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  • #46
    @Lithium - Please consider getting a career coach.  A few in here have and it helps getting someone with several career experiences and situations to guide you through yours.   Vesting is nice is a nice golden handcuff perk, but so is sanity and a good work/life balance.

    Administrators do their job and not absolutely not your friend; but remember, a turnover of any physician is costly.  Ramp up costs are tremendous and they were lucky to have you at 1.2 FTE -- that was totally eating their cake.  Now it's harder with the part time request, but the alternative is losing you completely and if it's even a decently hard/or bad time to recruit position, there's wiggle room -- they'll never show it either.

    But to the point again, consider a career coach to help you through this journey.  I probably would have gotten to my current path 2 years earlier with one.

    Comment


    • #47
      Lithium,

      I don't really buy the "let go and do anything" idea of self growth. Most of the time when I've done that it was self indulgent in retrospect as it was not reasoned/measured risk taking.

      What I've found helped me to grow was to do things that were incrementally difficult. There is a probably a reason you haven't gone to the admin with a 0.8 ultimatum because your bargaining position may not be great.

      Perhaps in a lot of cases 2X 0.4 is better than 0.8. More of a logistical hassle but better negotiating position and superior in terms of diversity of income and more diversified in terms of organisational risk.

      I've found hospitals wax and wane. Admins come and go. Corporate collective memory is low. My strategy is if I find them hard to work with I reduce my involvement gradually until it is 1 day a week. Even if the admin is terrible, I find 1 day a week tolerable. And you know what, if they know you can leave, they do seem to be more accomodating. I find whittling down, I cut out the parts of the job I enjoy least and I find myself less exposed to crazy admins and feeling too stressed.

      I think there will be a part of you that tells you what is sensible and where you can push yourself and perhaps it is good to listen to that. Incremental pushing yourself is healthy I think. But not anything radical that freaks you out.

      Staying at a place that isn't rewarding for golden handshake is tough. I tend to think life is too short for that, but the weigh up is individual and depends on your situation. Personally, I like to try something different every 4 years or so and might try a new location or institution a day a week to just keep from getting stagnant. Things maybe better elsewhere.

      I was most unhappy when I was at one group and I didn't get along with the CEO. I moved at a difficult time when our first child had just been born. I found my income went up 80% after the move. The best part was just leaving a place I really had stoped enjoying working at and a CEO who I really didn't like. After 3 years the new place started going downhill, so I cut it by 50% and took another appointment the other 50%.

      With organisations, I find if they need you at a particular time, they will cut you a sweet deal and when they no longer need you, well they will give you a less attractive deal. And sometimes they can be downright nasty. I find it better to move to where I'm more needed or treated better. I don't mind moving every 4 years or so if the new place has a better deal. I try not to burn bridges and I try not to leave them in the lurch. But I avoid being in a bad negotiating position.

      I would try to find an option B, for 0.4 that should be at least equivalent to current. Then negotiate with current for 0.4 or 0.6. If there is no option B, that is a problem and they have you by the negotiating balls. It is possibly something you can modify over time though. Have you thought about doing private practice for 2 days a week ?

      That being said, some people are happy at one organisation or 2 for their whole careers and they get through the tough times somehow and find a nice cosy niche. That was never me though.

      Good luck with it all.

      Comment


      • #48




        Lithium,

        I don’t really buy the “let go and do anything” idea of self growth. Most of the time when I’ve done that it was self indulgent in retrospect as it was not reasoned/measured risk taking.

        What I’ve found helped me to grow was to do things that were incrementally difficult. There is a probably a reason you haven’t gone to the admin with a 0.8 ultimatum because your bargaining position may not be great.

        Perhaps in a lot of cases 2X 0.4 is better than 0.8. More of a logistical hassle but better negotiating position and superior in terms of diversity of income and more diversified in terms of organisational risk.

        I’ve found hospitals wax and wane. Admins come and go. Corporate collective memory is low. My strategy is if I find them hard to work with I reduce my involvement gradually until it is 1 day a week. Even if the admin is terrible, I find 1 day a week tolerable. And you know what, if they know you can leave, they do seem to be more accomodating. I find whittling down, I cut out the parts of the job I enjoy least and I find myself less exposed to crazy admins and feeling too stressed.

        I think there will be a part of you that tells you what is sensible and where you can push yourself and perhaps it is good to listen to that. Incremental pushing yourself is healthy I think. But not anything radical that freaks you out.

        Staying at a place that isn’t rewarding for golden handshake is tough. I tend to think life is too short for that, but the weigh up is individual and depends on your situation. Personally, I like to try something different every 4 years or so and might try a new location or institution a day a week to just keep from getting stagnant. Things maybe better elsewhere.

        I was most unhappy when I was at one group and I didn’t get along with the CEO. I moved at a difficult time when our first child had just been born. I found my income went up 80% after the move. The best part was just leaving a place I really had stoped enjoying working at and a CEO who I really didn’t like. After 3 years the new place started going downhill, so I cut it by 50% and took another appointment the other 50%.

        With organisations, I find if they need you at a particular time, they will cut you a sweet deal and when they no longer need you, well they will give you a less attractive deal. And sometimes they can be downright nasty. I find it better to move to where I’m more needed or treated better. I don’t mind moving every 4 years or so if the new place has a better deal. I try not to burn bridges and I try not to leave them in the lurch. But I avoid being in a bad negotiating position.

        I would try to find an option B, for 0.4 that should be at least equivalent to current. Then negotiate with current for 0.4 or 0.6. If there is no option B, that is a problem and they have you by the negotiating balls. It is possibly something you can modify over time though. Have you thought about doing private practice for 2 days a week ?

        That being said, some people are happy at one organisation or 2 for their whole careers and they get through the tough times somehow and find a nice cosy niche. That was never me though.

        Good luck with it all.
        Click to expand...


        Really great advice, but also somewhat challenging for an individual to do, especially if he/she is feeling burned out or unappreciated. It’s hard to have the confidence to make bold moves when you do not feel good about your professional self.

        Agree with @startrekdoc that a career coach might be useful to navigate through your current situation.

        Comment


        • #49




          Fair, enough… Although I get you are not likely to follow the advice,  I write it for others that may.  No, just means start again one level higher.  Who is above your director?
          Click to expand...


          i always love your comments.

          however, I hate when people work around me and go one level up.  is that really how decisions are made in your world?  instead of working with the person above you, just undermine them and keep going up?  if there is any kind of reasonable admin structure, the one level up would likely just refer the person back to the original decision maker.  generally if I say no, there are a bunch of good reasons.  trying to 'get your way' just engenders everyone else to try and get their way and keep asking up the chain.

           

          Comment


          • #50







            Fair, enough… Although I get you are not likely to follow the advice,  I write it for others that may.  No, just means start again one level higher.  Who is above your director?
            Click to expand…


            i always love your comments.

            however, I hate when people work around me and go one level up.  is that really how decisions are made in your world?  instead of working with the person above you, just undermine them and keep going up?  if there is any kind of reasonable admin structure, the one level up would likely just refer the person back to the original decision maker.  generally if I say no, there are a bunch of good reasons.  trying to ‘get your way’ just engenders everyone else to try and get their way and keep asking up the chain.

             
            Click to expand...


            If the chain is broken, then it needs to be fixed.  It doesn't get fixed if everyone acquiesces.  But, I am realistic and kind in my approach. I know when to stop. I have absolutely walked away from positions that were soul-sucking.  I am INSJ not INTJ.  So making life decisions rationally on math is not my forte.  Nor is keeping quiet.  I push/challenge Lithium with my comments because, for whatever reason, his posts have touched me.  I worry about him and hope for so much more for him.

            Comment


            • #51






               
              Click to expand…


              As an older (54 YO) doc in private practice group that has to this point spent/borrowed $1.1mil on EMR, I don’t think that that anyone would argue against the increased convenience of extracting information from electronic medical records. The primary issue in our case is the inefficiency of Data Input. Older doc’s often never took typing in the past and Dragon Speak still is somewhat clunky. EMR has actually decreased the number of patients our physicians are able to see each clinic, cutting into revenues, and adding significantly to our expenses. It is a simple math problem from a financial standpoint.

              Working harder and making less is the stark reality that many physicians are facing, both young and old, and some, both young and old, will bow out, as this forum attests.

              As an aside, IMO, the government missed an incredible opportunity to increase efficiency and cut cost in healthcare when they failed to mandate that these systems be able to communicate with each other from the very beginning. Much of the data would have needed to be entered only once, especially from the patient’s perspective. Asking an 82 year old with mild dementia to list all of their medications every time she sees a new doc is utterly ridiculous.

               
              Click to expand...


              Interesting perspective, thanks for sharing.

              I'm not trying to sound like the young whippersnapper criticizing my older peers, if for no other reason I'm not actually that young anymore, but it's been a source of some mystery to me why these docs didn't invest some time in learning to type. Here comes the EMR, it's sure as ************************ not going away, and you kind of have to learn to live with it. Typing is hardly some kind of arcane skill. Most people can type far faster than they can write legibly.

              Good EMRs like EPIC definitely increase my efficiency and throughput. I started my last job on paper charts and it sucked, constantly hunting for the chart, trying to make sure your medico-legal MDM was legible etc. Occasionally on really complex or risky cases I would just print out a sheet of typerwritten MDM to stamp and stick in the chart. I mean if you're on T-sheets maybe you can go faster but those are notorious for hanging you out to dry medicolegally.

              Comment


              • #52







                Fair, enough… Although I get you are not likely to follow the advice,  I write it for others that may.  No, just means start again one level higher.  Who is above your director?
                Click to expand…


                i always love your comments.

                however, I hate when people work around me and go one level up.  is that really how decisions are made in your world?  instead of working with the person above you, just undermine them and keep going up?  if there is any kind of reasonable admin structure, the one level up would likely just refer the person back to the original decision maker.  generally if I say no, there are a bunch of good reasons.  trying to ‘get your way’ just engenders everyone else to try and get their way and keep asking up the chain.

                 
                Click to expand...


                Yeah.... Do not go over your boss's head unless you are ready to be fired over the issue. I literally cannot imagine a situation where I would ever go over my chair's head.

                Comment


                • #53









                   
                  Click to expand…


                  As an older (54 YO) doc in private practice group that has to this point spent/borrowed $1.1mil on EMR, I don’t think that that anyone would argue against the increased convenience of extracting information from electronic medical records. The primary issue in our case is the inefficiency of Data Input. Older doc’s often never took typing in the past and Dragon Speak still is somewhat clunky. EMR has actually decreased the number of patients our physicians are able to see each clinic, cutting into revenues, and adding significantly to our expenses. It is a simple math problem from a financial standpoint.

                  Working harder and making less is the stark reality that many physicians are facing, both young and old, and some, both young and old, will bow out, as this forum attests.

                  As an aside, IMO, the government missed an incredible opportunity to increase efficiency and cut cost in healthcare when they failed to mandate that these systems be able to communicate with each other from the very beginning. Much of the data would have needed to be entered only once, especially from the patient’s perspective. Asking an 82 year old with mild dementia to list all of their medications every time she sees a new doc is utterly ridiculous.

                   
                  Click to expand…


                  Interesting perspective, thanks for sharing.

                  I’m not trying to sound like the young whippersnapper criticizing my older peers, if for no other reason I’m not actually that young anymore, but it’s been a source of some mystery to me why these docs didn’t invest some time in learning to type. Here comes the EMR, it’s sure as ************************ not going away, and you kind of have to learn to live with it. Typing is hardly some kind of arcane skill. Most people can type far faster than they can write legibly.

                  Good EMRs like EPIC definitely increase my efficiency and throughput. I started my last job on paper charts and it sucked, constantly hunting for the chart, trying to make sure your medico-legal MDM was legible etc. Occasionally on really complex or risky cases I would just print out a sheet of typerwritten MDM to stamp and stick in the chart. I mean if you’re on T-sheets maybe you can go faster but those are notorious for hanging you out to dry medicolegally.
                  Click to expand...


                  I assure you that I knew my patients' medication lists 1000x better when I had to handwrite every single blessed medication down than when I click okay.

                  I knew their history better as well.   it sucked but there were some benefits.

                  ymmv.

                  the notes are terrible now.

                  so much extra bull crap.  they may be legible, but the content in my experience is way worse.

                  again, ymmv

                   

                  Comment


                  • #54
                    For the people that are saying that you feel as if medicine is your calling and you feel as if its an honor to practice medicine what are your fields of practice? I have a feeling the people that quickly grow tired of medicine would be physicians on the front lines ( hospitalists, intensivits, PCP's, pediatricians,psychiatry, ER) as opposed to the specialty fields. Maybe because of a high work load with relatively lower compensation than other fields of practice?

                    For me there is only so much BS that can be tolerated now and the longer I practice the less patience I have.  Dont get me wrong, I do enjoy my job but in the end I feel as if this is nothing more than a job.  Looking forward to the day where i'm FI and can work part time and do things that I find more enjoyable.

                     

                     

                    Comment


                    • #55
                      Happiness is overrated. If everyone just did what felt good we'd be in a world of hurt. Making the world a better place, touching people's lives, creating peace matter more.

                      Comment


                      • #56




                        For the people that are saying that you feel as if medicine is your calling and you feel as if its an honor to practice medicine what are your fields of practice? I have a feeling the people that quickly grow tired of medicine would be physicians on the front lines ( hospitalists, intensivits, PCP’s, pediatricians,psychiatry, ER) as opposed to the specialty fields. Maybe because of a high work load with relatively lower compensation than other fields of practice?

                        For me there is only so much BS that can be tolerated now and the longer I practice the less patience I have.  Dont get me wrong, I do enjoy my job but in the end I feel as if this is nothing more than a job.  Looking forward to the day where i’m FI and can work part time and do things that I find more enjoyable.

                         

                         
                        Click to expand...


                        I’m a psychiatrist, and I am definitely one who feels it’s an honor and a privilege. However, there are many other things I love and are worth doing, so I will be stopping when it is financially reasonable to do so, having already committed 30+ years to this starting with medical school. (I suspect I’d be much more burnt out if I were not in private practice however.)
                        My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

                        Comment


                        • #57
                          I know multiple MD family members or family friends who have worked, or will work well into their 65+ years.  Some are due to financial reasons (sending multiple kids to private college, HCOL area, etc.), but others enjoy the work, are dedicated to their patients, or just wouldn't know what to do with all their free time.  These docs include generalists as well as specialists, all in the private practice outpatient setting (as opposed to academics, inpatient, shift-work or employed setup), which may have something to do with it as well.  I think partially what keeps them going is the relationship with their patients, many of whom they've known for years.  Patients whom they exchange gifts with, attend events for/with, etc.  People talk about the importance of social interactions in life and retirement, and while it's atypical, I think the doctor-patient relationship can sometimes be a legitimate form of this.

                          While I aspire to FI asap, I'm not sure what I'd retire to, especially early retirement.  If it's a life of leisure, it may be wonderful for a little while, but not sure about doing it for 40+years.  Despite being in medicine, I don't feel like I'm missing out on anything in life and there's never really been anything I'd rather be doing in its entirety.  I feel like I live a pretty good life outside of medicine, I get to spent time with others, experience things I'm interested in, and have traveled pretty well.  Likely it varies by person, as I also don't have many wants or needs.  I read about others' desires beyond work and I often can't relate.  I don't desire to socialize more than I already do, I don't have many interests or hobbies (despite trying many things), I'm not particularly interested in many of the experiences that others enjoy/crave, and my travel bucket list isn't particularly long.  I imagine my ideal setup at some point would be part-time work, which would still give me ample time to pursue other things in my life and provide a nice sustainable work-life balance.

                          Comment


                          • #58
                            I was definitely one of those who had planned to work forever until a few years ago.  I just never thought about it any other way.  For a few reasons.  I enjoyed what I did, I made a good living doing it, I took plenty of time off and spent time with family, traveled, etc.  I also never really planned for a retirement.  Fortunately we were just big savers and never got into lifestyle creep.  I also incorrectly thought we had to save enough to live on 80% of what I made.  Then a few years ago, I had some health issues and had to stop operating.  Work became less fun and I took on more administrative duties.  That plus EMR, new rules to be followed, meant I spent more time doing non-patient related activities.  EMR is a good system for record keeping but it stinks for seeing patients.  Being in a very high volume field there is no way you can duplicate the ease and speed of paper.  With that turn of events, I started thinking about retirement and realized we were well past 80% of what we SPEND and then I knew I would be finished soon.  I consider myself lucky that we did ok without a real plan.  I also wish I could go back and tell my younger self to think about retiring early.  I hope to pass that message on to the younger physicians in our group.  Not to retire early but to have a plan in case things change and you want to take that option.

                            Comment


                            • #59




                              I was definitely one of those who had planned to work forever until a few years ago.  I just never thought about it any other way.  For a few reasons.  I enjoyed what I did, I made a good living doing it, I took plenty of time off and spent time with family, traveled, etc.  I also never really planned for a retirement.  Fortunately we were just big savers and never got into lifestyle creep.  I also incorrectly thought we had to save enough to live on 80% of what I made.  Then a few years ago, I had some health issues and had to stop operating.  Work became less fun and I took on more administrative duties.  That plus EMR, new rules to be followed, meant I spent more time doing non-patient related activities.  EMR is a good system for record keeping but it stinks for seeing patients.  Being in a very high volume field there is no way you can duplicate the ease and speed of paper.  With that turn of events, I started thinking about retirement and realized we were well past 80% of what we SPEND and then I knew I would be finished soon.  I consider myself lucky that we did ok without a real plan.  I also wish I could go back and tell my younger self to think about retiring early.  I hope to pass that message on to the younger physicians in our group.  Not to retire early but to have a plan in case things change and you want to take that option.
                              Click to expand...


                              I have thought fairly seriously of trying to put together a panel for my residents of docs who had issues like this during their careers. Not to be Debbie Downer but I think it would be a positive thing to put up in front of a bunch of 26-30 year old docs.

                              Seeing things like this happen to colleagues over my short career helps keep me on track financially. I think we all know cases of the opposite where health issues hit when someone is not on track for FI, truly a scary event. Thanks for your story.

                               

                              Comment


                              • #60


                                I have thought fairly seriously of trying to put together a panel for my residents of docs who had issues like this during their careers. Not to be Debbie Downer but I think it would be a positive thing to put up in front of a bunch of 26-30 year old docs.
                                Click to expand...


                                It certainly couldn't hurt but I wonder how much it would help.

                                When I was a 20-something resident, the idea of being a 40- or 50-something physician with health problems was incomprehensible to me. I expected to maintain robust health until my 80s or beyond when I would die of cancer. That was true even though I knew a surgical resident who developed lymphoma.

                                I was no more worried about poor health than a lightning strike or a fatal accident on the highway. I suspect that a panel of docs with health issues would have caused me as much concern as a panel of lightning-strike survivors.

                                 
                                Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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