Scheduling on demand “according to the needs of the department.”

[deleted836128]

Anyone else dealing with a constantly changing schedule?

Every two to six weeks our schedule gets changed with just a few days notice and it’s always “super urgent” for me as the scheduler to “make it happen.” There is no mind paid to the existing schedule which is sad because it is only done a month in advance so it shouldn’t be that hard to stick to. Our shift lengths will get cut and then a few weeks later they’re freaking out about volumes increasing, and then they tell me they want me to add an extra shift. Then I have to tell my group they’re going to need all of us to come in an extra day or two a week. Won’t be long before the shifts get cut, and then of course, another staff shortage freak out will follow. They’re basically wanting to schedule “on demand” based on day to day fluctuations instead of just bringing back the usual shifts and realizing some days will be busier than others. Instead of having some respect for people’s existing schedule and their work life balance. It’s obviously all cost savings but it’s incredibly stressful for all the providers in our group. And it’s even worse for me as the scheduler - constantly having to redo the schedule is one thing but I feel like I am often going to the group with my tail between my legs telling them about the schedule change that will be happening. Especially as everyone has already been so accommodating and they keep asking us to be more accommodating.

When I bring up the providers’ grievances with the schedule changes I am told this is all about COVID and this is how it is everywhere. They should be embarrassed how much they are asking of us as professionals - to jump whenever they say to jump - but if there’s any complaints we are all suddenly a bunch of whiny babies who don’t understand the needs of the department.

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[hundreddaysoff]

This sounds like a terrible job! I'm sorry you have to put up with these ridiculous demands from admin.

At my last gig with HCA, my boss changed the shifts by an hour or so every few months according to demand, but nothing like what you describe.

The only realistic solution for this kind of garbage that I can see is to work at a single-coverage shop. Unfortunately, by math we can't all have those jobs...

 

[southerndoc]

We're at 92% of our pre-COVID volume and just expanded most physician shifts back to 10-hour shifts.

 

[RustedFox]

Anyone else dealing with a constantly changing schedule?

Only my entire career.

 

[Janders]

We haven’t changed our schedules in... years.

Small shop, so people get they may stay late on super busy days. Eat what you kill so its worth your while at least.

 

[Brigade4Radiant]

That’s why I usually only two are for you I don’t stay late if it’s an hourly gig that’s not my problem that the waiting room blows up. If you want me to be on time that means I need to leave on time to.

 

[bravotwozero]

APP restored regular staffing at our sites. They even started paying for scribes which they had cut. You are at a bad gig. I know it’s tough right now, but look for other jobs in your area if possible.

 

[p1acebo]

I think it’s pretty disingenuous for them to say “it’s happening everywhere.” Maybe just in their circle, but it’s definitely not happening “everywhere.”

We have been fortunate enough to have minimal to no change in scheduling since COVID. Micromanaging the schedule like that is only going to burn people out quicker.

 

[turkeyjerky]

I think it’s pretty disingenuous for them to say “it’s happening everywhere.” Maybe just in their circle, but it’s definitely not happening “everywhere.”

We have been fortunate enough to have minimal to no change in scheduling since COVID. Micromanaging the schedule like that is only going to burn people out quicker.

Run of the mill gaslighting.

OP, are they doing this to the docs in your group to, or just midlevels? I'm assuming you work for a CMG. You guys should all get together, agree on a reasonable time-frame for schedule changes and propose it to admin. If you stay united, you have more power than you realize.

 

[Birdstrike]

They’re basically wanting to schedule “on demand” based on day to day fluctuations instead of just bringing back the usual shifts and realizing some days will be busier than others. Instead of having some respect for people’s existing schedule and their work life balance. It’s obviously all cost savings but it’s incredibly stressful for all the providers in our group.

Get Out Before You Stroke Out

For my first EM job I was scheduled for a string of 12 hour shifts. They told me "you're on call" the 4 hours before your shift in case "the department blew up," which was pretty much every day. They left this part out of the perfect wine-n-dine interview. If you hit a really bad stretch, you could end up having one or more 16-hr shifts during a string of 12's, which made for absolutely soul-crushing turnarounds, not to mention the fact that the place was busy as hell and understaffed. Also, getting out on time at the end of your shift was next to impossible. If you were looking to avoid burnout, they just made it clear they were comin' attcha with a blow torch, all so so admin to could get their 15 min wait times and max cash bonuses.

I've been telling you guys, EM is a doctor grinder. They put in a piece of meat and grind 'em out. Grab a fresh piece of meat, put it in and grind 'em out.

I'm telling you people, save yourselves. Get out before you stroke out. Until you walk away, it'll never change. They'll never have any incentive to change. Just grab a new piece of meat who wants to "make a difference." Grind 'em up, spit 'em out, throw 'em in the gutta, go get anotha.

Know what's behind this whole "EM doc oversupply"? More slabs of meat for their money-making grinder. That's all. It's no more complex than that. They know that the burnout they're creating is too much to handle. They have no plans to ease up. It's the opposite. The plan is to tight the screws even more. The oversupply is more meat for the grinder.

 

[deleted836128]

Run of the mill gaslighting.

OP, are they doing this to the docs in your group to, or just midlevels? I'm assuming you work for a CMG. You guys should all get together, agree on a reasonable time-frame for schedule changes and propose it to admin. If you stay united, you have more power than you realize.

Doctors are dealing with some changes, but it’s different and manageable for them. First off, there are 10 times as many doctors and tons more shifts as compared to PAs so they don’t take as much of a hit with schedule changes when we do. And also when their schedule changes it’s something reasonable like coming in an hour earlier. We are in a completely different boat. For us they will do things like shortening one shift and adding a whole other shift and expecting me to get this figured out by the next few days. It is bizarre.

 

[GeneralVeers]

Doctors are dealing with some changes, but it’s different and manageable for them. First off, there are 10 times as many doctors and tons more shifts as compared to PAs so they don’t take as much of a hit with schedule changes when we do. And also when their schedule changes it’s something reasonable like coming in an hour earlier. We are in a completely different boat. For us they will do things like shortening one shift and adding a whole other shift and expecting me to get this figured out by the next few days. It is bizarre.

They've done the same for us. I always have to check the schedule daily to make sure I'm not showing up an hour early or late. Our midlevels have it worse as they are all over the place, or have whole shifts get canceled entirely.

 

[Frazier]

Get Out Before You Stroke Out

For my first EM job I was scheduled for a string of 12 hour shifts. They told me "you're on call" the 4 hours before your shift in case "the department blew up," which was pretty much every day. They left this part out of the perfect wine-n-dine interview. If you hit a really bad stretch, you could end up having one or more 16-hr shifts during a string of 12's, which made for absolutely soul-crushing turnarounds, not to mention the fact that the place was busy as hell and understaffed. Also, getting out on time at the end of your shift was next to impossible. If you were looking to avoid burnout, they just made it clear they were comin' attcha with a blow torch, all so so admin to could get their 15 min wait times and max cash bonuses.

I've been telling you guys, EM is a doctor grinder. They put in a piece of meat and grind 'em out. Grab a fresh piece of meat, put it in and grind 'em out.

I'm telling you people, save yourselves. Get out before you stroke out. Until you walk away, it'll never change. They'll never have any incentive to change. Just grab a new piece of meat who wants to "make a difference." Grind 'em up, spit 'em out, throw 'em in the gutta, go get anotha.

Know what's behind this whole "EM doc oversupply"? More slabs of meat for their money-making grinder. That's all. It's no more complex than that. They know that the burnout they're creating is too much to handle. They have no plans to ease up. It's the opposite. The plan is to tight the screws even more. The oversupply is more meat for the grinder.

So very true.

It is both funny and sad to me that these days after a rather tough day in my subspecialty, my tongue in cheek mantra to center myself is "Still better than EM".

Works 100% of the time -- and the self-pity/frustration/anger/XYZ reels itself in quick once reframed.

Meatgrinder.

 

[emergentmd]

My first hospital job tried this crap when a CMG took over. They said we were on call 1 hr before our schedule shift and the working doc could decide. What a bunch of crap and we fixed this bc no doc would dare call in their partner 1 hr before b/c I would just show up 15 min before anyhow.

This was pretty crappy, what you are describing is horrendous.

 

[Birdstrike]

Doctors are dealing with some changes, but it’s different and manageable for them. First off, there are 10 times as many doctors and tons more shifts as compared to PAs so they don’t take as much of a hit with schedule changes when we do. And also when their schedule changes it’s something reasonable like coming in an hour earlier. We are in a completely different boat. For us they will do things like shortening one shift and adding a whole other shift and expecting me to get this figured out by the next few days. It is bizarre.

Here's the beauty of it. You're a PA. You made the right choice, the better choice. You can up and leave and become a PA in derm, Pain, family practice, sports medicine and any other specialty in the world that doesn't require working nights, weekends, holidays or taking call. You can much more easily walk away and be done with it.

It's sad that it's come to this, that the only solution is to abandon the specialty. But when those in charge don't care about its effect on the professionals under their wing, it's the only solution. In an abusive relationship, sometimes the best and only solution, is to walk away.

Over the last 20 years I can count 1,0000 maybe 10,000 "solutions" proposed by those in control of ED that focus on profits, to every one time I"ve heard a real concern for physician wellness. Their attitude is, "If you don't have what it takes to step on grenades to make us rich, then we'll get someone who will."

Name one EM leader who fighting for the soul of EM. Name one who's fighting to fix the problems that are important to you. Name one that will make your quality of life better, as an EM doc or PA, 5 years from now.

Name one that's willing and able to fight for the cause of wellness in the EM profession.

Name one that won't blame burnout on you.

Name one who's willing to risk his name and reputation to fight to make EM what he he tells recruits EM is and is going to be, for them.

Name one who's going to show true leadership by risking his career to change the system, instead of coasting to retirement as his CMG benefits and 401K mature.

Although you can't fix the specialty, there's good news. With this knowledge, you can fix things for yourself. Don't delay, because no one else is going to do it for you.

 

[deleted77919]

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[emergentmd]

I was in department director and would never tell a line doc to do something I would not/did not clinically believe in. Sad, but the only way to move up into higher admin is to toe the line and make docs do something you know is not necessary. I was out rather abruptly when I didn't find it necessary to meet the CEO on a weekly basis b/c there was nothing wrong with the department. I didn't find it necessary to meet just for him to tell me everything went well. Cest lavie, things always work out and I am in a better position than if I climbed the corporate ladder.

 

[xaelia]

We're at 92% of our pre-COVID volume and just expanded most physician shifts back to 10-hour shifts.

92% sounds good until you figure an almost 10% drop also means potentially 1 of every 10 docs is now redundant ... multiply by 35k EM docs ....

 

[GeneralVeers]

92% sounds good until you figure an almost 10% drop also means potentially 1 of every 10 docs is now redundant ... multiply by 35k EM docs ....

The math isn't as simple. We all just took an hours, and therefore pay cut. Down about 10-15 hours per months since pre-covid

 

[WilcoWorld]

When I bring up the providers’ grievances with the schedule changes I am told this is all about COVID and this is how it is everywhere.

They're lying

 

[turkeyjerky]

92% sounds good until you figure an almost 10% drop also means potentially 1 of every 10 docs is now redundant ... multiply by 35k EM docs ....

Or, each of those doctors, instead of seeing 2.3 pph, sees 2.1 pph and provides slightly better care, leaves on time, doesn't burn out, etc.

Or, the group no longer needs to employ a daily midlevel.

Or, most likely, continue staffing at 75% of pre-covid levels, and "providers" can average 3 pph. They can't complain b/c of the "surplus".

 

[miacomet]

I work at a place with changing seasonal volumes. We have 24 hours a day of coverage at one place and just a bit more at the other, and they both receive their fair share of patients needs lengthy procedures (extensive lacerations, reductions etc).

We solved this (mostly) by having a (paid) on call system. We cut down hours when we know we will be less busy, and if someone gets overwhelmed, they can call in the call doc. It's not perfect, and it does cost the department money, but it's worked fairly well and solves many of the problems you describe.

 

[emergentmd]

Bottom line is the Pot is still the same. Its not like you are making extra $$$ to be on call. They are just shifting money from the doc salary to get a paid on call.

So if you have 10 docs making 4M total then they generously add an on call position for 300K, then those 10 docs are now making 3.7M. Seems like a raw deal IMO

 

[miacomet]

Sort of. A few years ago they cut 4 hours a day of coverage and reallocated it to call, so yes. But without the call idea they would have just cut the coverage. So it was reallocation or nothing.

But...way better than schedules changing last minute IMO

 

[emergentmd]

Our SDG had the same on call bright idea but it is the same pot so instead of getting more partnership distribution, we would have paid it to the on call doc. More hours, same overall pot.

CMG may actually give your shop and extra on call doc without changing income but that money comes from somewhere and it is not from the Admins pocket. It eventually comes out of some other doc pockets.

 

[turkeyjerky]

Our SDG had the same on call bright idea but it is the same pot so instead of getting more partnership distribution, we would have paid it to the on call doc. More hours, same overall pot.

CMG may actually give your shop and extra on call doc without changing income but that money comes from somewhere and it is not from the Admins pocket. It eventually comes out of some other doc pockets.

I think there's some psychological benefit to getting paid for being on call, even if it's all fungible in the end. Same for getting a night-shift bonus. It just makes the s--sandwhich easier to eat.