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Urgent Care Doctor: I Quit
I quit my job last week. I was working another Urgent Care shift and I finally reached my limit. We have been slammed with the third wave of Covid. Volume is up to over 100 patients a day. This compares to normal times when 40 patients is considered a busy day. That’s 100 patients. 12 hours. One provider. One nurse. One X-ray tech. One front desk person.
Since the last surge, we have been begging our management to do something to relieve the pressure. For a brief two-week period, they paid time-and-half if people would pick up extra shifts. They had some shifts double staffed with providers. They even shut down registration when things got out of hand. But these were temporary, intermittent, and not consistent. By and large, we were just told to “deal with it.”
A particularly galling policy was that we’re obligated to see anyone who walked in right up to 8 p.m. we literally had patients walk in with less than a minute to go. This frequently resulted in our having to stay till 8:30, 9, or even on a few occasions 10 p.m. We’re told it was “Corporate Policy” as if this made it Holy Writ. We begged them to at least stop registering patients at 7:45 so we could have some hope of leaving at a reasonable time.
And so, December 30.
When we walked in, we were faced with over 30 patients in the online “save your spot” queue. Opened the doors and 10 more patients immediately rushed in. We got to work and were grinding through the patients. Covid positive. Covid negative. Influenza. Covid test for travel. Ankle injury. Etc., etc. At 1 p.m., I notice we are at 50 with the patients seen, the number in the waiting room, and those currently in rooms. Still almost 30 in the online queue.
At 2:30, I see we have 35 in the waiting room. I ask the nurse to tell management they have to shut down registrations so we can catch up. I’m told, “you’re going fine. You are seeing more than 8 an hour, and you should be able to see them and get out around 8 p.m.” We grind our way through the patients and by the time I take a break for dinner at 5:30 we are down to 12 in the waiting room and four more in the web check-in.
I come back in for the final push at 6 and try to clean things out. At 7, I notice we are down to about 10 patients, but suddenly two more pop up in registration. And two more are in line when I go to the registration desk. When asking the desk person, I’m told we are “just registering injuries and stuff like that.” And that’s when I snapped.
I get on the phone and call the clinic manager, and point out we are now 45 minutes from closing, still have eight patients to see and you have opened us up for more patients, pushing the total we are going to have to see to well over 100 patients for the day. Not for the first time, I pointed out that this was abusive of the staff, and frankly dangerous. And I told her I was resigning my position. I finished up my patients, thanked the staff for their hard work, emptied my locker, and walked out the door.
I’ve been in medicine since the 1970s. Starting as an orderly in the local ER, progressing through Med School, graduating in ’82, and working through a 40-year career, military Flight Surgeon, Residency Staff, EMS Medical Director, Hyperbaric Medicine, International Medicine, and most of all ER Physician. I’ve been able to see and do amazing things. It’s been a great ride.
Published in Healthcare
I do not like this post; but I respect this post. Thank you for your service. Please consider going to work somewhere where they treat you with respect and honor.
Those positions are almost impossible to find in my field of medicine now. We are all Corporate drones who only exist to generate billing. I’m gonna pack it in.
I suspect that very few of us outside the medical community can imagine the sheer fatigue and stress that comes with having to cope with the volume of patients that is flooding our emergency rooms/hospitals during these days of the Covid panic. I wish you well in whatever your future holds… just don’t give up on Ricochet — we need your experience and wisdom for our discussions here.
Can totally relate. I’m not an MD (spent over 40 years in IT) but I know that facts and logic are of little use in trying to argue with a suit (especially an empty one).
Enjoy your well-earned rest. And thanks for your service.
Read this much so far. I feel you, brother!
Based on your experience, what percentage of those walking in the door actually, in your opinion, need to be there?
Sometimes you just gotta walk away. Take care . . .
Take a deep breath, go do something that matter s to you and refreshes you for a while and then bring that experience, wisdom and passion back to something where it will do the good it is intended for – as well as taking care of yourself and yours – need folks like you!
Did you finish your notes? (just curious if you did your notes contemporaneously or on admin time or at home)
Enjoy your new life on the beach. You have earned it and then some.
Holy cow.
Rest, Kozak. Stay loose, see what God sends you to do next. It’ll be something cool.
I’m sorry it came to that. This pandemic has been very hard on our health care workers and while I am grateful for all those who are still on the job, I understand why at some point, some have to say “enough.” I wish you the best of luck in whatever you decide to do.
40 years is enough, especially if working conditions are not great.
It is interesting and sad. I had the same feelings at the end of my long teaching career. I had had many successes working with damaged kids, but by the last few years they were just sending kids into our program to generate state and federal funds. That they were inappropriately placed in my program made no difference. All that mattered was that the essential paperwork (IEPs) were done and updated quarterly.
I had trained as a paramedic in the service and got certified in Washington State. I did my street hours at Harborview Hospital to keep my license current while part of Mountain Rescue Council. I never saw the ER as bad as what you describe, but I saw enough days that were more like your normal busy days to understand exactly why you are quitting.
Leaving teaching, I think, was a lot easier than I imagine leaving medicine will be for you. However, I do know that what was once one of the most satisfying occupations one could have has evolved into something far more mechanical than the art it used to be. My doc recently retired. She was a great doctor, caring, professional, and very dedicated. However, during our last conversation I told her that the day I decided to retire I had attended a meeting at which my BS filters got clogged in the first five minutes. She asked me if she could use that line, and, of course, I said she could. It was obvious to me that her ability to deal with the garbage had just worn down to a nub. It was a good time to quit.
As “health care” has become a “right” and medicine has become a business run by corporations, we have lost sight of medicine as a calling, a vocation, a profession. There is zero respect for doctors in the situation you were in. I fear is will only get worse. Far worse.
I’m so sorry, Kozak.
I’m so sorry you had to end your work this way. But I am ever so grateful for your dedication, and especially glad to see you stand up for yourself under these conditions. Great job.
I actually feel sad for you, Kozak. I get the impression you LOVED being a doctor.
You can open your own clinic or urgent care, and take cash. If they’re really sick they’ll put down their cash. And you can open up your urgent care between the hours of 10 and 5, or 8 to 4. And you can hold the door keys and not security personnel.
[Redacted. This was a personal attack against the author of a post where a Ricochet member is sharing his heartfelt end-of-career decision. It is totally inappropriate in this conversation.]
Enjoy some time off, you and your family deserve it.
The fear mongers have been stoking a fire like a wood pellet stove, until the stove itself is glowing red. My wife and I have come to the conclusion the vaccine is really a therapeutic. The vaccine will not prevent infection, but it will mitigate the symptoms. We still enjoy our own happy hour. We still have family get-togethers, we still go grocery shopping, we don’t hoard toilet paper, and we don’t ask, or demand that friends and family get vaccinated.
So sorry for your hectic experience! Best of luck in the future. I very much appreciate your input on these matters even though we’ve had some minor disagreements in the past.
It absolutely sucks that medicine has turned corporate. It’s all just numbers now. Our privately owned vet clinic just got bought by a group who swears they won’t change how we do business, but I’m pretty sure I’ll end my job there just as you did. Godspeed and thank you for sharing your story.
I’ve also been in medical practice for over 40 years. I’m also under the gun to see large numbers of patients a day. I have adjusted to corporate medicine long since, although I had my own solo office for many years. I couldn’t keep up with the regulatory burden in a solo office, so went to work for the corporation. The company pays no attention to us in the office at all.
Right at the moment I am sitting at home, on forced inactivity, after testing positive for COVID on Dec 31. I had mild cold symptoms. No fever, chills, sweats, arthralgias, myalgias, fatigue. Just some nasal and sinus congestion and a nonproductive caught. I had had 2 shots of the Moderna vaccine in Jan and Feb 2021. I didn’t get the booster because I had just tested my spike protein antibodies and they were high. Got COVID while visiting relatives in Louisiana over the holidays. I presume it was the Omicron variant, given the mild symptoms. I tried to go back to work after 5 days per CDC protocol, but my employer wouldn’t allow it. So I had to stay home another 5 days. Feel great. Ready to roll. And, yes, I took Ivermectin, as the NIH prematurely and based, apparently, on bad modeling information rather than hard data, stating that the percent Omicron was 75%, revised the next day to 22% (Obviously the NIH has no idea at all what it is doing), had just advised against using the monoclonal antibodies, so these were not available (GSK product not available at all in Louisiana or my region of Georgia), the Pfizer pill was nowhere to be found, and there were no other treatment options.
The inflection point may come for me if the SC decides the HHS vaccine mandate for healthcare workers is constitutional (it is not, whatever the SC thinks) and extends this to include the booster. Since I have just had COVID, there is no need for a booster, in someone already vaccinated. I’ll get standard COVID serology testing in about a month to see if I have the IgM, IgG antibodies to the virus and if so, I’ll refuse the booster. That may get me fired. Maybe I’ll then do telemedicine or locums.
Great post. Opened the pharmacy at 9 this morning after my 23rd covid vaccination I looked up at the clock exhausted it was 10:10
Im glad to have the luxury to work or not (quit 6 months ago) but I feel for the future student loan debt slaves who have no choice
That IS a great line.
I would guess that’s a capital-intensive undertaking these days. I don’t know that for sure, though.
Those student loans are going to be “paid” by the government.
Not really. Get a small office and divide three exam rooms out of the back. Have a small office and a small waiting/reception area in the front. Employ one nurse or MA, and one receptionist/ clerk. The biggest single expense is liable to be the malpractice insurance.
I know a doctor who charges $100 a visit no matter how long or short. He rakes it in. And a lot of the people don’t even have insurance, or if they do it is Medicaid or somesuch with long days waiting for appointments and few seen each day, and so when they really need to see the doctor, for kids or a work note, they pay their money. $100 a visit is fairly cheap compared to medical insurance.
Congratulations, Doc!
Caveats up front: I’m Covid vax hesitant because I am mandate-hostile. I have no patience with run-of-the-mill antivaxers. I just resent this otherwise meh tool of a global wave of fascism.
Thank you for your hard work. You don’t have to be the legendary #skypenis pilot to fall under the rubric of “Not all heroes wear capes.” I always knew that patient-facing healthcare was a tougher road than I had in me. Also I might not be smart enough, but that’s kind of saying the quiet part out loud. “Period!”
Bad policy produces bad results, turning hard work into burnout and sacrifice into mere waste. We’re not getting any younger. Ain’t nobody got time for that. I presume you have means and flexibility, and I hope that you are able to enjoy this victory.
Did you just save the world by quitting? No. Just the same, there is value in contributing to the signal pushing back. Perhaps your replacement will work happily for time-and-a-half on the regular, and maybe 80 patients per day will be the lesson that corporate learns. “Hey the rats chew their way out of the maze at 100 if there’s no actual cheese — who’da thunk?” Bqhateverw.
When you can no longer contribute to succcess with your presence, then it is time to contribute with your absence. In this case it is the dysfunction of the enterprise, not the individual, and if it refuses to learn with an overworked full staff, then perhaps the enterprise will suddenly learn when abruptly short-handed.
And personally, who needs this sort of treatment. You have better things to do with your limited time — literally — as we’re not getting any younger. The bad policy from above is carried out by those below. I think that you have demonstrated courage and real integrity in telling the organization to get bent. You may feel that you have abandoned your staff, but each of them is a free decision-maker as well. You may inspire them, and even if you should never see any of them again, rest assured that they will tell stories of the day Doc got fed up and told the company what he thought of them on the way out.
Nothing tells a story like a story. And your staff has a meaningful, impressive story of the provider side of this healthcare debacle. They will remember.
If you should have the opportunity, I am sure I speak for probably everybody here in asking you to pass thanks and well-wishes (sounds lame, but it’s heartfelt) to your former colleagues and staff. Bad policy comes from above like rocks from a cliff, and the front-line folks have to carry it out or quit.
I think what you did was awesome. When one door is closed, another one is kicked right off its hinges. Nobody puts Kozak in a corner.
You put the ire in retire :-)