Guidance please, and please be honest. I'm struggling at my current position but don't know if it's a case of sucking it up vs finding a new environment.
As a background, I am a PA who spent the first 5 years of my career at a rural FQHC in family med. By the time I left, I was working with a full schedule. Pt appts were 20 and 30 mins and I was typically seeing 16-22 a day, depending on the amount of physicals and procedures I had and the weather. I was putting 50-60 hours in a week depending on the amount of off hours house calls I did. We had great support from our MAs, who would get the patients in early, and a lot of data entry and screenings done, helping with the EHR burden. It was busy but manageable. I had my own patient panel and knew my patients well. However, I was working for 70-73k/year and our clinic was never in a sound place financially, half our patients were Medicaid or uninsured.
I got married and moved to my current position at a private practice rural primary care clinic where I've been for just over a year. I'm the newest provider out of 2 physicians and 2 NPs and am still building up my patient panel. Initially, depending on the weather, I could start with 6-8 pts a day in my schedule and stay there, or end up seeing 22-24 a day. I'm probably averaging 20 patients a day at this point. The other providers are seeing on average 24-32 a day, sometimes up to 40 pts/day. Appts are every 15 mins or 30 mins for procedures/physicals. However, I'm struggling to keep up with this pace. I'm finding that when we are short on MAs, which happens 1-2x/week, I'm the one that is often scheduled to work on my own, relying on the kindness of another MA who can help room my patients, or I actually have to room on my own even stay remotely on schedule. Patients aren't required to show up early and can show up 10 mins late for their 15 min appointments and I am expected to see them. New patients are thrown into my schedule all the time and I will often have no records. Or the opposite, two days ago 500! pages of a new patient's medical records with a significant psych and surgical history were placed on my desk and the pt was scheduled less than 24 hours later, not having time to adequately prepare for the appointment or preload some of the history. Sometimes the MA will update the med list, most of the time it's my job update if they are an existing patient, or enter in everything entirely if they are a new patient (meds/surgical history/family history etc). I'm easily spending all my allotted time per patient on basic data entry and rooming patients, let alone trying to actually practice medicine. I'm spending a ton of after hours time trying to catch up on charting and the basic data entry.
I've been thinking about suggesting some changes, largely having a contingency plan when we are understaffed and asking patients to come 10-15 mins early so MAs have time to get the basic data entry and screenings (PHQ-9s, etc) done. I feel like I have no leg to stand on though where I am the least productive. Then I read this article from KevinMD about how advance practice providers are more inefficient and I am really doubting myself. I get frustrated because I see the shortcuts the other providers are making that I'm not ok with. Med lists are never up to date, if meds are even entered at all (seriously--I wish I was joking). Our most productive providers are also the leading prescribers of z-packs and prednisone for coughs and sniffles and I'm not willing to do that in order to save 3 mins of time spent educating pts about abx stewardship. Don't get me started on the amount of opiates rx for acute back pain or indeterminate abd pain. Basic histories aren't being entered into charts and sometimes I have a hard time following what is going on with patients. Patient followup on abnormal labs or imaging is delayed by weeks or there is no followup at all. We're talking stuff like labs showing new liver/kidney failure or with moderate to severe electrolyte abnormalities, abnormal stress tests, lung nodules without appropriate f/u, etc, and patients are ending up in the ER for things that might have been prevented if someone was paying attention. Visit notes from the other providers are usually 1-2 sentence HPIs with a generic ROS/PE clicked away and I have a hard time following care at times. I know this stuff is happening because like I said, I'm seeing largely acute visits from other providers.
The practice owner is my SP and is pretty reasonable. Can I go to him with my concerns, or is this just what primary care has amounted to? Was my first clinic an anomaly or is this a bad environment? I [thankfully] don't carry the financial burden of maintaining a private practice and can't imagine the stress of doing so while somehow meeting all the ACA guidelines with charting and EMRs. I don't want to come across as a snotty, goody two shoes, especially like I said where I'm seeing the least amount of patients.
As a side note, I recently had my annual review, got perfect scores on the 20 different measures I was evaluated in, and my SP said he has no clinical concerns with the care I provide (and he reviews every chart I write). I believe I am a halfway decent provider and with good support could be successful.
Thank you!
Comment