Well, it was probably inevitable. The nurse mentioned someone was pissed at me and messenging her online about it and mentioned "This won't be the end of it."

Sigh.

Well, if it's easier for someone to demonize me and make me into a horrible soulless bitch, go for it. Does it sound horrible that I'm too tired to care or worry about it right now? An addict lied to me, abused medication I gave him inside of a few days, possibly went to jail, and might be the one they said was suicidal yesterday.

And as I type this, she checked the state's jail records online. He's been sitting in jail a while. So it could be just drama in a small town kind of thing. Or it could be something that eventually will come back and bite me in the ass. I tell people all the time I make a convenient bad guy. So there it is.

My third no show intake this week! The day isn't quite as bad as Monday, but hey. I consoled myself with two donuts out of the humongous box that someone brought in. :D

I think I'll write more Avengers Academy fic. I'm only up to the Spider-Man event, after all... :)

ETA: Of course once I hit "post" the intake showed up. And oh my god, this poor woman. My heart goes out to her, and I feel so bad for her sake. She needs more than medication, but culturally it's taken a lot to get her to even come in for medication. Her story makes me want to cry. :(

I have seen ONE patient in my office this morning. ONE. So I could do telephone testimony in a incapacity hearing, did chart reviews, answered messages, signed a packet of scripts, and cleaned off my desk of material that's been here since at least October. WHEE!!!

There's something about a cleared off desk that feels wonderful.

I have old journal articles in the filing cabinet, as well as therapy things I had hoarded over the years since training, but I can put them together in a little bit. I am treating myself to my lunch a little early, then I can do that or go through my patient list and discharge the ones on the launching pad to get it under 700.

I know my quotas are going to take a hit after today, but whatever. *I* was here!

Names redacted to protect the not-so-innocent (namely me) I just got this message that was sent to the clinic director:


“We are grateful that * was put in our daughter's life to help her through her difficult journey with schizophrenia. It is very unfortunate that there are so few psychiatrists available in our area to treat so many affected with mental illness. Please let her know she is a blessing and appreciated... (Sometimes, the doctor gets the 'blame' when someone doesn't respond to treatment in our time frame. We seem to feel the need to put it there because there is no other place to put it... * has a way of making you think rationally in an irrational situation. Her calm demeanor & personality gives us the strength to be faithful - patient.) “



“* is an asset to this community. Her knowledge of medications, willingness to work with us. Consider our experiences with our daughter are invaluable.”



It's good to be appreciated. :D

I haven't really updated much on the personal front because there hasn't been much. Or, there hasn't been much that seems worth updating when I've been getting so tired.

Jedi has been doing great integrating into our family and our last training class is tonight. I've slacked a bit in the training in recent weeks, because more often than not, trying to sit on the floor and do sit ups after running through some exercises means I fall asleep on the living room floor. I've even gone to bed early a number of nights. I still probably could use another day's worth of hours of sleep.

Work is work. Lots of intakes lately, lots of follow up. Admin can say we're not doing enough, but hi, it's psychiatry. Insurance pays for shit, half my population is on medical assistance that pays for shit, and breaking my neck to try racking up anything isn't worth it. I meet whatever quota they set on visits anyway, so I'm not changing how I practice. Whenever I point out things like that, it gets dismissed, maybe because they really can't change the payment contracts, I don't know. They make it clear that I'm pulling my weight, but the constant harping on finances is grating. I know they don't want me to jump ship and go anywhere else. It's pretty sad if the recruiters open with "Your long tenure is impressive" when I haven't quite been here seven years. But since most places do two year contracts with their bonuses and then phase it out, I guess it is. I like who I work with, I like most of my patients, I like my home and neighbors, my kids are happy and comfy. I do have plenty of options even if I'm not here, within an hour's drive, and everyone knows I don't mind driving. So they probably humor me.

Maybe I'm getting salty about this because of the upcoming EMR change. The therapists are panicking, because the test domain doesn't work well, and the NP barely can even use the one we have right now. But she felt bullied into signing off on the one training day we had. I refused; five hours of poking at something that only halfway worked isn't enough training to be competent to create a trustworthy medical record. I will not be bullied and cajoled into signing anything I don't agree with, I will not budge, and that is that. I'm not too worried about it, because I learned the current system on my own. I'm sure poking at a working server will help, so I'm not wasting any emotions over it like my colleagues do. Then again, I'm more comfortable with computers and such than they are, so that's probably why I don't have to worry.

I'm sure it'll all be okay eventually. Maybe I'm just burned out feeling and salty because of everyone else's distress. Or absorbing the distress of my patients; sometimes I get so brain numb that I stare at a computer screen and can barely write or create anything for the Pathfinder game on Saturdays. Too many dumbass kids that think they'll be fine with drugs, or that overdosing isn't such a bad thing, or that they can quit on their own even though they haven't been able to for the last ten times they tried. Or the depression that's hard to treat. Or insurance denying payment for meds and requesting all kinds of records in an appeal just to deny it again.

The field can be utterly soul crushing, and not because of the patient load.

Not exactly looking forward to today.

There's a lunch meeting where administration is coming in for the Providers meeting. (Oh, how I loathe that term. I am a DOCTOR, and I'm still paying off the expensive piece of paper on the wall, WTF) They had apparently started a board to determine if primary care/walk in docs are seeing "enough" patients or if they're meeting expected quotas of patients. And if they don't, they're expected to put in more hours or days to meet that quota.

This is shaming bullshit. I said so at our department meeting, and I plan to say it again today. It's a shame when my six and a half years working here becomes the lead-in for recruiters to say that the length of time I've been here is admirable. It's a shame when I'm seen as disposable and interchangeable as my patients. Psychiatry is the redheaded stepchild of medicine, not really taken seriously until we're needed, and even then our opinions mean fuck all.

I keep a patient list. I curate it and drop the names of those no show out of the clinic or simply don't return. That still leaves me with 681 active patients on the list right now.

Fuck admin if they think I'm not busy enough or working hard enough. This leaderboard bullshit is not on, and I am not going to participate in it. As in, they're going to make the already front desk staff keep track of even more stats than they're forcing them to, but I am outright going to tell them that I'm not going to look at that board. I'm not going to change my hours of practice when I'm already booked full from 8 am to 5 pm five days a week with a wait list to see me and not enough time to do the paperwork or letters asked of me. Because a lot of it CANNOT be punted off to the nursing staff, and they're already stuck with doing the prior auths and all the other bullshit that insurance companies and Washington wants documented.

And then people wonder why there's a deficit of doctors, let alone psychiatrists. Once they realize this is what medicine has become, they walk. There are better ways to make money.

Happy New Year!!

I've been busy with work and/or children, so I didn't get a chance to post up anything sooner, even on the days off I had from work. I took the time to write instead when the boys were at day care and Maddy had a play date at her friend's house. So in between three and a half loads of laundry last Tuesday, I managed to write about 9 pages in the Yggdrasil series, finishing it off. O_O (Well, there's a way I can bring a character back to extend the series if I really wanted to, but it does feel complete and my beta reader just got back to me agreeing with that sentiment.)

There was a bit of a fender bender on December 23 while I was out with Maddy doing a little erranding before we went to see "Sing." (Awesome movie, btw, really good!) As in, we were both in the parking lot backing out at the same time. The guy was young and he had just gotten the car two weeks before, so he was upset about the scratches on his truck bumper. He insisted on calling insurance. Sigh. I mean, I'm not going to tell him what to do, I understand being upset about it. But sheesh, not worth the effort of getting insurance involved, IMHO. Both insurance companies feel it's going to be a 50-50 thing, maybe more my fault because he was out further and about to drive, but he didn't see me either. We'll see what happens with that.

Christmas was fun, and some relatives still have gifts to send, from what they told us. But there were still a lot of gifts to each other and from Santa, and I had Maddy write thank you cards. Instilling the etiquette early, folks. :D Jason worked for a good chunk of the holiday, and we switched off days last week to watch the kids or work. I even called my parents had a great conversation with BOTH of them. Mom wasn't feeling well, since she caught a nasty cold, but we talked about the holiday and kids and extended family. Not one word putting down my life choices, yay. And then my Dad came on to chat for a bit and say hi to the kids, and was righteously indignant on my behalf about the ETO cashout debacle, and agrees with me that I should just TAKE IT ALL in 2017 and be with my kids because they're disincentivising working all the damn time, which I really shouldn't do for the sake of my sanity and family anyway. Tho they push to see more and more people so they can balance their budget on our backs. Uh, no thanks. Rumor is that the hospital system is going to be bought out in a few years' time, and the company that might do it is more inclined to give doctors more benefits and assistance. I can prolly hang out that long, my kids are settled in here and have friends at school.

Yesterday, Jason went nuts home with the kids. Poor guy. Maddy was so upset to hear him grumble at me that he had the impulse to sell them after the day he had. (And you think I didn't have that on my days with them, huh?) I managed to talk her down a bit, but later had to pretzel Nick because he had a screaming tantrum and was starting to flail. The first time I had to actually pretzel my own child. Sigh. But he did eventually calm down, we snuggled, he wailed some more, and eventually I got his diaper changed and put him into pajamas like I wanted to do in the first place. I even managed to be calm the entire time, while Jason was all growly in the living room telling the older two not to interfere. He did calm down enough to read to Zach for a bit.

Avengers Academy, guys. THIS GAME. It owns me, and I spent gobs of Actual Money in the past week to buy generators and shards to get stuff. I only somewhat regret it, in the sense that this is the season of bills and we spent a lot on other stuff, too. But I actually do adore this game, so I can't regret it too hard. I get paid this week at least. :D

Work. Lots of it, and it never ends. Some days are better than others, and I'm updating now rather than going through my schedule to look for more intakes to do chart reviews, or going through my patient list to see who's on the chopping block. That's more effort than I want to spend on stuff that only I seem to do around here anyway. I'm caught up with all the messages for upcoming intakes, I can give myself a little break, right? Right.

Yuletide reveals are out, so I'll do that in a separate post in case no one really cares about the fic stuff. Or people that care about the fic stuff won't care about the personal stuff. It will surprise exactly no one what I worked on, tho. ;)

It's -2 degrees F outside, and the windchill has it less than -20 most of the time. Yet there are people waiting at bus stops without hats or scarves or gloves, not even huddling for warmth. And there are the inevitable people walking around in shorts. Meanwhile, I have my hat and winter coat and gloves, and my hands were still frozen stiff and reddened when I got into work this morning, and I was hunched over a bit as I filled the gas tank this morning. What is this state?! O_o

People always blame the full moon for weird behavior. Maybe that's why I was woken from a dead sleep at a quarter to two am (because I'm on call and it switches over at 8 am, lucky me...) by a dude stating he had panic attacks. So I'm talking him through it and telling him to call his doctor when the clinic opens in the morning, because he claimed to be on medication. Then his girlfriend yanks the phone from him and says "This is what's really happening," and at first I thought he was off his meds or kicked out or something. No, it turns out that SHE is the one with panic attacks, and it was bad enough she wanted to go inpatient a while ago. Well, our county doesn't have one, so our ER told her to go the other hospital system for inpatient help. Which didn't help. She never got around to getting a psychiatrist, and had panic attacks all day. I was explaining that she could call the intake coordinator to make an intake appointment, since we only have an outpatient clinic with our hospital system. The soonest appointment (since I happened to talk to her earlier yesterday after there was a snafu where I was accused of taking all the pizza that was left over from lunch when there were three boxes left when I went home and it turns out the nurse was concerned about the kringles that had been delivered that I never even touched, but that's a whole separate rant...) was in five weeks. Because it wasn't immediate, the boyfriend was upset about how broken the system is. Which I don't disagree with, of course, but I almost told him that the other hospital system has an eight month wait to see their psychiatrist. If they even see her, because they screen with a therapist first and usually refer back to the primary care doc.

Ugh. So, needless to say, waking at 4 am was difficult, but I did manage to haul myself out of bed eventually, and even went on the treadmill to wake the hell up. Ugh. Not pleased to be conscious even now, because EVERYTHING at home in the morning dragged ass. it's a good thing I keep makeup in my desk, so I could get something on my face. Because of course my skin still thinks I'm an adolescent, so it's blotchy.

Here's hoping the rest of the day looks up. Tho it's scheduled full enough that it may be another day with no bathroom break until lunch...

Feeling pissy right now. Not sure if it's warranted or not, but I am still pissed.

One of my patients went to a rehab/nursing home in the spring. My last contact was in May, and I found out after the fact that care was transferred to my colleague that visits that nursing home. It was a convenience thing, so I didn't take it as a slight.

Fast forward to a few weeks ago, she wants to see me again. I am fine with that, and the intake coordinator set up an appointment in December to catch me up to speed. I didn't think anything of it.

Then on the 17th, I am told that the ER is demanding that I see her, and somehow she was shoehorned into my schedule. I am shocked at how far she deteriorated in a few months.

And then today, the clinic manager forwarded a complaint about me regarding her. I apparently had ordered the trip to the ER, had no communication to the ER or family, said I was too busy to see her and that I refused to answer questions about it.

What. The. Fuck.

I am just pissed right now. I told the clinic manager to check the chart, I didn't get involved until the 17th. I had nothing to do with whatever the complaint was about, and he said that the one lodging the complaint has a beef with behavioral health. I'm not mollified in the slightest. This is still upsetting to me. I do what I can, help when asked, try to do a good job. Basically administration only cares about numbers and meeting their bottom line, and don't actually know what is going on. Crap like this makes me feel unappreciated and angry. I will probably be calm by Monday, but it's shitty and I don't like it.

I get offers to work elsewhere by recruiters all the time. They call my cell, I've had messages on my office phone and once even on my home phone. They send e-mail and snail mail to both work and home addresses.

This current e-mail is currently calling my six and a half years where I am a "lengthy run" and "a very impressive accomplishment." (Yes, direct quotes) It just boggles my mind a bit.

Are there really so few people that don't move around and switch jobs every other year? I mean, I knew people didn't stay here very long before me, as one patient mentioned she had seven different doctors in seven years before I moved here. But six and a half years being a lengthy run? What?

Then again, since I see kids, too, I already had reminders of time passing: boys coming back for the fall med checks and they sprouted and had voice changes over the summer. Seeing kids not only graduate high school, but college as well and I'm adjusting meds as they move through their first jobs. Seeing kids of patients grow from babies to toddlers. MY OWN babies turning into toddlers and school age kids.

If there are too many bullshit demands, I know I can pick up and leave at any time. But I guess I never thought of six and a half years in one place as impressive. I suppose I can start thinking of it that way, especially if the nurse practitioner is updating her resume this morning...

Okay, I wasn't really on vacation. I was at a conference in NYC, so it was nice to see family and former colleagues. It was almost like a reunion, and I was caught up on the gossip going on there for the past six and a half years. Half of the couples are divorced, the Old Guard of attendings and even the nursing staff are all gone now that there's a new medical director. I attended some really good classes at the conference, because I'm a geek that way.

It's a two day drive each way. Going there, we pushed as far as we could. The first hotel I found online looked like the scene of a horror movie murder, especially since it was right off the highway and there were no street lights. We doubled back to a pricier but safer looking one, though its brand new restaurant was really slow even though there weren't many people there and we ordered simple meals. On the second day, Nick threw up as we crossed over into NJ (an appropriate response, IMHO, lol!) There was terrible traffic across the GWB and Cross Bronx as always, and we certainly didn't miss that. We got to my inlaws, and it was great to see family again. Jason felt bad because there's some wankery on his side of the family for a change, but it's not something that directly affects us. It's more that his niece and her boyfriend are living in the basement, and my inlaws are pretty much raising their great-grandsons. While Jason and I don't want to assume anything, it does look like neither are really that concerned about getting their own place. And on top of that, my FIL wakes up early to fry an egg and sausage for the older great-grandson every morning, because he refuses to eat breakfast otherwise.

When Zach got sick with GI issues, we had to cancel lunch with my parents, but they actually drove out to us. O_O It was the first time they've met my dad, who was very nice throughout the visit. They took lots of pictures, my Dad made conversation, and apparently made mention of how he's going to be 70 in January, and really has started to appreciate things more. Glory Hallelujah! I even talked to him on the phone coming back from the city via train, and when we were almost home on the way back. Of course we got loaded down with food and clothes and vitamins and other gifts and tchotchkes, not all of which we kept, but it's their way of saying that they care. Which was nice. Usually I just get ignored or lectured to death. Maddy and the boys watched way too much TV and had dessert every night at Grandma's, and enjoyed playing with their cousins. We did have Maddy do her "homework," which was journaling every day what the events were. She had already done her math worksheets before we left for NY. She loved being there "on vacation" while I went to class. Zach intermittently had other GI upset around the time we were heading home, and even at school on Monday. Poor thing. But he did okay enough to go trick or treating like a champ.

So now we have oodles of candy, so the kids all get one piece a night instead of waiting for our usual dessert on weekends only routine. I have to say, we're definitely stricter with our kids than my SIL or niece, or even my colleagues in child psychiatry. O_O

I did do some networking and met a new friend in the field. She lives in TX and is another geek! So I'm sort of being roped into doing the same sort of thing she does. Tho honestly, coming up with book lists for kids and adolescents isn't exactly a hardship. :D

Ugh. More piles of work and messages to sort though. Most of it got done, tho!

I feel like I haven't updated on Real Life in forever. Work is in the busy season, and the kids are busy with all kinds of activities. School is going well for them, and Zach varies between loving on school and hating on reading. He loves being read to, though. He just doesn't want to read for himself. Nick had an episode of high temperature (not quite feverish) after the last bout; I took a look and he's sprouting some molars. O_O

Jason's been off on Saturdays, so our usual routine of Story Time at the library and then going to the farmer's market is off. Last weekend we went to Pumpkinfest, though, which had a very expensive breakfast and a lot of walking, as the bounce house and other younger kid activities were all price gouging. Since when is a single trip in a bounce house $5?!? In our home city, it's usually 50 cents a ticket and $5 for an all day pass. Sunday, the kids pretty much ran around the neighborhood. Church had a really good demonstration on what world hunger is like for 70% of the world, and it really struck Madison. She went around with the ELCA donation box and asked for me to keep one at work. She hopes to raise more money, because the neighborhood donations is enough for a beehive, but "Those families need chickens and cows, too!" Times like that, I'm so proud of her generous heart. But she's also eight, because this morning she was chasing the boys around the house while playing with them, screaming like a banshee and preventing the boys from getting ready for school.

This weekend, Indy gets boarded for a week or so, and then we drive to NY so I can attend a conference. We're going to stay with my inlaws and meet up with my parents for lunch on Monday. The kids are really looking forward to spending time with their grandparents and cousins. I plan to be armed with notebooks to work on my Viet themed novel and some Yuletide fics. I may have 940 words in my gift so far. :D

I generally work pretty well with others, and I do like the people I work with. Most of the time. The MA I complained about before has gotten better at the job, and does ask me now what needs to be done rather than just ignoring it. And I'm pretty forthcoming about that kind of thing, it's not like I'm bitchy about it. Like, if there are letters asking for return to work status or accommodations at school, she knows my messages back to her saying "Okay to write letter stating they have x and would need assistance for classes in school" means to write that as the body of the letter. No secret lingo, I promise. sometimes wires get crossed, but it's pretty clear going now.

No, the one irritating me right now is the NP. Because she saw me this morning and was talking about one of her patients, who she had asked me for advice on in the past. Apparently this is someone very anxious, and had never been on meds before the NP put her on them. She maxed out one antidepressant and tacked on an antipsychotic which is damn near maxed out. The NP looked at me and without a lick of artifice said she had no idea what to do. Um... switch antipsychotics or antidepressants? There are twenty something different antidepressants and this lady has never been on anything before. The field is wide open, unless there's something the NP isn't telling me. I know she's not good at computers or the EMR, but apparently she's on call today and got a consult request. She asked the MA to look for any "intake information that can help me" and was very vague about it. To the point where the MA was looking through our chart room and the EMR thinking this was one of the NP's patients, but we can find no record of it. I even help digging through the EMR, all the way back to early digitized records from 2007, when the hospital system first instituted them.

And nope, it turns out this is a consult, a new patient entirely. And the NP can't even do her own chart review to see why she's being consulted. Or, you know, calling the doctor requesting the consult. ::face palm::

No wonder most of my patients tell me I can't ever leave this place.

Oops. I haven't posted in forever. Some of that is that there isn't a whole lot of news. The kids continue growing like weeds and intermittently deciding it's a good day to ignore everything I say, or that they're going to be adorable dweebs that make being a parent worthwhile. There was about a week between Maddy's Y Break summer day care and the start of school on September 1, so she was either in one of the spare offices here or with Jason. She bored easily, so twice I commandeered her to "babysit" kids in my office while I talked with the parent. (The parent okayed it, and I think it set their minds at ease that their baby could play with stuff and not fear them swallowing random things.) She picked up knitting again and intermittently worked on a scarf that she'll give to one of her brothers; odds are good she'll be done by Christmas, lol.

I've written a bunch in fics and I've been reading books a lot. I even review some online under my pen name, and I've tried working on my novel. Gmail is being weird with sending stuff to the junk folder despite me marking it off multiple times as Not Junk. If I don't reply to you, assume that's part of the reason and keep poking me. Pathfinder has moved to weekly from biweekly, and I scribble a bit in the next novel in a notebook. I just started chapter 3 on Saturday night. It's slow going because there's so much going on, but I'd rather go slow and steady and do it right. Especially since the new one involves Vietnamese culture so much. Tho I just sent my heroine and her sister and cousin sideways into another dimension, so I probably don't have to angst quite so much now. heh.

And it's September! The busy season at work is beginning, though I've had TONS of intakes. at the moment I'm using cancellation time to go through my patient and whittle it down from 660. I'm the only one that actually does it here. Just like I'm the only one that does chart reviews, or some of my own letters and paperwork. Because the others are too good for it or something, IDK.

Okay, back to work with me.

It was a nice and relatively stress free weekend, and I may try to get on the computer tonight and do a proper picspam. :D

Anyway, I did talk to the clinic director about Thursday and Friday with the MA. Hopefully I don't get thrown under the bus and she hates me for it, and I specifically stated that I have no problem with her as a person, but I have concern about the "I didn't know how to do it so I just didn't do it" comment (and apparently the patient's father is a bigwig, so he's definitely going to look into it) and the "I don't feel like dealing with her so she'll have to wait until Tuesday" comment.

So, we'll see what happens...

To cleanse my brain's palate, I'm going to post smutfic. :D

Is it really petty of me to be freaking irritated with the MA taking so damn long to do the vitals and PHQ-9/PSC-17 before I see my patients? I run 10-20 minutes behind because I don't know if she's done it yet or not, and then when she does, she takes a long time doing it. Plus, there are times when she doesn't know what medications do or how to field questions on her own like the nurses do because she's never been in psychiatry before. I have some patients that complain about her attitude on the phone with them, complaints that she doesn't answer their questions, and apparently there was a letter I asked her to write for me that she never did because she didn't know how to do it and never asked anybody how to do it. I only found out when I got a message from the patient three days later and asked her, and she said "Oh, no, I didn't know how to do it, so I didn't."

What. The. Fuck.

This is her first time working in psychiatry. Before this she was at a nursing home. I understand this is different. I'm trying to not act bitchy and be understanding. But if you don't know how to do your job, ASK SOMEBODY. I'm pretty damn approachable, she should have said something and asked me about it. Okay, I know this post doesn't sound like it, but I'm pissy atm, and I actually gave her a list of all psych meds ever made EVER when she started and wrote on the list which ones could only be printed, which ones printed/call in and which ones were call in. I know prior auths are a bitch and a half to do and every damn insurance company requires an auth because they don't want to pay for anything anymore, but Jesus fuck, let me know if you're not doing something I asked you to do so I can do it my damn self, because I actually do. I get irritated when not running close to being on time because it throws off the schedule for me and for everyone else that bothered to show up on time, and I see it as disrespectful.

And I saw someone else in the office with her, and she was talking about classes she was taking and how it was at her nursing home before, and complaining about the paperwork and patients being nasty to her on the phone when they run out of meds after no showing appointments. No one introduced this other lady to any of us in the office (reception staff had no idea who she was), neither of them introduced her to me, and it slowed everything down even more this morning.

GRRRRRRRRRR.

I miss my nurses, man. Administration is so freaking shortsighted about the bottom line sometimes. I know why they do it, because the medical system is falling apart and the buck is being passed to us. But it's going downhill fast.

My mandatory education day tomorrow was just cancelled about a half hour ago. I have no intention of using my ETO for that, so apparently I will have last minute patients and lots of time to write.

Always nice to be told "You need to stop being so good! Not all the new patients can have you as their doctor!"

Heh. Though if I start screwing up, I'd get fired. Oh, well, I guess I'll just have to keep doing what I do. :D

I know it's not my fault, but I still feel like a dick right now.

Context is necessary for a statement like that, of course. But about a year ago, there was talk about moving us to a different part of town, and it never materialized. Late last October, after my outburst at the clinic director about being overwhelmed and upset, there started to be rumors about splitting the staff here between this location and Internal Medicine to start the integrated care movement. It was mentioned at the November staff meeting that it would happen it December, but it never happened. Mostly because administration has no clue how to make it work as a reality.

Around that same time, the clinic director and his boss came around separately to each of us prescribers to ask about the paperwork situation. Remember, these are also the same people shocked that I do chart reviews and some of the phone calls and paperwork myself. If they could get a medical assistant to do that paperwork, could I see more people? Probably. Then the real issue became the finances, because then instead of two nurses, they would want to have one nurse and two MA's to cover all the paperwork, phone calls, urine drops, etc. I know my response was that it made sense from a paperwork aspect, but I would feel terrible about doing that to the two nurses that we have. We're practically like family around here. She of course asked me not to say anything about it, and I didn't. Mostly because I thought it was a lot of hot air like moving us or splitting staff.

Apparently, it wasn't.

Yesterday, the clinic director talked with the two nurses. I didn't know about that until late in the day yesterday when I saw one of them crying. She told me that apparently that move is going to be made. The two nurses we have here will have to reapply for their job, essentially competing for the one slot. They're going to allow the other one to apply elsewhere in the hospital network, and actively recruit to find two MA's to do the paperwork and such.

So yeah, I feel like a dick. Jason says it's not my fault, if I had said something months ago and they didn't do anything, I'd've made them worry. But I feel like a dick, and so does the NP, who had come in here to talk to me about this a few minutes ago. She talked to the clinic director yesterday about it, upset, and his response was that it had all been discussed and agreed upon months ago.

God, I do feel terrible. This is completely shitty. Maybe I should consider listening to recruiters when they tell me there are jobs out there willing to pay me $400k+ a year plus loan repayment. But at what cost? What am I going to have to do for a payout like that? Because I refuse to be a pill pusher. That's not why I got into this line of work, and I have the feeling that's what they would want from me.

Man, I love the surprise on peoples' faces when they hear I do some of my own paperwork. /sarcasm.

They act like it's new that I do some of the prior auths (very few, but still), FMLA or disability paperwork, letters to schools, chart reviews, keeping a patient list, doing discharge notes, all that stuff. The other two prescribers and the clinic manager had a lunchtime meeting today to figure out the best use of nursing time and how they could justify hiring someone else to help. So the upshot is, if we get another person to do paperwork and running urines to the lab, then we see more people to cover the cost. One of my colleagues mentioned rooming people in different offices and we duck in and out like primary care does.

Um... No. I really wouldn't be able to do that. Or maybe more accurately, I don't want to do that. I'm not a medication factory and I refuse to act like one. Maybe his patient population could be, one segment of it at least, but I would never do that with the kid patients, the developmentally disabled and some of my neurotic adults. I'm probably one of the few psychiatrists that actually talks and does some therapy along with dispensing pills. And one or two have said that I'm the only one they know that actually takes herbal remedies and CAM therapies into account.

::headdesk:: No easy answers for anything. But I resent being made to feel like I'm not making the hospital enough money or not seeing enough patients when I know that even with no shows, I regularly see more than the set capacity limit.