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Considering leaving current role - want to make sure I'm not being unrealistic

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  • Considering leaving current role - want to make sure I'm not being unrealistic

    Hello! I'm reaching the breaking point at my current job and want to make sure my expectations aren't unrealistic.

    I'm about a decade out of training, currently working in academic primary care within a larger health system. I love my patients and working with/teaching the residents, but clinically I'm miserable. Our practice is chronically and constantly short staffed and it's just getting worse, sometimes with 4 MDs working with 1 MA or LPN in recent months. Due to "critical staffing constraints" we're consistently asked to room our own patients, do our own vitals, click all the QI boxes, do the whole telehealth visit from start to finish (eg no "virtual rooming" from staff). Additionally, every call or portal message gets sent directly to the doc - PA requests, referral requests, "my ear hurts what should I do", how do I get a COVID test, etc. We're expected to do all of our own lab/result callbacks. I'm paid at <25%ile of AAMC benchmarks (from 2017) for rank including my "productivity bonus " - which is unclear how it's actually derived and I see RVU numbers approximately q6-12 months and I question their accuracy. I'm one of the more efficient EHR users in our practice, usually get all my notes done same day and have one of the higher RVU #s when prorated for my FTE and have great patient satisfaction scores. Due to some other academic roles, my patient contact time is only about 0.6 FTE and it's still burning me out.

    Financially we are doing just fine - secure but not yet fully FI, no debt aside from our primary mortgage and we live well below our means. Great benefits from my spouse's gov't job, so I don't actually need to work FT for health benefits, so I have a lot of flexibility. I've considered doing locums work for a while just to see some other practices and build up a bigger financial cushion, and at this point I don't want to jump from a bad job into an even worse one. I do have a significant non-complete clause (which is probably not really enforceable but am not really eager to find out the hard way) and we're tied to the area for another 12-24 months due to spouse's work.

    Questions - are others in academics or working at large health systems dealing with the same staffing vacuum and lack of support? Is doing locums for a few months-years a big red flag, and are most of the locums primary care jobs equally miserable? Would I just be signing myself up for even more patient contact time with the same lack of support? Is this just what primary care is like for physicians these days?

    Thanks in advance for all of the collective wisdom here!



  • #2
    You are getting severely abused and should definitely consider a different job.

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    • #3
      There’s staffing shortages everywhere and that likely won’t change. That doesn’t mean you still can’t be respected and it sounds like they don’t respect you. Honestly, I don’t see how a different job could be worse. I’d pursue personal happiness in your situation.

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      • #4
        I would give minimum notice required by your contract immediately and then leave when finished with that time. Your job is literally physician abuse. Sounds like you have the luxury of being able to quit without a new job lined up.

        Plus/minus a letter to HR/department head/etc spelling out why you are quitting, including very specific details such as how long you have been short staffed/etc. They clearly are not holding up their end of the bargain. Is that enough to be safe from a non-compete? I would hope so, problem is that large organizations have lawyers on staff that have all the time in the world to make you sweat.

        Good luck!

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        • #5
          I think you asked the wrong question. It shouldn't be on whether or not to leave your current horrendous clinical environment.

          Instead, it should be whether or not you should wait to give your notice in till you have another source of income lined up.

          That is something only you can decide.

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          • #6
            When you say chronic that means they don't care. Support staff like a MA or LPN is peanuts.

            Noncompete enforcement seems to be highly variable. Last time I talked to a lawyer that specialized in these type of cases he said he could predict the outcome depending on the judge assigned to the case. My old program did go after an attending who left and won the case forcing him to practice out of the city for a year.

            Regardless I would look for a better opportunity that is not burning you out.

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            • #7
              I don't have primary care specific experience or advice and avoid academia due to the lousy pay but this sounds unacceptable. The take home for me is when they add admin duties such as rooming patients, vitals, doing your own PAs. Understand this rarely ever goes away and instead becomes the new norm. I have no problem declining the request to be a team player. You are in a great position with a spouse who has fed benefits. I'd take full advantage of that cushion and try anything that looks interesting. Please keep us posted and best wishes.

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              • #8
                My wife is in a similar situation with short staffing but not as severe as you. The short staffing is fairly widespread currently, but I'm sure you could find somewhere that pays its staff better.

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                • #9
                  Originally posted by zlandar View Post
                  When you say chronic that means they don't care. Support staff like a MA or LPN is peanuts.
                  I don't disagree, but the issue isn't cost. It's finding bodies. We're havering the same issue, as I'm sure most are. It leaves us paying overqualified staff to do ma work

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                  • #10
                    Your story is my wife’s story, as she’s an outpatient internist in an academic clinic. Much of what you initially said is close to what she faces but as I read on and read it again, no question your situation is quite a bit worse. Grass is very likely greener on the other side in your case

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                    • #11
                      I stopped reading a few sentences in…..you should go. I’m in academic EM. If they asked me to do vitals or room patients, I would laugh.

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                      • #12
                        Originally posted by VentAlarm View Post
                        I stopped reading a few sentences in…..you should go. I’m in academic EM. If they asked me to do vitals or room patients, I would laugh.
                        I might do his job for a short time if i received the MA salary and the RN salary along with the MD salary. Fat chance.
                        Last edited by FIREshrink; 01-09-2022, 07:08 PM.

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                        • #13
                          I work in academics , apart from lower salary , I don’t have complaints . If they make me do all this, I will be looking elsewhere .

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                          • #14
                            Originally posted by 8arclay View Post

                            I don't disagree, but the issue isn't cost. It's finding bodies. We're havering the same issue, as I'm sure most are. It leaves us paying overqualified staff to do ma work
                            Then pay overqualified staff to do the work. Hire a PA/NP to share among the docs to do the work. I have multiple PAs wanting to work at my group. Starting salary is $90-100k for a new PA and goes up depending on what they can learn to do on the job.

                            The academic center isn't look because they have the docs doing the work for free.

                            edit: I would not be surprised if the academic center is underpaying for MA and LPNs relative to the local market rate. There are certain hospital systems in my area known among the techs/support staff for being "cheap".
                            Last edited by zlandar; 01-09-2022, 06:03 PM.

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                            • #15
                              Originally posted by VentAlarm View Post
                              I stopped reading a few sentences in…..you should go. I’m in academic EM. If they asked me to do vitals or room patients, I would laugh.
                              You wouldn't laugh if it were a private group and that was also your income sitting out in the waiting room. Besides, the nurses are always busting their ****************** so I don't mind completely triaging and discharging a patient by myself. I'll even clean the room. I can't go to work and just sit there. It's better for the patients, it's better for business, and you'll find that you start getting stuff that you need done from other people quicker when they realize you're not above doing it yourself.

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