Stay or Go?

[Old_Mil]

Advertisement - Members don't see this ad

I have been working at a job that I have been fairly satisfied with for the past year. Had a good dept with 15 minute door to doc times, good customer satisfaction scores that had us between the 85%-96% of similar sized EDs.

We just switched to Cerner a month ago and it is a train wreck. Can't dispo patients without chosing diagnoses from an ICD code pop up table. All our metrics are shot. We went from a waiting room that we could keep relatively empty to one that is full much of the time. This may be one of the worst computer programs I have seen.

It isn't getting better. Frankly going in to work sucks now. My first job out of residency sucked from day one and quitting was an easy decision. This one used to be pretty good.

What to do?

Sent from my Z10 using Tapatalk

 

[fahimaz7]

It gets better. Always a rough learning curve.

 

[daveyjwin]

Cerner is one of the WORST EMRs I have ever had to deal with. I started residency on Pulsecheck, which was in hindsight, pretty awesome, and then we switched to EPIC, which was frought with problems and annoyances and slowdowns, and then I had an out rotation with Cerner, and all I wanted was EPIC back. That's how back CERNER is...

 

[RustedFox]

Duuude, you keep getting the ****-end of the stick.... didnt you also quit your first gig out because you hated the patient mix?

 

[gman33]

What if you leave and your new job switches to Cerner?
I'd stick it out for a while and see if it gets better.

 

[Hamhock]

I am surprised to hear this from an long time poster; which makes me sad/mad.

I am a very junior doc, so I hesitate to offer this opinion, but: I suspect you/your group will quickly learn to "get around" the inefficiencies of CERNER. This will be especially true if your metrics are tied to pay. Just like all clipboard nurse-based metrics and JACHO-metrics can be "gamed", so can CERNER.

However, if this is a sign of a larger dysfunction within your system -- or lack of communication between your group and admin -- then I'd be concerned and looking for a way out.

HH, who is pleased -- like BirdStrike that I have "extra" training and like White Coat that I am about to enjoy "financial freedom", which allows me to say "NO"

 

[Groove]

Mil, give it 8-10 months before making any rash decision. No system wide EMR implementation goes smoothly and it takes that long, at the very least for MIS to optimize the framework, smooth out interface processes and address a grab bag of other variables/bugs. Trust me, I used to implement these types of things in my last career and I've been part of 2 EMR transitions already and am about to be part of a third.

In the end, what you have on your side are metrics, physician satisfaction and plain $$$. "Most" hospital administration will be eventually receptive to a persuasive argument that the EMR is just plain 1)slowing down the ED and 2) pissing docs off that they are starting to look for other jobs, etc.. They will either cave to another EMR transition (Experienced a T-sheet --> McKesson/disaster --> Epic, OR they will adopt an ED selected "best of breed" such as Wellsoft or Medhost. My last job used Allscripts and was a disaster, but it was too late and too expensive to switch to anything else, so they allowed the ED to implement Wellsoft (best of breed) which was the right decision (too late to switch to another EMR, but allowed the ED to slap a best of breed package on top).

No EMR is perfect, and all suck at implementation. It takes a good year to get them all smoothed out, much less to even realize that it was the wrong decision and plan for another one.

If everything else about your job environment is great, then give it time. If the primary satisfaction you had revolved around metric efficiency, then sure... it's not unreasonable to look for another gig, but that's probably not what this is about.

 

[RustedFox]

Unnnghhh. You said "McKesson".

Wow. I'm so glad that I don't work there anymore.

 

[Groove]

Unnnghhh. You said "McKesson".

Wow. I'm so glad that I don't work there anymore.

I know dude... that system sucks. Royally.

 

[RustedFox]

Uhhh-huhh-huhh-huh-huh.. it sucks.. huhh-huhh-huhh....

*insert clip of Beavis and Butthead here*

 

[Old_Mil]

Well, that first job was a lousy deal. It had essentially misadvertised everything including its volume. This one has been pretty good. I am not an anti EMR guy - like you I trained on Pulse check which I agree, is pretty awesome. We switched from Meditech to Cerner and this is a serious downgrade.

You can still see patients relatively quickly on the front end, provided someone with plenty of time is mindlessly entering PMH/PSH/FH/SH...there is no way to do that quickly because it is all tied to ICD codes and menu driven (which has killed our triage process) the inefficiencies are in the disposition which is why I am concerned that things aren't going to get better. That, and nothing has changed for the better since launch.

Guess I will give it six months.

Sent from my Z10 using Tapatalk

 

[Birdstrike]

Here's a big problem with EM. You can have a great job and six months later it's terrible. New EMR, you lost your contract and work for a new group and had no choice in the matter, 5 docs left and you're working 50% more than you want until new hires come in, there's a new CEO, and you're back on nights 'cause superhuman "night-shift guy" finally cracked. Then, 1 year later....it's changed again!

The last clinical EM job I had, we changed computer systems 5 times in 2 years, going through 3 different EMRs, and multiple stages of phasing in physician order entry systems. It's all foisted on you with no choice, decreases your productivity, decreases your take home pay (lower RVUs and/or collections) and generally creates frustration slowing you down while you're told, "Go faster." You have little if any control over it and are told to "suck it up," it's for "meaningless use" or "blah, blah, blah." Nowhere in there is, "It's so you can take care of patients better."

The last place I worked (for almost a decade) I saw 15-20 docs come and go and all but one or two left to the "perfect job" only to end up somewhere else a year or so later. That's when I decided to get out rather than be in constant upheaval, chasing the Loch Ness monster of perfect and stable EM jobs where I had any control over anything.

So to answer your question, Old Mil, "Should you stay or go?"

I can't give you a valid answer, because 6 months from now your current job could be a totally different one, and six months from now, so could the "perfect job" you're looking to go to.

That's one thing that frustrated me endlessly. Those "great jobs" were supposedly out there like Big Foot, but no one seems to really see one face to face or if they existed, no one let anyone else get their hand on them. I think like the ED itself, chaos and instability is the norm with EM jobs. And there's very little if any control over the practice environment. You can spend years working up the admin chain trying to change the practice environment and then get booted out of your seat due to a contract change. Your only mode of control over your practice life to always rent, and be ready to pack up and change jobs as many times as you need to, or can stomach.

This is the reason that I think the herds of doctors willingly leaving private practice for "employed" jobs could be making a big mistake. They're going to suffer these same consequences as the price of "security."

 

[Old_Mil]

Maybe the solution is to have a stable of places that you maintain an ongoing relationship with and you can bench jobs if they go south...

Sent from my Z10 using Tapatalk

 

[spyderdoc]

Simple: hire a scribe. Our group subscribes to a scribe service. We have the choice to use them or not, but we pay individually for them. I'd say 2/3 of our group uses them. we use Pulsecheck (Ibex) and yes, I have couple hundred macros, but I love using the scribes to do the H&P, exam, document conversations, enter radiology results, built in chaperone, etc. It saves me a few hours of home charting after each shift. Worth every cent.

 

[NERDY]

did you talk to the IT dept/EMR group about your dislikes with the new system?

 

[Old_Mil]

Yes. We submitted a list of improvements at the end of the second week. None have been implemented. Anyway, I guess this is more of a question of how much time to give before giving up on ii.

Sent from my Z10 using Tapatalk

 

[katmandu]

Here's a big problem with EM. You can have a great job and six months later it's terrible. New EMR, you lost your contract and work for a new group and had no choice in the matter, 5 docs left and you're working 50% more than you want until new hires come in, there's a new CEO, and you're back on nights 'cause superhuman "night-shift guy" finally cracked. Then, 1 year later....it's changed again!

The last clinical EM job I had, we changed computer systems 5 times in 2 years, going through 3 different EMRs, and multiple stages of phasing in physician order entry systems. It's all foisted on you with no choice, decreases your productivity, decreases your take home pay (lower RVUs and/or collections) and generally creates frustration slowing you down while you're told, "Go faster." You have little if any control over it and are told to "suck it up," it's for "meaningless use" or "blah, blah, blah." Nowhere in there is, "It's so you can take care of patients better."

The last place I worked (for almost a decade) I saw 15-20 docs come and go and all but one or two left to the "perfect job" only to end up somewhere else a year or so later. That's when I decided to get out rather than be in constant upheaval, chasing the Loch Ness monster of perfect and stable EM jobs where I had any control over anything.

So to answer your question, Old Mil, "Should you stay or go?"

I can't give you a valid answer, because 6 months from now your current job could be a totally different one, and six months from now, so could the "perfect job" you're looking to go to.

That's one thing that frustrated me endlessly. Those "great jobs" were supposedly out there like Big Foot, but no one seems to really see one face to face or if they existed, no one let anyone else get their hand on them. I think like the ED itself, chaos and instability is the norm with EM jobs. And there's very little if any control over the practice environment. You can spend years working up the admin chain trying to change the practice environment and then get booted out of your seat due to a contract change. Your only mode of control over your practice life to always rent, and be ready to pack up and change jobs as many times as you need to, or can stomach.

This is the reason that I think the herds of doctors willingly leaving private practice for "employed" jobs could be making a big mistake. They're going to suffer these same consequences as the price of "security."

This post has become stuck in my brain. I'm only on job number 2, but what Birdstrike is saying seems very likely. What are the options besides leaving clinical medicine? Having moved with me during residency and jobs 1 and 2, my spouse is getting sick of the nomad lifestyle. Now, with kids in the picture, moving frequently becomes even less attractive. Rather than continuing to search for the dream job, is it reasonable to commit to an geographical area, ideally with a lower cost of living, and then be more flexible with the job (locums, etc.).?

 

[Birdstrike]

This post has become stuck in my brain

Sorry. They can have that effect sometimes. It's that patented brain glue I apply to my posts (can't share the recipe).

 

[tube_em]

I have been working at a job that I have been fairly satisfied with for the past year. Had a good dept with 15 minute door to doc times, good customer satisfaction scores that had us between the 85%-96% of similar sized EDs.

We just switched to Cerner a month ago and it is a train wreck. Can't dispo patients without chosing diagnoses from an ICD code pop up table. All our metrics are shot. We went from a waiting room that we could keep relatively empty to one that is full much of the time. This may be one of the worst computer programs I have seen.

It isn't getting better. Frankly going in to work sucks now. My first job out of residency sucked from day one and quitting was an easy decision. This one used to be pretty good.

What to do?

Sent from my Z10 using Tapatalk

Where I did my residency, we also switched to Cerner. It was a terrible first six months or so. The system never got better, but we got to the point where we were reasonably efficient with it. No doubt, it is one of the worst EMR's available and I and all of my coworkers hated it. However, I agree you should wait it out and see if it becomes tolerable before deciding to leave your job.

 

[worfndata]

This post has become stuck in my brain. I'm only on job number 2, but what Birdstrike is saying seems very likely. What are the options besides leaving clinical medicine? Having moved with me during residency and jobs 1 and 2, my spouse is getting sick of the nomad lifestyle. Now, with kids in the picture, moving frequently becomes even less attractive. Rather than continuing to search for the dream job, is it reasonable to commit to an geographical area, ideally with a lower cost of living, and then be more flexible with the job (locums, etc.).?

imo parents that move their kids around a lot are subjecting them to emotional abuse. let them settle and grow up in a place they can firmly call home. of course you have a while as 5 year olds will have an easier time adjusting but around age 10 id say no more moving.

 

[deleted547339]

imo parents that move their kids around a lot are subjecting them to emotional abuse. let them settle and grow up in a place they can firmly call home. of course you have a while as 5 year olds will have an easier time adjusting but around age 10 id say no more moving.

that's helpful.

 

[worfndata]

ok I could have used better words but i meant well. 😳

 

[tkim]

imo parents that move their kids around a lot are subjecting them to emotional abuse. let them settle and grow up in a place they can firmly call home. of course you have a while as 5 year olds will have an easier time adjusting but around age 10 id say no more moving.

do you have kids?

 

[Old_Mil]

I think the right answer is to just pick a place where you would like to live and raise your kids and travel to a place (even if it is your full time gig) and knock out the shifts. Especially in this housing market you can't just up and move once or twice a decade... the numbers are in. Pre Cerner door to doc times < 15 minutes. Post Cerner door to doc times 40+ minutes. Average length of stay + 1.5 hours. Just a caution to any decision makers who might be considering this product. It's like drugs - just say no.

Sent from my Z10 using Tapatalk

 

[la gringa]

interesting... we have Cerner at my main job - use it for orders and documentation w/ Dragon. bit of a learning curve, but easy with the build the hospital system has. this is HUGE - we used Cerner in residency and it was only vaguely similar to what we have at my current job. do you have a 90% page for orders? whatever the hospital requires for dispo is required by the hospital, not the EMR...

am working at a 2nd hospital (single hospital not a large system) that uses Meditech, which I absolutely abhor. they don't use it for documentation, there is a TOTALLY SEPARATE system into which you can only import vitals, allergies, and labs. the labs are a total mess when put into the note. you have to type in rads studies. voice recognition software is horrid from what i hear - i will try it soon. result? huge chart backlogs, lower RVU's/hr despite working your TAIL off.

why do i work there? they are desperate, it's another subsidiary of my larger group so it's basically an internal locums. pays well w/ paid travel. staff is great, crazy acuity... it's really just the documentation. (ok, and the hospital's REFUSAL to let nurses order much of anything, but that's a separate issue!)

the hospital probably has a lot of control over what you have the ability to do, Old Mil... all of the big EMR's are subject to the local site's "build". sorry 🙁

 

[katmandu]

I think the right answer is to just pick a place where you would like to live and raise your kids and travel to a place (even if it is your full time gig) and knock out the shifts. Especially in this housing market you can't just up and move once or twice a decade... the numbers are in. Pre Cerner door to doc times < 15 minutes. Post Cerner door to doc times 40+ minutes. Average length of stay + 1.5 hours. Just a caution to any decision makers who might be considering this product. It's like drugs - just say no.

Sent from my Z10 using Tapatalk

Do you think being gone for multiple blocks of time (to travel for shifts) would be less disruptive to family life than frequent moves?

 

[Old_Mil]

As far as commuting that really depends on how many shifts you want to work...14-16 shifts a month probably isn't going to be easy. 7-8 shifts a month won't be a problem.

Sent from my Z10 using Tapatalk