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  • Avatar jacoavlu 
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    Not sure how that’s relevant, and I also don’t consider it appropriate. If you’re in middle in Montana and covering 2 tiny community hospitals I guess it’s ok but not ideal and not what I’d want for my family.

    I don’t think many people are taking stroke call at multiple hospitals and actually doing interventions commonly.

    Not sure what you mean having a good relationship or how my views about it being inappropriate to round at 3 hospitals relate to a relationship with other physicians? As a resident I’ve personally seen numerous cases where care is delayed because attending is at another hospital. It’s inappropriate. I call out bs when I see it.

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    point is 1) in the real world lots of physicians cover more than one facility, it may be less than ideal from a patient’s perspective but it’s reality and 2) some people view you and I as available-ists as well – “hey they just put in a feeding tube up on rehab please provide a stat read” – perhaps I’m sitting at my computer finishing an ER case, or maybe not and it’s a nice summer evening and I’m outside trying to teach my daughter to ride a bike; in the latter case, the nurse and patient are just going to have to wait a little bit before I get to it

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    #214728 Reply
    Lordosis Lordosis 
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    Status: Physician
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     Would you ever take a job where you’re expected to work 42 hours a week 52 weeks a year?

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    Uhh I work 50 hours a week 48 weeks a year.  I guess I should be looking for a better job myself.

     

    I do agree that I would not like a 7 on 7 off schedule with a family. I could get behind it if I was single at least for a few years.  I mean we all did residency that was 12-14 on and 1 off for 3-5 years.

    “Never let your sense of morals prevent you from doing what is right.”

    #214730 Reply
    fatlittlepig fatlittlepig 
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    7 on 7 off is OK, it’s the 7 on 12 hr a day shifts and you can’t leave even though you finished rounding and notes at 3pm that’s a non starter.

    #214731 Reply
    Avatar hightower 
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    Status: Physician
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    Ya I’m sure you’re making sure they’re getting the care they need when you’re 2 hospitals away… Give me a break. Why should you not be in the hospital for 12 hours? It’s literally what you’re paid to do, ie take care of patients.

    I don’t get it. The job is usually like 7 on 7 off. It’s set up that way because it’s understood you’re in the hospital a lot when you’re on, thus you work half the year. It’s like you want to have your cake and eat it too.

    Also I really don’t think going out for lunch for 30 min to an hr is the same thing as rounding at 3 hospitals on same day.

    I don’t think it’s appropriate for specialists to operate or do procedures at multiple hospitals on same day. Someone at clinic can leave their clinic and go see a patient if needed. What if you have sick patient at both? ” hey can you go see this patient that is crumping, I’m rounding at another hospital or taking care of someone crumping at this one.”

    A hospital is an availablist, thats literally the job. Hence why you work a ton when you’re on, and off half the year typically.

    If the job was popping in and rounding on patients and going home then every primary doc would see their own patients.

    You can delude yourself all you want but there’s huge conflicts of interest here with working at numerous hospitals simultaneously and it’s going to result in poor care.

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    It’s literally not the job.  The job is to admit, round, discharge.  We can get away with not being in the hospital all day every day because that’s what call is for.  When I’m the “on call” physician, I’m physically tied to the building for those hours taking admissions and doing cross coverage.  But, if I’m just a rounder for the day, there’s no reason I need to be physically strapped in.  I can come and go as I please.  If my presence is needed at the bedside, the on call doctor can cover for me.  That’s what partners are for. Of course I make sure not to give my partner a bunch of work and I try my best to make sure they are not bothered at all.  But, we’re happy to cover for one another so that when we’re not on call we get the privilege of being able to have some time away from the hospital.  What we choose to do with our time away from the hospital is our own business.  If we want to work 2 jobs, we can do that.

    I think you may have a misunderstanding of why the job was created. It was created because primary care docs no longer had the time to get away from their crazy busy offices.  It was to help with volume, which we can do without being in the hospital the entire shift.  Again, that’s why we have doctors on call in every group.  We take admits and do cross coverage.

    If you’ve seen cases where care was delayed, that should never happen in a hospitalist group because there will always be at least one doctor in the building on call at all times.

    #214742 Reply
    Avatar jessikaur 
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    “can we have a family meeting for goals of care at 1 pm?”

    No sorry I gotta go round on my 2 other hospitals worth of patients

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    To imply that my quality is not on par with regular hospitalists is a bit rude and assuming. There’s a reason I was elected chair of internal medicine only one year out of residency, and sustained the position for four years before I decided to try something new. At the LTACH, I meet with the families daily, and if they’re not there when I’m there, I call them esp. for major updates.  at the private job, they’re post surgical consults, so no family meetings necessary. I usually go here first to make sure all my patient’s are out of the hospital by 11am (time to d/c is very important metric for hospitalists)

    I recently had a tiff with hospital admin at private job because they wanted to hire a service to manage the diabetes and take this control away from the regular hospitalists — I agree with the learned helplessness comment that someone on this post made — none of the hospital employed docs decided to fight this, although they all agreed that it was a useless waste of money. I spoke at the MEC meeting on all the reasons why I didn’t need this service (hello!!! I’m an internist, this is our bread and butter, to give up control to an NP was ridiculous) anyway, through this process, and many meetings later, I found out all about my quality.

    0% hypoglycemia

    0% near hypoglycemia

    2.2.% hyper glycemia – and I could explain all those cases (patient eating skittles ATC, nurses not following protocols (i.e. holding meds based upon their judgement)  — and I said there was no way this service could improve upon my own results as I don’t know how they could’ve prevented these issues.

     

    anyway, short of it is, even though I literally had the best numbers in the hospital, they needed everyone to be on board with this to “get consistency” so that the nurses wouldn’t be “confused” by my orders as they were “different” than whatever protocols this sugar-service was using.

    Long and short of it is, even though I fought the good fight, they ended up forcing me to use the service anyway (hospitals can do this, whether you’re private or not) and it was a huge waste of my time! so OP, the hospital is not gonna change.. I think someone else said it, it might be easier just to get another job that has your preference of scheduling as opposed to trying to change the system.

     

    #214752 Reply
    Avatar Tim 
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    “We can get away with not being in the hospital all day every day because that’s what call is for. When I’m the “on call” physician, I’m physically tied to the building for those hours taking admissions and doing cross coverage. But, if I’m just a rounder for the day, there’s no reason I need to be physically strapped in. I can come and go as I please. If my presence is needed at the bedside, the on call doctor can cover for me. That’s what partners are for.”

    I guess that’s ok. Stroke patient taken to emergency room. Paralyzed 4 yrs with history of heart attack. Floor nurses are really nice. When can the family with medical power of attorney and financial power of attorney speak with the “doctor”? When he/she decides to make rounds.
    Two frigging weeks is ridiculous. It’s a one way ticket to unneeded misery. Yep, finally it’s time.
    10 minutes and “discharge tomorrow at 10 am, medically we can’t do anything. Two choices, hospice at home or a hospice facility. Which do you want?”
    I guess it’s ok, the discharge was executed. Thanks for the 15 minutes. Go enjoy your bike ride while we explain to his 92 yr old mother that things aren’t too good.

    “The job is to admit, round, discharge. ” Check.
    I guess that’s all in a day’s work. Real experience this year. Stop the feeding tube? Maybe. Your choice. It comes across as “starve him to death for his own good”. Just another minor decision in the precious 15 minutes.

    On the receiving end, it’s not pleasant.

    #214759 Reply
    Avatar jessikaur 
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    Joined: 11/01/2017

    @jessikaur

    Sorry if you covered this… are you not violating non-competes?

    Also, as efficient as you may be, do you think it’s a detriment to spread yourself so thin.

    Not trying to criticize, just seems like a lot of work.

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    No non-competes violated (I’m not stupid). I think my next book will be on efficiency.. for example, I did the two jobs today (2800 bucks for 5 hrs of in house work with commute included), I had to do two discharges at the LTACH which took forever, since we rarely have to d/c people there. I did 10 new patient surgical consults at my private hospital, 6 follow ups. I have had two total pages today one was at 8am asking for a d/c med rec on my patient at the private hospital (which if the nurse knew me at all, knows that I complete all of these in the morning without any reminders (I had every med rec completed before 9am on all of my patients whether they were leaving the hospital or not), the other was for Flonase which a patient forgot on their med rec. I know the surgeons that consult me, so I actually see the patients in the preop area BEFORE they go to the surgery (as some surgeries can take forever), and they’re not groggy so I can get a proper h&p, it takes me two minutes or less to dictate an h&p.

    Today was happy healthcare day or something, so I had to socialize at a picnic at the private hospital, and clearly I am sitting at home wasting time writing to you guys now! I think I got home around 1:30 or so.

    I went out late last night with friends, and had poor sleep due to drinking too late at night (but they were in town only for tonight, and I consider this an easy day) so I’m tired.. I was actually off my game today, I probably could’ve finished sooner with better sleep.

    I actually don’t think I’m spread too thin — my nurses/case management tells me that I’m the most available doc as I answer every page within minutes of receiving them (and if I don’t they worry something has happened to me) but I also don’t get many pages because I do a thorough job of making sure every patient is taken care of appropriately — i.e doing everything before I am asked. I typically round with the nurses to make sure all of their “needs” are met, and then the charge/nursing sup to make sure my wishes get fulfilled. and I cover for my fellow surgeons who are much less “available” than I am (they’re in the OR, in clinic etc example from today, the patient said if we wait for Dr. W to get here, it won’t get done until 5pm and the whole reason I came to the hospital today was to start the bowel prep early for my ex lap so i’m not up all night pooping) I promptly placed her orders. I caught a new murmur…

    I mean I can’t explain it, I have set up systems that allow for frequent early discharges, with great patient satisfactions scores because my ability to communicate with patients is memorable and easy to understand. Ok, so lets say a patient needs to be discharged and I’ve already left and lets complicate it by saying they’re going to a SNF. I have signed 3008s ready and available in all the hospitals for just such an instance, I will log on make sure all the consultants have cleared the patient (as stated, I already did the med rec) and then I will write the d/c order. there is no overnight delay for this patient.

    My interactions are almost identical for every patient so I make sure I never “miss” anything.

    Hi, I’m Dr. K, an internal medicine doctor that works with Surgeon X, and I’m here to help with your medical problems like diabetes and HTN. I really don’t do too much with the surgery, so if you have questions about that, best to ask Surgeon X. Trust me, I drop my fork at dinner every night, so you really don’t want me operating on you…. now how are you feeling?

    Patient answers: I was nauseous, and vomited once, and the surgical site obviously hurts.

    Ok, well typically on day 1 post op I blame anesthesia for everything, it should come out of your body as the day progresses, and if it doesn’t just let the nursing staff know, they have me on speed dial. and pain at the surgical site is generally within normal, I will call the surgeons and ask them if it’s ok to go up on your meds, as they typically don’t like me messing with that.

    I’m going to ask you some questions, and I’m gonna sound like a commercial, so bear with me and let me know if any of these ring true

    (full ros) are you having chest pain, sob, nvd,fc, lightheaded dizziness (the patient’s typically think it is funny that I can recite these so quickly, and then I do it backwards and in Spanish to show them how OFTEN I am doing this and that I can do it in my sleep)

    — typically they answer no, to which I tell them that those are my “danger symptoms” and if anything comes up, they need to let me know. if they answer yes on ROS– obviously, I tell them what my plan is (SOB — order labs and cxr, will call them if anything positive, and order treatments)

    Lastly, I tell them the plan — Surgeon X wants you to stop using the clicky-pain medicine thing (PCA) and wants your pain controlled on oral pain meds, we’re gonna remove your foley and make sure your pipes are working, if you don’t go in 6 hrs, you’ve got to let us know, I want you to use that blowy-thing (incentive spirometer), it helps us prevent pna, and you’re gonna work with PT today to make sure you can do whatever you gotta be able to do at home before we let you go.

    Any questions? typically at this point they say no, sometimes tell me that their brain is fuzzy on pain meds, I remind them they can reach me via the nurse at anytime.

    Then, I tell them I will do a quick physical exam and be out of there way. and I do.

    This whole interaction takes less than 5 minutes. and I have my notes set up to reflect it all (the ROS, the plans, the physical exam, so I only have to make changes if something is going on)

    that’s the private hospital. the ltach is a different animal on admit day, although day to day is pretty much the same (you have a gazillion things going on, and we have a gazillon consultants helping me with your care, you have a pulmonary doctor to help with your lungs and get you off this breathing machine, you have an infectious disease doctor managing all these antibiotics, I’m gonna do a swallow study on you soon to let you start eating again)

    Ever hear the phrase.. people rarely remember what you said, but they always remember how you made them feel.

    All of the above interaction with a 1000 watt smile.

     

    #214760 Reply
    Avatar jessikaur 
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    Joined: 11/01/2017
    It’s not working 12 hrs a week if you’re sitting on your butt in the call room for half the day. People apparently have time to round at 3 hospitals, but doing 1 for 7 days straight would be exhausting? That’s not logically consistent. Makes no sense. What would we say if an Ed doctor said ” why should I have to stay in the hospital all the time?” inpatients can have emergencies too. Literally the job. Availablist is literally the perfect discription of what a hospitalist is. That’s the entire point why the job was created.

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    clearly not a hospitalist! I’m not even sure works in a hospital at this point. Ok, so there are these services called RRT (rapid response team), that is available at every hospital (if they’re worth their salt) made up of specialists that are responsible for the “crumping” patient, they have my cell phone number, they call me immediately, we place our orders rapid fire over the phone, and typically the ICU doc is on the other line waiting for a verdict, sometimes, it’s just inevitable that the person needs to be intubated and goes to the ICU, most hospitals nowadays have closed icus, so if a patient is REALLY crumping, the patient goes over to the ICU, the ICU doc takes over the care, and you are done (I do frequently visit the patient there, waiting for them to come back to the floor, and I am the one that calls the family to let them know what happened)

    If it’s an open ICU, you still send the patient over there, you give your orders, and you consult pulm/ccm to help you with management.

    as for the second part of your comment… I am not saying everyone can do it!! I am saying I can do it, but my friend also a hospitalist will work until 2 am on her week on with only 15 patients. I cannot explain this (makes me think shouldn’t be a hospitalist, as clearly SOMETHING is going on if you can’t get your work done in a 12 hour period).

    and you’re wrong (usually I just politely disagree, but in this case I have to just say you’re wrong). a hospitalist was created to help PCPs as they were having difficulty doing clinic AND rounding in the hospital… so all of our metrics that we’re now required to do (early d/cs, paperwork blah blah) could get done in a timely manner. Not only that, I have nothing bad to say against pcps, I love them, I think they do a fantastic job with the amount of overwhelming work they’re given, and the ones that come to the hospital, hats off to them, BUT I will say when you work as a “true” hospitalist you start to recognize clear barriers to discharge (I can look at a patient and realize they are sick) I can look at a patient and realize they’re not going anywhere but rehab, I can look at a patient and almost give you a medical history without speaking to them, I know when patients are gonna do well and not do well, and that comes from experience. I can spot a drug seeker from a mile away (if you are able to eat, you cannot have iv pain meds… typically they’re desire to eat far outweighs the desire for iv opiods). this is something you learn with experience by treating a LOT of patients a LOT of the time.

    You are correct, hospitalists are a dime a dozen. Good hospitalists are difficult to come by. Good nocturnists are worth their weight in gold.

    #214761 Reply
    Avatar jessikaur 
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    MST #214703 Reply | Quote Panscan Participant Status: Resident Posts: 712 Joined: 03/18/2017 Not sure how that’s relevant, and I also don’t consider it appropriate. If you’re in middle in Montana and covering 2 tiny community hospitals I guess it’s ok but not ideal and not what I’d want for my family. I don’t think many people are taking stroke call at multiple hospitals and actually doing interventions commonly. Not sure what you mean having a good relationship or how my views about it being inappropriate to round at 3 hospitals relate to a relationship with other physicians? As a resident I’ve personally seen numerous cases where care is delayed because attending is at another hospital. It’s inappropriate. I call out bs when I see it.

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    Sigh. Panscan are you aware that there are radiologists that have figured this out yet? I have my scans being read by someone in New Zealand because that is there daytime hours. Because everyone knows that going without sleep is bad for you! We now have robots working in the ICUs to help with ICU burnout, or to help areas that don’t have access to an ICU MD. we have stroke alerts that go around all over the world, and that these neurologists are giving orders in real time as they’re getting the scans and the story. I’m sorry you work in a crappy area where doctors are not responsive, but you cannot blame every hospitalist for the shortcomings for a few (that’s the job of administrators, as you will learn when you get out in the real world).

    to your second point. if you have an internist or intensivist or cardiologist or basically any other specialty that you can trust while you are busy doing procedures (especially in a rural area!!) that is the definition of a good relationship. You want to be able to go take care of someone else, knowing that your patients are being cared for, and if you don’t have that relationship, you cannot go somewhere else.

    I frequently admit the patients for my interventional radiologist colleagues. they are not used to the hospital system, but are providing an incredible service that any hospital would want available (especially rural areas!! and they always have someone on call for emergencies). they want to do their procedures and go home knowing that their patients are taken care of for the night (by a hospitalist). I see the patient the next day, they see the patient next day, they provide their follow up care, I provide my follow up care. I have had situations after UAEs where I’ve had to call them to tell the patient is bleeding, and I’m transfusing and they have always been responsive. that is the definition of a good relationship.

    As a resident– you need more experience. I wish you well, I hated being a resident, but I did learn a lot.

    #214773 Reply
    Avatar jessikaur 
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    @jessikaur i’m on the fence of being not sure if you are making some of this stuff up, or telling the truth. I’m leaning towards the latter. Fatlittlepig gets it, you like to be productive, you like making money, you enjoy the hustle- but seriously it’s not “normal” or healthy to work 50 days in a row. Sorry, nothing you say will convince me otherwise. physicians, and humans in general, need days off to destress, unwind and to recharge. As to working at multiple hospitals/jobs during the same day, that to me seems odd– what if you are paged about a patient you saw at hospital #1 and you are at hospital #3. I can understand if you are a day laborer, or waitress, the need to work multiple jobs out of necessity.. but as a physician finding one decent paying job seems to me to be a more sensible proposition.

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    Ok. I get it. I have been told by multiple people over the course of my lifetime that they have never met someone “quite” like me before. I’m fairly sure they don’t mean it as an insult.

    I am not conventional— I will admit that. I am a workaholic. I have admitted that (by the definition it’s not necessarily a good thing). Maybe I can ease your mind a bit about my how many days I work, as you will see, if it’s not in-house, i.e it not stuck to the cubicle or whatever work room they have hospitalists trapped in nowadays, it’s doable. I work smart. Not necessarily hard. That being said, I will wholeheartedly admit most of my colleagues could not do what I do or should.

    Here is what I currently do:

    job 1: ten minute commute. I have a private job – it lets me work 5 days on 9 days off, but they will call me if they need help on my 9 days off, and usually, I just see ortho follow ups and new patients which are surgical consults. that is very easy. doesn’t even take two hours for the ten patients (and I get to choose if I come in or not — I always do if I’m in town) so.. even if I work wed-sun, and maybe wed-fri of opposite week(week off) I’m still probably only working 2-4 hours every day, the rest is on-call, this particular job, the tradeoff that I would be oncall until 9pm. but, I can do orders, answer pages from my phone, be out and about etc remotely, so this 9pm tradeoff is annoying, but ok. (it would be 7pm for regular hospitalists) and as I’ve stated previously, if I’ve completed everything and did everything that the hospital, nursing staff, surgeon expects of me— I rarely get paged. this is a systems based appraoche I have. it is 4:20pm now, I have gotten four total pages. two I already said in a previous post and 2 more alerting me that I had new consults (if the secretary had checked before paging, she would see my dictations up and my orders in — completely unnecessary pages)

    today is the first day of my five days on– wed-sun.

    Job: 2

    A new group starting at the ltach. sort of. don’t ask, kind of a divorce from any old group. anyway, they are building their census. I have moonlighted for them previously, and they asked me to come on “full time” — this job is literally across the street from where I live. maybe 2-3 minute walk. of course I said yes— how could I not, I already moonlight at this hospital for the other two groups there, and know all the consultants, nurses, how the hospital works, and the proximity makes it ideal. they offered full benefits, and a salary over asking price (250K, week on week off day time shifts, not in house with moonlighting for any shifts that you come in on your off week, plus additional moonlighting in case the census goes over a sensible load)  because of my reputation and I threw in there that I would I work continuously until the census built up —- before they asked. because I knew they would need me since they are trying to build their group at other hospitals, and it is nothing for me to walk across the street and see ten patients.

     

    Job 3/4 — again the other two groups at the ltach.  one has a mon-fri schedule, and one has a ten on four off schedule. mon- wed …

    so I staggered it. I do the continuous easy full time job of 2-10 patients every day, doesn’t take me that long with occasionally doubling up with private job moonlighting when they need me.

    then I do my regular 5 on shift, plus regular full time easy job (remember I already know the patients) so Wednesday of my week on is easy because I only have one hospital’s patients’ to “learn”. that was today. THEN I start moonlighting for job 3 tomorrow (the ten on four off, starts on Thursday) I made it the same week that is already my “week on” for efficiency sake. so then I do these three jobs for three days wed. thurs. fri.

    THEN. job 4 kicks in for the sat/sun that they need off. so.. only for two days out of 14 am I doing all four jobs. and the total maximum patient count is around 84. usually less — and remember, in the hospitalist world not much happens on the weekend, you can rarely get procedures or discharges. but the other beauty of this is, is if you’re just covering for someone else on the weekend, that group and the family do not expect you to do “family” talks. that being said if you’re a crap hospitalist and you’re not talking to your patients every day, I have done these talks, and made patients comfort care, and discharged them. (I really don’t know why it’s so difficult to talk to patients after reviewing a chart. I really don’t.)

    as others have stated on this site, you can do ANYTHING for two days in a row. (that being said, I’m usually home by 4pm on these days, the zero commute helps)

    Anyway, Monday comes around, and suddenly these 2-10 patients seem like a vacation! so you wake up a little later, have a nice couple of cups of coffee, go see them and (maybe, just maybe spend a little extra time with them) come home exercise. read relax. there’s a lot of spare time.

    By Wednesday of the week off, you know whether your private job needs you, and they’ll tell you for wed-Friday. private job rarely wants you to work on your “weekend off” as they want you to be your normal rambunctious self on your week on and they don’t want you to burn out.

    so you go to constant job. you go to private job, you’re home by noon. everyone is happy….

    sat – Wednesday  you’re just at constant job. and MAYBE job number two that is mon-fri and DOES need you for their weekends. so again you’re doing two jobs, but remember you’re at constant job so you know these patients like the back of your hand, you can recite all of their relative names because you’ve talked to them all at some point during their visiting hours. and job number two, you covered their patients last week, and remember this is an LTACH that’s average length of stay is 25 days, so you probably know the majority of them, and in fact they get mad at you for not visiting during the week because they’ve seen you talking to other patients.

    so.. week off, now you have two jobs from wed-sun BUT it’s not all the same as always, so rarely gets boring.

    mon-tues of your week on comes around, and it IS a vacation because it’s just constant job, and it’s only 2-10 patients and sometimes since you know everyone and nothing is happening necessarily medically day to do, you can be done in an hour. it’s almost like having a whole day off.

    Now. I’ve LITERALLY had to draw on a calendar where I am working when… and even my husband doesn’t know half the time. His favorite annoying question to ask me is “are you going to work today” because for him.. I’ve been home all day! (and it’s practically true)

    Anyway, I take a ton of vacation a year. and no one minds because I always come through, never call in sick, and they (all of the multiple groups) have never heard a complaint about me.

    I am not a machine. I do get tired. But most days I’ve got high energy, and I dunno, I get a real dopamine hit when I’ve done a good job, or actually helped someone. The money doesn’t hurt either.

    that’s my current situation.

    But I’ve been doing something like this more or less since 2011 July 1 actually since I graduated residency. I dunno technically I’m Sikh (I’m not sure I practice it enough) but one of the core beliefs in this religion is hard work and giving back (seva). I googled it for you all, in case anyone was wondering

    “Seva Sikhism definition

    Seva is the essence of Sikhism. If there is one solitary word to sum up the Sikh religion, I would unhesitatingly pick seva as the operative word. Seva is the voluntary service to fellow beings without any expectation of reciprocation. It is deeply ingrained in the collective psyche of the Sikhs.

    I am relatively lazy compared to my father (who worked six days a week caring for 3 daughters on a taxi drivers’ salary as a single parent) in which he worked from 2pm through 6-7 am, just enough time to get us dropped off at school, sleep, pick us up and go back to work after making sure we had our meals available. On his day off, he would take us to temple, and then we/he would do the chores for the week, like all of the grocery shopping, making sure we had our “target” shopping (toilet paper, tampons and toiletries). Course he would make us suffer through watching football, and was always disappointed he never had a son.  He did this schedule for the better part of 20 years.

    My other family members in India work like crazy. they wake up at 4am, and don’t come back at home at 9am. I could go into all sorts of detail on this.

    If you’re somewhat interested in Sikhism you can look up that Sikhs are basically taking over the trucking industry here in the US (I found this so funny to hear on a podcast). They enjoy the long hours as it’s giving them their seva-hit, they like that they don’t need to change their appearance (cut their hair or beards, as most of the time is spent solitarily) and truck stops are now catering to them by serving Indian food!

    I am a major digresser.

     

    #214787 Reply
    fatlittlepig fatlittlepig 
    Participant
    Status: Physician
    Posts: 673
    Joined: 01/26/2017

    Too long only skimmed it.

    Let’s see, you state that you have worked 50 days in a row

    You purport to have 4 different jobs at different facilities.

    Your father worked long hours out of necessity. What’s driving you to work like this? I’m not at all convinced you are doing as good of a job as you may think, being this stretched.

    #214816 Reply
    Liked by Lordosis
    Avatar Megalops 
    Participant
    Status: Physician
    Posts: 25
    Joined: 02/05/2016

    I knew a great ER attending in residency. Learned a ton from him, patients thought he was wonderful. Dude lost a ton of money in reals estate, started working crazy number of shifts. I think at one point he’d worked like 90 straight ER or urgent care shifts. About this time he approached my buddie’s wife who was a nurse extern and asked if she could give her physics professor a paper he’d been working on proving gravity didn’t exist…Heard he went off for help but never got any updates after that.

    #214826 Reply
    Liked by childay, Tim
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 5647
    Joined: 01/12/2016
    Splash Refinancing Bonus

    Docs from all kinds of specialties cover multiple hospitals all the time in the real world. Its not appropriate for emergent type care, but for most anything else its not only fine, but increasing the access for a patient population. Every now and then a pt waits for their procedure…, who cares? Make the doc cover only one place and where ever else theyre not is now 100% without a doctor all the time, how is this better?

    Lots of things like this seem like big deals in residency, and for the most part they end up not meaning squat. In residency we rounded at the childrens hospital and main hospital the same day, did those pts not get what they needed? Seriously how much bedside time do pts actually need? Very little for most specialties. Whats the difference when you’re in surgery and cant leave to visit a pts family, or any other task from mundane to serious?

    This is not a logically sound argument. Though 3 full jobs seems like a lot, its likely theyre all just not that busy or the person is much more efficient. This I can actually believe. Have you seen other people operate and round that are at least 2-3x slower than others. I certainly have. Some people just mess around a lot. If you just get things done you have more time than others. Even a surgical specialist has these issues.

    I know people who operate faster and slower than me, same for EMR type stuff. This makes a huge difference in the volume you can do in a day, week, month, etc…I dont see that as any different than taking on 2-3x the pt load since its effectively equivalent.

    #214831 Reply
    fatlittlepig fatlittlepig 
    Participant
    Status: Physician
    Posts: 673
    Joined: 01/26/2017

    Skimmed a little more. Sounds like on some days she has 84 patient encounters. Hmm… I’ll leave it at that.

    #214832 Reply
    Liked by MaxPower, childay
    Avatar Allixi 
    Participant
    Status: Physician
    Posts: 76
    Joined: 03/16/2016

    I don’t care how fast and efficient you are, it would be extremely unusual to have all work done and be able to leave at 2 PM. Sure, you can probably see all your pts by noon, but many of them are still waiting on test results, for specialists to see them, etc, until 4-5 PM in the afternoon, especially on a Monday. Sometimes you need to go back in the room and go over things with them!

    There is only so much that can be done in advance, and off-site/remotely. And I say this as someone who often does pended discharge meds and tentative discharge summaries the day before.

    On the other hand, there is no point in physically staying in the building twiddling your thumbs for 2 hours if you are truly finished. Heck, some companies are trying 4-day work weeks, because they realized their employees could get stuff done by Thursday. How does administration enforce this? Do you clock in and out like nurses?

    We currently need to answer phone calls until 5 PM, after which they go to the call person for the day. This may be changed to 7 PM in the future – I have no problem with this, but I have some coworkers that are already grumbling about work life balance, horrified at the prospect of having to keep their phones on for 2 extra hours.

     

    #214833 Reply
    Liked by q-school, Tim

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