Question for health care peeps in academic mc

[pinkpeony08]

Hoping to get a get of info about other places.

I am an NP in the palliative care clinic at an academic medical center. Our institution leadership has implemented new patient facing guidelines for NPs and PAs in an ambulatory setting of 36 patient facing hours per week/36 hours of open clinic slots per week. They are telling us it is based on a national standard, yet I can find nothing about a national standard and posting on a FB group for APPs in my specialty gets the same reaction we have had, which is: that’s nuts and not possible in this speciality. Essentially they are asking us to essentially double the patient volume with no room for any flexibility or time for patient related tasks.

-has your academic medical center implemented a 36 patient facing hour work week for APPs?
-what do you know about this national standard?

Thank you!!

[Saudade]

NP family practice, FQHC.

I'm 36 hours, 4 admin

But that is absolutely *not* my patient slots, that's beyond ridiculous to expect that. How does that even work? My acute care visits are 20min slots, new patients are 45-60min (depends on who is scheduling them in)...follow-ups, physicals, pre-ops, procedures-it all depends. They're not allowed to double book unless we do it or ok it. Not only that, but they don't want us to have more than 20 patients on any given day, ever. This is the expectation for APPs and MDs.

I've never heard of this being a "national standard" and that doesn't make sense. Every institution or practice area is unique and I don't feel like you could standardize that.

Are you salary or RVU? What are the expectations for the MDs? Have you posted on the NP subreddit?

[pinkpeony08]

Saudade,

They are telling us we have to have two 4 hour clinic blocks - each block with 2 news (60 min) and 4 follow ups (30 min). Our patients are all very sick by nature of the specialty and we cover a ton in one visit. An "all in" visit is covering goals of care, 4-5 symptoms, psych social support, code stats and hospice discussions. It usually takes 60-80 minutes. Follow ups are generally 25-30 minutes face to face. There is literally no space between visits, and we get a lot of calls that require us to actually do something - opioid refills, call and figure out if they want to go to the ER or get a hospice referral. Again, things that take time!! Prior to all this, may days were full with 2 news about about 5-6 followups in a whole day. The only saving grace is so far we haven't had the patient demand to fill all the slots.

I am salary. Palliative care has never made money, only saved money for the health care system. Expectations of the MDs are the same for a 4 hour block, but they have a lot less clinic - most have 2 half days of clinic/week if they aren't on service.

We are currently technically at 32 hours with the plan to roll out to 36 hours in coming weeks. We filed an "exemption" to 36 hours and it was denied. The decision was made by a committee with only a total of 2 practicing clinicians on it, otherwise primarily MBAs from my understanding.

I'm off to look into the NP subreddit! I'm not really a reddit user, but that's a great idea as likely lots of people to tap into!

[Saudade]

pinkpeony08,

How much do you love your job? lol. That just doesn't seem sustainable and I'd be looking. Ultimately admin is shitting on staff and patients. It's not fair for anyone.

I don't understand how they think that's going to work, especially if the demand picks up. Everyone is going to get burnt out and patient satisfaction will decline.

[pinkpeony08]

Saudade"

What really sucks is I really, really love my job. I hoped to stay for my career. I’ve never worked with people I liked so much in any job ever. This is a total recipe for burnout, totally unsustainable and I’ve been screaming concerns about this since it was rolled out at 32 hours last May. It’s really devastating. I’ve been here 10+ years. I have sent many emails, met with the ombuds office and then was essentially gaslighted by my manager at our last meeting.

[Saudade]

pinkpeony08,

I really hate this for you, even more so since you love it so much. I get that. I absolutely LOVE my job. It's not easy. You do extremely hard work and then your admin shits all over you, while getting huge bonuses. It's really unfortunate that your manager is such a d-bag too. I hate when they drink the kool-aid.

Are there penalties if you can't meet the metrics? I mean, there's only so much you can do to control that. It's not fair to be there past your contracted time. We all end up having to do charts at home occasionally, but if that becomes the norm....

The other thing you can do, though it would risk your job, is to just leave your charts open for a long time. I would imagine there is a way to do it that doesn't totally risk your job...ie: leave them open for a longer than normal time, but not an excessive amount of time. That way they can't bill it.

[wanderingback]

I don’t work in academics but healthcare admins are all about the bottom dollar. They don’t care what’s best for patient care or provider wellness. I don’t have an answer for you, but I hope that you can figure out a way to continue to do your job well since you enjoy it and say fuck off to admin. Are you all in a union? In one of my per diem jobs us physicians have been thinking about unionizing because it’s so shitty how they know that we’re disposable and can just make whatever decisions they want regardless of what is best for patient and provider well being.

[pinkpeony08]

wanderingback. Thanks

I know they only care about the bottom line, but I would think they would care if there is a mass exodus of staff and you have to rehire and train at the tune of $250k+ each! I’m told that’s the cost to replace someone! I wish I could see where this lands in 6 mo. I also wonder where this data is to create a national standard.

We aren’t unionized, but I wish we were.