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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
Then there is this:
Good grief.
The man in the cubicle across from me has worked at our factory for 42 years. He spends most of his day spinning his chair around in boredom. He’s kind of gone loopy. He talks every day about his plans to retire. I keep hoping for his own sanity that he goes sooner than later.
It sounds like you have more than earned a respite, Kozak. Maintaining a pace like that can’t be good.
Of all the people to work with (both civilian and military) the worst are “short timers”. It wouldn’t be so bad but I recall some that “unofficially” retired years before they went out the door for the last time.
The physical jobs have at least one good part: They end in accomplishment. If you have to load heavy objects onto a truck, you know when you are done that you have succeeded in your immediate task. If you have to paint a house, you can see the result. Other types of jobs don’t necessarily offer that. You wear yourself out and there is no sense of closure. That can be hard also.
I used to work doing billing and insurance work for a major hospital network. It was endless. They like to drive up volume. Everyone was taxed and burned out. This is what corporate hospitals do. It is awful. Nothing about it is healthy or good for anyone. All they care about is metrics and getting as much done. It strips people of their humanity. We need an overhaul of our entire health system. Insurance is garbage. They are crooks. And there is a lot of cronyism going on from top to bottom.
Crikey. I got into television expressly to avoid work and responsibility.
Of course it is, but is it the hardest on the planet? I don’t know. Social workers, pastors, missionaries, all deal with emotional turmoil like you describe.
There are guys undercover posing as customers to bust child sex trafficking coping with the first hand experience of things like baby rape. Talk about hard.
A cop buddy of mine once told me about a kid they found who’d been holding his chin to his chest for hours after his mother tried to cut his head off.
There’s plenty of hard out there. Doctors experience just one kind.
That is nearly unbearable too.
But what makes doctors’ work lives extraordinary is the responsibility they shoulder for human life. There’s no wriggle room for error.
Kozak is an ER doctor. That takes a very special personality. He has to be a very decisive person.
I was in the ER for almost a whole day and night with my mom because she was having heart issues. It was a very strange place to be. At one point I thought the staff was just sitting around doing very little.
Then I heard sirens and phones ringing. The next thing I knew the doors swung open and there were four ambulances in the passageway, with two more on the way. These people who had seemed so nonchalant and relaxed suddenly sprang into action. There had been a major traffic accident on our local highway. The speed at which they were working was unbelievable to me.
This is who they are. This is what God created when he made these particular people. They are smart, decisive, and accurate. Diagnosis under those circumstances takes a unique mind.
There are not people this earth I have more admiration for.
When the Boston Marathon bombing occurred, the ER crews were extraordinary. There was quite an article in the Wall Street Journal afterward talking about how many lives and limbs were saved that day by doctors who could not and did not hesitate.
There are hospital administrators out there who are doing a terrible job of managing talent.
There should have been an administrator in Kozak’s urgent care offices making sure that things were going smoothly for everyone: the staff and the patients. And based on the person I’ve gotten to know a little bit on Ricochet, he belongs in a level 4 trauma center. I hope that’s where he ends up. It’s certainly what a decent hospital administrator would have realized.
We’re heading for a real crisis losing doctors like him.
How about White House Spokesperson for Joe Brandon.
Actually, she makes it look pretty easy…
Yep.
Big reasons I went to private practice as a therapist.
Power brother!
I have heard that described as Retiring in Place (RIP).
In the Navy it was called the ROAD program-Retired On Active Duty.
Thanks for all your hard work over the years.
I wish there was a way to keep older doctors around part-time and working at a slower pace.
It sounds like the only solution is just to quit your job every few months when you get exhausted or fed up. That’s not much of a solution.
Uh, didn’t we just do that?
I think it was in all the papers.
The half life of the initial bolus of medical knowledge may be 8 years, but a competent physician is constantly adding new knowledge. What we did 36 years ago is indeed irrelevant to what we do today.
Consider the work I do most, therapy for osteoporosis. When I came out from my residency and fellowship in 1989 we had Premarin, fluoride, vitamin D and calcium. We did not have bone density testing. We added calcitonin nasal spray in the mid 1990s, We added alendronate in 1999, and the dam burst, we now have a half-dozen good therapies with the last, romosozumab (I did not make up that name!), introduced in 2019. Others are certain to follow.
The 36 year rule will bring me to 2035, when I will be 69 years old. That last fact, rather than any putative decline in my medical knowledge, will be reason to retire.
Consider me again in 1989. The wealth of therapies now available was unimaginable. One can look at it the other way, too. In 1953 the disease was not even accepted as an entity.
Times change.
So.
An internist, a surgeon and an ER doc go hunting.
A bird flies by, and the internist raises his shot gun and yells, “Duck, rule out goose, rule out pheasant, rule out quail ” and never pulls the trigger.
A minute later another bird, the surgeon whips up his shotgun, and confidently yells “it’s a duck” and fires.
A couple of minutes later another bird. The ER doc raises his shotgun and empties the magazine filling the air with lead, turns to his buddies and goes “what the hell was that!”.
Bulwark writers.
I was a mason tender the summer before college – doing all of the above, including cement bag schlepping, loading cinderblocks onto staging, pushing that wheelbarrow filled with wet concrete all over the site and some on narrow boards (note that heavy, high loads making tipping over real easy like).
But I didn’t have to make life or death decisions at the drop of a hat, or worse, deal with the federal health care bureaucracy.
That seems worse.
Kozak – that is so grueling, and you are right, so abusive. You have served our country, and the sick and we are grateful! No one should have to endure this. Corporate profit and lack of support are driving this country into the ground. It’s terrible all the more because people are sick and need quality care. Thank you Kozak.
Okay I’m going down a rabbit hole here. Quite possibly the most astonishing “metric” (to me) everyone focused on through the panicdemic has been hospital capacity. What percentage of beds are filled? How many remain open? Then break it down by ICU beds. Have to get that percentage down as close to zero as possible!
Not necessarily defending big corporate health care, but how can such a huge chunk of the population not grasp that a hospital full of empty beds won’t be around long? Hospitals are businesses. Businesses first and foremost (at least last time I checked) have a responsibility to make a profit. They can’t make a profit if all of the beds are empty.
Apologies – everyone can now return to their regularly scheduled conversation.
Valid point. But, it’s not just the beds involved, it’s the people. And everyone I know who works in the hospitals is exhausted. We’re going to pay for this crisis with huge shortages in medical professionals and when the medical schools start accepting lesser candidates to make up the difference, we’re going to pay in poor quality.
Also a valid point, although I would suggest the shortages in medical professionals are much more due to the politicization of covid than it was to the virus itself. In my state there have been over 1000 of them who have been fired for refusing the jab. Simply astonishing.
Like I said, it was a rabbit hole.
Mr. She used to call them the “in-service retired.”
Keep your head high @Kozak. They thought they were your masters. Now they know better. I would bet that the management folks running your clinic work normal 8 hour days. How arrogant can they be?
LOL. I’m sorry I missed it.
The redaction notation makes it sound a lot worse than it really was.
My wife knows a nurse who was laid off during the height of COVID. All “non-essential” procedures had been cancelled in order free up hospital space for a massive increase in COVID patients which never happened. Due to the huge loss of revenue, the hospital had to start cutting costs, i.e., staff.