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Employee Vs Employer

Some Docs Seem Confused Which Role They Play

Medicine is currently experiencing a high demand and a limited supply of clinicians. It has responded by credentialing NP’s and PA’s to fill the need.

Doctors are, for the most part, not recognizing this shift because it has been so gradual. They are sitting on their thrones, eating grapes and quail tongue, assuming that things will just hum right along.

In the pre-HMO days making 300-500k for a family doc was the norm. The docs kept nickle-and-dime-ing patients and overcharging the insurance companies until the insurance groups fought back.

HMO’s became the ‘shitty’ medical groups, the cheaper option. Yet they had no problems bringing the Patel’s, Chang’s and Ogunyimu’s from other countries to fill the US clinician spots.

Most doctors these days have offices which are hospital-based, meaning that for the most part they are employees. Some have partnership-rights but don’t get it twisted, that just means there is a profit-sharing aspect there which generally is only $10-20k/yr, or in other words, it’s just a perk to make you think you have say in the company.

So why do some employees act like spoiled little shits? It’s likely an entitlement thing, they believe something is owed to them for being doctors. It stems from the high demand and low supply. They behave in a manner at work as if they are doing their employer a favor by being there.

After all, a family doc could get up and go anywhere else to get hired. The need exists.

Let’s be honest, most of us never really ‘interview’ for jobs. I mean sure if you’ve molested some children and you gotta explain that shit on your resume you may be fucked but for the majority of us we submit a resume, talk to the medical director who kisses our ass, calls 1-2 of our references and then we generally got the job.

If we don’t get full-time gigs there are plenty of part-time and per diem positions available to us.

I will say that most family doctors working for larger medical groups have a sense of entitlement. This is displayed when they whine about any sudden changes in the organization. If more work is dumped on them they will complain. If they are asked to pick up extra shifts they will protest.

They rarely stop to think why the organization is making these changes or asking them to help out more. They want to bite the hand that feeds them, only thinking about what’s best for them at the moment.

Sadly, many of these docs live their personal lives in such a manner as well. They want to do only what’s best for them or their family. They buy the secluded house up on some fancy hill and lock themselves up in their homes except for the occasional weekend warrioring, trekking up to the mountain while grumbling about ‘all these goddamn cars on the roads’.

A successful organization has a hard enough time making changes. Large medical groups are under the microscope for every fucking thing they do. They have unions, governing bodies, IRS and various privacy and compliance laws they have to abide by.

In order to stay competitive change is absolutely mandatory. The leaders dictate the direction of the organization. Deciding on the trajectory isn’t tough, I’ve been sitting in enough meetings now that I can say the biggest hurdle is getting whiny fucking docs to just go along with the plan.

Yet I worry that most family docs will sit around and grumble … feeling victimized. Their cheese got taken away and they are gonna hold their breath until someone makes it right.

In the meanwhile foreign doctors will flock to the US. NP’s and PA’s will do the work that MD’s and DO’s are too good for.

The doctors will grumble at that too: ‘They are taking our jobs and don’t do as good of a job as we do!’.

However, when the organization suddenly got a bump (dump?) of 30,000 new patient members these doctors weren’t all willing to pick up extra shifts so as to allow the organization to build the back-end structure to support the new herd of patients and build up enough reservoir to increase the doctor’s salaries in return.

So instead the medical group will go and hire PA’s and NP’s as well as foreign doctors. I’m not even discussing whether they are better or worse than US trained docs, the point is they are cheaper and more accessible.

And they are hungry. For the most part (except the unionized ones) will work their asses off. They will play their employee role down to the t. It’s the immigrant mentality, give me a job and watch me work the shit out of it. Fuck you, you got nothing on me, and thank you for giving me an opportunity. If I don’t like it I will get up and find something better. 

Nobody is forcing you to play the employee role. If you don’t like the changes happening around you and don’t want to bother with figuring out why someone above you wants to intentionally torture you then why not open your own clinic?

This is your chance to be that perfect employer who won’t make changes to your clinic. You will bring on staff and providers and you will make them one promise and never stray from that. ACA changes? Who cares, you would rather keep your employees happy than keep your doors open.

You will give them regular raises even if they suck ass. And if you have a chance to grow and absorb another clinic’s patients you will hold your ground because you can’t expect your providers to see more patients until the patients transition over.

What’s right, is right, after all.

I figure this is why so many people want to open their own coffee shop. They romantically think they can hire the perfect employee who will smile at every customer, they will sell all sorts of different foods that are fresh and cheap. They will get the best coffee beans and open early in the morning and close late at night. They will keep the temperature perfectly controlled inside and not care if customers want to sit there all day ordering just 1 cup of coffee.

I am not taking anything away from the family docs who are abused by the high panel volumes, scores of digital messages and labs, numerous quality measures to meet while dealing with sicker and older patients.

The point is that they were hired for that task specifically. If they don’t like it then they are welcome to leave it. Where do they go? To the urgent care, of course.

“But the hours are bad, the patients are sicker and the volumes are higher…wehh!”

Look, of course there are good and bad things about any alternative. But, staying in primary care and hating it while growing roots and digging your heel in makes no sense either.

Neither does it make sense to work in an urgent care and complain about high patient volumes. WTF?! You were hired to see high patient volumes. If you think it’s unsafe then throttle your flow, nobody will kill you nor fire you.

I’m not proposing that unhappy family doctors switch to urgent care. The point is that there are other options. Anything is better than standing around and whining, complaining, asking your mommy to step in and make things all better.

There are 2 ways to vote in this country… and no it’s not with a ballot. It’s with your money and your presence. You don’t like where you are get your ass up and move. You don’t like what’s happening around you then don’t take income from it and don’t feed money into it.


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