spend an hour with them chatting about their dementia...

Just looked luckily my tail is covered even if I'm fired.
They want me to round bedside with every nurse every day, which isn't that bad it's a small hospital.
They also want me to beef up my notes so they can bill the maximum DRG nonsense

Dude the thing is, I've worked at bigger places before and some of the private doctors there would literally committ malpractice on a daily basis and would never get in trouble.

We had one guy who was infamous for this. Have a heart? Cardio. Have lungs? Pulm. For every patient and he had like 4,000 pts in his outpatient practice. He would literally never see some of his pts. Of course everyone was happy in a FFS world though.

That's wild. The crazy nurse is getting fired, but the problem the hospital is in right now is they have literally 0 ICU nurses for the next 3 days lol. This is the **** that rural america deals with...so they need her for at least a few more weeks.

Wait, they’re putting you on a PIP to have you round with a nurse every day and to make your notes longer for billing? And your boss “thought she had to do something”?

Agree with above, ditch these people. It’s almost insulting at this point. That’s just nuts.

 

[Crayola227]

Well, the question is this: is anything this nurse complaining about actually true? Also, unless she is shadowing you every second of every shift, how does she actually know any of this?

“Doctor doesn’t spend enough time with patients”…how does she know if you did or didn’t come back to see the patient again? Is she in the room with you when you see the patient? As a resident I can remember quite a few patients where I came back later for one reason or another…also, is there a minimum amount of time a doctor must spend with an inpatient per day? Are the patients complaining? Is the doctor billing 60 min of care time and spending 5 min with the pt? Who knows…

“Doctor doesn’t auscultate patients waiting for placement” - is the doctor charting that they did auscultate? That would be potential fraud…but if the doctor is writing a sort of “express note” for the rocks awaiting placement, maybe he/she isn’t doing or documenting a full physical exam, and maybe that’s ok…

“Doctor does not answer phone”…this can be tracked easily in the hospital phone system, and easily disproven if it isn’t true…and there are times where you’re not going to be able to pick up the phone right away, too.

“Clinical practice is poor”…outside of horrific situations like Christopher Duntsch etc, nurses tend to be really poor judges of this in my experience…IMHO nurses try to call anything “poor practice” that makes their lives harder or that doesn’t fit their own uneducated idea of what should be done, even if it’s actually the right thing…plus if you haven’t been there long it would take you having made some really egregious and outrageous errors for anyone to try to put you on a PIP already…

IMHO the whole thing smells more like “hostile work environment” than bad doctor…and I’ve seen bad docs (and the things they get away with) at a lot of hospitals…generally nobody is putting them on PIPs or filing complaints after a few months, even if they probably deserve it…

From my experience at my first awful job, my suspicion here is that the “troublemaker nurse” is somehow well connected or otherwise politically powerful. I had an MA in my office at that first job who was an awful, lazy employee (she had lost her license as a nurse and was working as an MA)…basically she was nasty to patients and everyone else and tried to get away with doing as little as possible at work, and the office manager and her were apparently best buddies in high school. The office manager was really good friends with the higher up hospital admins, and she had convinced them all that this person was a “really good employee”, so basically this person was untouchable even though she was completely incompetent and shiftless and nasty to deal with. To keep the MA there, the office manager’s strategy was apparently to try to make the doc look as bad as possible…so they tried to claim i was late to work when I wasn’t, and all this other silly BS. The hospital was apparently willing to lose a doctor they had invested hundreds of thousands of dollars into in favor of some lazy MA and an office manager who “had her back”…that’s how politically stupid all of this gets.

In your situation, note that this crazy nurse lobbing accusations isn’t the one who got fired…it’s the people around her…

Oh, I completely agree. It was more the issue of not auscultating. It's secondhand but I've been told this is a classic "gotcha" that is attempted to be used in malpractice or fraud. I think of anything that was mentioned, that would be the one thing to be cautious of. Because if you were dragged to court and both the patient and nurse agreed you did not do it, but it was in your note, that would be less than ideal in front of a jury.

Hospitals don't want to see **** like this being said in black and white is all. It's all nothing burger but not appearing to "respond" to the nurse's "concerns" is bad and is often what has to happen even if it's all BS. But there's more than one way forward to check the box.

But the fact that THIS is how the hospital is going to show it "cares" about these complaints is yes, the bigger red flag.

Personally it's one of the places I put effort into in my template. The documented PE has to be both the minimum for billing, and I have to at least do that much in the room.

It gets into this other thing too about PE and liability. People really have no way of knowing if your exam is appropriate, no way to judge if you did what you are "supposed" to do, but they do have this idea you are supposed to listen to their heart and lungs. (The other thing is if they complain about a body part and you don't at least give it your Midas touch). So just putting your steth on someone can nip a lot of that in the bud. Call it physical exam theater. Waste of time? No more than than anything else we do for CYA, and at least in my mind it has more utility than a lot of CYA practice. I guess take your pick of your favorite CYA. Some of it has probably been proven for CYA, and some of it is probably just what voodoo makes you imagine more or less wind on your backside.

My other favorite tip is to pepper your notes with the patient's name. If you only use patient aside from the beginning autofill of the name, I had an a doc tell me a medmal attorney say that is an easy gimme to say "this doc doesn't give a **** about his patients, look, he can't even be bothered to use their name in his notes, so impersonal!"

My experience is that any complaint, no matter how bull****, can be used against you by non-physicians given the wrong situation.

Anyway, "not listening to the heart and lungs" by a doctor sounds bad to just about everybody, even 12 year old kids who watch too much TV. Documenting you did when you didn't.

Also patients read their notes a lot more now too. They will latch onto something like that "lie" in your notes and it just spirals. It's not that hard to place your steth or write a stock PE you can bill and actually do.

It's funny that of anything that was the complaint that stood out to me as something.

 

[dozitgetchahi]

Oh, I completely agree. It was more the issue of not auscultating. It's secondhand but I've been told this is a classic "gotcha" that is attempted to be used in malpractice or fraud. I think of anything that was mentioned, that would be the one thing to be cautious of. Because if you were dragged to court and both the patient and nurse agreed you did not do it, but it was in your note, that would be less than ideal in front of a jury.

Hospitals don't want to see **** like this being said in black and white is all. It's all nothing burger but not appearing to "respond" to the nurse's "concerns" is bad and is often what has to happen even if it's all BS. But there's more than one way forward to check the box.

But the fact that THIS is how the hospital is going to show it "cares" about these complaints is yes, the bigger red flag.

Personally it's one of the places I put effort into in my template. The documented PE has to be both the minimum for billing, and I have to at least do that much in the room.

It gets into this other thing too about PE and liability. People really have no way of knowing if your exam is appropriate, no way to judge if you did what you are "supposed" to do, but they do have this idea you are supposed to listen to their heart and lungs. (The other thing is if they complain about a body part and you don't at least give it your Midas touch). So just putting your steth on someone can nip a lot of that in the bud. Call it physical exam theater. Waste of time? No more than than anything else we do for CYA, and at least in my mind it has more utility than a lot of CYA practice. I guess take your pick of your favorite CYA. Some of it has probably been proven for CYA, and some of it is probably just what voodoo makes you imagine more or less wind on your backside.

My other favorite tip is to pepper your notes with the patient's name. If you only use patient aside from the beginning autofill of the name, I had an a doc tell me a medmal attorney say that is an easy gimme to say "this doc doesn't give a **** about his patients, look, he can't even be bothered to use their name in his notes, so impersonal!"

My experience is that any complaint, no matter how bull****, can be used against you by non-physicians given the wrong situation.

Anyway, "not listening to the heart and lungs" by a doctor sounds bad to just about everybody, even 12 year old kids who watch too much TV. Documenting you did when you didn't.

Also patients read their notes a lot more now too. They will latch onto something like that "lie" in your notes and it just spirals. It's not that hard to place your steth or write a stock PE you can bill and actually do.

It's funny that of anything that was the complaint that stood out to me as something.

No I completely agree, and I think it’s something to try hard to make sure you’re doing.

 

[Crayola227]

I think I would have to pay back the full $40k after tax right?

That's what I'm saying. Not every patient awaiting placement needs me to spend an hour with them chatting about their dementia...

Just looked luckily my tail is covered even if I'm fired.
They want me to round bedside with every nurse every day, which isn't that bad it's a small hospital.
They also want me to beef up my notes so they can bill the maximum DRG nonsense

Dude the thing is, I've worked at bigger places before and some of the private doctors there would literally committ malpractice on a daily basis and would never get in trouble.

We had one guy who was infamous for this. Have a heart? Cardio. Have lungs? Pulm. For every patient and he had like 4,000 pts in his outpatient practice. He would literally never see some of his pts. Of course everyone was happy in a FFS world though.

That's wild. The crazy nurse is getting fired, but the problem the hospital is in right now is they have literally 0 ICU nurses for the next 3 days lol. This is the **** that rural america deals with...so they need her for at least a few more weeks.

I hear ya about the malpractice. Whatever study they did showing the #1 predictor of a suit being brought was "the patient didn't feel heard or that you were honest", not outcome, does sort of show the fickle nature of it all.

Dozitgetchahi makes the great point that so many of the complaints can be disproven with objective measures, so most of it doesn't matter.

 

[Osteoth]

Wait, they’re putting you on a PIP to have you round with a nurse every day and to make your notes longer for billing? And your boss “thought she had to do something”?

Agree with above, ditch these people. It’s almost insulting at this point. That’s just nuts.

Yup.

Oh, I completely agree. It was more the issue of not auscultating. It's secondhand but I've been told this is a classic "gotcha" that is attempted to be used in malpractice or fraud. I think of anything that was mentioned, that would be the one thing to be cautious of. Because if you were dragged to court and both the patient and nurse agreed you did not do it, but it was in your note, that would be less than ideal in front of a jury.

Hospitals don't want to see **** like this being said in black and white is all. It's all nothing burger but not appearing to "respond" to the nurse's "concerns" is bad and is often what has to happen even if it's all BS. But there's more than one way forward to check the box.

But the fact that THIS is how the hospital is going to show it "cares" about these complaints is yes, the bigger red flag.

Personally it's one of the places I put effort into in my template. The documented PE has to be both the minimum for billing, and I have to at least do that much in the room.

It gets into this other thing too about PE and liability. People really have no way of knowing if your exam is appropriate, no way to judge if you did what you are "supposed" to do, but they do have this idea you are supposed to listen to their heart and lungs. (The other thing is if they complain about a body part and you don't at least give it your Midas touch). So just putting your steth on someone can nip a lot of that in the bud. Call it physical exam theater. Waste of time? No more than than anything else we do for CYA, and at least in my mind it has more utility than a lot of CYA practice. I guess take your pick of your favorite CYA. Some of it has probably been proven for CYA, and some of it is probably just what voodoo makes you imagine more or less wind on your backside.

My other favorite tip is to pepper your notes with the patient's name. If you only use patient aside from the beginning autofill of the name, I had an a doc tell me a medmal attorney say that is an easy gimme to say "this doc doesn't give a **** about his patients, look, he can't even be bothered to use their name in his notes, so impersonal!"

My experience is that any complaint, no matter how bull****, can be used against you by non-physicians given the wrong situation.

Anyway, "not listening to the heart and lungs" by a doctor sounds bad to just about everybody, even 12 year old kids who watch too much TV. Documenting you did when you didn't.

Also patients read their notes a lot more now too. They will latch onto something like that "lie" in your notes and it just spirals. It's not that hard to place your steth or write a stock PE you can bill and actually do.

It's funny that of anything that was the complaint that stood out to me as something.

The problem is with cerner copying forward is much harder than when I've had meditech in the past. Templating isn't as easy, unless you have a good trick?

Some of this I honestly think is growing pains, I'm a new doctor, but I think it would be a much simpler and more educational conversation to just say "hey, I know this is dumb but sometimes you gotta do it" instead of getting all this paperwork involved.

The patient's name is bull****, such bull****...

Yes, another learning point that in a small hospital people really care and read your notes and everything you put out. I feel like when I was at bigger places every patient had like 5 doctors on the case so everything was so much less scrutinized.

I hear ya about the malpractice. Whatever study they did showing the #1 predictor of a suit being brought was "the patient didn't feel heard or that you were honest", not outcome, does sort of show the fickle nature of it all.

Dozitgetchahi makes the great point that so many of the complaints can be disproven with objective measures, so most of it doesn't matter.

So annoying, a patient reported me through the hospital's formal evaluation process, and he's 81 so probably the family helped him, but every single day I spent at least 10 minutes with him and his annoying family talking in circles with them trying to figure out what to do with this guy who eventually went hospice. HE WENT HOSPICE IT DOESN'T MATTER IF I AUSCULTATED HIM. So frustrating.

 

[NotAProgDirector]

Earlier on the thread there was a brief discussion of resign/fired. Places often offer to let you resign. You get the benefit of saying you resigned. They get several benefits: 1) you can't claim unemployment, 2) it's much more difficult to sue them, 3) you waive any rights to any grievance process. And they might get their signing bonus back, as already discussed.

 

[Osteoth]

Earlier on the thread there was a brief discussion of resign/fired. Places often offer to let you resign. You get the benefit of saying you resigned. They get several benefits: 1) you can't claim unemployment, 2) it's much more difficult to sue them, 3) you waive any rights to any grievance process. And they might get their signing bonus back, as already discussed.

Problem with that is they might just fire you instead and then it’s a big problem

 

[dozitgetchahi]

Yup.

The problem is with cerner copying forward is much harder than when I've had meditech in the past. Templating isn't as easy, unless you have a good trick?

Some of this I honestly think is growing pains, I'm a new doctor, but I think it would be a much simpler and more educational conversation to just say "hey, I know this is dumb but sometimes you gotta do it" instead of getting all this paperwork involved.

The patient's name is bull****, such bull****...

Yes, another learning point that in a small hospital people really care and read your notes and everything you put out. I feel like when I was at bigger places every patient had like 5 doctors on the case so everything was so much less scrutinized.

So annoying, a patient reported me through the hospital's formal evaluation process, and he's 81 so probably the family helped him, but every single day I spent at least 10 minutes with him and his annoying family talking in circles with them trying to figure out what to do with this guy who eventually went hospice. HE WENT HOSPICE IT DOESN'T MATTER IF I AUSCULTATED HIM. So frustrating.

I’m a bit confused by your discussion of “copying forward” in Cerner vs Meditech…I’ve used both, and this might be the first time in recorded history that anyone has expressed a preference for Meditech over any other EMR.

Are you concerned that Cerner is copying forward things like your physical exam? Yes, you do have to be careful to check what was copied forward, but at least in Epic (it’s been a while since I’ve used Cerner), there are ways to have it flag those things so that you have to review it before you sign the note.

I don’t remember that much about Cerner’s templating capabilities, but I do remember Meditech being absolutely horrible at templating (“Meditrash” was one of the reasons I refused to do inpatient consults at that first lousy job I had - they had Meditech on the inpatient side, and Centricity outpatient…neither was a good EMR, both had very primitive templating capabilities compared to Epic and Cerner, but Centricity was marginally more tolerable…)

 

[mszzeta]

Yup.

The problem is with cerner copying forward is much harder than when I've had meditech in the past. Templating isn't as easy, unless you have a good trick?

Some of this I honestly think is growing pains, I'm a new doctor, but I think it would be a much simpler and more educational conversation to just say "hey, I know this is dumb but sometimes you gotta do it" instead of getting all this paperwork involved.

The patient's name is bull****, such bull****...

Yes, another learning point that in a small hospital people really care and read your notes and everything you put out. I feel like when I was at bigger places every patient had like 5 doctors on the case so everything was so much less scrutinized.

So annoying, a patient reported me through the hospital's formal evaluation process, and he's 81 so probably the family helped him, but every single day I spent at least 10 minutes with him and his annoying family talking in circles with them trying to figure out what to do with this guy who eventually went hospice. HE WENT HOSPICE IT DOESN'T MATTER IF I AUSCULTATED HIM. So frustrating.

What you have gone through is completely bull****. Just leave this terrible place.

No, you will not get sued for not auscultating for an end-of-life patient. The wrong documentation, albert it is wrong, is trivial and no reason to be a big deal. Everyone copy and paste notes all the time, and there will be errors in note as long as one is a human being. Physicians need to prioritize on medically important things to save lifes.

 

[Splenda88]

I had a conversation with my boss today, and I was told that because I am employed by a staffing company that subcontracts through the hospital to provide hospitalist coverage, that the PIP is not NPDB reportable, and even if I was fired it would not be a reportable offense unless it was to go through the medical staff at the hospital and lead to a revocation of privileges. Anyone have any experience with this?

Leave man and pay back the sign on bonus. Why don't doctors listen?

They just don't like you at that place.

Why risk your livelihood?

 

[glorifiedresident]

I can't imagine staying under these circumstances, just way too much uncertainty and stress.
Leave, and do a honest assessment of things you could or could not have done better.

 

[MD46]

Sincere advice is to leave
40k when u look back will be well worth leaving rather than dealing with the hassle of staying in this situation.

They likely already discussed your dismissal plan in the ivory tower, this PIP thing is just a step towards that. Actually I am sure of it to be honest.

Do locums and make that 40k quickly, you will find a way I am sure.

Best of luck