I ran across the following email post from April, 2006; for some reason I kept it in one of my Outlook folders and after reading it, I can see why I did. The poster will remain anonymous but it sums up the level of frustration I am seeing out there today, especially in mid-size medical practices. It again shows physicians are too concentrated on overhead when the real problem is growing the top line. It also shows the level of frustration management has out there with their physicians. It’s not too amazing that the issues of 2006 are the same as those in late 2009. What do you think?
I'm ten days behind in posts, and just took some time today to try and catch up. The thread on age, job performance and turnover, and all the rest was just outstanding. Well done to each and every one of you. I am so proud to be a member of this listserv. I am taking a huge risk in posting this, because some of you know me, and some of you know my group. I am relying on the kindness of strangers (as well as known colleagues) to listen to my rant without using it in any way against me or my organization. I am just so frustrated I have to get this out:
The reason I am ten days behind in my email (not to mention job, and life) is that three of my doctors walked in ten days ago and demanded that I make deep cuts in our staffing. The actual document that I was presented stated that I was expected to have two employees per physician as a staffing goal, and no more than three staff per physicians at the outside. I do not need to explain to any of you that the rest of the document was equally deranged and out of touch with reality. I tried to explain median staffing. I tried to explain benchmarking. When that didn't work, I turned to the most delusional of the three and stated, "Alrighty, then. We'll leave your medical assistant and surgery scheduler. You're out of luck for anyone to answer your phones, schedule your appointments, verify insurance eligibility, register your patients, code your office visits and surgeries, key them, collect them, perform your transcription, take your x-rays, handle your credentialing, negotiate your contracts, and pay your bills."
I feel as though I was watching my entire life flash before the list's eyes as I read everyone's posts. Been here three years this month, so the honeymoon is over. The group is compensated based solely on production (you eat what you kill, so we don't play well with others and we REALLY don't cooperate with projects over the long-term that might affect an individual's bottom line adversely, despite improving the overall health of the organization). God forbid anyone make or keep a plan for more than a month at a time.
When the dust settled, I had 36 hours to make the cuts, although they were not as severe as originally demanded. I set a world's record for firing people last Friday morning, and terminated 9 individuals, one of whom had been with the group for fifteen years. And oh yeah, in writing, the doctors stated (and this is a quote): "Our ultimate goal is to make this a fun place to work, while providing excellent orthopedic care in a cost efficient manner. Perhaps an employee purpose statement is required by which to screen and evaluate workers and to assist in our decision making processes." Note to list: I have no idea what that sentence means. None of the doctors participated in making decisions on the cuts, nor did they want to. None of them participate in the hiring process. One did charge that I maintain office morale. Always a happy statement to hear when combined with demands for significant cuts.
That I can take. Business is business. I made the best choices I could under the circumstances, and I think we will survive the this short-sighted and hysterical response to a temporary problem (a doc just decided to retire with one month's notice). I handled it all as professionally as possible under the circumstnaces, but what I did NOT appreciate were the threats made by one doctor. He suggested that he suspend my pay, since the group is in transition and his paycheck has been affected. He also stated that I do nothing, know nothing, and am incompetent. I have had situations before where I clashed, disagreed with, or had other conflicts with physicians, but nobody has EVER stated that I wasn't working hard, or that I was incompetent.
So, I guess this is where age comes in: I am old enough and mean enough at fifty-two to survive this, and I'm old enough and mean enough at fifty-two to smile at a young doctor who has the affrontery to claim that I am both incompetent and lazy and say, "Oh, no, I don't think so."
Sometimes being a survivor just means working hard and staying lucky, and smiling in that special way that reminds your physicians that they really are better off with you, or waiting until you electively move on.