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Subject:  Re: OT: Career crisis Date:  10/16/2005  11:27 PM
Author:  xraymd Number:  212680 of 312945

Greetings, JAFO, let me answer your questions one by one:

---1. Was that the parner doctor who is still not on the system?

Also, with one doctor not on the system, how can the practice ethically claim to be 100% EMR?

The partner doctor still not on the system was not the partner who participated in the site visit. The one who did is thought to be one of the computer-savvier of the practice. And I don't think the claim that we are 100% EMR is meant to be final yet - it represents the INTENTION for the practice. I, too, am waiting to see what happens when the senior partner is supposed to go live next March. Perhaps he will take to it better than he thinks but I am predicitng that he lasts a week, hurls the interface through the window and insists that someone else do his documentation while he continues to do on paper what he has excelled at doing for 30 years now. I could be wrong, but that's what I'd wager. He's at least as much a perfectionist as I am.

---2. Is the CEO a doctor? To whom at your EMR vendor is the CEO related? Or what else is the CEO getting in return?

How ironic you should ask this. I have on occasion wondered the same thing. The CEO is definitely not a doctor. He is a businessman. I would believe that he could easily have cut a side deal but I have not a shred of proof of that and it would be ugly to suggest it, though it is not hard to think it. I will say this, though: the email I sent him on the system last January has gone unanswered because he does not know how to sign on. So how can he profess to know whether it is easy enough to use or not? He pretty much goes by what the young maestro doc succeeds in doing. Heck, if I could succeed in doing what the maestro does, this thread would not exist! (and I LOVE this doc but realize he is in a category by himself, and I think everyone who works with him also realizes it).

---3. Who runs risk management at the practice? A discussion with your risk manager/professional liability issuer might straighten out some of the problems (or make things much worse for you, at least until you leave). Spotholder codes that are never replaced; less than adequate records lacking detail. I hope you get out before the big malpractice hit that is inevitable occurs.

Risk management is masterminded by the office manager. She is pretty astute. One of the first things that came up in the conversation we had this afternoon related precisely to issues of incompleteness of documentation and the liability it confers, and that was not initiated by me. So she gets it. She also completely gets that despite all the talk about my needing counseling and needing to streamline what I've done successfully before (wrong on both counts), it simply may never come to pass that I get synchronous on this system. It is finally dawning that since they did not plan for failure (leaving aside how badly they have burned me out over this), that there is going to be a latter-day cost. They are simply going to have to either spend money on offloading me - or on unloading me. In the latter case, they wouldn't be paying a doctor's salary to me anymore but they would have to find a way to cover all the patients I DO see daily in the hospital as well as the patients I have seen in the afternoons. And since the schedule of the other docs has filled up to the brim, there is no-one else presently available at the practice to pick up the load. So they will have to go out and hire someone, which they've been trying to do for over a year without any success. The next most likely candidate does not graduate until next June. One never knows; perhaps they will get a good resume tomorrow, but the fact remains that there would be a ramp-up cost to replacing me that would not be any smaller than to hire a coder to give me a break and let me get productive again as I had been, which in turn would bring in even more revenue than has dried up since March and my going live. It's fairly simple math, really. And if I had to state it in human terms, it seems outrageous that they would ever have let this go on for so long. Does the idea of hubris seem out of place here? I am no longer the darling of the CEO given that I have not performed according to his plans. But nobody seems to be listening to me what it would take to get me back to that level of performace. We are 100% EMR, you see, so what I need to have to get my work done timely and completely has been taken away from me. I've felt far more like a yoked ox than I have a respected colleague and the office manager definitely knows this. But the decision rests with the partners and with the CEO. It rests with me, too, and I am as willing as I've ever been to simply walk away from the paycheck and reclaim my life and my sense of internal equilibrium. There will be changes made this week, even if they are not the final solutions. And forward progress started with posting here and laying it out for consideration and feedback. Thank you so much for yours.

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