• Rosalind Kaplan, MD

Is the Grass Greener?

By Rosalind Kaplan, MD

Employed physicians and other healthcare workers have, for years, been saying this about jobs in the healthcare sector: 'The grass is brown everywhere." In other words, if you're unhappy with your healthcare system-based job, there's little point in looking for a new one, because it probably won't be better. That's because working in our insurance-driven, profit-driven 'medicine-is-a-business' system is hard and grueling and often toxic. We train for years, pay exorbitant professional school tuition, sacrifice our personal lives in our 20's and early 30's, and take countless exams, for which we also pay obscene amounts of money, to be healthcare professionals- nurses, doctors, NP's, PA's, etc. Most of us are truly in it to help people. We do all this believing that the resulting career will be satisfying enough to justify the way we got there.

I found out pretty early on that the ends didn't really justify the means if I worked for a health system, which is why I worked for myself for close to 15 years. Unfortunately, my partner and I were not very good on the business end, and as things got more complicated with technology and insurance, running our own practice just didn't make financial sense anymore.

And when I returned to working for hospital-based, academic health systems, I found myself back in that feeling that, despite the intellectual stimulation and the satisfaction of caring for patients, the toxicity just wasn't worth it.

For me, it specifically was the progressive loss of autonomy, and the pressure applied by the ever-increasing herd of non-physician administrators to maximize profit through seeing more new patients than I could care for well, and through exhaustive documentation to maximize insurance payments. That meant filling out reams of on-line forms, and plugging in lots and lots of data. If we fell short in these areas, we were shamed and our hands were slapped. On occasion, we were threatened with financial punishments. Meanwhile, I was told more than once that I should 'spend less time with patients.' Wow.

The other hot-button item for me was that, while other employees of the health system had clear job descriptions and had mandatory breaks and limited work hours, physicians do not have any reasonable limits on the range of duties we perform or on how much time we work at a stretch, or in general, once we are out of residency training (I never had limits as a resident, either; work hour limits came after I finished training). What I mean by this is that, if a receptionist or medical assistant or other office employee was on break, or absent, or it is after hours for them, it was assumed that I would do their jobs as well as my own, should I have to fit in a patient, or if I wasn't done for the day. Checking patients in, rooming patients, taking vital signs, nursing documentation, collection and preparation of lab specimens, interfacing with insurance companies, cleaning rooms, checking patients out-- all became my job if there wasn't someone else to do it.

Now, I'm not going to say that I did these things all day, every day, but it happened much more than it should have. And I wouldn't refuse, because it was the patients who would be hurt if I didn't do it. And I would be shamed by administrators and managers, who would imply that if I refused, I felt it was because I was 'too good' to do the dirty work. In fact, I didn't mind any of those tasks for their substance. The problem was that it was more of my time, time that I was already short on, because when I wasn't actually in a room with a patient, I had documentation of my own to do, and an inbox to manage--prescriptions to order, patients to call, emails to attend to... And remember, salaried doctors don't get paid for any of that extra time! I will also hazard a guess that male doctors were not asked or expected to do nearly as much of this sort of stuff as female doctors, nor would they be shamed for declining to perform these tasks. The blurry boundary of job descriptions, caused by the fact that I sometimes performed these tasks, also made it harder to ask staff to do the work. They were, in fact, understaffed and overworked. Who could blame them for trying to get someone else to do some of it?

So up until the last couple weeks, I'd tell you that yes, the grass is brown everywhere, because changes in job did not change the dynamics I've outlined. The culture seemed to be pervasive. What happened a few weeks ago is that I began employment with a new urgent care company, one that is not part of a larger healthcare system. It is, in fact, a for-profit business. But immediately, I have seen a very different culture.

The first thing that happened is that I had upwards of 50 hours of training on the electronic medical record and the day-to-day workings of the clinics (in my last several jobs, I walked in and was left to figure all this out on my own, save a few hours of EMR training). The support staff-- medical assistants, technicians, schedulers, receptionists--also seem to have had adequate training. And they have clear job descriptions, which they actually perform consistently. So far, I have not noted any understaffing, either. We did have one day when an employee feel ill late in the day, and we all cooperated to get the work done without her. That meant I printed discharge instructions out myself and gave them to patients, and I gathered my own equipment for a procedure. Not a big deal at all, and I felt appreciated for it.

Another thing I've noted is a positive aura-- I have yet to see anyone gossiping or back-stabbing each other. Everyone is pleasant to patients and each other (and civil even in moments of adversity.) I think this is the result of good boundaries, clear job descriptions, and full staffing (which is likely because the pay and benefits are fair.)

The downside at this job is a clunky electronic medical record which means that 'death by a thousand clicks' is now something closer to 'death by twelve hundred clicks.' Some of the administrative processes are burdensome. I will likely find other problems as I am there longer, but it has started out far better than any other place I've been.

Look, it's not going to be a lush, green lawn. Healthcare doesn't have lush green lawns. But it doesn't have to be a bed of dry straw, either. The large healthcare systems could learn a lot about employee wellness and retention from this smaller company, but I'm not sure they are interested.

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