Oh, how the tide changes from one day to the next. Yesterday, newFNP was busy as hell, yet she didn't feel as though she had been crushed by a wooly mammoth when she returned home. In fact, as readers may recall, she actually felt wonderful.
Wednesday, March 19, 2008
Today, not so much.
Yes, it was busy. That is the only similarity. Busy, busy, busy with uncontrolled diabetics, physicals and a slough of other utterly non-interesting cases. And busy with an infuriatingly frustrating all-staff meeting-slash-clusterfuck at the end of the day.
It started out innocently enough. Introductions, welcome new staff, blah blah blah. Then newFNP's CEO moved on to the very touchy subject of providing decent care.
In newFNP's clinic, there is no such thing as patient flow. We do not have EMR; there are no reminder cards that it is time for your pap or mammogram or cholesterol screening. Patients come in waves - charts overwhelm the hard plastic bins in which they are placed while providers attempt to make it through visits. There is no urgent care clinic, nor are there hours set aside for urgent care. Walk-ins are folded into the schedule along with appointed patients. Sometimes appointments are cancelled when the front-desk floodgate is so widely opened that the walk-in deluge overwhelms capacity. Some providers see the expected amount of patients - about 25 per day. Others see far fewer.
These are a few of the issues in newFNP's clinic. Is it any wonder that we miss screening tests, the topic that opened this Pandora's Box? Theoretically, all it takes for a provider to miss something is too little time or too little motivation. At times, newFNP is sure that even the best provider has been overworked or lazy or distracted.
So what does newFNP's clinic want? Do they want thorough care or do they want fast care? Do they want urgent care or do they want primary care? Because they just cannot have both in the "system" currently in place.
And then to top it off, newFNP had her first real taste of subtle NP-bashing while chatting about these issues with three of the physicians and the CEO after the meeting.
"Really," the new doctor said, "I'm the only doctor in C. [her clinical site in a nearby neighborhood]." Directing her eyes toward the two other physicians, she continued, "I think we should get together and talk about these issues."
"Get together as doctors or get together as providers?" newFNP asked.
"As providers, if mid-levels are interested. I just don't see a lot of mid-level interest in these systems issues in C.," she responded.
Yeah, asshole, mid-levels are interested. NewFNP has been quite vocal about this for the past two and a half years. She has met with the CEO. She has talked to the CMO. She has discussed ideas with other providers. She brings up systems issues in every provider meeting. But unless management gets on board with these changes, newFNP may as well just spend her energy window shopping as Barneys because she is just as likely to have a closetful of Manolos and Marc Jacobs as she is to have these changes come to fruition.
What is more maddening is that, up until this comment, newFNP always felt like she had a respected voice in this discussion. It is fucking bad enough that the expectations for productivity are so high and that newFNP's patient flow is relentless. But then to be devalued by a provider who has been working part-time at the clinic for all of three months? NewFNP knows that there are physicians who just think that NPs and PAs are idiots, but aren't they smart enough to simply wait until the NP or PA leaves before they insult them? And if you think that NPs and PAs are lame, why in the fuck would you work in community health where there are tons of them!