Post doc and FMLA

[Carson_Tay]

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I’m currently a 2nd year neuropsych fellow. I am going on FMLA for a sever health condition which have been preventing me from working so I got very behind on work and I’m going on leave starting Monday. I had a meeting about it today and my supervisor is requesting I work through the weekend so get all the pending report done (that’s 8 reports on 4 days) - my health condition is still preventing me from working and I’m not supposed to work weekend but they wouldn’t hear it. What can I do? Is this normal?

 

[WisNeuro]

How long are you going on FMLA for? Kind of a sticky situation, they need to honor your FMLA, but they can't have patients waiting for reports for an inordinate amount of time. Furthermore, what kind of reports are these? Something like a run of the mill dementia report should take 30-45 minutes.

 

[Carson_Tay]

How long are you going on FMLA for? Kind of a sticky situation, they need to honor your FMLA, but they can't have patients waiting for reports for an inordinate amount of time. Furthermore, what kind of reports are these? Something like a run of the mill dementia report should take 30-45 minutes.

It’s 3 weeks. And they make us write report like is 2002 and they’re 9 pages long for dementia patients. 12 or more more epilepsy and other. It’s maybe 1/2 dementia and 1/2 other stuff

 

[WisNeuro]

Ok, so like 1-2 for those reports, even if you say 3 hours a report, that's 24 hours over 4 days as an overestimate? Assuming you aren't seeing new evaluations in that time?

 

[PsyDr]

I feel like you want to hear that this is not fair, and there is some way out of it. But you have patients, and you are responsible for them.

Ways to easily get this done

1) By the sounds of this, you are writing reports by test rather than domain. Go back, find an old dementia report that you did well on. Copy each test section. I'm guessing that you write something like, "on a subtest of crystalized verbal knowledge, the patient scored in the average range". Great. Find where you wrote "average range". Replace that with some low frequency phrase like "blacksheepwool", so that your new sentence reads "on a subtest of crystalized verbal knowledge, the patient scored in the "blacksheepwool" range " Repeat this for each subtest, and each test. Now you have a template for dementia patients.

2) Take that template. Create copies for each patient. Next, take your first test. Let's say it's the WAIS. Go subtest by subtest, replace "blacksheepwool" in the template with whatever descriptor is appropriate. Do the WAIS for the next patient, then the next. Now you've done all of the WAIS sections. Now do that with the next test. Don't even pay attention to what you are writing. You're just operating as a replacement machine. Now you've banged out all of the tests. That's the majority of the work right there.

3) For epilepsy, do the same. You know they're gonna want you to say some extra stuff about handedness, language, port wine birthmarks, gait, maybe fencing, maybe religiosity, etc.

4) Next write your intro for each. You should have this relatively standardized. "Patient is a age, handed, gender, with years of education who .........". Again, each component is pretty standardized.

5) Only you only need the summaries. Eight summaries? Not hard. First paragraph, you copy the intro, then rephrase a few of the sentences. Next paragraph then say something about the overall scores, and pattern of performance. Next paragraph you correlate with whatever diagnosis. It's likely that at least two are going to be DAT.

You could have that done by tomorrow. They're not going to be strong reports, but they will do.

 

[WisNeuro]

I'm with PsyDr on this one. As a 2nd year postdoc, you should have templates up and ready to go. As mentioned, it's plug and play for describing test results, that's 10-15 minutes tops. Interpretation and summary, maybe 20 minutes. Half hour to fill in the individualized psychosocial, which should also be heavily templated. for a 5-7 page dementia report, with my templates, once I have the tests scored, these are 10-15 min reports. Granted, this should take longer at the postdoc level, but at that stage, I was writing 4 outpatient reports, and 3-5 inpatient reports, while doing most of the testing and other meetings/trainings per week.

 

[Therapist4Chnge]

Spot on.

It’s also highly advisable to have templates like this bc you’ll find that 98% of clinicians don’t care about anything but the summary and recs from a neuropsych report. You still should included the info, but it’s basically a narrative of summary chart info.

 

[jdawg2017]

Fist off, I’m sorry that you aren’t doing well and hope the time off helps!

I would agree with most of what has been said above. Honestly, if you’re going to be gone for 3 weeks I feel like most patients can wait (assuming your site or hospital is okay with that); maybe you or your admin staff should let them know there will be a small delay if they are expecting results sooner. The only exception would be if you have an epilepsy patient who may be pending a fast workup for neurosurgery. I’ve gotten to basically turning my reports around within 1-2 business days while on postdoc unless there’s something extremely complex, but dementia evals typically don’t need that quick of a turnaround. Yes, you have an obligation to your patients, but if you truly cannot do the work due to a major medical event or condition there is no way around that…

What I’d recommend if I were in your shoes would be to see if you can write all the 8 backgrounds in the next two days and push the reports until after your FMLA (assuming it will only be 3 weeks and not longer). It’s easy to forget key details, even with good notes, after we take weeks off. The test interpretations and summaries should be fairly straight forward to do upon your return.

 

[WisNeuro]

Fist off, I’m sorry that you aren’t doing well and hope the time off helps!

I would agree with most of what has been said above. Honestly, if you’re going to be gone for 3 weeks I feel like most patients can wait (assuming your site or hospital is okay with that); maybe you or your admin staff should let them know there will be a small delay if they are expecting results sooner. The only exception would be if you have an epilepsy patient who may be pending a fast workup for neurosurgery. I’ve gotten to basically turning my reports around within 1-2 business days while on postdoc unless there’s something extremely complex, but dementia evals typically don’t need that quick of a turnaround. Yes, you have an obligation to your patients, but if you truly cannot do the work due to a major medical event or condition there is no way around that…

What I’d recommend if I were in your shoes would be to see if you can write all the 8 backgrounds in the next two days and push the reports until after your FMLA (assuming it will only be 3 weeks and not longer). It’s easy to forget key details, even with good notes, after we take weeks off. The test interpretations and summaries should be fairly straight forward to do upon your return.

Most places I have worked at have had policies dictating documentation being finished, usually within 1-2 weeks from when the patient had been seen. Also, a lot of the time, their follow-up appointments (e.g., neurology) are pending our reports, so now that is being delayed as well. Definitely see what kind of compromise can be made, but if possible, I'd just try to get these reports done over the next 1-2 days.

 

[PsyDr]

When you use FMLA for time off your supervisor does not have the right to push you into working. Most organizations rely on pre-made templates and standardized procedures as a quick method to complete reports. The issue could be clarified better by informing the supervisor about your health condition while presenting the FMLA protections you have. You should establish limitations and outline your inability to operate under such conditions when medical guidelines prohibit the work tasks. Stay firm about your needs.

Great way to get a letter to the board saying, “this person is an impaired provider”.

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I would agree with most of what has been said above. Honestly, if you’re going to be gone for 3 weeks I feel like most patients can wait (assuming your site or hospital is okay with that); maybe you or your admin staff should let them know there will be a small delay if they are expecting results sooner.

…

We must have different state laws or see different patients. Someone looking for presurgicsl evaluation for a partial corpus callosumoty due to intractable seizures might feel differently., as might their neurosurgeon.

 

[jdawg2017]

Most places I have worked at have had policies dictating documentation being finished, usually within 1-2 weeks from when the patient had been seen. Also, a lot of the time, their follow-up appointments (e.g., neurology) are pending our reports, so now that is being delayed as well. Definitely see what kind of compromise can be made, but if possible, I'd just try to get these reports done over the next 1-2 days.

I 100% agree that’s the norm at AMCs I’ve been at as well. I’m more stating that a lot of time they could *theoretically* wait 3 weeks if it came to it.

Great way to get a letter to the board saying, “this person is an impaired provider”.

We must have different state laws or see different patients. Someone looking for presurgicsl evaluation for a partial corpus callosumoty due to intractable seizures might feel differently., as might their neurosurgeon.

If you read my whole comment you would see that I said that… it’s literally the next sentence.

 

[WisNeuro]

I 100% agree that’s the norm at AMCs I’ve been at as well. I’m more stating that a lot of time they could *theoretically* wait 3 weeks if it came to it.


If you read my whole comment you would see that I said that… it’s literally the next sentence.

Given that they had a day and a half of work prior to going on leave, they could theoretically just pump those reports out pretty easily. Otherwise, FMLA should have started sooner.

 

[PsyDr]

I 100% agree that’s the norm at AMCs I’ve been at as well. I’m more stating that a lot of time they could *theoretically* wait 3 weeks if it came to it.


If you read my whole comment you would see that I said that… it’s literally the next sentence.

My apologies. I was wrong.