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
david,
thanks... and i have no doubt... a lot of local patients to the rural office already drive to the larger office 30 miles away... and if the rest of her patient population realizes she's on her own, it may raise red flags in their minds. i also think the referrals would plummet... because her being independent would further the outlying pcps' suspicion that she's a problem. all in all, i think it will be a bad situation... i'm just glad i'm no longer a part of it. i think i lost 10 lbs in two days... the weight's been lifted. :)