support staff

[onconconconconc]

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Hi all, I was hoping to get a sense of the level of support everyone has for their outpatient clinical practice. My setup feels inadequate and I think this is a major contributor to my escalating burnout. However, I am open to considering the fact that I may just be inefficient and lazy. 🙃

I work in an academic satellite practice (solid tumor) seeing up to 18-20 pts a day 4 days a week.
I have no say in hiring decisions and minimal input regarding how resources are allocated to my clinic.

For support, I have:

• Various MAs shared among several MDs who take vitals, labs/EKGs, and room patients
• One clinic RN who supports 2-3 MDs. This RN helps with triage calls, results, refills. Over the years, no one has stayed in this position for more than 3-6 months. They usually don't physically interface with patients.
• Onboarding RN supporting 2-3 MDs. This RN coordinates new consults.
• Two to three midlevels who collectively support 5+ MDs. These NP/PAs don't work every day and provide ad hoc support - mostly to help see surveillance/treatment visits
• A scheduling pool supporting 7+ MDs (scheduling errors abound)

On paper it may not sound terrible, but there is no one specifically dedicated to helping me run my clinic efficiently. I feel like I am constantly getting pinged by Epic chat, staff message, mychart message, and sometimes text about items that a good RN or NP/PA could easily address if they knew my style and my patient panel. This on top of patient care is leading me to exhaustion on work days. I am falling behind on my inbox and feel like I can't focus on higher-level work anymore.

Would love to know the setup that others have to get a better sense of what is standard and what I (and anyone else in a similar position) should be asking for moving forward. Thanks!

 

[dozitgetchahi]

Hi all, I was hoping to get a sense of the level of support everyone has for their outpatient clinical practice. My setup feels inadequate and I think this is a major contributor to my escalating burnout. However, I am open to considering the fact that I may just be inefficient and lazy. 🙃

I work in an academic satellite practice (solid tumor) seeing up to 18-20 pts a day 4 days a week.
I have no say in hiring decisions and minimal input regarding how resources are allocated to my clinic.

For support, I have:

• Various MAs shared among several MDs who take vitals, labs/EKGs, and room patients
• One clinic RN who supports 2-3 MDs. This RN helps with triage calls, results, refills. Over the years, no one has stayed in this position for more than 3-6 months. They usually don't physically interface with patients.
• Onboarding RN supporting 2-3 MDs. This RN coordinates new consults.
• Two to three midlevels who collectively support 5+ MDs. These NP/PAs don't work every day and provide ad hoc support - mostly to help see surveillance/treatment visits
• A scheduling pool supporting 7+ MDs (scheduling errors abound)

On paper it may not sound terrible, but there is no one specifically dedicated to helping me run my clinic efficiently. I feel like I am constantly getting pinged by Epic chat, staff message, mychart message, and sometimes text about items that a good RN or NP/PA could easily address if they knew my style and my patient panel. This on top of patient care is leading me to exhaustion on work days. I am falling behind on my inbox and feel like I can't focus on higher-level work anymore.

Would love to know the setup that others have to get a better sense of what is standard and what I (and anyone else in a similar position) should be asking for moving forward. Thanks!

Sounds like a bit of a ****show.

I’m rheum. At every job I have had so far, I have had a dedicated RN and a dedicated MA (for me only) - and there are times where I feel like even that may not be sufficient. I totally agree that you need at least some staff in your clinic who is familiar with your style specifically. If one of my staff are out sick and I have a float that day, it’s often *so painful* to have to handhold them through all the details they don’t know about my clinic. You are basically dealing with that every day.

I also have a scheduler who currently handles only two rheumatologists, and even then we have recently pushed to have one scheduler for each of us.

I’d imagine the day to day volume of stuff to deal with is even worse in onc than it is in rheum. You’re basically getting 2/3rds of a nurse to yourself, 1/7 of a scheduler to yourself, and random ad hoc midlevels who are probably at least as much trouble as they’re worth because they don’t know you and your clinic specifically. That’s not good enough.

Consider going PP. One of the glorious things about PP is that you usually get a lot more say in hire/fire decisions regarding staff, and can also allocate more resources to your clinic if you’re willing to pay for it.

 

[gutonc]

Hi all, I was hoping to get a sense of the level of support everyone has for their outpatient clinical practice. My setup feels inadequate and I think this is a major contributor to my escalating burnout. However, I am open to considering the fact that I may just be inefficient and lazy. 🙃

I work in an academic satellite practice (solid tumor) seeing up to 18-20 pts a day 4 days a week.
I have no say in hiring decisions and minimal input regarding how resources are allocated to my clinic.

For support, I have:

• Various MAs shared among several MDs who take vitals, labs/EKGs, and room patients
• One clinic RN who supports 2-3 MDs. This RN helps with triage calls, results, refills. Over the years, no one has stayed in this position for more than 3-6 months. They usually don't physically interface with patients.
• Onboarding RN supporting 2-3 MDs. This RN coordinates new consults.
• Two to three midlevels who collectively support 5+ MDs. These NP/PAs don't work every day and provide ad hoc support - mostly to help see surveillance/treatment visits
• A scheduling pool supporting 7+ MDs (scheduling errors abound)

On paper it may not sound terrible, but there is no one specifically dedicated to helping me run my clinic efficiently. I feel like I am constantly getting pinged by Epic chat, staff message, mychart message, and sometimes text about items that a good RN or NP/PA could easily address if they knew my style and my patient panel. This on top of patient care is leading me to exhaustion on work days. I am falling behind on my inbox and feel like I can't focus on higher-level work anymore.

Would love to know the setup that others have to get a better sense of what is standard and what I (and anyone else in a similar position) should be asking for moving forward. Thanks!

this was pretty much the setup I had in my last job. It's not that we were understaffed, it's just that the staffing wasn't consistent. I would be assigned an MA at the beginning of each day. Usually the same one, but not always. We had triage RNs (a pool, all remote starting in pando times) and 1 RN coordinator/2MDs. We didn't use "clinic RNs" for results/refills/etc because RNs here are expensive (a FT RN in this area makes well over $100K). We hired an MA to be a "clinical coordinator" to do as much as they could within their license/privileges and offload the few things we needed an RN for to the RN coordinators. It was an OK system, but not great by any means.

Now I have my own RN coordinator, 1 NP and my own MA. The scheduling and PA stuff all gets done here in the clinic which leads to fewer mistakes that are easier to fix when they do happen.