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Subject:  Career crisis Date:  10/15/2005  1:31 PM
Author:  xraymd Number:  979 of 1311

Greetings, all, I've written about once a month over the past few months regarding an evolving impasse at work concerning the requirement to document on EMR.

Now I believe a career crisis is upon me. In an effort to "help" me, the management of the practice has shunted all my new patients to other physicians and has attempted to offload me by giving me urgent care patients to see (in their thinking, the new patients are more detail-heavy and would take longer, but, ironically, I am actually faster seeing new patients because I capture their visits 100% on paper). This was decided for me and I was not involved with the "solution." Even more ominously, the CEO and one of the senior partners met privately with me last week to discuss with me their concern for how "wound up" I seem, and that the staff is complaining that I am asking too much of them. They suggested that I get some counseling because I seem so tense and depressed.

Sounds ducky, eh? The truth is that I am tense and depressed at work only - because I have said all along that the real problem I am having is being required to document on the EMR. On paper I am as fast as I ever was. But on the EMR it is taking me literally 3-5 times longer to encode a visit. The second meeting with me was about how I could streamline my input to cut out detail while still upcoding. I am definitely open to suggestions about how to do this, especially from the senior partner whom I respect (and who is himself not YET on the EMR because he had concerns it would impact his productivity - duh!). I am quite willing to learn. But the atmosphere under which this is being conducted is a damaging one: I am being treated like I am defective and solutions are being dictated to me, while simultaneously, nobody appears to be listening to me regarding what I think would help. That's because what I think is at cross-purposes to what the practice wishes to commit to: now we are "all-EMR, all the time" and despite getting high marks from my patients, I am now a liability because I have not been able to adapt.

So I have been witness to seeing all the patients who wished to sign up with me be distributed to other docs in the practice, and I also put the EMR workout to its truest test this past Thursday afternoon (I round in the hospital on all the hospitalized patients of our practice, mine and others, in the mornings) when I was scheduled for a full load of urgent care patients throughout the afternoon (rather than a mixed schedule of physical exams - which take longer, thus fewer patients get seen but the revenue stream is roughly the same for one physical to 3 urgent care patients). As I feared, having to get on the EMR for 14 patients instead of 5, despite the simpler issues, took me well into the evening and I took work home to get on from home to finish it there. I was falling asleep over inputting - was not even done by 11pm - because I needed to spend some portion of the time after seeing patients to also answer phone calls and sign off on labs and studies to be sure to leave work for my medical assistant to do the following morning while I would be rounding. Thus the documentation following seeing the patients had to come last (which would in the past, on paper, have been done SIMULTANEOUS WITH the patient visit and be DONE when the visit was done).

Bottom line: if this is what is in store for me, I am toast. It has been going on like this since March of this year when I was required to go live. I am quite honestly totally drained since all I do is deal with patient documentation and have not been able to get home night after night any sooner than about 9pm.

And it does not appear to be an option to let me do what I was productive doing previously. I am not given the option of documenting on paper now, even if someone else codes the visit into the EMR. Not permitted.

So hence the crisis. I would appreciate ANY comments from anyone who has faced a similar crisis. I am afraid that a bridge is getting burnt here and do not want to be precipitous in taking my leave but this is not a workable arrangement. I am literally depleted and am now witnessing the draining of future practice-building as well as uncertainty from the staff over how to respond to me since I am clearly so exhausted. It's pretty bad when the office manager wrote me a note in a card expressing sympathy for what has been happening to me and offering to help any way she could - that was certainly a nice gesture but it is hard to see how her help could extend to creating a 36-hour day given how I am told I must work.

Thoughts? To say I am discouraged does not begin to capture what it feels like to have spent 9 years in medical school and residency to reach this point. The first two years went well enough in this practice, under the old rules of how to document. This last year has been a travesty and it's hard right now to see how else to do anything any differently.

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