I also need advice

[legobikes]

Pretty comfortable at my job, been here for six years. Employer has multiple clinics in the region, one per town/city. As of this month, I'm the only pediatrician for our clinic. We had another one who was just putting in the 3 year time in order to get his visa, and now he's leaving (for a NICU fellowship!).

They were having the other pediatrician drive around to some of the smaller towns to drum up business / provide coverage I guess. Whereas I said from the start I did not want to drive anywhere. Which is why I live a mile from my clinic.

Also early this year I went from fulltime to 0.8 FTE / 4 days per week. Anyway I got an email from the boss's secretary saying he wants me to work at a town about 35 minutes away, one day of the week. He's a pretty good boss - very accessible and understanding, so I wasn't annoyed that he'd communicated this via email from his secretary. I'm just going to call him up to ask for more information, but the issues are the following:

1. driving - not my thing, really
2. the other clinic usually has a slow schedule, which I don't mind, because I can just read a book, but if I'm dropping from 4 days/week to 3 days/week at my local clinic, then my schedule here will probably be packed all the time
3. not sure I want to set a precedent in terms of being willing to commute

My position at this place is pretty secure, AFAIK. They need me even more now that the other guy left. I don't think it's easy to recruit for this area. But also I'm going to need to bargain with them again, on and off, regarding various things (for example I've periodically taken leave without pay after exhausting my PTO). So I have to negotiate, if they want me to do this indefinitely. Im not even sure I want to do it indefinitely and I need an out ahead of time. But I'm not sure if there's other considerations for this situation. Thoughts?

[White.Beard.Doc]

How to handle this situation totally depends on your bargaining power. And that is something that is unknown from your post. How easy is it to recruit pediatricians to your area? How easy is it to replace you?

If you don’t want to drive to the remote clinic, why don’t you start there. Stay very positive and act very collaborative, but simply say that you live close to the current clinic and that is where you want to work. It doesn’t work for your life to commute a long distance.

Or perhaps compromise, say you will go to the other clinic once every 2 weeks, but only for a period of 3 months in order to allow them to find a new doc or an NP. After 3 months, it is up to them to staff it, and whether or not they have someone to cover in 3 months is up to them.

[ENT Doc]

Careful of the precedent. I’m sure that’s not in your contract, so try to get the location of providing care in there on your next iteration. Bargaining power is key. You know the boss better than I do, but I think that’s pretty bush league to be having the secretary email you about this. It might be in your contract (and probably is) that you have to provide services for X institution at their various locations, or doing what is reasonable. This wouldn’t be considered unreasonable IMO so saying “no” may be a violation of your contract. If you want to escalate this be prepared to deal with any fallout in regards to you being terminated for breach of contract. If the situation even has the potential to escalate to this level I’d start looking for other jobs now. That’s your best bargaining chip if it goes to 11.

THEN, start off by playing nice. Set up a meeting where you have multiple permutations planned out. Start by asking questions about long term plans regarding this clinic and hiring plans. I would politely decline but only budge if they are willing to step up pay, guarantee this to be short term (in writing), and are willing to help in some other way that you’re interested in. I’d be suspect of a promise to make this short term though or to commit to this at all. Camel’s nose under the tent. And then if they don’t budge - “I’ve really enjoyed my time here and think you’re a great boss, so it would be a shame for this to mark the end of my time here.”

[Lordosis]

Are you compensated by production? It would suck to go work this clinic and take a pay cut because it is slow.

[Nysoz]

Maybe only go once a month if it’s really that slow over there.

Don’t increase your current clinic volume to a point to stress out your current practice.

You're doing them a favor so you need to be compensated for it and not an increase of stress on your life.

Make the wording clear in any contract negotiations or addendums to prevent them from making any changes to your practice in the future. Also give yourself an out clause in case you absolutely hate driving there.

[CordMcNally]

It really depends on how much bargaining power you have but ENT Doc had a fantastic response. I would also fully expect that if you did it that you would eventually be seeing the same number of patients in 3 days as you used to in 4 days.

Also, douche move for the boss to have his secretary email you about this.

[VentAlarm]

Ummmmm….I’d have a big issue if this came from my boss’s secretary and email.

I’d either ask to meet in person or at least a phone call.

Is this person a doc or administrator? Either way, I’d shame the heck out of him or her. “Hey, look, when I started here I told you I wasn’t willing to drive to a satellite clinic and we had an agreement that I would only work here. Heck, I bought a house 1 mile away from the clinic because I hate having to drive - I get that it may not seem like a big deal to you, but it is to me. Now you have your secretary email me saying you’re going to go back on your word and unilaterally change my job - how am I supposed to take that? I feel like that’s going back on your word and profoundly disrespectful. It seems like you’re doing this to drive me out, or at the very least your going back on your word as soon as it’s convenient.”

[Tim]

It seems you don’t have a clear picture of your or their long term plans. WBD has many times indicated finding what they want is so important.
Seems like getting that info greatly impacts your response. Not enough info, this could be a “cover for me, I am recruiting”. Or a permanent change. Flexibility short term seems like not that big of deal. Long term, the boss and you have some negotiations. From the description of the relationship, it doesn’t sound like he is unreasonable. Find the long term plan and what he really needs and explore alternatives.

[billy]

Ummmmm….I’d have a big issue if this came from my boss’s secretary and email.

I’d either ask to meet in person or at least a phone call.

Is this person a doc or administrator? Either way, I’d shame the heck out of him or her. “Hey, look, when I started here I told you I wasn’t willing to drive to a satellite clinic and we had an agreement that I would only work here. Heck, I bought a house 1 mile away from the clinic because I hate having to drive - I get that it may not seem like a big deal to you, but it is to me. Now you have your secretary email me saying you’re going to go back on your word and unilaterally change my job - how am I supposed to take that? I feel like that’s going back on your word and profoundly disrespectful. It seems like you’re doing this to drive me out, or at the very least your going back on your word as soon as it’s convenient.”

Nice use of Never Split the Difference techniques, whether intentional or not.

[legobikes]

Thanks for the advice folks. Going to call him up and ask him what the plan is, because I will only be willing to do this temporarily. Boss is also a physician who practices 3 days of the week, generally has been very flexible and understanding, so I'm willing to overlook the whole email thing though I'm glad y'all agree that it's a bit of an oversight/imposition/presumptive.

My long term plan is working here for another 4 years for PSLF. Then I might take a very long sabbatical. So I intend to stay, though I could also get hired elsewhere with little trouble. I was ready to walk away a few weeks ago because of the change in the EMR, but they are making real changes and have been pretty responsive, and I've made some adjustments that make it tolerable.

I don't know what their long term plan is but I'm fairly sure that they aren't planning on getting rid of me because I'm the only pediatrician they have and we're one of only two places that takes Medi-Cal and that also has a pediatrician for a very broad geographic area. So business is a guarantee and constant, and they tolerated low volumes for a long long time to keep me.

Are you compensated by production? It would suck to go work this clinic and take a pay cut because it is slow.

I'm paid a regular salary. There are incentives for higher workloads, but I never reach them. So my compensation would not drop, but my workload would increase - and a commute would be added. I come home for lunch, and while my kid was in Montessori I would pick her up on the way home for lunch. So those are all additional considerations that can only temporarily be overlooked as my family is currently out of the country and I'm in transient bachelorhood, which makes it easier for me to be flexible. I really don't think I'd mind doing this for 1-2 months, but not long-term, so I need to make that clear.

[StarTrekDoc]

Okay salaried position. Treat this like I did at the VA. T

They have you during time of tour. 8A-430P.

What they want you do to do during that time -- their call to make.

Your home base is your home clinic.
They want you to travel to other clinic, that's on them,

-from 8A checkin at your home clinic and then arrival at the remote site and travel back to home clinic DURING Tour so you end at your home clinic at 430P (or whatever your regular end of day schedule is).

-this includes time to look at messages at home clinic when you return too. otherwise, no messages until the following day when IN clinic

-travel to remote clinic is on company car or reimbursed mileage on your own vehicle.

[Kamban]

The fact that the other physician stayed for visa (?J1) means that you are in a physician shortage area. It will be difficult to get any US citizens or greencard holders there, especially if it becomes known as "medicaid clinic". I used to work in one and I know what a pain the medicaid clinic label was hanging over my neck.

The only thing that works against you is your 4 years remaining for the PSLF. You don't want to jeopardize it. But you also don't want to be taken advantage because of it. What was the reason for the 1 day at the other clinic? That will determine if getting out of this commitment in 3 months is realistic. It is very unlikely that they will get another pediatrician there in 3 months. You may be struck there long term.

At the very least ask for better pay. Maybe extra vacation. And some travel expense reimbursement.

[Zaphod]

I dont know why the doctor driving to some rando location keeps getting floated, oh, thats right, its because numbskulls propose such a thing without thinking at some meeting and its instantly given a yes vote by people. It doesnt usually work out.

People come to a centralized physician, this is the efficiency. It is highly inefficient for the doctor to go to the pt, decreases all efficiency. If its slow, than wtf? This community can come to you, it makes all the more sense. If they want some top of mind they can advertise and or put a RN/NP out there to act as a funnel.

Anyways its dumb. People always working to increase that marginal 1% to max 2% instead of going after the 99% (working where you are now).

[StarTrekDoc]

I dont know why the doctor driving to some rando location keeps getting floated, oh, thats right, its because numbskulls propose such a thing without thinking at some meeting and its instantly given a yes vote by people. It doesnt usually work out.

People come to a centralized physician, this is the efficiency. It is highly inefficient for the doctor to go to the pt, decreases all efficiency. If its slow, than wtf? This community can come to you, it makes all the more sense. If they want some top of mind they can advertise and or put a RN/NP out there to act as a funnel.

Anyways its dumb. People always working to increase that marginal 1% to max 2% instead of going after the 99% (working where you are now).

Usually driven by access metrics. x population needs to be serviced within y minutes travel. VA has these and we've leveraged telehealth with mobile clinics to meet many access metrics. I presume same type of access metrics exist. Harder to telehealth peds though.

[Zaphod]

Usually driven by access metrics. x population needs to be serviced within y minutes travel. VA has these and we've leveraged telehealth with mobile clinics to meet many access metrics. I presume same type of access metrics exist. Harder to telehealth peds though.

That makes sense, from a why standpoint at least.