Saturday, January 22, 2011

The Way it Work

Several months back we four kidney docs decided that for sanity's sake, we would upend the way we've traditionally divided our "work" (that would mean the clinical load: outpatients and inpatients). For years we operated a practice that had each of us following patients in the hospital as well as putting in a full day's work in the clinic seeing outpatients.

The system worked well with the hospital and downtown clinic rolled into one, large self-contained unit. Fortunately, our practice has never required us to jump in the car and drive to other hospitals to round/consult on  inpatients. However, several years ago, our practice model fragmented as all of us took on responsibilities at satellite clinics around town.  We kept the one hospital model but traveling far afield became the norm. One of my colleagues flies on a (teeny tiny) plane to a site on the Olympic Peninsula several times a month. Glad that's not me (sigh). The rest of of have a more civilized ride on the freeway to one of several free standing clinics. Our patients are delighted to see us at a facility with FREE PARKING and closer to home. Good for all. Probably.

What happened was that the combined hospital/clinic work inherent in the downtown practice became insanely heavy. Urgent hospital issues would disrupt the flow of clinic appointments as we struggled to be in two, even three places at once. We'd find ourselves hopelessly behind, covering our duties in both clinic and hospital. After several years of escalating tension around this annoying issues, we re-booted the entire system.

We now have one doctor assigned to  hospital duties and the other three are here, there and everywhere: they could be enjoying a much needed vacation or, more likely are seeing outpatients in any one of our four locations. The only problem is: we have to have at least two of these three docs in the downtown location. Why? Because volumes are highest downtown and the acuity/complexity scale is often ramped up to the max. Patients with a recent kidney and/or pancreas transplant require detailed review and can wind up back in the hospital in nothing flat.

There-in lies the problem. With docs scattered to outpatient locations separate from what we call the "mother-ship", satisfying the two doc rule and simultaneously allowing for an occasional day off or a vacation is challenging. Whereas we used to decide on a vacation a few months ahead of time, now we need to get vacation dates on the calendar 6 or more months in advance. Case in point: I just asked for the day after Thanksgiving off last far down the road is that?

So, while our new model of care has some advantages, we've also learned that we need another doctor. Desperately and yesterday. We're recruiting but it takes a long time to find the proper fit: someone who will bring clinical expertise and commitment and yet have a bomb sense of humor and ability to play well with others. So until then, we work long days and feel like we're never finished. I speak for myself, I suppose although I do hear my colleagues making similar comments.
Medicine is a harsh mistress.

I'm still savoring my Monday's off. As the only one of the four who is "part-time", I've managed to keep a grip, although slipping some, on a life.

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