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Outpatient provider potentially asked to “flex” to hospitalist

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  • Outpatient provider potentially asked to “flex” to hospitalist

    Hello again,

    I am outpatient IM. Salary based income as I am 6 months out of residency through hospital affiliated group as full time outpatient. Strong likelihood of being asked to work as full time hospitalist shifts for coverage in the coming weeks due to covid 19. No other info at this point re scheduling, backup, compensation, etc. oh btw never been oriented to the hospital I would have to cover, and I’m not sure when I would start at this point. I don’t even have training on the inpatient EMR

    Our hospital affiliated practice has also planned to Reduce work hours and compensation for salaried employees, which would include reduction in my comp which seems strange since my salar model is based off median IM RVUs and mine consistently have exceeded median in past 2 months. We have moved to telemedicine and even with reduced practice hours I would still generate median rvu level productivity. I am technically paid by the hospital as I am employed with them.

    what questions/concerns do I need to have? I can think of many but things are moving fast and I would appreciate more experienced advice re navigating these issues above.



  • #2
    Originally posted by guitarguy23 View Post
    Hello again,

    I am outpatient IM. Salary based income as I am 6 months out of residency through hospital affiliated group as full time outpatient. Strong likelihood of being asked to work as full time hospitalist shifts for coverage in the coming weeks due to covid 19. No other info at this point re scheduling, backup, compensation, etc. oh btw never been oriented to the hospital I would have to cover, and I’m not sure when I would start at this point. I don’t even have training on the inpatient EMR

    Our hospital affiliated practice has also planned to Reduce work hours and compensation for salaried employees, which would include reduction in my comp which seems strange since my salar model is based off median IM RVUs and mine consistently have exceeded median in past 2 months. We have moved to telemedicine and even with reduced practice hours I would still generate median rvu level productivity. I am technically paid by the hospital as I am employed with them.

    what questions/concerns do I need to have? I can think of many but things are moving fast and I would appreciate more experienced advice re navigating these issues above.

    What does your contract say? Do you have a contract? Are you an at will employee? These details will determine what the hospital can and cannot do.

    And then there is the ethical aspect. Your community is in need. You are a doctor. What does your conscience tell you to do?

    Comment


    • #3
      Imo, right or wrong no one is going to care about your issues and the specific nuances of your current circumstances During these times.

      They’ll expect you to transition to inpatient and comp will be comp. most of these are demands not requests. Any email you send or concern you raise related to your pay during this will likely only hurt you or your standing going forward

      im not one to say just take it from these admin guys but at this time I don’t think there is any other way around it.. unless if you truly didn’t care about your long term future there. Even then you’ll still get tagged and any future employer will possibly get the lo down from your current admin about what a horrible game uy/gal you are...(according to them).

      personally I’m giving it 3 months where I kind of have to suck it up and take the orders.

      Comment


      • #4
        I volunteered do do exactly what you are describing. I figured we would be asked so better for me to just step it up.

        It is the right thing to do. I am 5 years out and I will be Rusty as heck but I am sure I can be useful. We had a few others who volunteered. We may need to force a few more.

        We are all getting screwed pay wise. I am doing so much uncompensated work and less then half my usual compensated work.

        Your hospital will likely get some sort of bailout at some point. Keep track of what you lost and what you did extra and when this is over present your case. They will be more likely to share when they are getting government assistance rather than now.

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        • #5
          The entire medical group took survey of capabilities of each physician - specifically looking at inpatient coverage capabilities. Being 20 years out of residency --- I'm probably not the first person to start a central line, but more than willing to try--at least can push a gurney effectively.

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          • #6
            All I asked is let me know early so I have child care and proper orientation. Some specialists like GI volunteer to help out too. I'm willing to do to keep afloat and be a teamplayer.

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            • #7
              We asked the pediatricians in our system if they could take care of our pediatric outpatients if we get pulled to do inpatient work. There was a collective *phew* that could probably be heard on the other side of the county. Of course one jerk said no.

              I've said it before in reference to other topics but just because you're a physician does not mean you're a good person. But when something like this comes up you will find out who the good people are. Yes in an ideal world no one would try to screw us and we would get paid for all this extra more hazardous work we are going to do. But whoever said this world was ideal?

              Unfortunately the jerk who said that he would not even help cover outpatients is probably going to make out better than the rest of us.

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              • #8
                It’s great to be ethical and a team player and to do the right thing. Does your administration do the same? Have they taken a pay cut with reduced revenue? Have they furloughed non-clinical staff like marketing and middle managers?

                Doing the right thing will likely be thankless. Admins will return to business as usual afterwards. Clinicians always just suck it up. At least be compensated for the risk-negotiate for something you want perhaps more control.

                I have been offered surge hospitalist at an ortho “hospital” to be converted into med-surg beds. I’m thinking of asking for an ownership stake in the hospital like the orthopedists have. No need to bail out their idled overhead without compensation. Then again they may have enough “volunteers” who will work for the usual since salaries are down and debt payments continue.

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                • #9
                  In my previous life, say a couple of months ago, I worked part time both clinically and in leadership. In that other life we had been enjoying travel quite a bit.

                  These days, I am working as much as 16 hours a day, 7 days a week, still both clinically and in a leadership role. I am writing policies and I am providing care at the bedside. While I often worry about both the patients and the staff, I find myself worrying more when I am home. Strangely I feel calmer when I am at the hospital providing care and fighting the fight.

                  Comment


                  • #10
                    Originally posted by White.Beard.Doc View Post
                    Strangely I feel calmer when I am at the hospital providing care and fighting the fight.
                    Qi'ra (star wars). -- 'you're the good guy's
                    go get them Han

                    Comment


                    • #11
                      Reminds me of a recent WCI Network blog post titled "The Hospital Won't Love You Back." Do what allows you to sleep at night, keep food on the table, and put a roof over your head.

                      As one who can afford to walk away from medicine I spent a bit of time thinking about whether now was the time to do so or if I was willing to put my own health and that of my family at risk in order to continue doctoring. In the end I decided I couldn't live with myself if I walked away now. So I continue to work shifts with increased hazard for even less money that I don't need. But at least I can look myself in the mirror and feel good about what I'm doing.

                      Plus the signal to noise ratio in the ED has gone WAY up, so that's enjoyable. Interesting pathology and a lot less BS.
                      Helping those who wear the white coat get a fair shake on Wall Street since 2011

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                      • #12
                        Something like this exposes true colors.

                        I won't say which hospital this was at (not my current one or any that I've been associated with recently) but during the Ebola scare there were several docs in my group who refused to do the PPE training and openly said if an Ebola patient showed up they would walk off shift and go home.

                        See what WCI said just above about mirrors and their use.

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                        • #13
                          It is easy to blame the admins still getting their pay and keeping their jobs. But does one know if this really true. They might be also furloughed and having a significant pay cut but that is not disclosed out in the open.

                          As other have said, take precautions but also ask if you can look at the mirror as well as the society if you shut the office down or don't step up because you were too selfish about your own needs. Have a balanced approach. I still see my own patients in my subspeciality if they are admitted and keep the outpatient open for follow ups and therapies and new patients so that they don't flood the ER and get admitted and occupy the beds that may be needed for COVID.

                          And in my free time I do gardening, or walk in the woods and listen to nature in order to feel calm and relieve the stress.

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                          • #14
                            For all those worried about managing covid patients, its honestly one of the easiest patients to manage (besides the fact that if you don't gown up properly and take appropriate precautions you can get the disease and die of course).

                            Medically speaking they are alot of younger patients with not many comorbids and you just check the oxygen and titrate up or down. If you are being asked to help, hopefully the hospital will Triage you these types of patients(or maybe ask them to is a good idea). Our hospital is making a lot of makeshift centers exactly for these type of patients.

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                            • #15
                              I have some guilty feelings that I should be doing something more. I talked with another retired physician also in his 60s that feels the same way. We are also aware of a 67 year old doc locally who is on a vent. I am preparing to hunker down and hope to keep myself out of the ER and off a vent.

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