Rant: Shift Change Etiquette

[EMhawkeye]

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Professionalism is a lost art

 

[BoardingDoc]

Counterpoint: when you're single coverage, it blows staying over for an hour+ dealing with an ICU train wreck admission that rolled in at 7:06 because your relief is late, again, and you had to spend time with lines/tubes/labs/calling...

I don't get this mentality. If this person rolls in at 706 and the 7a doc shows up at 710, you tell them to take over and you leave. I have no idea why you would stay to manage that patient. Hell, if a total Trainwreck rolls in at 655am, I'm generally giving that patient to the 7a doc as well. That's just sort of understood to be a viable option. Is this actually not an option at other people's shops? Am I just taking for granted that I work with a bunch of other actual adults?

 

[Fox800]

I don't get this mentality. If this person rolls in at 706 and the 7a doc shows up at 710, you tell them to take over and you leave. I have no idea why you would stay to manage that patient. Hell, if a total Trainwreck rolls in at 655am, I'm generally giving that patient to the 7a doc as well. That's just sort of understood to be a viable option. Is this actually not an option at other people's shops? Am I just taking for granted that I work with a bunch of other actual adults?

Yeah, you are.

If you're single coverage and a cardiac arrest rolls in at 0703 and your relief is 20 minutes late because of "traffic", you're gonna be doing some stuff and writing a chart. There's no warm handoff of that.

 

[bky3c]

I never actually entered the hospital until about 5 minutes before my shift. I'd get there about 15 minutes early, listen to a bit more of my podcast in the car, reply to a text, etc. and then walk in only when necessary, but still early enough to get settled in time to take signout right on time. That way I felt like it was still my own time, not dead time that I was just wasting. But if I did hit traffic or whatever, the buffer was there.

 

[bky3c]

Yeah, you are.

If you're single coverage and a cardiac arrest rolls in at 0703 and your relief is 20 minutes late because of "traffic", you're gonna be doing some stuff and writing a chart. There's no warm handoff of that.

Exactly. Even if someone is 5 minutes late, that's enough time to be up to your elbows in an intubation or a line or whatever, and even if you didn't do anything but run the resus until you could hand it over, you still have to document that. So now you're leaving at least 15 minutes late because your colleague was 5 minutes late (5 min running code, 5 min handover, 5 min charting). And inevitably something will come up with your own patients (or new ones) during that time, and since you're physically present, you'll get 3 nurses coming to you with questions/orders/concerns "just real quick before you leave."

 

[xaelia]

And inevitably something will come up with your own patients (or new ones) during that time, and since you're physically present, you'll get 3 nurses coming to you with questions/orders/concerns "just real quick before you leave."

As I frequently say – the longer you stay, the longer you stay.

 

[DeadCactus]

Counterpoint: when you're single coverage, it blows staying over for an hour+ dealing with an ICU train wreck admission that rolled in at 7:06 because your relief is late, again, and you had to spend time with lines/tubes/labs/calling consultants/charting and then dealing with worsening traffic on the way home isn't fair so your colleagues can avoid "drinking coffee to avoid ever being late show up at their scheduled times like an adult with a professional job" (there, I took those rose-colored glasses off for you).

One of our noctors is routinely 20-30 minutes late because of "muh traffic" while the department is melting down. Somehow this is just accepted, and the powers that be don't ask her to stay late to make up the difference in scheduled hours.

In the grand scheme of cosmic karma, show up to your damn job on time. Why is this so hard? You had to do it in med school, you had to do it in residency. It's not cute, it's not cool. You can get a pass once in a while. Don't make being late a habit.

Your acting like extreme edge cases in a specific sign-out circumstance are the routine outcome and using inflammatory language to back up a practice that is all about local culture and has nothing to do with professionalism. No one is talking about routinely showing up 30 minutes late but aiming to be on time and rarely being 5 minutes late is reasonable as long as the same courtesy is extended to everyone. You've unilaterally decided to do 2 hours of unpaid time in the hospital a month and think everyone else is shackled by your decision which is not reasonable. The problem is people being on different pages or being treated differently and not with any specific approach. It's the same bull**** that pops up with people calling in sick or having personal emergencies.

 

[BoardingDoc]

Yeah, you are.

If you're single coverage and a cardiac arrest rolls in at 0703 and your relief is 15 minutes late because of "traffic", you're gonna be doing some stuff and writing a chart. There's no warm handoff of that.

Note to self: thank my colleagues for being exceptional.

In your scenario it would be perfectly acceptable to stay and manage that patient from start to finish. It would also be perfectly acceptable to say "I just tubed this guy from our lady of clinical incompetence nursing home, he's a hot mess. Here's what I know. I'll write the intubation procedure note, the rest is all you."

Again to reiterate though, I don't work with anyone who is habitually late by more than a minute or two.

 

[Fox800]

Your acting like extreme edge cases in a specific sign-out circumstance are the routine outcome and using inflammatory language to back up a practice that is all about local culture and has nothing to do with professionalism. No one is talking about routinely showing up 30 minutes late but aiming to be on time and rarely being 5 minutes late is reasonable as long as the same courtesy is extended to everyone. You've unilaterally decided to do 2 hours of unpaid time in the hospital a month and think everyone else is shackled by your decision which is not reasonable. The problem is people being on different pages or being treated differently and not with any specific approach. It's the same bull**** that pops up with people calling in sick or having personal emergencies.

To each their own. I wouldn't routinely hand off an active resus, but maybe the culture of your shop is different. Unless the circumstances were really unusual (patient reasonably stabilized on the vent, has access, waiting for the helicopter, whatever).

This isn't an extreme case, I've worked at CAHs and had enough chronically late coworkers and had it happen a few times.

It gets old managing an unstable resus that rolled in at shift change while your relief walks in with their coffee, there are five new patients that are waiting to be seen, while you still have other patients to sign out.

 

[Fox800]

Note to self: thank my colleagues for being exceptional.

In your scenario it would be perfectly acceptable to stay and manage that patient from start to finish. It would also be perfectly acceptable to say "I just tubed this guy from our lady of clinical incompetence nursing home, he's a hot mess. Here's what I know. I'll write the intubation procedure note, the rest is all you."

Again to reiterate though, I don't work with anyone who is habitually late by more than a minute or two.

I guess it was just the way I was trained, but I wouldn't sign off a patient I just tubed with a procedure note and then yeet it to the oncoming doc. The idea makes me feel weird. It's just not how things are done, it seems sloppy. At least stabilize them to the point they can go to imaging or have the ICU come down and do stuff.

I don't know maybe it's a culture thing or a training/residency thing.

Are ya'll tubing and coding people and then doing just the procedure note or dropping your .signout smart phrase? Jesus 🤣

 

[Fox800]

I never actually entered the hospital until about 5 minutes before my shift. I'd get there about 15 minutes early, listen to a bit more of my podcast in the car, reply to a text, etc. and then walk in only when necessary, but still early enough to get settled in time to take signout right on time. That way I felt like it was still my own time, not dead time that I was just wasting. But if I did hit traffic or whatever, the buffer was there.

Same. I leave early with a little buffer, then sit in my car until it's time to walk like 3-4 minutes before shift change.

I don't do unpaid work. I don't start work early, and I go home on time.

We do get paid for staying late for active patient care/delayed signouts if your relief is elsewhere.

 

[CoolDoc1729]

I guess it was just the way I was trained, but I wouldn't sign off a patient I just tubed with a procedure note and then yeet it to the oncoming doc. The idea makes me feel weird. It's just not how things are done, it seems sloppy. At least stabilize them to the point they can go to imaging or have the ICU come down and do stuff.

I don't know maybe it's a culture thing or a training/residency thing.

Are ya'll tubing and coding people and then doing just the procedure note or dropping your .signout smart phrase? Jesus 🤣

If I only caught the case because my relief was late, I would have no compunction giving it to them when it’s time for me to leave.

In the single- coverage, no overlap 7:06 code example I would have no compunction about taking the immediate actions and then handing it off as soon as my relief is settled in. And I would expect to take it if I were late.

I can’t imagine working somewhere you’d be expected to stay hours over shift to finish up a single case because a colleague was late… Really seems extreme.

 

[BoardingDoc]

I guess it was just the way I was trained, but I wouldn't sign off a patient I just tubed with a procedure note and then yeet it to the oncoming doc. The idea makes me feel weird. It's just not how things are done, it seems sloppy. At least stabilize them to the point they can go to imaging or have the ICU come down and do stuff.

I don't know maybe it's a culture thing or a training/residency thing.

Are ya'll tubing and coding people and then doing just the procedure note or dropping your .signout smart phrase? Jesus 🤣

Side question: "Have the icu come down and do stuff?" I don't think I've ever worked in a hospital, residency at a massive tertiary care centre included, where an intensivist was ever in the ED managing a patient of mine unless I'd already signed it out to them and it wasn't actually my patient anymore. How does that work on your end?

As to the sign out thing, this is again a rather extreme edge case that you've pointed out. I can think of one time in the past 6 years where it's been relevant, but yeah, in that scenario a code came in. I started running it. Guy had already been tubed by EMS. Relief came in maybe 3 min into it. We talked about what was going on for 5 more minutes or so as we co-ran the code and he gradually took over and I went home.

I would expect to do the same for any of my post-overnight colleagues in that scenario if I came in as the morning doc.

 

[Mount Asclepius]

This is completely dependent upon how you are paid. If you are productivity based, then of course you are staying late for critical care. Your dollar per hour is amazing in that scenario. If you are hourly, then you are hyper aware of 5 minutes.

 

[bougiecric]

What I don't get is the cognitive dissonance. I'm assuming it's universal to be annoyed when your relief comes in late. How do the people who are chronically late get irritated at others but rationalize their own behavior?

 

[trackrunner321]

If a sick patient came in while I was waiting for a late colleague, I would do what needed to be done and instantly sign it out upon their arrival.

 

[CoolDoc1729]

What I don't get is the cognitive dissonance. I'm assuming it's universal to be annoyed when your relief comes in late. How do the people who are chronically late get irritated at others but rationalize their own behavior?

I don’t care at all if my relief is 10-15 minutes late. We have 2h overlap , I see pretty much everything up to their start time, document, finish what I can finish and go home when it’s time. We also get paid for overtime if needed. But i wouldn’t be staying over to finish a x:06 code .. that’s more the “saw 3.5/h and still have stuff to do and it will take longer to sign it out than to just do it” situation.

 

[Fox800]

Side question: "Have the icu come down and do stuff?" I don't think I've ever worked in a hospital, residency at a massive tertiary care centre included, where an intensivist was ever in the ED managing a patient of mine unless I'd already signed it out to them and it wasn't actually my patient anymore. How does that work on your end?

As to the sign out thing, this is again a rather extreme edge case that you've pointed out. I can think of one time in the past 6 years where it's been relevant, but yeah, in that scenario a code came in. I started running it. Guy had already been tubed by EMS. Relief came in maybe 3 min into it. We talked about what was going on for 5 more minutes or so as we co-ran the code and he gradually took over and I went home.

I would expect to do the same for any of my post-overnight colleagues in that scenario if I came in as the morning doc.

I don't expect the ICU docs to run the resus, but ours are quite good about doing arterial and central lines. Our nurses can't monitor art lines in the ED.

As long as we have a couple of good peripheral IVs and the patient is intubated and hemodynamically stabilized to a reasonable degree, the ICU doc will come down (typically on their own) and start putting in orders and may start doing central lines, arterial lines, ordering the meds they want, etc. That's what I meant by "doing stuff"...ICU stuff.

 

[Janders]

One of the benefits of being eat-what-you-kill:

If you are staying late, it’s likely bc you’ve seen a ton of sick people and are billing mad RVUs and critical care time and you’re getting paid to be late. Eventually when it is appropriate you sign out a couple of OBSV, psych, and straight forward pending-CT cases.

On these edge cases where a code comes in at 0657 or 0702 and your relief is still walking in from the parking lot…

Keep it yourself, bill the intubation, CPR CPT, 32 minutes of critical care and write a note. Your prerogative to make money.
Or
Handle the first 2x pulse checks, intubate, bill that (a 40 second note), and give a warm handoff to your partner when they walk in. Your prerogative to make a lil money, and get out of dodge when safe.

This said I work with a group of people who would (1) appologize for being late (2) are excellent ED docs and I’d have no compunction signing a code-in-progress to them (3) try to get the post-night doc, specifically, out ASAP.

This is an atypical edge case, but I’ve had a couple similar things happen over the past dozen years. Unstable upper GI bleed comes in at 2059 and I’m in the toilet [working til 2300] and the off going doc (off at 2100) throws 2x US PIVs in, bills for them, and walks off after ordering the labs when I return from my big boy pee pee break. Totally reasonable. I’ve also stayed late and run codes that started 10 minutes AFTER my shift ended when the solo-cover doc is slammed with 12 things to do. So be it, take care of the patients, and get paid.

 

[DocEspana]

I work at a place where the "we are all adults here" rapidly became "no one has etiquette". Thankfully a few of us are newer hires who jumped ship from a nearby place where if you werent at least 1 minute early you were late. The three of us are not so much complaining as we are playing stupid. Whenever someone is >5 minutes late, we text them at minute 6 concerned and making sure they woke up and didnt get into an accident on the way to work.

The people who would show up 20 or even 30 minutes late on the regular are now all making it in 5 minutes late or less because of the power of shame and not knowing how to answer that text every time it comes in.

 

[ercat]

We had a couple of these losers at my previous shop. Literally arriving 20 min late to relieve night shift single coverage guy, putting stuff down, saying "I'm gonna grab breakfast and then take your sign out."

There's a term for this: narcissistic personality disorder.

Yep. There’s a doc in my group who comes in, SEES ME sitting there with my bags at the end of my shift waiting to sign out, and GOES TO THE LOUNGE FOR 25 minutes. Who goes to the lounge for 20 plus minutes at the beginning of their shift anyway?

 

[valianteffort]

Yep. There’s a doc in my group who comes in, SEES ME sitting there with my bags at the end of my shift waiting to sign out, and GOES TO THE LOUNGE FOR 25 minutes. Who goes to the lounge for 20 plus minutes at the beginning of their shift anyway?

 

[valianteffort]

Bumping this post as a friendly passive aggressive reminder to you newbs

 

[911MD]

Show up early. Do your job. Nobody cares about your feelings.

 

[DocEspana]

I show up *at* the minute I am supposed to, but i'm also in the parking lot in my car 20-30 minutes beforehand jamming out to 2000s and 2010s alt rock to get hyped for the shift. I could easily come in at any point. I just sort of know that I dont get paid to be there early and all my coworkers know if the clock EVER strikes 1 minute late to call me immediately because I either overslept or am dead and need my wife informed of my passing.

I have actually received panicked calls at 7:01 as I'm badging through the door because I was that few seconds late due to wanting to finish the song in my car and timing it wrong. My partners know I am *not* late and know to sound an alarm the second I'm 1 minute late.

but also... am I an dingus for not coming in a few minutes earlier if I'm just there in the parking lot anyway?

 

[911MD]

I show up *at* the minute I am supposed to, but i'm also in the parking lot in my car 20-30 minutes beforehand jamming out to 2000s and 2010s alt rock to get hyped for the shift. I could easily come in at any point. I just sort of know that I dont get paid to be there early and all my coworkers know if the clock EVER strikes 1 minute late to call me immediately because I either overslept or am dead and need my wife informed of my passing.

I have actually received panicked calls at 7:01 as I'm badging through the door because I was that few seconds late due to wanting to finish the song in my car and timing it wrong. My partners know I am *not* late and know to sound an alarm the second I'm 1 minute late.

but also... am I an dingus for not coming in a few minutes earlier if I'm just there in the parking lot anyway?

Totally fair. I wouldn't show up substantially early if I wasn't compensated. It is easier for us doing 12s switching immediately with another doc so fluctuating shift times don't really impact overall group cost. Often showing up early to let the prior doc escape is the only good I do that day. But mannnnnn people who show up late should be fired (and have been from our group). It's outrageous to minimize how insulting it, which seems to be the norm for people who are always late. If you get wellness check calls at 701 you are clearly not the problem lol.

 

[EctopicFetus]

Totally fair. I wouldn't show up substantially early if I wasn't compensated. It is easier for us doing 12s switching immediately with another doc so fluctuating shift times don't really impact overall group cost. Often showing up early to let the prior doc escape is the only good I do that day. But mannnnnn people who show up late should be fired (and have been from our group). It's outrageous to minimize how insulting it, which seems to be the norm for people who are always late. If you get wellness check calls at 701 you are clearly not the problem lol.

No need to show up substantially early but if your shift starts at 7 am that means you should be badged in, computer ready and start seeing patients at 7.. im RVU based so the math is clearly different but i try to show up 10-15 mins early. I don’t hate my job so being there a few mins early doesnt matter to me. When I come in early AM to relieve the overnight I try to get there 15 mins early. Nothing worse than being stuck post overnight.

I do think showing up late if you are relieving someone makes you a dingus FWIW. Of course traffic happens, life happens etc. BUt this should be a 1-2 times a year event not a chronic problem. The way people will view you if you are 5 mins early rather than 5 mins late is significant.

 

[JacobMcCandles]

I show up *at* the minute I am supposed to, but i'm also in the parking lot in my car 20-30 minutes beforehand jamming out to 2000s and 2010s alt rock to get hyped for the shift. I could easily come in at any point. I just sort of know that I dont get paid to be there early and all my coworkers know if the clock EVER strikes 1 minute late to call me immediately because I either overslept or am dead and need my wife informed of my passing.

I have actually received panicked calls at 7:01 as I'm badging through the door because I was that few seconds late due to wanting to finish the song in my car and timing it wrong. My partners know I am *not* late and know to sound an alarm the second I'm 1 minute late.

but also... am I an dingus for not coming in a few minutes earlier if I'm just there in the parking lot anyway?

What kind of group are you in? Is it single coverage? If the departing doc is waiting on you then you’re a borderline dingus as you’d probably be annoyed if you were ready to leave but the oncoming doc was walking in a minute late.

My goal is to get the leaving doc out on time or a few minutes early. If they want to stay late then that’s on them but I’m there to get them out on time at the latest. That means being there and ready to roll about 5 minutes early.

 

[DocEspana]

What kind of group are you in? Is it single coverage? If the departing doc is waiting on you then you’re a borderline dingus as you’d probably be annoyed if you were ready to leave but the oncoming doc was walking in a minute late.

My goal is to get the leaving doc out on time or a few minutes early. If they want to stay late then that’s on them but I’m there to get them out on time at the latest. That means being there and ready to roll about 5 minutes early.

Thankfully right now its all overlapping coverage. But I did do that when it was 7a/8a 7p/8p so I did have someone who was waiting on me, but they werent tubing anyone at 6:58 waiting for me because there was another provider offset by an hour.

 

[throway134]

I show up *at* the minute I am supposed to, but i'm also in the parking lot in my car 20-30 minutes beforehand jamming out to 2000s and 2010s alt rock to get hyped for the shift. I could easily come in at any point. I just sort of know that I dont get paid to be there early and all my coworkers know if the clock EVER strikes 1 minute late to call me immediately because I either overslept or am dead and need my wife informed of my passing.

I have actually received panicked calls at 7:01 as I'm badging through the door because I was that few seconds late due to wanting to finish the song in my car and timing it wrong. My partners know I am *not* late and know to sound an alarm the second I'm 1 minute late.

but also... am I an dingus for not coming in a few minutes earlier if I'm just there in the parking lot anyway?

I didn’t hate the people who did this, often had charting to do for a few minutes and my group had good overlapping coverage except for nights. but in the same vein is your partner paid to stay late? Do you have an instant sign out? Being there 5 minutes early is helpful

Sign out is quick for Ed people, but ~5 minutes isn’t that crazy .

 

[DocEspana]

I didn’t hate the people who did this, often had charting to do for a few minutes and my group had good overlapping coverage except for nights. but in the same vein is your partner paid to stay late? Do you have an instant sign out? Being there 5 minutes early is helpful

Sign out is quick for Ed people, but ~5 minutes isn’t that crazy .

Contemplating change after these comments.

 

[RustedFox]

I show up *at* the minute I am supposed to, but i'm also in the parking lot in my car 20-30 minutes beforehand jamming out to 2000s and 2010s alt rock to get hyped for the shift. I could easily come in at any point. I just sort of know that I dont get paid to be there early and all my coworkers know if the clock EVER strikes 1 minute late to call me immediately because I either overslept or am dead and need my wife informed of my passing.

I have actually received panicked calls at 7:01 as I'm badging through the door because I was that few seconds late due to wanting to finish the song in my car and timing it wrong. My partners know I am *not* late and know to sound an alarm the second I'm 1 minute late.

but also... am I an dingus for not coming in a few minutes earlier if I'm just there in the parking lot anyway?

Name bands so that I can judge your tastes.

 

[DocEspana]

Name bands so that I can judge your tastes.

Frequently the killers, arcade fire, Bastille, awolnation and muse.

Lately have been listening to Sweet disaster by dreamers and blackout by breathe Carolina. Before work you have to get the stuff that pumps you up. During work. I can do the more classic emo hits from my high school and college days.

 

[RustedFox]

Frequently the killers, arcade fire, Bastille, awolnation and muse.

Lately have been listening to Sweet disaster by dreamers and blackout by breathe Carolina. Before work you have to get the stuff that pumps you up. During work. I can do the more classic emo hits from my high school and college days.

I'm too old.

 

[CopaceticOne]

I'm too old.

For some reason I was expecting something more along the lines of Back in Black by AC/DC

 

[thegenius]

For some reason I was expecting something more along the lines of Back in Black by AC/DC

I was imagining Pantera or Slayer kind of stuff.

 

[endo]

Wait, your saying if I’m the medical director I can show up late?

 

[Apollyon]

Wait, your saying if I’m the medical director I can show up late?

It's good to be king.

 

[wareagle726]

Early is on time. On time is late. Late is unacceptable.

I just had this conversation with my kids today.

I can probably count on one hand the amount of times I've been late for a shift. Drives me crazy. If I've worked 12 hours single coverage I don't care about the RVUs at that point. I'm ready to GTFO. It's also a not small number of times that the stroke alert, kid in respiratory distress, cardiac arrest, etc... happens to come in at X:02 and I have to deal with it because I don't know if you're showing up at X:03 or X:30 or even at all.

We all make mistakes. We all forget to set an alarm or misread the schedule. We all get stuck in standstill traffic. I get that.

But when it's every shift...

 

[EctopicFetus]

Early is on time. On time is late. Late is unacceptable.

I just had this conversation with my kids today.

I can probably count on one hand the amount of times I've been late for a shift. Drives me crazy. If I've worked 12 hours single coverage I don't care about the RVUs at that point. I'm ready to GTFO. It's also a not small number of times that the stroke alert, kid in respiratory distress, cardiac arrest, etc... happens to come in at X:02 and I have to deal with it because I don't know if you're showing up at X:03 or X:30 or even at all.

We all make mistakes. We all forget to set an alarm or misread the schedule. We all get stuck in standstill traffic. I get that.

But when it's every shift...

I just went over that saying with my kids as well. I show up 10-15 mins early every shift barring an issue. Im even more cautious if it is solo coverage or someone is waiting on my to go home.

You are paid to be ready to work at shift start, that means computer on, logged in, stethoscope out (even if you dont know how to use it). Traffic happens, life happens.. plan ahead.. if you are driving far check google maps..

 

[WhatJobDoIPick]

I just went over that saying with my kids as well. I show up 10-15 mins early every shift barring an issue. Im even more cautious if it is solo coverage or someone is waiting on my to go home.

You are paid to be ready to work at shift start, that means computer on, logged in, stethoscope out (even if you dont know how to use it). Traffic happens, life happens.. plan ahead.. if you are driving far check google maps..

Agree 100%.

My caveat is that on the flip side, groups shouldn't expect you to be staying 1-2 hours late after your scheduled shift because the charge nurse decided to bolus you with 6 patients 2 hours before shift end and the group wants everyone seen.

 

[EctopicFetus]

Agree 100%.

My caveat is that on the flip side, groups shouldn't expect you to be staying 1-2 hours late after your scheduled shift because the charge nurse decided to bolus you with 6 patients 2 hours before shift end and the group wants everyone seen.

My mantra and what I tell my residents. The goal at the end of the shift/ priorities for the shift 1) do a good job. 2) leave on time.. I give sign out and I take sign out. other than an LP or rectal/pelvic ill take whatever else. I personally dont sign out procedures. So sometimes I stay late for a reduction etc. Thats incredibly rare. I expect the MLPs and docs to leave on time.. period.. full stop.

 

[Mount Asclepius]

I’ll add my two cents again as this thread will probably be perpetually revived with many not taking the time to read back through. People have likely settled into their camps though.

The concept of leaving on time drives home the concept of physicians as employees. You’d never hear a partner in a law firm or an entrepreneur put such a focus on that issue. Part of the reason PE has taken over physician staffing is because many physicians don’t have the desire to put in the effort of ownership and find it easier to be white collar pawns. Clock in and clock out means no control and a lower pay check. EPs on this forum constantly search for a way out, but don’t take back what should already be theirs. I know there are other nuances and system influences, but leaving on time is an artificial construct. See a patient, make another dollar. There is a point of diminishing returns and decreased job satisfaction. Time rigidity though leaves a lot on the table. Better to remain a little flexible.

 

[WhatJobDoIPick]

I’ll add my two cents again as this thread will probably be perpetually revived with many not taking the time to read back through. People have likely settled into their camps though.

The concept of leaving on time drives home the concept of physicians as employees. You’d never hear a partner in a law firm or an entrepreneur put such a focus on that issue. Part of the reason PE has taken over physician staffing is because many physicians don’t have the desire to put in the effort of ownership and find it easier to be white collar pawns. Clock in and clock out means no control and a lower pay check. EPs on this forum constantly search for a way out, but don’t take back what should already be theres. I know there are other nuances and system influences, but leaving on time is an artificial construct. See a patient, make another dollar. There is a point of diminishing returns and decreased job satisfaction. Time rigidity though leaves a lot on the table. Better to remain a little flexible.

Agree about having this mentality as a partner.

 

[EctopicFetus]

I’ll add my two cents again as this thread will probably be perpetually revived with many not taking the time to read back through. People have likely settled into their camps though.

The concept of leaving on time drives home the concept of physicians as employees. You’d never hear a partner in a law firm or an entrepreneur put such a focus on that issue. Part of the reason PE has taken over physician staffing is because many physicians don’t have the desire to put in the effort of ownership and find it easier to be white collar pawns. Clock in and clock out means no control and a lower pay check. EPs on this forum constantly search for a way out, but don’t take back what should already be theirs. I know there are other nuances and system influences, but leaving on time is an artificial construct. See a patient, make another dollar. There is a point of diminishing returns and decreased job satisfaction. Time rigidity though leaves a lot on the table. Better to remain a little flexible.

I’m a partner. I leave on time. Someone else can keep the $1-200 it’s not worth it to me.

Being a partner is about what you do when you aren’t on shift. It’s also how you treat patients when on shift.

People in many forums whine about the ******* complaints. I’ve been doing this a while. I’ll take 400 ankle sprains over 1 old lady weak and dizzy etc. I can get that ankle sprain dc’ed in no time and I get paid for it.

Your comment I think speaks to “ownership” not in the term of a partner but of the business and contract. I agree there.

 

[HemeOncHopeful19]

I’ll add my two cents again as this thread will probably be perpetually revived with many not taking the time to read back through. People have likely settled into their camps though.

The concept of leaving on time drives home the concept of physicians as employees. You’d never hear a partner in a law firm or an entrepreneur put such a focus on that issue. Part of the reason PE has taken over physician staffing is because many physicians don’t have the desire to put in the effort of ownership and find it easier to be white collar pawns. Clock in and clock out means no control and a lower pay check. EPs on this forum constantly search for a way out, but don’t take back what should already be theirs. I know there are other nuances and system influences, but leaving on time is an artificial construct. See a patient, make another dollar. There is a point of diminishing returns and decreased job satisfaction. Time rigidity though leaves a lot on the table. Better to remain a little flexible.

I mean I’m not EM but I get genuinely annoyed if my PP group works “overtime” not because I don’t want to put in the work or take pride in my business but usually because it results from mismanagement on some level that the other partners just accept as “how it is.”

 

[WhatJobDoIPick]

I’m a partner. I leave on time. Someone else can keep the $1-200 it’s not worth it to me.

Being a partner is about what you do when you aren’t on shift. It’s also how you treat patients when on shift.

People in many forums whine about the ******* complaints. I’ve been doing this a while. I’ll take 400 ankle sprains over 1 old lady weak and dizzy etc. I can get that ankle sprain dc’ed in no time and I get paid for it.

Your comment I think speaks to “ownership” not in the term of a partner but of the business and contract. I agree there.

Omg I'll take all the ankle sprains and URIs

 

[Mount Asclepius]

I’m a partner. I leave on time. Someone else can keep the $1-200 it’s not worth it to me.

Your comment I think speaks to “ownership” not in the term of a partner but of the business and contract. I agree there.

You are further along in your career than some so the time value of the extra dollar understandably isn't worth it to you anymore at this point, but it likely would be to someone earlier in their career. The control of ownership and extra income leading to earlier independence begets even further control. There is clearly a difference in older physicians (perhaps even before all of our time) who had to establish practices and the new generation who would rather be employees punching time clocks. I think most of us fall somewhere in the timeframe of practice and continuum of thought between the two. While I'm not end of career, I channel that antiquated idea of ownership of practice. I understand the value amidst a sea of change. Perhaps I'm clinging on to a dinosaur concept, but I'd rather take the extra dollar to have more options later depending on what happens with healthcare in this country. A 2.83% Medicare cut this year multiplied further leads to physicians punching clocks and receiving European pay. That being said some of the happiest places are the Nordic countries.

 

[EctopicFetus]

You are further along in your career than some so the time value of the extra dollar understandably isn't worth it to you anymore at this point, but it likely would be to someone earlier in their career. The control of ownership and extra income leading to earlier independence begets even further control. There is clearly a difference in older physicians (perhaps even before all of our time) who had to establish practices and the new generation who would rather be employees punching time clocks. I think most of us fall somewhere in the timeframe of practice and continuum of thought between the two. While I'm not end of career, I channel that antiquated idea of ownership of practice. I understand the value amidst a sea of change. Perhaps I'm clinging on to a dinosaur concept, but I'd rather take the extra dollar to have more options later depending on what happens with healthcare in this country. A 2.83% Medicare cut this year multiplied further leads to physicians punching clocks and receiving European pay. That being said some of the happiest places are the Nordic countries.

I agree here. The value of hustling hard means I can enjoy my career now. I go to work cause I want to. I enjoy showing up to work. Thats 95% because of my practice model (ownership in an SDG) and 5% involvement and my enjoyment of solving problems. I will say the 5% would be 0 if I was solving problems for a PE owner or hospital system I didn't like or at least feel had the needs of the patient near the top of mind (HCA).

I don't blame the clock punchers. I want to believe I would be different but to me it is like having senioritis. Why go the extra mile? So some scum bag can buy higher quality coke to use on his yacht?

 

[TooMuchResearch]

I’ll add my two cents again as this thread will probably be perpetually revived with many not taking the time to read back through. People have likely settled into their camps though.

The concept of leaving on time drives home the concept of physicians as employees. You’d never hear a partner in a law firm or an entrepreneur put such a focus on that issue. Part of the reason PE has taken over physician staffing is because many physicians don’t have the desire to put in the effort of ownership and find it easier to be white collar pawns. Clock in and clock out means no control and a lower pay check. EPs on this forum constantly search for a way out, but don’t take back what should already be theirs. I know there are other nuances and system influences, but leaving on time is an artificial construct. See a patient, make another dollar. There is a point of diminishing returns and decreased job satisfaction. Time rigidity though leaves a lot on the table. Better to remain a little flexible.

My privately held democratic group pays me an hourly rate and I almost always leave on time.