In my clinic of three physicians, we have three front desk personnel (one handles check in, one check out, and one posts charges), three medical assistants, a referral coordinator, and an office manager.

You may remember the fact that in November the front desk staff was discovered refusing to schedule patients on the Wednesday before Thanksgiving. Instead of firing them as I was encouraged to do, I authorized a final warning which is the step just before firing. It was nearing Christmas, after all…

Within a few weeks, all three resigned. In some ways this was good. It saved us from having to go through HR crap and unemployment filings. 

Interestingly, though, as soon as they were gone our schedules exploded. My partners, who had been struggling to get their numbers up? Yeah, not really a problem anymore.

Following that, one of the other physician’s medical assistants resigned.

Then my medical assistant resigned.

Then the third physician’s medical assistant resigned. 

You can imagine that if even one of those people is gone, it puts tremendous stress on all of the other employees. It is rough for a week or two but drag that out into months, and the pressure is just too much. It creates a snowball effect. Staff members start dropping like flies. 

Then add to that the exploding schedules. It is one thing if you grow/ease into it. To have it suddenly dumped on you? Beyond stressful.

While trying to restaff my clinic over the past six months, I have uncovered some mind boggling things:

First, we are required to use a “recruiter”. I have heard for over two years that there are “problems” and that the system is trying to make it better. It is just getting worse. Turns out the recruiting company is actually only two employees for our entire healthcare system. 85 openings currently. As it turns out, it does not matter if I give them resumes. Hell, it also does not matter if fully qualified people send their CVs in on the website. I have a position that we have been trying to fill for over five weeks now. After beating the bushes, applying pressure, we were finally given four “screened” applicants, of which two were woefully inadequate and one had already taken a job elsewhere. On a hunch, I had my office manager access the applicant pool for our position. 

Over 180 CVs. 

That we are not allowed to touch….

Second, while the tradition is a two week notice when leaving a job, at this pace it takes a couple of months to wait for a suitable applicant to be sent over. Once we offer the position to someone, it takes three weeks for them to clear employment screening. Then there is a full week of training with corporate before they ever end up in our office. Overlap these, and a small office simply cannot function. We are crippled. 

Temp agencies? You are paying $23-25/hr for someone that would have been only $15/hr, someone who is most likely sub par anyway AND when you throw in our overly complicated, counterintuitive system (seriously, it is embarassing) without any formal training? It only makes things worse…

Third big revelation? If we are told the day before a new hire is supposed to start that they did not pass the pre-employment screening, we are screwed. We have to start the process all over again. The job has to be reposted. Have it happen a second time and we are now at four months looking for someone for this particular position. The system works somewhat for large clinics because they have more flexibility. The work of one person divided among seven is much easier to handle than if it is spread between two. 

I have been begging, pleading for help from corporate and none has materialized. 


And that, ladies and gentlemen, is only the tip of the iceberg….

Why am I still here? 

I get this question a lot, and I have spent a lot of time thinking about this as I have watched the foundation of the clinic collapsing. It is the same everywhere in corporate medicine. I have seen it as I have interviewed for positions in clinics elsewhere. 

You don’t know what kind of employee you are really getting from a 20 minute interview. Once you have them it is a hell of a time getting rid of the bad ones and retaining the good ones. Being a little clinic required to play by the rules of a giant, out of touch corporation is the way of things. 

Hands tied. 

I am too old to go solo and insurance companies make it difficult to negotiate lucrative contracts as an individual in primary care. Even crappy EHRs are expensive. Malpractice insurance is expensive. All of the increasing government regulations and mandates and certifications are difficult to keep track of: PCM, meaningful use, PQRS, HIPAA, “shared savings”, CLIA, radiology regulations, Medicare guidelines, Medicaid guidelines, ICD-10, OSHA… I know I must be missing some.

What I want to do is just see patients. Patients are what keep me coming back every single day. All of this other stuff, these roadblocks to good care? I don’t want to even have to think about them. But I do. I have to. They make me stew and boil and…. 

Deep breath.


118 thoughts on “Support

  1. As the employer, who has spent time, money and energy to achieve all that you have I wonder when the moment comes that you literally say screw it and give up?
    Would you do all of this again if you really knew what was in store?

    Liked by 2 people

  2. government with its myriad of unnecessary regulations and big corporations who are out of touch and a legal system where people are free to sue anyone for anything amounts to certain catastrophe for a medical profession where patient centered care used to be the norm.

    Liked by 2 people

  3. Any time you are up against ‘the system’ it can end badly. Both for the patients who fall through the cracks and the professionals who just want to care for them. Our ‘system’ is different, of course, but I have met so many excellent healthcare professionals driven to screaming point… and to quitting… by the way the system ties their hands, preventing them for doing what they need to be able to do, what they have trained to do and what they are employed to do… but can’t.

    Liked by 1 person

  4. One thing I have disliked is there are horrible people who don’t do good work/care who interview well and get jobs. Yet people like me who are nervous at interviews but are good caring workers have trouble getting a job. I’ve worked as caregiver and C.N.A. And there’s to much bad stuff going on to mention.

    Liked by 2 people

  5. Two words: that sucks. I am always amazed at how grumpy the front staff are at doctors’ and dentists’ offices (with a few exceptions of course.) It’s like: why did you take a position that requires heavy interaction with worried/anxious people if you dislike said requirement? Your story just confirms me suspicion that these people are selfish and not reliable. I am sure there are sources of frustration, like the electronic records system/insurance/billing/etc, but I think helping people would be so rewarding. Why can’t the system be simplified, and people who actually want to help people and need employment get those jobs?

    Liked by 3 people

  6. This is (in large part) the result of all these damn mergers. Why do we need ONE of everything. One airline … one hospital group …

    I feel for you. When I left WHO, where it took WEEKS and 7-8 signature to send out a simple letter, I vowed never again to work for a big place. And I don’t. (Our HR manager did, and he keeps instituting policies designed for a huge corporation. We simply ignore him.)

    Liked by 2 people

      • Without sufficient staff, it’s hard to ignore the folks standing in your way!

        (At WHO we did get around it. Interviews were set up, folks hired and then the CV given to personnel. They got very crabby about it, but we did get our staff!)

        Liked by 2 people

  7. And while you are going through all of that, the patients are going through similar leaps and jumps through the red tape just to find a doctor that they like and feel comfortable with. Insurance companies have built up walls that we have to get through. Many patients just give up. It sounds like, as usual, the corporations are creating work to keep themselves employed, even if it bogs down the entire system from the professionals to the support staff to the patients. Crazy. Something needs to be done about it but as usual, things will have to get much worse before they get even a tiny bit better.

    Liked by 2 people

  8. A sad tale, and very frustrating for you. Much of the problem is in the care-delivery model, which is both poorly structured and brittle. Poorly structured in that there are 3 sources of rules that must be obeyed–government, corporate, and insurance. Having 2 bosses doesn’t work, so having 3, well… Brittle in that it doesn’t bend under stress, but just goes straight to catastrophic failure. That is always bad.

    You talked once about going into some other health-related field like health policy. Any more thoughts about that?

    Liked by 1 person

      • There is politics in every job. If it is a management job, there is also personnel and budget. If you are lucky, there might be a little time left over to do the job you signed up to do, but that definitely comes last.

        I’m now a contractor. I mostly do what I originally signed up for. I’m a one person company. There is no HR department. There is no formal budget. The guy I work for asks for my opinion and listens when I give it. How cool is that?

        Liked by 1 person

  9. If it makes you feel any better, I work in a hospital system. We FINALLY got approval (that process in itself took a year) to add another nurse (I work in a surgical specialty) in January. I 1/2 jokingly said GREAT we should have them by June. Everyone laughed at me. It took 6 weeks to get the job listed on our online job listing site. 6 weeks AFTER we submitted it. There were several nurses, already employed and working inpatient in our system that approached us b/c they were very interested. We were not allowed to interview or anything on our own. Had to go through HR, submit their resume online, go through the recruiter, get screened and THEY would tell us who we would interview etc. some of the ones who approached us, and we knew very well and would have hired on the spot, gave up and did not even last to the interview stage. We did not start interviewing until the end of April. THEN have to do the whole thing you discussed which took weeks (orientation, approving the salary, etc) Guess when our new nurse started, June 1. So frustrating.

    Liked by 2 people

  10. Wow, that sounds so frustrating! Way too many hoops to jump through and red tape to get caught up in. That on top of being a mom… I don’t know how you handle it all. My prayers are with you and I hope you get some quality help soon!

    Liked by 1 person

  11. This sums up so many problems for me. This is why I left. I am excited to try Locums- and get back to seeing patients. I’m not interested in all the BS that comes along with working for such a huge system anymore.

    Liked by 1 person

  12. That is beyond ridiculous, and yet far too common in the world of inefficiency. I think you should send this post to the head of your organization. Put it in a Word document and tweak it so he/she doesn’t know it’s a blog post. Maybe if they see the absurdness of this in writing, they’ll seek a better solution.

    This would’ve made me have to double the Prilosec dose I was on when we adopted the EMR and I developed acid reflux for the first time in my life…

    Liked by 3 people

  13. That is awful! As with our government, any large entity just becomes crippled by regulation and eventually everything just freezes. I hope you get workers soon, it’s sad that so many out of work people need jobs and you desperately need employees but the system is stuck

    Liked by 2 people

  14. I have come to the conclusion that there are WAY too many Chiefs and ZERO minions running everything bureaucratically. And this is another reason why some of my friends with MI go untreated because of what the doctors have to go through to get even a basic staff! You are an amazing Dr and AMAZING mom! Even through it all you are still trying to take care of your patients-when so many get the shove off. ARGH! I want to march upon corporate business and the Capitol and Congress and The House and start knocking idiots upside their selfish heads ARGH!

    Liked by 3 people

  15. Hello Doc,
    It’s funny, I thought it was just here where all the red-tape and bureaucracy (implemented by those who probably never worked a decent day’s of work in their lives, like ‘normal’ working folks I mean!) became a nightmare. Sometimes I think it’s a conspiracy to make working effectively impossible, and then give a reason to fire all of us. But then, who will do all their dirty work? πŸ˜‰ Sorry for the vent, but I could – sadly- relate to this in many ways. Sigh…I don’t understand humans sometimes. Sending warm wishes your way. Hope your children’s smiles can make you feel a little better πŸ™‚


  16. OMG doc, what is going on??? I usually read through everyone else’s replies but tonight I jumped right on mine. This shit is like everywhere and you’re not even in my state. We are bleeding here. Two VP’s after 30 and 24 years are jumping ship, one 26 year director, multiple nurses and we lost our MLTC insurance provider who we service. We have to close our private pay service for lack of patients and let go five nurses who did not want to come to the CHHA. Our main server crashed today… the list goes on and on. And all of this is in one month. We have one recruiter for the whole agency of 1000 people total. We cannot get people in. I am currently hiring a paraprofessional trainer and she wants a ridiculous amount of money. (Why do nurses automatically think they are teachers btw? I want an educator first who has a clinical license second) She is qualified, but wants more than my 26 year veteran Lead Clinical instructor…. and she may get it. BTW, my instructor makes 10 cents an hour (technically) more than me, but she is worth every dime. I have gone from three employees to five and soon six and a whole new program to rescue if they keep it….. so far no one is offering me any more money. It made me realize today how crappy I am paid. And they wonder why good people jump ship. Our company is really in deep doo doo and I have not been writing about it because it is so unbelievably bad. The stress is through the roof. Why is it getting so awful? I do not know. But, yesterday I was thinking about it and decided to cop the attitude of “This is so exciting watching the metamorphosis of something new”,…. but it is so hard to survive it. It like being in a swirly waiting for the final flush.

    Liked by 1 person

  17. I hope that whoever is in charge finds a way to alleviate the workload, hours and smooth the workflow. Making overtime and running around is doable for a while.

    After that while though…

    Liked by 1 person

  18. So sorry how complicated things have gotten, Doc. In the late 1970’s, I was the only recruiter for a 2 unit hospital system in central Michigan..we had folks hired and in orientation within days/weeks at most.Just for fun, I went and checked on them…they are now part of Allegiance, a system that handles 40 locations in that same area. So…there you are. It’s everywhere. and it must suck.

    Liked by 1 person

  19. Pure insanity. I wonder if this is why the veterans’ clinics and hospitals are having so much trouble. They have the big government bureaucracy to deal with too. In your case, I keep wondering if corporate complications are worth the benefits they provide. I hope it gets better soon.

    Liked by 1 person

    • Your have a valid question about the complications being worth the benefits. And the truth is, I don’t know. I have never experienced the other side of it. Truthfully, the unknown is much more terrifying than the known. I am scared to find out. I keep saying I am going to make enough to retire quickly and then start volunteering, working with the indigent or overseas. Then it feels like it will be medicine on my own terms. When I am no longer accepting money for what I do, I no longer owe anyone except the patient anything at all.

      Liked by 2 people

  20. Temp recruiters are extremely incompetent, who knows how they even have their jobs. I remember trying to get a job through them once, talking to the recruiter on the phone- I had to give them my information probably 5 times before they could write it down correctly. The recruiter gets paid for just getting someone hired, regardless if they are good or not, and they do not care at all!!

    Liked by 1 person

  21. You know, your notes, and sorry I am not reading them as often as I should, give me a completely different view of private medicine.
    Having always worked in nationalised health service- first in Prague and then in the UK, I used to think that in private medicine, you are more independent, free, have less bureaucracy. It seems I have been deluded,

    Liked by 1 person

  22. I am so sorry to read this – what an absolute horror show! Being short-handed in addition to over-scheduled is terrible. With regard to hiring personnel, I went through that for years hiring technicians and some of the ones I interviewed left me laughing. It was occasionally hard to put into words why I rejected them (more BS for the administrators). Somehow I lucked out (good gut response?) because there was only one I came to rue and I kept her on her probationary period long enough to build up a resume of why I was letting her go. Another hurdle to handle. Wish I could help you out!

    Liked by 1 person

  23. Although I do have a wonderful primary care Physician, how I long for the good old days when our doctor made house calls. His office was right in the neighborhood and usually in his home. He knew our family and all of his patients by name, delivered babies, and handled everything short of cancer, even did certain surgery’s. He was respected and dedicated and his patient’s loved him. You strike me as that type of Doctor. I guess it’s just the timing. Chin up and keep smiling. I am sure you are much appreciated. :o)

    Liked by 1 person

  24. And to think this started because your good employees wanted to spend time with their families the day before Thanksgiving…
    In spite of all the frustrating process, I certainly hope you remain in the medical profession. Good caring physicians are too hard to find nowadays.

    Liked by 1 person

    • Don’t get me wrong. They were NOT good employees, that bunch. Perhaps they were better than nothing? But they were not good. We had no idea how much they were holding back the practice and hurting patient access until they were gone and the schedules started filling up. We are all three booked out for weeks now. And this is the problem…. trusting staff ever again. That is going to be hard. As for spending time with their families, we worked out shifts with people taking time off and others covering, rotating holidays. They all had Thursday and Friday off, and the whole weekend. We have to balance staff needs with patient needs and it is a challenge sometimes to do that. We make sacrifices. Refusing to schedule when we are open, when that is their job? When taking care of patients is our job? Inexcusable. It ended up being so much more than that one day. It had been a systematic thing, ongoing for years.

      Liked by 1 person

  25. It’s hard to like this Doctor. Though I have been super blessed with great doctors I am forever commiserating with my doctor about how he does not get to be in control of medical decisions and care. We have to go through what “the company” says I need. Oh the cursing that goes on in my head about this.

    Liked by 1 person

  26. I’m exhausted and heading for bed in another few but will reread and read all the comments tomorrow. This is…so horrible. I knew it could be this bad outside of medicine. I don’t know why I thought practical considerations (that we CARE about people) would have made it different in medicine. Insanity.

    Liked by 1 person

    • There is no reliable way to determine if someone cares until you have them working for you and even then is dicey. I behaviorally interview the hell out of people all the time and it does not seem to make a difference.


  27. Pingback: My Article Read (6-28-2015) | My Daily Musing

  28. OK. I won’t say this ever again. Take a twelve month sabbatical, come over here (down under) and check us out. You just might like it. Don’t go to the big cities go to the country, you’ll be worshiped.And most Australians can understand Yank language. And if you don’t like it you can always go back to your own private Idaho.

    Liked by 1 person

  29. You know, I would give any amount of money to have a physician such as you… Yet I would also empty my pockets not to have to deal with the corporate office where you work. It makes me long for the old days (from before I was born) when doctors could doctor, and employees were there to work, and patients were respectful and appreciative. Go figure.

    Liked by 1 person

  30. I often think that if I ever get sufficient capital investing it in management or recruitment consultancy would be extremely lucrative! I am sure there exist good consultancies out there. However, in many cases I get the impression one is paying for something which the individual holding the purse strings could do equally well (if not better)! You lost me with all those abbreviations! Kevin

    Liked by 1 person

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