When to abandon ship

[heyjack70]

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I'm in an administrative role and feeling increasing micromanagement of our department by CMO. To the point where he's reviewing all consults to see if psych is falling short of expectations, for example not getting to consults on time. Any perceived potential problem is being assumed to be an error unless proved otherwise. Recently a doc saw a consult same day but forgot to sign the note until next morning, and CMO was on top of this emailing about how psychiatry is not getting to consults on time, so I had to point out that the patient was seen on time, just the note was not finalized and CMO neglected to look in the draft note section, which he knows how to do. Another where ED boarder was stuck for a few days and CMO complained no med changes were happening, but I reviewed the case and several fairly significant and appropriate med changes had been made by the consulting psych MD. Another case where a consult order was entered, but on call doc handled it over the phone and no in person consult was needed, doc entered a brief note explaining patient wouldn't be seen in person, and CMO saw that and assumed doc was dodging the consult even though the attending doc was in agreement that no in person consult was needed. Several examples like this increasing over the last 3-4 months and I'm honestly worried about the CMOs agenda and job security. I haven't personally been caught up in any of these specific cases, but it's exhausting having to review notes and report back to CMO about how nothing has been done wrong, and it's bleeding over into the team of docs when I have to check in with them about cases as they feel they are being unfairly scrutinized. This has been a good place to work for several years, but recently this makes me feel like they want all the psychiatrists to quit. When do you know it's time to bail on a bad situation?

 

[splik]

I think it depends if the CMO has always been like this or it has been a change. I can tell you that hospitals everywhere have been stretched during the pandemic and many psych patients are boarding in EDs and medicine across the country. There is a lot of pressure to deal with this and of course the CMOs feel the strain and implore psych consult services to do more. Our CMO is very nice but recently has been badgering our consult service to do more than is possible given the limited staffing and increasingly high volume of high acuity patients. We just put the ball back in their court, that they need to commission and pay for more services if they want it. Everytime we bring up the money, the CMO goes quiet.

I think you or whoever is in charge of your department needs to meet with the CMO to discuss their concerns, the concerns from your department, and come up with an action plan that is realistic and puts the ball back in their court. I think it is unlikely that they are generally micromanagey (since this seems to be a recent issue) or they are trying to get rid of the psychiatrists (the hospital couldn't function without psych). They often have to look like they are doing something and frequently that becomes pointless emails that don't actually help.

 

[Merovinge]

I'm not sure that this is necessarily COVID related. Most of the country has had IP beds go down while demand goes up and bordering in the ED with terrible infrastructure for this has been a norm rather than exception even prior to the pandemic. Doing this work in a way that actually puts the patients first and makes logical sense from a treatment perspective (e.g. not starting an antidepressant in the ED prior to being shipped off to an IP unit not associated with your hospital system) seems to be increasingly fleeting. At my last job, I experienced a lot of pressure to initiate large med changes in the ED and continually pushed back on these as well as little support for inappropriate consults or stat consults after the patient had been in the ED for many hours to days with a psychiatric CC. They also frequently pushed to discharge if bed availability was taking too long but of course wanted all the liability to be on psychiatry. Clearly s/p suicide attempt everything gets better after boarding in an ED for 72 hours...

You could not pay me any amount of money to go back into CL/ED psychiatry at a place with a weak psychiatric department and ED docs that get paid based on shortening LoS. It was the absolute worst experience in medicine I have ever had including all my off-service and grunt work time in residency. Kuddos to anyone who can do this work and get patients safe and appropriate care.

 

[deleted1100659]

Im in the same situation in regards to the thought process of when to abandon ship. My problems are a little different (they want me to sign all the controlled substances, take on a bunch of midlevels 5 or more, and they're trying to make us a medical psych facility so I would have to manage the medical and psych issues, etc) but I empathize with the point you're making.

If you have been wondering this question for a while then I think you already have your answer to be honest. I think at the very least, considering alternative positions is a good idea and possibly applying to other jobs.

Life is too short to wait it out for a prolonged period of time if you don't feel that its likely to change in a positive manner anytime soon. See what else is out there.

 

[TexasPhysician]

Hundreds of reasons why the CMO is like this. Only you can decide if it’s time to leave.

If it were me, I’d schedule a time to meet with the CMO to discuss goals and an appropriate time frame to review success. Reviewing each case individually is bogging you down and decreasing efficiency/morale. Psychiatrists leaving due to poor morale is the opposite of what the CMO should be aiming to do. If you understood the CMO’s goals, you may be able to assist in a most effective way.

If this is just how the CMO works, I’d start looking for a new job.

 

[Merovinge]

I will say the research/science behind decision making tends to suggest that we should be making more big changes rather than less and if you are actually pondering this significantly that you should look to see what else is out there. I was geographically constricted at my last job so there were no other options (other than telepsych which I had 0 interest in doing on a full-time basis), but I cannot tell you much better I feel now at my current job. I have people thank me on a near daily basis. My boss is a psychiatrist and a trove of information. There is 0 economic incentive to see patient's faster or practice bad medicine. I sleep so much better at night and my blood pressure runs 10 points lower. I haven't wanted to break any objects or smack my head into a wall a single time since leaving that last job.

 

[comp1]

Second most of the above. I applaud you for advocating for and protecting your team. Now it's time to focus on your own emotions. Have you relayed your concerns to the CMO? It seems like they are quite comfortable talking directly to you, so it might be best to make that a little more two way. I don't think you need to threaten to leave. Instead, approach this from trying to understand their perspective. Note to them that you've noticed that they have raised more issues and concerns recently even though you haven't personally seen any sort of decline in quality of care. Ask what sort of pressures they are feeling from their leadership and why that is. Try to keep it empathic, but also make it clear that repeatedly raising these concerns over the long term can have a significant negative impact on staff morale and retention. Try to problem solve other approaches that might take place to help meet the goals that the CMO has. This sort of conversation is ultimately their job. Now if they do indeed decline the meeting or brush you off, yes...it might be time to look for another job. Right now though, I'm not sure the CMO fully understands how much this is bothering you.

 

[whopper]

 

[whopper]

Bail. It's not your fault you've been shoved in the middle of a bad situation. OK so you do what you can to help. Hospitals got extra wads of cash from the government to do stuff like pay their employees more and many of them paid their employees nothing more. That's an institution you leave.

If you're doing what you can, trying to fix the situation, address your problems and concerns and even better offer realistic solutions that can be done, and they're not showing you the right amount of respect (and this need not just be money, it can be getting more staff members, addressing your concerns, looking into what they can do to help) leave. I'd give the institution the length of a few months to see what they do about it. If there's no response and there's nothing that can explain it-leave.

That's why I left my last job.

It's not about the money. It's about the disrespect.

 

[Sushirolls]

These are bad signs. There is likely nothing left to salvage. I've spoken up plainly, bluntly in the past on these things. Other times I've kept my mouth shut. I only regret the times I stayed silent.

Have your typed resignation letter already on stand by and in draft mode in your email. One click away.

Request a meeting with the CMO. Start out earnestly, request for plain English what is going on, what the CMO wants and why they are doing what they are doing. Try to understand what they are up to. If you get a cryptic political wishy washy answer, call them on it and label it as such. If you get no clear understanding of the what/why, express your disappointment and soon to arrive resignation. Time to leave yesterday.

Or if they have some pseudo logical reason you can track for what/why, reflect on the necessary response; but chances are you'll need to tell them you are providing feedback and educate how they are not helping and ruining things. Tell them to stop before people start to leave.

If things go south, communicate to your colleagues its a sinking ship, you submitted your resignation letter and they might want to strongly consider the same.

 

[PsyDr]