Whiny Post about Work

Surrounded by charts right after our move last year (10dpIUI #4)

Warning:  the following post is just me complaining about my job.  I try to limit my work talk on here as much as possible, but things have gotten so bad, I have to write about it today.

I have a love/hate relationship with my job.  And these days, the hate is winning over the love.

I love the complexities of a difficult clinical case.  I love meeting someone who feels hopeless with their medical problems and giving them the keys to a solution.  I love the challenge of figuring out how to get someone motivated and involved in managing their own medical problems.  I love it when I know I’ve made a difference in someone’s life, even if it’s just because I did something as simple as listen to them when they needed it.  I love it.

There are the patients who don’t care.  The ones who blame me (or the entire healthcare system) for their problems.  The ones who say things like, “If you want to pay for my meds, I’ll take them, but otherwise I’m not going to,” as their breath reeks of tobacco.  But I knew I’d have those challenges when I signed up for this job.  And I have gotten better at being able to distance myself from those patients.  I no longer find myself getting upset because I care more about their health than they do, and that makes it much easier to see these patients and not have it ruin my entire day. 

What I didn’t expect was the fact that it’s getting harder and harder to practice medicine.  I’m scheduled to see a patient every 15 minutes.  My job isn’t just to prescribe a couple of pills and move on – there’s a lot to talk about, and sometimes 15 minutes just isn’t enough.  I usually can make up the time when someone doesn’t show up for their appointment, but I never have time to write notes during the day to document each visit.  As someone who bills Medic.are, I have to follow their rules for billing.  Which means that I have to have all this stuff in my notes from each visit that has nothing to do with the care I gave, but I have to have it in there to support the level of service I bill.  So in addition to the 15 minutes of direct patient contact, I have about 5-10 minutes of documentation for each patient.  And then there’s the paperwork outside of the patient contact – I have anywhere from 30-60 minutes worth of “nonrevenue generating” paperwork to do every day.  If your insurance company doesn’t want to pay for the drug or test your doctor thinks you need, your doctor has to spend 5-10 minutes filling out a form, or even longer waiting on hold to talk to someone with your insurance company, to try to convince them otherwise.  And we have to do that for free.  What other profession that bills for services does that? Why is it that doctors are supposed to do so much work for free, and why is it poor form for us to talk about that?  I or one of my partners have to be available at all hours for calls.  If you’re my patient, you can reach me at 2am to talk about anything, even if it’s not an emergency.  And I can’t charge you for it, even if it was a frivolous call that could have waited until normal business hours.  Again – can you imagine how much your attorney would charge if you called her at 2am?  Add in the fact that our crappy electronic medical records system – that was supposed to make things faster – has made things even slower.  (For those of you in the medical field – I’ve done EMR before.  I love it.  I couldn’t wait to get it again.  We’ve been on it now for over 5 months and I still hate our system.) 

I have more paperwork to do in a day than I can possibly get done.  And now the administrators are telling us we need to see more patients, we need to get our paperwork done more quickly, and we also need to serve on committees, and do volunteer work, and complete more after hours training.  In the meantime, I have no time to do any reading that might be relevant to my job.  I get weekly emails with updates on the latest journal articles; I used to read these every day, and then do extra reading on top of that to stay up to date.  I currently have over 45 of those emails unread in my inbox, so who knows what I’m missing.  I know I’m not as good a doctor as I could be, because things fall through the cracks because I’m trying to do too much.  And it’s not because of Finn – he’s almost always asleep by 8pm these days.  It’s because all my downtime has to be spent doing paperwork.  Paperwork that, for the most part, has absolutely nothing to do with the actual business of caring for patients and everything to do with business of health insurance.

Last year we ran our numbers against a national databank and discovered that I’m more productive (I see more patients on a daily basis) than 95% of the doctors in my field in the country do.  And yet I make less than 75% of them.  My salary is the same now as it was when I started over 7 years ago.  Exactly the same.  And yet I’m being told I don’t see enough patients, I don’t bill enough, and I need to do more, more, more.

Recently it’s just gotten to be too much.  Our current way of doing things can’t continue.  And so, at our monthly meeting Wednesday, I let our office administrators have it.  As one of my partners pointed out, the fact that we’ve stayed here as long as we have shows that we want to be here.  But at some point, wanting to be here isn’t enough.  And while I know that the state of medicine is similar everywhere in the country these days, and I’d just be trading one set of problems for another if I left, at least I’d be paid more and work less if I joined a different practice. 

When I used to dream of being a doctor, I never dreamed of the work life I have now.  The older doctors, the ones who were around before all the regulations, say it didn’t used to be this way.  My particular practice has it worse than others, just because of the type of medicine we practice, but it’s getting worse for everyone. 

I can’t imagine what else I would do if I hadn’t become a doctor, but I would urge anyone thinking of medicine as a career to look elsewhere.  I’ve actually contacted the manager of a drug company to ask if they’re hiring physicians.  I’d hate that job.  But at least I’d have a life outside of work.

And that’s just sad. 

After over a year of promising to get a meeting scheduled with the head administrator, it’s finally being scheduled (I tend to be the driving force in our office, and while I was distracted with being pregnant and then being a new mom, not much got done).  I’m in the process of drafting an email to the administrator outlining our specific problems.  And making it clear that while we don’t want to leave, it’s getting to the point where it would be crazy to stay.  It’s possible that they might be able to do something to make things better.  I’m willing to give them a little time to try. 

In them meantime, I’m just trying to stay afloat at work and trying to be fully present with Finn when we’re together so he'll never realize how stressed out I am.  Exercise is pretty much out of the picture.  Reading for pleasure?  Not so much.  I do get to watch tv, but usually while I'm doing paperwork, so I can only really watch things I've seen before, since I really can't pay close attention.  I anticipated I might go 6 months between hair cuts when I had Finn.  I never anticipated I'd have such little free time with just one baby. Especially one baby who is such a good sleeper.

 If you’re still reading – thanks for listening.  It felt good to get it out of my system.  Maybe tonight insomnia and headaches will leave me alone so I can finally get a good night's sleep for the first time in weeks.