Episode #16 Protecting Your Personal Life
When you are working in the medical profession there is a lot of demand on you. You are seeing patients, charting, managing authorizations and if a business owner, the business. There is a lot of stress and time involved in that. The time and stress can start to creep in and take over your personal life. In this episode, we are going to take a look at how that happens, how it looks from your family’s point of view and ways to protect your personal life from being consumed by your work life.
When you are new to this profession, it doesn’t seem so difficult to see the patient, chart on the patient, follow up on labs that you have ordered and be finished by the end of the day. Especially when you are often not given the real picture of a full patient load during your clinical experience. You get shielded as a student from the big picture. As your patient load increases, or you start to encounter more complex patients that require extra care coordination getting that charting done might be a little bit more difficult before the end of the day. Next thing you know you’re taking your charting home. This begins interfering with your home life. Most often, your family does not understand why when you get off at five or 6 o’clock you still have to work. Unfortunately, this is where we are right now, with a ridiculous amount of documentation required for reimbursement. With the introduction of pay for performance reimbursement, we will see what happens. The theory behind this pay for performance is that it is about the quality of care, not the quantity of care. Meaning that instead of billing the E& M codes You will be coding the diagnosis’ and the outcomes. Meaning you are reimbursed and incentivized for A1C, BP and cholesterol levels within goal and for decreasing visits to the ED. Unfortunately, this doesn’t reduce the number of patients that NEED to be seen when you are booked out 6 weeks. The current system requirements to see 30 to 40 patients a day to make a viable income is quite ridiculous. This reduces the quality of time spent with the patient.
You often find yourself needing to choose between getting your work done before the end of the day or spending your time with the patient that is in desperate need of your attention and services. Patients do not come in with a clear-cut problem that can be tended to in 15 minutes. Often the patient will come in and you’ll finish reviewing the studies, Completing your objectives for the visit just in the nick of time, with your hand on the door and they say, oh one more thing.
Of course, you don’t want to cut them off, you need to address with that one more thing is. You can’t have them make another appointment to go over that one more thing because you were booked out for the next six weeks and they are there now in front of you requesting another moment of your time. That moment usually turns into an additional 15 minutes. Most insurance companies will not reimburse you for the extra time spent on an acute problem that was added on to the established care visit. They want you to make them have a separate visit for acute problems.
Again, the goal of this podcasting adventure is not to get into data and details and regulations and insurance issues. The goal is to put things into real life. To give you the tips and tricks that you need to take care of yourself and take care of your patients, preserving your sanity and their health. In episode #8 I talked about How To Maximize That 15 -Minute Visit to be able to fit it all in. If you haven’t listened to that one check, it out. I’ll link to it in the show notes for today.
You don’t want to become bitter and burned out and forget the reason that you went into this profession. You don’t want to start neglecting the patient’s needs because you need to finish charting or move on to the next patient. You also do not want to take it home with you and become irritable or spend your free time working on documentation.
Today I want to share with you a chance encounter I had to see things from the family’s side. The encounter I want to discuss is the one involving the significant other of another nurse practitioner asking me for advice or support. This encounter was with a gentleman that was at my office to do some contract work. He had scheduled the work for me to be done on a holiday weekend. I gratefully accepted the offer to meet me at the office on this day, as my schedule is quite insane and the issue at hand need to be tended to rather quickly. While he was there doing the work, I asked why he had offered to do it on a holiday weekend. I learned that his wife was a fairly new nurse practitioner, in a primary care office, And then came what was like a huge slap in the face of reality to me. The reality of the current situation in our profession.
He said to me, “she’s always working anyway, doing charts and stuff so it doesn’t matter”.
I was literally speechless for a few moments. He looked so sad and looked away, shrugging his shoulders as he said it. We continue to have the conversation around the work situation. I felt it almost an obligation to help him to understand some of the downfalls to what we do in our profession. I of course supported the fact that our patients are more important to us than ourselves sometimes, even if that wasn’t right. Inside, I deeply wanted to help him to not be disappointed. I also wanted to be supportive of her as she was finding her place in the practice, and with her patients, in her first year of practice. But as I was talking, I found that I was only making it worse inside of myself. Why should I support the fact that this woman was gone from home for 50 hours a week at the office and then brought home her work every evening and weekend and holiday. Why is this right? There was no extra compensation for this. She’s actually compensated per patient. She does not have a base salary; she is completely commission based and at the same time is pushed with minimal experience. Without speaking to her myself, I didn't know the complete extent of this, but I was gathering that she had minimal support in her new role and was not only trying to see the patients, document on the patients, but research of course what was needed to effectively treat her patients. There was a flicker in me that was furious that someone was being treated like this and was being encouraged to run patients through as fast as possible for a dollar with minimal support, but I did not let that out. I just listened.
I always thought that the things I did for myself were of my own accord. I own my business, I am an entrepreneurial spirit, I have multiple projects always in the works, therefore self-inducing my demands on self and indulging my workaholic nature. if you were to ask any of my staff, they would tell you they don’t ever want me to have free time because it will only give me time to think about new ideas. I will blame this trait on my mother.
Nothing is ever perfect, but You have to learn how to work with in your career and your life with balance. Balance is the key. And if you don't get that balance from the beginning or work hard to find that balance once you own up to it as a need, you’ll find that you're getting burnt out. I'm afraid this is only going to lead to misery. You can't do everything; you can't cure everyone, and you can't fix everyone. And when you're honest with yourself and with your employer or coworkers they will appreciate that as much as you do. Your family will appreciate that. In the profession of caretakers, put yourself first, because when you take care of you, you're much better for everyone else.
The moral of the story in this one, is to hang in there if you are a new graduate and build your confidence. With things like this podcast. It’s a learning process. You do have to seek out other resources. You were given so much information in your program to get you to where you are right now, but unfortunately a lot of it is not real life. You may not have gotten a good first job. You may struggle with finances that have been put on hold while you were in school. Don't succumb to a greedy bully that is called your boss. Remember that there is a learning curve. Have an open discussion with your family about that learning curve, but definitely be aware of their feelings also and do what you can to not make it a snowball effect that only gets worse instead of better. Start with the discussion with your employer about needing a little bit more time your skills and confidence. If they are not willing to budge, maybe you need to look at other opportunities.
Do not sacrifice yourself or your family. There are too many options and opportunities out there. If you’ve been at this a while maybe, consider starting your own practice. If that’s not in your interest that’s ok. There’s no shame in seeking a position that allows you to protect yourself and your family.
A little lesson from the heart. We’ll get back to more of the medical stuff next week and care of your patients. I’ve just felt it necessary to give some love to my colleagues for your own health.
I encourage you to share your own personal experiences to help others.
Have a great week! May it be filled with many Health Interventions!