I don't want to be in this position again.
Background:
Last October, we had our quarterly all-staff meeting and the CEO said they were in deep doo-doo financially:
1. Their Medicaid reconciliation was due much sooner than they had anticipated. Evidently, Medicaid deliberately overpays FQHCs, and at the end of the year, there is a reconciliation Medicaid will get refunded their overpayment. This can amount to several hundred thousand dollars.
2. This system said FQHCs do better when they are bigger, so they bought 2 clinics and didn't realize those clinics were a huge mess, which became a financial drain.
3. This system needed a new clinic building in one location, so built it, but it went way over budget and was several months late getting completed.
The old CFO was fired.
There was also another factor which lead to a slow death spiral: This is a remote rural area, so it is hard to get providers and when providers do accept a position, it is hard to keep them. The clinic had gone through a long period of nothing but locums and even they wouldn't stay for very long. So, they lost patients, because patients got sick of the revolving door of providers and were willing to drive up to 50 miles to find a more stable clinic and a provider they could count on. The pediatrician was great, but kept getting told by patients and community members that while there was a high demand for her services, patients in the area didn't trust the clinic anymore to keep a good provider, so they were going to other clinics with long-term permanent providers. She got laid off, too.
In addition, this system did not run any campaigns to even out demand. For example, the summer months are extremely slow - sometimes I would see only 4 patients in a day! I have since learned that most clinics run campaigns to get patients in the door, in essence, they do some marketing! I had wondered to myself why this clinic system wasn't doing this, but thought maybe healthcare was different. Well, it isn't - clinics must be financially viable, as must any other business.
This is also a poor and depressed area. The main industries have been declining, and the population is declining as well. Driving down Main Street, most of the businesses are closed.
To be honest, while it is never fun to be laid off, I am mostly relieved as I was becoming very unhappy. It is just too rural for me. I took this position in the spirit of adventure, but for any others considering this, be prepared:
- No high speed internet and cell phone service very spotty. The first day at work, I was told to drive to an even more remote clinic for orientation. My GPS stopped working and my cell phone had no service. I was truly in the middle of nowhere and it was scary.
- One crappy grocery store and drug store, crappy overpriced restaurants (one good one). The lack of good groceries bothered me more than anything else. Having to drive 50 miles each way for good food is just not for me.
- Crappy services and stores in general because there is no competition, so people who live here can get lazy and greedy. Everything is overpriced because there is no competition. For example, one of the other NPs needed help moving his furniture when it arrived. He had arranged to pay $50 to a local man for literally 15 minutes of work to just help him move his sofa - never showed up and when my friend called him, the guy said that his girlfriend told him it wasn't worth it! What few business are around close at lunch and at 5 pm, most are not open on the weekend.
- Very hard to get decent housing. In rural areas, there is little to no new construction. Finding a decent rental is hard and the landlords also get greedy and lazy, because they know you have no options. My air conditioner broke last summer and the landlord refused to replace or fix it.
- I thought this would be great for outdoor activities, but we've had an influx of homeless people and so now it is dangerous to go hiking, etc.
- There just aren't very many college-educated professionals to socialize with. I get along with most people, but I am starving for intellectual conversation that is not about work. And for single people, forget it. Another NP is young and single, and he goes out of town every weekend because he wants to find a woman to marry and start a family with. He's only here to get loan repayment, and if he isn't accepted into the program, he's leaving.
- I really took this job because the former CMO was awesome. Unfortunately for us, but fortunately for her, she has a rather esoteric medical specialty passion, and to her surprise, she was offered her dream job doing that full time, so she took it. The new CMO is such a jerk - no one can stand him and all the providers avoid talking to him. Even patients were starting to refuse to see him any more.
- The clincher: late last year, I was asked to go fill in for a week at another, even more remote clinic because their locums quit. So, Friday night, I left the clinic and headed home. No one warned me that the only road to get home was "open range." (I thought that had disappeared 100 years ago!) Well, it was twilight, almost dark, and I hit a freakin' cow, which was standing in the middle of the road. This was a dark country road with no lights and no signage indicating open range or watch for livestock. I am very lucky to be alive. My car was totaled and I can't express how frightened I was. No cell phone service. Freezing cold. Dark. I had visions of dying out there and never being found. By some miracle, a nice lady drove up a few minutes later and she happened to be a dental hygienist that worked for our clinic! She helped me make a phone call. Then an ambulance drove up, before I had even made a call - the crew was on their way home. Then a Highway Patrol officer! He was just doing a normal patrol. My guardian angels were working overtime that day! It took over an hour for the tow truck to get there and the officer had to shoot the cow - I could hear it crying and moaning before it was shot and that whole experience gave me nightmares - poor cow. The tow truck driver towed my car and gave me a ride home - got home at around 11 pm - had to leave vehicle in front of my house. Another NP, who lives across the street from me, came running out to check on me. He told me his wife saw my car being towed and it was so smashed she started crying and thought I was dead! I ended up having a very bad concussion and some bad bruising and pain in neck, arms, chest, back, but I am so freakin' lucky!
So, now I have no car. I don't have much money as a new grad NP with student loans. The neared car dealerships are 50 miles away and my dad had added me to his policy, which didn't have rental car insurance. And I didn't even have a way to go get a rental car.
My work friends - NPs, RNs, MAs, were very sweet and helped me a lot. However, the clinic management did not call me, send me a get well card, or even send flowers. Nothing. Then, when I asked for a rental car so I could go to work and also so I could go to the nearest town to buy a new car, they said only for one week and were very rude about it. They pressured me to come back to work before my concussion healed, threatening my job, and my own doctor had to intervene and demand I be given enough time off to heal. So, management was mad at me!
Now I had to buy a new car and have new car payments, which caused me financial hardship. My old car was just fine and was paid off.
Give me some credit for commitment - I wanted to fulfill my 2 year service requirement for Nurse Corps Scholarship and I didn't go running back to the city!
However, things just got worse and worse. New CMO tried to bully me, which didn't work, I put him in his place fast, so then he would pick out another NP and go through each of them, bullying them. He got in a shouting match with an NP that traumatized all who heard it and that NP almost quit on the spot. He then turned to another NP and started "hazing" him like a college frat boy. He sent two long emails (like novels) to all the management team and all the providers ranting about how crappy our clinic system is, we give crappy care, and our EMR sucks (it does, but not the way to handle it). He then began verbally telling all the clinic employees our clinic sucks and we give crappy care (we don't). Patients began refusing to see him. I got a lot of complaints about him from patients who switched to me and they were consistent complaints: bad bedside manner, not helping them (he gave a lot of bizarre and wrong diagnoses), and telling multiple patients they just had mental problems (he literally told a woman who had a horrible persistent ear infection due to a clogged ear drainage tube that she needed to go see mental health!). There's a lot more, but you get the picture.
In conclusion, this was a great learning experience. Due to being so remote, I got to do and learn a lot, both regular primary care and urgent care. However, I am not cut out for living in such a remote area. While I was told I did a great job, the car accident and then getting laid off was hurtful and depressing. I do run into many of my former patients when I am out and about, as I am getting ready to move, and they have been so nice, hugging me and telling me how much they miss me! Most of the people here are very nice and so grateful to have a provider who wants to be permanent.
So, I have decided next job will have to be in a city of at least 10,000 people with a decent size hospital, as this means there are generally a decent number of outpatient NP jobs as well in primary and specialty care. I will only consider a smaller town than that if it is no more than 30 miles from a decent size town.
I am getting lots of job interviews and have one written offer and one verbal offer, with more to come.
Note: I don't want to scare people - some people truly do love the rural live. We hired one NP who is a true country boy from the South and he moved here with his family and is as happy as a clam.
Forest2
625 Posts
I had to laugh because I live in the country. There is no free range here but there are escapees. Mostly people hit deer which can total out their vehicles. But horses and cows do get out, it is not uncommon. We don't put tracking devices on them, can you imagine tracking devices for a thousand head of cattle? When I lived out west we had horses that just roamed around, walking free along the sides of the roads. The world is a big place with all sorts of interesting things.