okay,
so... "only time can tell," right??
well... "time" has brought me to a frustrating point in my new job. the things that i am frustrated about are things that i could not have really been warned about because no one has ever been in this position with my doc. 
also, as a new np you don't know to think about some of these things... so hopefully, these considerations will help you newbies in your quest for jobs.
for fun, we will refer to my supervising md as "gd"...
some background info:
a) after graduating in december, i started work for a cardiology clinic of 9 mds (and i was the first mlp)
b) we use an emr system for documentation and billing
c) we just merged with a large corporation
d) i was hired primarily for a rural office with gd as the only md that comes to that office, but it was understood (and in my contract) that i was hired for the whole clinic/group of mds
e) gd works at both the rural and not-as-rural offices, more so at the rural one... and then has patients/procedures at 3 area hospitals
f) there is another np working for one cardiologist, strictly in the office setting (her preference)
g) gd has no spouse, sleeps on our office couch, and is a self-martyr
h) the medical director of the group was a clinical preceptor during school and loves me. i know that he will support any change i need and any problem i have.
i) gd is excellent at what she does, is a huge patient advocate, and puts her patients above all. and i mean... "all..." to the point that i think she uses her "patient involvement" as a crutch.
my frustration:
1. gd would rather see patients than do her documentation/billing
a. gd gripes about not making much money last year or having a life but she is a self-martyr and i made too many sacrifices in school to be making work-related sacrifices now
b. she pressed for our offices to get the emr system and she does not utilize it. instead, she just prints out a med list... jots down a few notes... and throws it in a folder for me to stress out over when i see the patient in a follow-up visit, when a pcp calls for consultation report, surgical clearance, etc. because she didn't document in the emr - she's a computer nerd! it's not a "speed" issue. all of the other doctors in the group are older than her, much less computer savvy and still manage to document and bill each patient as they are seen. she has office visits and electronic notes incomplete since 2005!!!! most are within the last 8-16 months, but still!! this is where her lost revenue is... stocked up in her office! she knows she needs to do the notes, but has been saying she needs to do them for months and hasn't done it. i am not about to do her documentation from god-knows when. no other self-respecting mlp would. right??
2. gd was not ready for a mid-level provider
a. she swears that she knows better than anyone else the role of a midlevel... but she doesnt. during the mornings, while she's doing procedures (and i have been waiting on hospital privileges), i answer phone calls and handle "nursing duties." bullcrap. i should be seeing follow-ups, at least!
b. she will not "let go" of her patients... she says they are possessive of her... wrongo! she is possessive of them!!
c. the documentation thing... someone cannot... in their right mind follow behind her and see patients. it pisses me off daily when i try to pull up a note to see what was done at the last visit and show nothing documented for >1 yr.
d. her schedule... she does procedures in the morning 30 min away from our rural office and schedules patients 15 min apart starting at 1:00 thru 5:30-5:45. she's generally late, slow about seeing patients, doesnt document well, talks too much (inappropriately so), allows herself to get distracted (pulled out of the room, answering her cell for hospital calls), and doesn't see this as a problem. if she does, she may make a comment about "oh, i'm tired of staying late" or whatever... but doesn't ever do anything about it. and we're stuck there until 7-8:00 pm... routinely! the office opens at 9.
e. instead of being supportive and not worrying about me being a "competitor" she thinks that if i document better billing than her, it makes her look bad (duh!!)
f. i am trying to build good habits and it is very difficult with her negative, poor-me, self-martyrdom, and "i don't give a crap about the rules" attitude
g. plus, she has upset a lot of the community pcps (that govern the local hospital) because she isolates herself
3. i feel like the "rural" office and gd are holding me back from full potential
a. the rural office does not have nuclear testing, our own lab, or other ancillary services that i can readily get reimbursed for. the other np functioning in other office billed for $32k in feb alone and will get $10k of that as salary/incentives. i should have the same opportunities.
b. gd can make up for this loss with her procedures and duties in the other office, where as i cannot. but, she gets a larger percentage of the bonuses i am eligible for... so you'd expect her to be more supportive. right?
(bonus structure example: np billed for $32k in feb. take out minimal overhead and np monthly salary... what's left over is divvied up 70/30 at the end of the quarter. md takes 70, np take 30. longer np with larger corporation, bigger np percentage becomes and smaller md percentage.) i was told by the ceo himself that within the second 6 months of being there, my salary would become "meaningless." woohoo! :)
c. gd is concerned about me making her look bad if my documentation and billing practices are better than hers
d. over the next couple of weeks, i will be spending time with the other np and other partners in the group (which by the way, gd is not a partner), and gd did not think that i should do that. she wants to control me all by herself.
e. when i met with the ceo about my contract, she was upset because i did not ask her permission to go talk with him (she didn't tell me... she told the office mgr who told me). i think she was worried about what i was going to tell him!! in this meeting, by the way... i told him that i was getting to a point of utter frustration where i wanted to leave if it didn't improve. and i love what i am doing... but she's gotta improve for me to stay!
okay... so, there are probably more bits and pieces of the story... but i'm tired of thinking about it. i just don't think it was fair for a new np to be put in such a pile of crap... however, i can't really blame anyone because nobody knew it was so bad. i don't know how to help her. i don't have the experience and i don't think it should be my responsibility to "change" her... because i don't know that she will ever change. i just want to go to work... and be done... and come home. i know that healthcare is a 24/7 business, but my family has to come first. then work.
i feel stuck. there are not many np positions, let alone acnp positions around this area... but there is enough need in the entire group for me to keep a job. i just don't think my current position is right for me. at least not right now.
DaisyRN, ACNP
383 Posts
okay, i have talked with the medical director...
he asked me what was going on with our office, so i just opened up (and i didn't cry!
- i cry when extremely frustrated). and i avoided the "he said...she said..." approach. i just told him what my concerns were and why i didn't think it was working out. i told him that i fear repercutions from her because she has caught wind of me communicating with the ceo, office super, and director. since my original posting, she has gone to the supervisor and falsified information about me (that i text message in patient rooms, that i had to be asked multiple times to come back into the office when i was outside talking with the supervisor for privacy, that i hurt the receptionists feelings, that i gave her a dirty look, blah blah blah.). none of which are true. i also shared my concerns with her holding me back from success and seeing me as a threat instead of a help and additional provider. there were some other issues, but that was the gest of it. oh, i also told him that she did not offer me much guidance or direction in seeing patients, knowing "what to do next" for her, or whatever... i compared my experience with her versus my superb learning experience with him.
his responses:
a) despite the issues that have gone along with it, he appreciates my coming forward and making them aware of these issues as the mgmt was very much in the dark about a lot of things.
b) they have been waiting on her to sign her contract with the corporation for influential power over her, so to speak. he said that he's been addressing some of the previously mentioned issues with her in the past few years but did not have any disciplinary influence over her. now he does. she is not a partner. she is contracted through the corporation where if the partner's group pulls out, she's on her own.
c) he and i talked about the plan for me to spend more time with him and the time frame for when i should start really seeing patients "on my own."
d) he made a "personal commitment" to me to ensure that i was not going down for anything she has done or said. and ensured my job security and future with the group.
e) he asked me what i thought they should do about the situation... and asked me if i wanted to just start hanging out with him. i told him that would be fine with me, however... i think gd would throw a fit and it would add more fuel to the fire. the medical director said that it would be helpful for me to stay in the rural clinic and monitor for the changes they are trying to make and also to maintain a sense of "peace" with her, for now. he assured me that if at any time i need to get out, and even if i have to walk away from that clinic and never go back, i have a desk in his office with my name on it.
f) he assured me that her opinion and comments are not taken with much weight or credibility among the group. i told him i was worried about having a negative rep with the partners due to all of this commotion and me not wanting to come off as problematic or unpleasant to work with, so that's why he mentioned this.
i feel much better about things because i know how he feels and know that he is now aware of some key issues. i'm anxious for the corporation to get in the rural clinic and do their thing, make the changes, and see some changes. i guess we'll just have to see how it goes...