By Dr. Margaret Curtis, WCI Columnist
[EDITOR'S NOTE: Readers of The White Coat Investor might know our columnist Dr. Margaret Curtis as a pediatrician, half of a dual-physician household, and the proud owner of a sidewalk sofa. She has been around long enough to have seen and experienced all kinds of professional challenges that physicians face. As her alter-ego, Auntie Marge, she shares opinions and gives advice. If you have questions about your work or financial life, Auntie Marge is here for you.]
“My employer has recently mandated that physicians will chart in a shared workspace or on mobile computers. We will no longer have offices or dedicated phone lines. We have been informed that we are not allowed to use exam rooms for charting after a patient has left, so that patients can be roomed sooner. But we don’t even have enough staff for that kind of rapid room turnover, so I don’t get this.
I never thought I would be stuck in a cubicle at this point in my career. The thought of working out of a bullpen (aka ‘working out of a collaboration space that is nothing more than a big room with lots of desks') is making me miserable. What do I do?”
The advent of cubicles as physician workspaces may be the most benighted of all the slings and arrows hurled at us by Healthcare in America, ca. 2024 (and yes I know that cubicles and open workspaces are not the same thing, but the distinction is meaningless because both of them are stupid). While the rest of the business world realized about a decade ago that cubicles actually worsen performance, the powers-that-be at American healthcare employers have recently decided that crowding physicians into open-plan areas cheek-by-jowl with medical assistants, triage nurses, and schedulers is a good idea. Clearly, someone went to a weekend seminar on “regressive business practices you can institute to feel clever” and came home brimful of enthusiasm.
You are right to feel demoralized because cubicles are demoralizing. According to LinkedIn, “Doors are only for managers and people who have earned them! Cubicles are organized and equal, so employees know their place in the company.”
First, I would like to say: drop the exclamation point, you fascists. Second: we have earned those doors. We have earned doors, at least one window, and a bulletin board where we can put up kid art and anti-admin snark. We need private telephone lines to make sensitive phone calls, dedicated computers where we can keep our resources, a bookshelf for clinical references, a plug-in kettle, and weird mementos (mine has kids’ toys. My urologist husband keeps a collection of bladder stones. I don’t like it, but no one else is allowed to criticize it). We know our place, and it is not at the end desk that Cathy isn’t using right now because she’s out on FMLA.
I (Auntie Marge) have worked out of “open workplans.” About 50% of the time, I come home with a splitting headache from the background noise (and sometimes the noise is me chatting with someone nearby, so I’m part of the problem). What can you do about being put in a cubicle, or really about any of the many indignities of modern physician employment? I’ll start with the most logical and effective and end with the most satisfying.
- Show the data. You can cite studies that show that cubicles worsen employee morale, diminish privacy, decrease working memory, and don’t actually increase collaboration. When your coworkers start calling out sick with influenza A, make one of those bulletin boards with thumbtacks and string connecting the sick contacts.
- Remind your boss that HIPAA requires that healthcare workers access “only the minimum amount of protected health information needed to accomplish the intended purpose of the use.” Overhearing a colleague discuss a patient’s diagnosis on the phone is not a HIPAA-approved use. Be sure to mention “The Feds.”
- Request an accommodation. This can be for ADHD, migraines, hearing loss, or any of the other totally legitimate reasons that you should not have to work in the cognitive equivalent of a mosh pit. If you don’t have documentation of any of these, you may have to ask your PCP. If you are a PCP and are asked for a letter—well, I won’t tell you what to do, but “Mental Health” is always an honest answer. Ask yourself how well you would do working in a bullpen and then start writing.
- Join forces with the other physicians and ask for a quiet workspace of your own. Avoid any mention of the status you have earned through unending years of toil as a student and resident or risk being labeled an elitist. Being an elitist gets you in trouble with HR and with the nurse manager who feels strongly that physicians need to be taken down a notch. Then, you have to do paperwork.
- Ask for noise-canceling headphones.
- Ask nicely if you can at least finish your charting in an exam room.
- Don’t ask and just finish your charting in an exam room.
- When caught finishing your charting in an exam room, say “I just forgot.” Say this every time you get caught.
- When caught finishing your charting in an exam room, yell “HAVE YOU NO SENSE OF DECENCY?”
- Quit.
More from Auntie Marge:
How Can I Make My Terrible Doctor Job Less Terrible?
Should I Feel Bad About Taking Time Off?
Whether you choose to suffer (No. 1) or take up arms (No. 9 and No. 10) depends on how well the job otherwise works for you. If you can walk away—and I recommend that all physicians know where the exit doors are, no matter where they are in their careers—your position will be stronger. Your work is worthwhile and you deserve a workspace that will allow you to do it to the best of your ability. Whatever you decide to do, I am here for you.
Want to hear even more from Dr. Margaret Curtis, who made two presentations at WCICON24? Then, check out the Continuing Financial Education 2024 course that presents 37 hours of content from WCICON24 (you can earn up to 16 CME hours) and guides you on how to make wise financial decisions and have meaningful, sustainable careers.
Have you ever had to work in a cubicle or a bullpen? What was your experience like? Did it hinder your work? How did you get out of it?
Thanks for this post. This happened to me. I worked at a public hospital that moved its physicians from an old, dingy building of mostly small offices to a brand new building with cubicles for most of us. Despite the newness, this was a major downgrade for many of us. Having worked in a cubicle for a year before med school and not liking it at all, the move definitely kickstarted my thinking about career options. That, and the three-foot-high “walls” between our cubicles.
I know three facilities with common workspaces for physicians and other staff – two that I worked at plus one other – and all of the were built in the last ten years. All the amenities except for private workspace. Nefarious.
Wow. Talk about a nuclear option. I am not in an open space like that, but telling your boss that this is a HIPAA violation and threatening to notify the authorities sounds Extraordinarily aggressive. Is it Sheila Office better than being in an open floor plan? Certainly more comfortable. I don’t know if it is any more productive. In my first job I had an open floor. I didn’t like it, but it really was not a big deal. I mean you’re working with professionals. The reality was there just wasn’t enough space in the building for everyone to have his own office. There were a lot of doctors. So it was what it was. No big deal. If I had gone to the boss and said you need to give me my own office or I am going to complain to the state and federal authorities to come down on you. I would expect the next day they would arrange a meeting and within a week I would be looking for another job that appreciated, my incredible and unique talents. as a boss that’s certainly what I would be thinking. Seems like a very aggressive response to a very small matter.
if you’re in a doc only room, maybe. But if schedulers and the cleaners can hear you telling Mrs. X she tested positive for chlamydia the risks of that tea spilling are way higher if 20-30 people all paygrades hear you than if 4-8 fellow docs do.
So… you know … don’t talk loud. That’s easier than threatening your employer. If you allude that you might consider reporting them bec there’s just not enough room for everyone to get a private room you really should have another job lined up. Personally I’d start filling that persons files with reviews that they are disruptive in advance of letting them go. Unless there’s a legit good reason you can’t threaten your employer and expect to have a positive future with them.
Uhhh Keith….this article is pretty tongue-in-cheek. I don’t think the author is recommending we call state or federal authorities (start with the city police of course). I also don’t think requesting a quiet, private work space for a physician in an outpatient practice is that far fetched. I guarantee the administrators of an office practice wouldn’t work in a shared work space. Your comments seem to be a little too closely aligned with the business/admin folks in healthcare….I also don’t really buy that’s it’s a “small matter”. The “small matters” are the million little paper cuts that add up and make physicians feel undervalued, under appreciated and burned out. That doesn’t lead to quality patient care.
I guess I read it differently. Saying that you can’t not talk loud to dictate and this violates HIPAA and telling your boss the practice is in violation implies to me “and I’d hate to be the one to bring it up the the state medical board,” or “this is a really nice business you have. It would be a shame if anything happens to it.” I think it’s perfectly reasonable to say “hey I can’t function with other caregivers also dictating,” and see what happens. But considering that every ED and urgent care works this way as well as many offices, I don’t see the big deal. Like I said in my first practice there just wasn’t enough room in the clinical area for every doctor to have a private office so the newest six of us or so were in a shared space. It wasn’t a big deal.
Exactly. I’ve never had an office. I mostly just get annoyed that my computer logs me out every time I go in to see a patient. It’s probably a HIPAA violation to yell at that methed out patient to get back in his room and away from the other patients too.
How would this be a HIPAA violation?
Because the other patients are finding out his diagnosis of being drugged out. Not that this would ever really fly, but it’s really hard in some places like EDs to keep patients from knowing what’s going on with other patients, especially when care is loud like a code or wrestling someone down or whatever.
I can understand that. I suppose context is important. I worked in a shared work space with other physicians and PAs. It definitely made it a bit more difficult to make phone calls, document, focus. But at that time I felt pretty supported by my employer and enjoyed the camaraderie, so the shared space wasn’t bothersome to me. I’ve also worked in a tent in the desert providing care, so I get unpleasant work environments, and sometimes you just grin and bear it. I am not sure that sharing a space is an automatic HIPAA violation, but it certainly makes it more likely that someone is getting access to PHI when they don’t need to. Again, I think the author is using a bit of humor/hyperbole to make her point.
David, thank you for reading for both content and tone.
I would argue that a shared workspace of multiple physicians is substantively different than a common room with several physicians, a triage nurse calling elderly patients, three MAs conferring about vaccines and an NP student presenting to a preceptor. Regardless, if your workspaces suit you, so much the better. Regarding HIPAA: I expect that any concerns I raise in a thoughtful, measured way, including “we are not doing enough to safeguard patient information in these workspaces” be met with an equally thoughtful response from my employer. If raising my concern got me labelled as a disruptive physician, that indicates much larger problems with the organization.
TLDR: Auntie Marge should be taken seriously but not literally.
Tell the executives in charge making this decision that you will work in a cubicle when they will. Charting is difficult and tedious enough as it is (and good charting protects from malpractice claims). Sometimes the only way for me to finish my notes is to close my office door so I can just focus. I would never work in a cubicle.
I’ve never met an administrator that worked in a bullpen. Never even seen one swanning around there.
Get an AI based transcription service to save time. Edit slightly and you’re done. Many people also go home and complete their notes although some of us can’t do it especially with kids in home.
Buy noise canceling headphones and talk louder on it with patients and annoy the people so they can complain that it’s too loud in the common space. If you don’t make noise, no one listens. That’s basic human nature. That’s why kids cry to tell you that they are hungry.
I asked for – and received – unused office space that I could use for charting. Not mine exactly but good enough.
Following the AI transcription thing – will be interesting to see where that goes.
I’m a hospitalist who has never had an office and works in a shared work space. I have no dedicated space in my hospital. I actually enjoy the social aspect of it most days. If I want to run a challenging case by someone or just vent about a challenging patient encounter there is always someone there. When I am feeling moody and want to be left alone I just put headphones in.
It would be nice to have a place to personalize. A window would also be nice.
I think the culture also matters. In some shared workspaces everyone is really expected to be available to the group at all times, and putting in headphones is considered rude. That would put me right over the edge.
As an ED doc, I’ve worked in a cubicle/fishbowl most, if not all of my career. We do it because it keeps us abreast of the ED and have rapid communication with the staff. The downside is that it is noisy, we are subjected to constant interruptions and it is not very conducive to contemplative thought. But most of us knew what we were getting into when we started. For most physicians their office is their sanctuary, their home and well-deserved. Taking that away is emblematic of the course of medicine and unfortunately we have been complicit in our lack of leadership and desire to “just practice medicine” (“and not taking on the administrative issues”-a famous recruiting line used over the years).
I wonder how much of this is the different workflow in EM vs primary care (the importance of urgent communication) and how much is the self-selection of folks who choose EM and like all the input. You all have always struck me as a bunch of extroverts. Do you do all your charting in the fishbowl? or do you have space to chart etc away from the hubbub?
Nope, you dictate right there where 20 other people can hear, including patients if doors are open or they walk up to the desk.
I have definite my life in 2 phases: before I saw Office Space, and after I saw Office Space! 🙂
I think the popularity of that movie is as you mentioned Margaret is the demeaning connotations that putting an employee in a confined cubicle comes with.
yeah, I agree with you that if this set up bothers you, something has to be done. that’s why I and all of docs should be financially literate- to have the option to not be boxed into a cubicle because we are slaves to our income!
PC Loadletter? What the &*$% does that mean?!?!
“The thing is, Bob, it’s not that I’m lazy, it’s that I just don’t care.”
My next blog piece is going to be how Office Space was the origin of quiet quitting.
Briliant movie!
That movie was shot in Austin. It’s fun to drive by where the exterior of Chotchkie’s was shot. That’s only a few minutes from my house, and that building is now a bank.
https://images.app.goo.gl/bbkBk9GJhJ65cnmc7
I need to see this, and then make a pilgrimage to Austin.
On a related note, at my previous job, our on-site parking was taken away and we ended up having to take a shuttle to and from a lot a half-mile away.
That’s not the only reason it became my previous job, but it is definitely one of the reasons.
dude are you F—ing kidding me? I’m sorry I’m glad you left. As if taking care of patients is not worth on-site parking!!! I get that yes we as physicians are still highly compensated but come on, we have the most important job in the hospital and are not worth on-site parking???
I hope you weren’t getting hassled for being late to the clinic/hospital btw!!!
also, who got the on-site parking after it was taken away from you?
It was sort of a mess. We moved from an old building with some onsite parking, to a new building right next to a long-standing paid parking lot that was formerly at the fringe of the expanding medical center.
Thus, the powers that be decided not to plan for any onsite parking for the new building, and had the staff use the paid parking lot. They did eventually pay for staff parking in that lot.
But, that decision bit them within only a couple of years when the medical center decided to develop on the parking lot, and we had no control over that and had only a minimal amount of space to create onsite parking.
The onsite parking that was created went to admin.
It was definitely was more poor prognostication than malice on their part, don’t get me wrong. But for my own part I will admit that after having trained in that med center for 8 years, and being on the bottom of the totem pole, and scrabbled for parking for the better part of that decade, having my own parking space was one of those little “you made it” markers that turned out to have more importance to me than I might have realized until it went away. Parking-scarcity mindset, I reckon!
Never ascribe to malice what can be better explained by incompetence. Unless it’s both.
I’m sorry for your loss (of good parking).
That happened to me in the military. Then a few years later I lost my parking spot near the ambulance bay at my current hospital.
I think most of you got this, but bc it’s the Internet it might be good to clarify: the linked LinkedIn article was satire (it’s signed “The Outdated Leader,” and full of hyperbole)
Thank you for reading, and clarifying!
Unfortunately, if you work for a big institution that doesn’t give a damn, you could try all the above tactics which may backfire and make the working environment even more toxic. As fancy as a doctor, to employers, it is just another high-paid position that is dispensable, replaceable, and dischargeable. Employee doctor may have to choose the battles, i.e. trying to get an individual office vs. getting better staffed shifts etc., I would think the latter is more important. The way to achieve FIRE needs to be sustainable without compromising your physical and mental health. Doctors need to know how their employers operate, budget, profit etc., and making requests is like making a business case, pros and cons, value proposition, etc. An employer would not give an employee doctor a nice individual office unless there is a clear cost benefit (i.e. can’t recruit or retain doctors due to cubicles), health care systems these days would never provide individual office so employee doctors could feel respected and important. Citing HIPPA, that is risk management, chances are not that high that somebody from the doctor cubicles would leak patient information that would cause some law suits. So who cares?
By the way, Federal Trade Commission’s voted to ban noncompete agreements. This would have big impact on health care professionals, who are more and more likely to become employees than small business owners. Would WCI do a post on how not to get bitten by the unfair non-compete agreements? Of course, greedy hospitals represented by The American Hospital Association quickly oppose the ban.
We’re blessed to have our own offices. The problem I have with being out in the open is our Dragon device picks up ambient conversation and it messes up my dictation. ( Our Dragon doesn’t work properly at baseline)