“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






Email Dr. Alice

 
Lately I've been stopping by to visit our office manager almost every day. Her office is across the hall from the patient care area, in the administrative section. Sometimes we chat about non-work-related topics like food, holidays, and weekend activities but more and more often we sit and dissect the workings of the group.

This week I came back on Tuesday from a couple of days off and was greeted by our manager with the news that one of our doctors is quitting the group. He's the second one in two weeks to announce that he's leaving. A third initially threatened to leave but later changed his mind and elected to stay. For now. I, for the record, have no intention of leaving. I like it here, and I really don't think things are going to be that much better anywhere else I might try to work. We are constantly pushed to work hard, be more productive, etc. but in this managed care climate, I imagine every medical group, and for that matter, every solo physician, is faced with that dilemma. The insurance companies have pretty much exhausted any merger possibilities and now are trying to tighten their belts, raise premiums and do anything else they have to do to survive. We, and the patients, are feeling the pinch.

On my good days I look at this as a challenge, like learning to juggle. I try to see if I can do things a little faster, squeeze in one more patient or one more phone call. One more ball added to the workload, requiring a little shift, a bit of an adjustment, and then things will keep spinning along. Join another committee? Another ball. Get assigned to reviewing referrals? Another ball.

The problem, if you will allow me to continue the metaphor, is that the balls are being taken from a shrinking pile marked "Personal Life." Dating? Forget about it, I haven't been on a date since I moved to Los Angeles eight (Eight! Jesus!) years ago. Weekends? If I told you how many Sunday afternoons have been spent here you'd scream at me. Weeknights - spent here.

(Above portion of post written at start of working day... terminated till after hours to avoid seeing patients in tearful mood of self pity...)

I'm not the only one in this dilemma, I know. And doctors aren't the only ones feeling pressure to perform either, this happens in every profession - I know that too. But lately it seems we get no good news, only bad. I present you with an email I got from my good friend who works down the hall from me; she practices endocrinology and internal medicine, and is supposed to be working part time. She seems to stay just as late as I do though, and she has two small children. (How do people with kids do this job? Damned if I know.)

At the Friday meeting [which I missed - A.] we got appointment scheduling guidelines...their "expectations" include
- "comfortably" seeing 3 pts/hr (FTE = 31.5 hrs = 95 pts/wk)
- given a 10% no-show rate, should book 105 pts/wk (23/d) (figuring I book 2 hrs less per day, I figure I should book 6 less - 17/d - I'm there!!)
- frozen slots (in my practice, that means lunch & after the end of the day)
- see other folks pts & all schedulers should have access to all schedules
- review your schedule 2 days in advance
- call your patients to ask why they're coming in & forstall unnecessary visits or be better prepared
- review master schedules q 6 mo

It irritated me, but then I think I'm doing my job. Tho, according to my eval, I'm only doing about 97-103% of expected, which is 'adequate'. Sorry, I can't walk on water with these shoes. Come another day.

Enough. I don't think anyone can work well under this kind of constant pressure. It really got to me today; I wound up blowing up at a patient who walked in, without an appointment, at 12:55 and insisted on being seen immediately. We offered her an afternoon appointment and she started yelling at my receptionist. I stalked out and called her a spoiled brat - yes I did - in front of a waiting room full of patients. And I'm not sorry I did it, either. I did wind up seeing her, just to get her the hell out of the office.
posted by Dr. Alice at #