Well, it's official: I've submitted applications to work somewhere else.

[Aristus]

The revolving door for medical providers at the mainstream clinic has just put too much pressure on me to see every patient sent over from the shockingly understaffed main facility. I had twenty-seven patients on my schedule when I started the day yesterday, and even though I had a few no-shows, it seems like two or three walk-ins and stand-bys showed up for every no-show.

I had a monster headache for most of the day. I'm fortunate to have such a superb medical team who kept things going smoothly until closing. The day when they find me slumped over my desk dead seems to be getting closer and closer. The clinic I applied to is in the same part of town where I work now, so all of my patients who want to can visit me there, assuming I get the position. That's the one thing that has kept me here this long: I don't want to abandon my homeless patients.

Anyway, this country needs to get out of the mindset that good work should be rewarded with more work. The pathetic, bleating whine of workplaces bosses everywhere: "Nobody wants to work anymore", is just a bad-faith expression meaning "Nobody wants to work themselves to death anymore."

You're damned right...

[demmiblue]

1. K&R (I hope you get the job).

[Aristus]

4. Thank you.

[True Dough]

2. We need Friday Night Buzz

to remain a recurring event here at the DU for at least another 30 years. So, yeah, find a way to turn the stress down a notch or two.

As a side note, I had surgery on Thursday to reattach my left biceps tendon at the elbow. The injury occurred on Monday, so the system treated me well (many wonderful docs in nurses in that whole process). I'm grateful for the work that you do.

[Aristus]

5. I hope your recovery goes well.

And I'm glad to hear your medical team is the best.

Are you in any pain?

[True Dough]

11. I was surprised at how tolerable the pain was from the injury itself

Thanks! Post-surgery, the pain pretty quickly rose to a 6 or a 7. They prescribed Tramadol and hydromorphone. I took 3 pills over the course of the first night, 2 last night.

As of this afternoon, I'd say the pain has subsided to a 2 or a 3. I may be done with the opioids already!

[niyad]

66. Sending vibes for swift and complete recovery.

[True Dough]

80. Much appreciated, niyad

I feel that I'm well on my way!

[niyad]

81. Excellent! Please keep us posted on your progress.

[TdeV]

3. Bravo

From one of your fans.

[Aristus]

8. Thank you very much.

I have fans?

[Hekate]

41. You have fans. All the best to you from me, too.

[Aristus]

45. Aww...

[niyad]

68. We all love you.

[Aristus]

71. I'm one lucky guy.

For all that we curse social media for the slimy rocks it has overturned, letting the filth run around in the light, we forget the way it has also brought people together and forged tight-knit communities of people who may never actually meet in real life.

That's a tribute to both the power of technology and the strength of the human heart.

All I can say is, I'm overwhelmed.

[niyad]

82. You expressed it perfectly. I am so glad to be part of this amazing community,

and uts wonderful denizens.

huggggs.

[Ilsa]

86. You are a blessing to your community and to us.

I don't know a better way to say it.

[Aristus]

87. That way was perfect.

[murielm99]

6. Good for you.

Take care of yourself first.

[Aristus]

14. I think one of the positions may be helpful for that.

It's an urgent care job. Word on the street is, it's a pretty laid back clinic; eight or nine patients a day on average. With a schedule like that, I can really slow down and take all the time I need with a patient, which is the best recipe for improved clinical outcomes.

[erronis]

19. How much of your workload has been because of the short visit times and the insurance hassles?

I used to work for a state organization that (supposedly) monitored healthcare throughout the system - patient, provider, insurer, hospital, payment. It was so frustrating trying to come up with consistent metrics when every commercial entity along they way fought disclosure.

Personally, I also thought something like "concierge" care might be useful but it never took off in my area and there were way too many unknowns.

Would "universal health care" solve many of these problems? No more insurance companies (except for very rich people), no prior authorizations, far less paperwork.

[Aristus]

23. Universal health care coverage would solve huge numbers of the problems with our current

system. It would be a lot less expensive than private, for-profit heath care. You don't need a huge, expensive bureaucracy to determine who gets care and who doesn't when everyone gets care.

I have so many patients who frantically try to squeeze as many medical complaints into a single fifteen-minute visit as possible, because appointments are hard to come by, and expensive for the uninsured and underinsured. That just makes the provider's job a lot harder. That would improve dramatically with universal health.

For all the talk about the scarcity of primary care providers, this could be solved simply by offering medical training for free, paid for by the government. When a new doctor graduates, he can be required to work for a specific period of time in primary care in order to pay the people back for the free schooling. Kind of the way military academy graduates pay for their superior free education with service to the nation.

[jmowreader]

43. My VA doctor also works in private practice

He says he LOVES working with the VA for one reason: no hassles with insurance. If he has a test he wants to order, in his private practice he has to worry about two things: will the insurance company pay for it, and can the patient pay for it if they won't. At the VA, he just orders it.

[niyad]

79. There are communities that do this, but not nearly enough. The basis for the plot

of "Northern Exposure" was that. But much more sensible for the government to do it. And would possibly cost less than the military academies

[3catwoman3]

33. 8-9 patients a day sounds positively luxurious!

I hope you get that job. How soon might you know?

15 a day was a comfortable pace for me. 16-18 tolerable. More than 20 and I’d feel like a beached fish.

In the “old days,” before electronic medical records, we used to see about 25 per provider. I recently read an article on MedPage Today entitled, “Death By 10,000 Clicks,” brutally and deservedly criticizing all the unnecessary crap that so many EMRs require. The EPIC system that my former office uses was specifically singled out as a huge time waster.

On the 31st, it will be 2 years since I retired. Mostly, I don’t miss it.

[Aristus]

48. EPIC is definitely a big time-waster.

We used to use AllScripts, which was wonderful. If I needed a drop-down menu to complete a chart note, I just clicked the arrow, and a huge menu of templates dropped down; I chose which one I wanted.

With EPIC, the drop-down templates are already embedded in the chart note, and you have to delete all the ones you don't want. It takes me a minute or two of clicking just to get a standard visit note template arranged the way I like it. If I don't delete the crap, my completed note looks cluttered and nearly unreadable. In clinical medicine, every minute counts.

[3catwoman3]

63. I created all my own templates because I didn't like...

…the ones designed by EPIC. I found their wording very stilted and unnatural, and not at all the way I would say things. And ALL of the templates included the phrase “Medical, surgical, social and family history reviewed and updated.” Then, if I’d click on any of those sections of the chart, it would show, “Never reviewed.” I saw that in most of the physicians’ notes most of the time.

If I didn’t do something, I didn’t want my documentation to say I did.

The worst example of that was from a pediatrician in one the other practices in our consortium. She used an EPIC-generated note that always included a full neurological and head-to-toe skin exam, regardless of the reason for the visit. The first time I read one of her notes was for a patient of mine she had seen for strep at the consortium’s after hours walk-in clinic.

I remember saying to myself, “Did you really do cranial nerves, DTRs, etc, and inspect the skin of the perineum on a kid with strep? (Not likely) And if you did, you probably shouldn’t have.” Either not being truthful, or doing unnecessary things to jack up the visit complexity.

[usaf-vet]

52. As an ex military medic it's maddening to see how the dumdest of the dumb are destroying our....

.... care.

I have two very close friends who are retired doctors.

BOTH RETIRED early because they hated the way the medical care system was being destroyed.

I have no idea how the average patient manages to maneuver through the current system.

YET those in Congress have NO need to worry about cost or scheduling for their own care.

It is part of THEIR BENEFITS. Imagine that!

TERM LIMITS!! Serve, then go home and struggle as the rest of us do.

[RobinA]

92. Not Only The Average Person

but I have a mother and an aunt, in their 90's and upper 80's respectively, who are intellgent and capable but need a lot of help negotiating this system. Considering the average age of medical system frequent fliers, it boggles my mind how you can hand a 90 year old an iPad and tell them to fill out forms on it (with a submit button you have to scroll to find). My favorite was the one that wanted me, while sitting in a waiting room chair filling out the form, to take a picture of my driver's license with the iPad. Yeah, my mother born in 1930 can do that no problem, right? I mean, HELLO?????

[leftieNanner]

7. Good luck with the job hunt

I'm having a problem on the other side of the deal

We moved to Tacoma six months ago and I can't find a doctor. All of the practices near me are full.

Two 70 year olds relying on the immediate care isn't the ideal.

[MiHale]

9. One of my Dads favorite sayings was...

“Hard work never killed anyone.” I yelled at him, probably first time I ever yelled at my Dad… “Hard work kills people everyday!” We had a good laugh together…never said that again.

Hope it all works out for ya. 🤞

[Aristus]

15. Good for you for telling him off.

Anyone who says hard work never killed anyone hasn't really done very much hard work.

[LisaM]

22. So true. Most famous buildings or bridges exacted a death toll.

Building the Pyramids probably killed thousands. People died building the Brooklyn Bridge and the Golden Gate Bridge. There have been recent construction deaths in Seattle.

[Hekate]

46. The Transcontinental Railroad was a man-killer, & regarding the Erie Canal...

One of the most poignant things I ever read about the Erie Canal’s planning and construction was that the planners tried to rent Southern slaves, but since the slave-holders knew what a man-killer it was going to be, they reckoned their valuable property would be wasted. There’s really no nice way to say that.

In any case, along came the Irish, near cousins of my ancestors.

[LisaM]

49. I know, it's interesting.

That's why a lot of western cities like Butte have an Irish history. Anywhere the railroad was built.

[Marthe48]

10. The more you give the more some people want

It never works out for the employee. Good luck on your application to a different job.

[Ms. Toad]

12. Been there, done that - two jobs rewarded good work with more work.

The first took 60-80 hours a week, the second took 80-100 hours a week. Like you - I stayed because of students I didn't want to abandon.

I'm enjoying retirement and making up for all those evenings and weekends I as doing the "more work" I was given as a reward.

Good luck for a better working situation.

[RobinA]

94. I Have Found

that this happens in high school, too. Doing AP classes seems to mean more work, not more sophisticated work, which is what I would have expected.

[Ms. Toad]

95. My first encounter with this "reward" was when I was teaching high school.

The school system I taught in was next to weakest in the state. Each of the math teachers was assigned one of the two classes which were the easiest - but has the most repeat students because of prior failure. A few truly couldn't master the arithmetic or concepts involved. (The math was 7th grade level, at the highest - and was the more advanced of two mandatory math classes.) More frequently, the students were ones who moved between school systems frequently enough they never earned credit, or were frequently suspended/expelled/sitting in the Principal's office because they were so disruptive they had to be sent there. Some of these were very bright - but attendance and/or discipline prevented them from earning credit.

The pass rate in those classes was generally around 30%. The pass rate in my class was close to 50%. So they rewarded me with 3 of them. My pass rate was so "high" because I did a lot of individualized work and tried to create useful exercises. Essentially I turned the classroom into life lessons. I treated it like a job - they earned "pay" for the time they were in class. If they were late - they were docked "pay." If they were absent - they were docked "pay." No vacation time, since most of the jobs they were likely to get gave vacation time. Each week they calculated their pay (starting just with pay rate x hours worked), and gradually moving to paychecks with taxes deducted. They shopped with their pay (calculating unit prices and comparing "deals" that weren't really deals). They saved for things they wanted, earning interest on whatever they depostied in a bank. They wrote checks for purchase and balanced their checkbooks, etc.

Obviously, it was a better way to teach - based on the pass rate. But since each student had different hours, different paychecks, different purchases, etc. it was a ton of individual grading. (This was back before things like Excel, which would have made it lots easier.)

[LoisB]

13. I sure hope you get the job. Nobody should have to work until they keel over. It seems as if the

more you work, the more you are expected to work.

[yonder]

16. A simple and sincere good luck to you.

It had to have been a tough decision.

[dlk]

17. No one wants to be exploited to generate profits for someone else

The corporate overlords are miffed. You deserve so much better. Good luck with the move.

[erronis]

20. That's the real problem - the "corporate overlords".

I don't want to facilely label this as "venture capitalists" or other terms, but that's what is happening.

Insurance companies have become profit-driven at a huge rate. And the USofA still requires job-originated insurance for most people. There's a parasitic relationship here - not mutually beneficial for the insured and insurance companies. The Blue Cross, MVPs, United Health Care, etc. are sweeping up any available money.

Add in the Pharmacy Benefit Managers (PBM) that are the go-between for companies and pharmacies and who also dictate prices and profits.

BeJeezus. How is a normal person supposed to get a normal procedure done with a normal expected payment?

[dlk]

77. The monetization of healthcare has a definite downside

Patients become profit centers, unfortunately. My sister-in-law is a nurse who is quite open about the fact she has received bonuses bested on the number of tests she’s ordered.

[multigraincracker]

18. There is the perfect job out there waiting on you.

It just has to find you.
My new wife is an RN and loves doing home care. Doesn't pay as much as working in an ER would, but she loves her patients, the parents not so much.
Just keep an eye out. Plus you are doing a great service for those that need you.

[calimary]

21. The point where you realize that unemployment is better than this.

I've been there, too. I sympathize! Maybe if you find a similar position elsewhere, you can let your homeless patients know where to find you? I'd guess they usually don't get somebody who cares like you do.

[Aristus]

26. The clinic where I am applying is two blocks away from my current clinic.

It's a popular landing zone for providers bailing out of the organization I work for. One of the plusses of being hired there will be seeing a lot of my old colleagues again. And of course, any patients of mine who wanted to could follow me over there.

[3catwoman3]

34. No restrictive covenant in your current contract...

…that prevents you from working so close by?

[Aristus]

50. No.

I don't think my organization even cares. Upper admin all draw million-dollar salaries. Once you've risen that high, any contractual concerns other than high productivity rates tend to get the "Eh, whatever" treatment.

[calimary]

35. Good! Sounds like you're a real keeper, Aristus!

Evidently I’m not the only one who thinks so. Nice that you’ll be in the same area, too.

[Aristus]

51. Aw, very nice. Thank you.

[CaliforniaPeggy]

24. My dear Aristus! Good for you!

If you don't take care of yourself, you cannot really take care of anyone else.

I hope they'll hire you and that you can get the word out to your homeless clients too.

[irisblue]

25. Will you be able to take your dearly loved staff with you?

[Aristus]

27. If I get hired, I'll let my staff know.

If they want to apply over there, I'll give a sterling recommendation, and even the idea of a package deal; you know, if my team comes with me, you'll have a ready-made medical team already accustomed to working together under huge pressure; that kind of thing.

[Demobrat]

28. This is so sad.

27 patients. If you work a ten hour day with no breaks that’s a patient every 27 minutes. And some of those minutes must be used for paperwork. So each patient is lucky if they get 15 minutes. And you’re lucky if get to shovel in a sandwich at some point during the day.

Assembly line medicine. I’ve felt it at my doctor’s office. I believe she means well but she always seems rushed. It scares me because that’s when mistakes are made.

When I had a routine outpatient procedure I was rushed out because they needed the bed for the next patient. Sorry, your 45 minutes are up. You have to leave now.

This was at a top rated San Francisco hospital.

Doctors are overworked and patients are under cared for. And it just keeps getting worse.

[pwb]

29. The Medical field is in trouble here too.

They often rely on temps who are unreliable. Forcing more work on regulars. My daughter is a nurse, she has filled me in. Covid consequences ?

[highplainsdem]

30. Smart decision, Aristus! I hope you get good news soon on the job

application. You've had to deal with entirely too much overwork and stress where you are now.

[Hope22]

31. Fingers crossed that you get the position.

At some point our health, both physical and mental has to come first. The best to you.

[Evolve Dammit]

32. Hope you get it. I admire your dedication and commitment to your patients, and the need for self-

preservation. Gotta take care of you! Put on your oxygen mask before assisting others. Still say it looks like a margarine cup....
Hang in there!

[lonely bird]

36. Nobody wants to work anymore

Has been said for literally multiple decades.

Today, wealth has discovered people don’t want to work shitty jobs for peanuts.

[2naSalit]

37. You're damned right...

And I hope you get the position.

[Aristus]

53. Thank you!

[2naSalit]

54. ...

[Fiendish Thingy]

38. Hey, Canada needs doctors...

Vancouver Island is a beautiful place to live, especially my town of Nanaimo.

The provincial government just raised the reimbursement rate for family doctors so the average income for family doctors is expected jump from approx. $285kCAD to $350kCAD (that’s gross, not net of staffing and overhead).

BC has also initiated efforts to ease the certification process for foreign trained doctors.

[Aristus]

55. I'm a Physician Assistant, not a doctor, but I know Canada has PA's, too.

I live only a few hour's drive and a ferry ride away from Victoria, which Mrs. Aristus and I both love. We're actually thinking about retiring there. But we've dismissed the idea of finishing out our careers there, at least for the moment. Mrs. Aristus doesn't want to be so far away from our grandchildren.

If I was a bachelor, I'd zip up there in a heartbeat and get a work visa. I'd love to own a small house overlooking the Strait of Juan de Fuca, with a view of the Cascades to the east, and the Olympics to the south, and be able to gaze from afar at the madhouse of a country I'm currently living in.

[Fiendish Thingy]

73. It will be difficult to retire here if you don't immigrate when you're younger

We applied when we were 50, emigrated when we were 55, retired at 62.

For skilled worker visas, they start subtracting “points” after age 50.

Being a PA, things might be different, as that profession is one in high demand. If you tried to get work visa, age might not matter, but you’d have to work long enough to obtain Permanent Resident status in order to retire here.

Whatever path you take, good luck. (And let me know if you need the name of a good immigration lawyer)

[Aristus]

74. I will, thank you.

That’s very thoughtful.

[Diamond_Dog]

39. Hope you get the position, Aristus.

Nobody should be working themselves to death. Especially good health care providers.

Good for you wanting to keep your homeless patients. I bet they will be happy to know you will still be around to see them.

Best of luck to you, and I hope everything works out!

And, yeah, if I hear “Nobody wants to work” One More Time ….

[Aristus]

64. Thank you, Diamond Dog.

You rule, okay?

If I switch clinics, my current employer might no longer provide clinic at the local homeless shelter one afternoon a week. If not, I'm going to propose to my new bosses that we take that over. Although the complexity of the medical care we can offer at the shelter is limited, it's actually a terrific outreach tool, getting patients to present to the clinic for primary care needs, instead of going to the emergency room all the time.

[Paula Sims]

40. Yea!! They thought I had Parkinsion's - turned out to be PTSD from my job

Mental health IS health (as the commercial says) and it's so dismissed by today's management as a sign of weakness. Prioritizing it for yourself first so you can be more help to others later is a brave and selfless move.

May you be blessed with a wonderful position with management that appreciates you. They're out there - I know, I finally got one after 34 years of being with narcissistic management.

Please keep us informed

Paula

[Aristus]

57. Thank you, Paula.

My former clinic manager is now the district manager, and he and I have a good relationship. He's a brilliant administrator, and as an ex-Army sergeant, places the well-being of the clinic staff first. But even he has contractual obligations to fulfill, including reminding me what my contractual obligations are every time I mention the workload.

[Duncanpup]

42. Good luck

[Aristus]

58. Thanks, brother.

[panader0]

44. Your work ethic has been visible through your posts here on DU.

I hope you get the job you want. You deserve it.

[chillfactor]

47. Best of luck to you....you deserve a change of pace.

[debm55]

56. Wish you luck, Aristus. You owe yourself, time to be doctor you want to be for your patients.

Last edited Sat Mar 25, 2023, 08:36 PM - Edit history (1)

[Aristus]

59. Physician Assistant, but yeah.

I love my patients, and I think they know that.

[love_katz]

60. Checking in for the Aristus Fan Club.

You do have fans here at DU. I join in with the rest of the gang, wishing you the very best of good luck and success in getting the better job. Being worked to death benefits no one except for the undertaker and rich oligarchs. May the door a better job be open and the way be clear! Even better, may the prospective new employer see the excellent offer of hiring both you and your support staff as the solid gold opportunity that it is and jump on it. Wishing you the best.

[Aristus]

61. Thank you, love_katz. That's very kind.

[love_katz]

62. You are welcome.

It was meant with total sincerity. Sending hugs right back atchya.

[niyad]

65. Sending vibes and energy and hugs for best possible outcome.

[Aristus]

67. Thank you, niyad.

My beloved DU'ers always give me the strength and courage to go on. It's impossible to overstate how much that means to me.

[Stuart G]

75. "One Day at a Time."

...I heard that one many years ago. Change is NOT easy.
............ Don't give up ...EVER! .........................

You will be happier with any positive change. Is it worth it to take a risk?
Yes, and if it isn't, then take a risk again. It might take some time to get the correct job, but it is worth it.
I took a risk 40 years ago in 1983, and it changed my life in a total positive way. You won't know, until you
take the risk I went teaching in an inner city school, to a school with "gifted students." That is brilliant students
with educated and brilliant backgrounds. No, I didn't know what the risk was, or how it would turn out. But, I took
it and was totally grateful for taking that risk. If it fails, then take another risk, and change again. What is the point?
...By taking that risk, and maybe another, you can change your life in a positive way. Just like I did. Is it worth it?
You damn well know that it is worth it. As you take that first risk, you will become gifted in ..."RISK TAKING."
...You will find that in the end, it is worth it. (mine was, I can only speak for me) The change was positive, and the
new job accepted me in ways that I never, NEVER IMAGINED.
....iF i AM WRONG, i CAN ONLY TALK FROM MY EXPERIENCE. EVERY CHANGE IS RISKY...IF ONE CHANGE IS NOT WORTH IT,
MAYBE THE SECOND WILL BE WORTH IT. IT IS THE FUTURE, YOU WILL NOT KNOW TILL YOU MAKE THE CHANGE.

[Aristus]

76. ...

Thank you for that, my brother…

[Mr.Bill]

70. I hope this all works out for you.

I can tell by reading your posts that you are very good at what you do. There are a lot of medical professionals in my family, my wife is a retired RN. You will be an asset where ever you go to work.

[DFW]

72. I'm not in your line of work, but I can sympathize.

An old French friend of mine used to quote Clemanceau: The cemeteries are full of irreplaceable people--all of whom have been replaced.

[area51]

78. Good luck.

[malthaussen]

83. Good for you.

Nobody seems to appreciate good workers anymore.

-- Mal

[bluboid]

84. wow, aristus - take care of yourself...

stress like what you describe is a killer - be careful.
your voice & your work is extremely important.

[cilla4progress]

85. May the road rise up to meet you, Aristus.

Glad you'll be sticking around here!

[sarge43]

88. Good on you.

Quoting my dear brother (RIP), "If it ain't fun, don't do it."

Can you take some time off before you start serious job hunting? You should decompress before you start that rat race.

Hugs and good vibes.

[RainCaster]

89. Nobody wants to work themselves to death for shit wages

I will be retiring in two years, and won't look back. There is no concern for workers quality of life anymore. The focus is entirely on how little they can pay, which includes benefits.

[Aristus]

90. Well, the truth of it is, I'm actually very well-paid.

That isn’t the issue.

It’s the workload.

I dropped down to 32 hours per week to avoid burnout, because the lost income meant less than the increased time with my family.

But my bosses just crammed more patients onto my schedule for the days when I’m there, pretty much neutralizing the additional time off.

[uppityperson]

91. That's insane, congratulations and I hope it works out for you

[Yavin4]

96. The "more with less" management ethic

Higher up managers getting paid the big buck by making 3 people do the work of 30.

[Ocelot II]

97. Good luck getting the new job, hope it happens fast!

You deserve to be appreciated and not worked to death.