Employee MD- anything to do to prevent deterioration of work conditions?

[MPMD]

fasteddie911 wrote:

In my area PP is dying out and there are only a handful of large hospital systems, but interestingly their approach to hiring and employee retention are opposites.  One seems to have no clue that good pay, good work environment, employee retention, etc. matters.  They’ve had an exodus of physicians over recent years due to poor pay and work environments, yet they change nothing and continue to hire unsuspecting doctors.  On the flip side, another hospital works closely with doctors, values them, interview carefully to find the right fit and minimize turnover. One can guess which hospital is doing better.  I think as an employee being vocal can work sometimes, but sometimes not.  The other option is to vote with your feet and change jobs, of course being as sure as possible that the new job is solid and vetting them as well as you can.  Another option is FIRE so you’re not beholden to any employer and can choose work as you please.

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Leadership matters.

Culture matters.

I cannot emphasize how true I've found this to be.

[MPMD]

Vagabond MD wrote:

I second pushing back (saying “no”) on unreasonable demands and anything that fosters a deteriorating work environment.

Sometimes this requires saying no, and if you can relate it to a quality or patient safety issue, even tangentially, you will have a strong argument. And definitely put those in writing. “Yeah, we understand you want us to do more of x, but given the same resources and infrastructure, we are concerned that the quality of the work will suffer and patient safety compromised.”

Get that in an email, and it will give most Admins significant pause before moving forward.

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a BRIEF email!

[VagabondMD]

I second pushing back (saying “no”) on unreasonable demands and anything that fosters a deteriorating work environment.

Sometimes this requires saying no, and if you can relate it to a quality or patient safety issue, even tangentially, you will have a strong argument. And definitely put those in writing. “Yeah, we understand you want us to do more of x, but given the same resources and infrastructure, we are concerned that the quality of the work will suffer and patient safety compromised.”

Get that in an email, and it will give most Admins significant pause before moving forward.

[fasteddie911]

In my area PP is dying out and there are only a handful of large hospital systems, but interestingly their approach to hiring and employee retention are opposites.  One seems to have no clue that good pay, good work environment, employee retention, etc. matters.  They've had an exodus of physicians over recent years due to poor pay and work environments, yet they change nothing and continue to hire unsuspecting doctors.  On the flip side, another hospital works closely with doctors, values them, interview carefully to find the right fit and minimize turnover. One can guess which hospital is doing better.  I think as an employee being vocal can work sometimes, but sometimes not.  The other option is to vote with your feet and change jobs, of course being as sure as possible that the new job is solid and vetting them as well as you can.  Another option is FIRE so you're not beholden to any employer and can choose work as you please.

[MPMD]

I think the value of saying "no" is underappreciated by docs. If you feel like you're on an eventual collision course that is going to result in your leaving there isn't much harm to be realized in just saying no to a bunch of stuff you find to be unreasonable and seeing what happens.

There's a right way and a wrong way to do this. The wrong way is with an angry, 2 page, paragraph delineated email sent at 9:30pm to your medical director with a bunch of people CC'ed. The right way is brief, direct conversations (or emails) followed by refusal to engage with argumentation quickly or directly.

Example, your hospital says you have to start seeing patients until 6p instead of 5p. Just respond with a brief email saying "Unfortunately I will not be able to accommodate that request. Let's work together on some new options." When the person right up the food chain fires back an angry email boiling for a fight, wait a week before you respond.

Hospitals and health systems are absolutely full of docs who have crafted special rules around themselves, some of which are reasonable requests and some far from it. I would imagine most of these were successful not b/c they argued longest or loudest but b/c they were so bad at email that their bosses got sick of trying to have the argument at all.

[shady]

I don’t think most admin understand retention saves money. At least not in my area. I’ve been in my current job for 2 years. We’ve lost 20+ physicians in that time. I can only count 3-4 new hires that have stayed. The same goes for many positions in the hospital. We subsist on locum docs, traveling nurses, traveling rad techs, traveling assists in the OR. We hemorrhage money I’m sure yet still no interest in retaining any of the good people left.

[Zaphod]

Lithium wrote:

StarTrekDoc wrote:

Until the decision makers believe retention is more important than employee churn, it will be hard to stop the cycle . You don’t need to unionize, but as a group of docs you can bring up specific issues and ask admin to sit down and address them with the goal of improving conditions.

Ultimately, if they don’t believe there’s value in what the docs bring with retention, there is little recourse.

You have sure there is not union opportunity given sounds like direct hire situation

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I know this is probably preaching to the choir, but this really seems to be as pound foolish as it gets.

Between costs of recruiting, revenue losses, signing bonuses, and costs of training, physician turnover per position easily runs in the six figure range

We all should be asking for retention bonuses in contract renewals.

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Agree, but it does seem to happen often. Even though its predictable in outcome, many places seem to allow it, get really rough for the better part of a decade before they figure it out, recover, and then feel all big and pompous again. You have such admin churn as well, they just bounce around every few years implementing damaging policies and such and move on.

[Lithium]

StarTrekDoc wrote:

Until the decision makers believe retention is more important than employee churn, it will be hard to stop the cycle . You don’t need to unionize, but as a group of docs you can bring up specific issues and ask admin to sit down and address them with the goal of improving conditions.

Ultimately, if they don’t believe there’s value in what the docs bring with retention, there is little recourse.

You have sure there is not union opportunity given sounds like direct hire situation

Click to expand...

I know this is probably preaching to the choir, but this really seems to be as pound foolish as it gets.

Between costs of recruiting, revenue losses, signing bonuses, and costs of training, physician turnover per position easily runs in the six figure range

We all should be asking for retention bonuses in contract renewals.

[G]

The docs who plan on staying there forever need to stick together. The more specialties the better. Gather data in turnover and how that effects permanent hiring, pt sat, outcomes. Go through MEC which reports to the hospital board. These are usually reasonable people with ties in the community. The last thing your CEO wants is to look like he is being a high rectal enema to the men and women who take care of their families.

[StarTrekDoc]

Until the decision makers believe retention is more important than employee churn, it will be hard to stop the cycle . You don't need to unionize, but as a group of docs you can bring up specific issues and ask admin to sit down and address them with the goal of improving conditions.

Ultimately, if they don't believe there's value in what the docs bring with retention, there is little recourse.

You have sure there is not union opportunity given sounds like direct hire situation

[MaxPower]

In my experience the only option is to leave. It’s a race by hospital administrators to the bottom. They continue to chip away at things that improve morale, but that may cost the system money until they can’t squeeze any more. They think we are all just replaceable cogs in a machine, and if one doctor leaves then there is a lielne of them ready to take their place.

[Peds]

If you switch to something worse it sounds like it's easy to come back ?

[Raddoc123]

It’s a nice part of a competitive metro area.  Although they have troubles recruiting, someone always comes along eventually.  We've had many docs leave over the years, and the ones there are mostly unhappy but fixed to the area or fear switching into something worse.

[Lithium]

If my job were that bad, I don't know how we'd ever hire anybody.  Why do any docs work for you instead of the other shop in town?  If all the jobs in town are that bad, I'd start looking at independent contracting or extending my commute.

[Raddoc123]

Other than switching jobs, how do those of you employed deal with constant downward pressure on work conditions?  I have experienced increasing unreasonable workloads, stagnant pay, added undesirable shifts, malignant administration who aren’t responsive and replace docs for unknown reasons and lower group morale?  This despite troubles recruiting, high turnover and being in a desirable geography.  We can’t unionize, strike, or be too loud for fear of retaliation.  Unfortunately, pretty fixed in this geography for the time being.  Switching to private groups makes me nervous because of all the corporate takeovers and another job could be even worse!