Home Forums Discussions General Discussion Burned out. Need advice from everyone.

Thanks everybody, I substituted my name for bert's and Int med for peds and saw my own predicament. Can't go to yahoe, but have a lot to chew on. Sorry Bert, I have nothing to add. You've been a great help to me and others on this user's board, I always wondered how you did it. You have given alot of yourself to your practice and to us Amazing users! Thanks.

Tom

Folks,
We at IMP call this getting "Breathing Room".... If a doc does not have breathing room they will quickly start to suffer from any number of burn out like issues and problems....

BERT!!!!! Earth to Bert!!!!! Please, Please, Please... NOW, Right Now, this weekend.... Get the Hell Out of Dodge and just take care of YOU... NOW!!!! OMG, 7 1/2 years without ANY time off at all... That would drive any person insane, no less all the time you all too generously share with all of us here at the board....

I strongly recommend all you solos please take a gander at some of the stuff at IMP and start to re-think what it means to be a "real" doctor..... Back when doctors did what your ideal of a real doctor was, I KNOW that their panels were not 2,500 to 3K large that is for sure...

They had what many would consider a Snob Nosed practice today. And they made a relatively good living while doing it too. So they had money to relieve other stresses of life by being able to pay folks to do lots of other chores and things for them, not worry about mounds of debt trailing them and nibbling at them (eating them alive like us), and yes they got to take real vacations, most were in small or solo practices so they all covered for one another more cooperatively I would gather, and they were all unavailable on Wedn to play golf as the old joke used to go.... Don't get sick on Wednesedays, Right???? And being treated with respect and treated to dinner once in awhile was not considered kick back... They had No or almost NO HMO, Managed Care BS, Many didn't PAR at all, their spouses were able to do billing simply with a ledger book, and their charts were simply a few words or sentences on large Index cards, just enough to remind them about the most basic parts of the visits. Not some endless legal hold up in court and CMS witch hunt document that now requires a SQL Serve based multi-thousand dollar programs with thousands in not a few million man hours worth of code in it.....

So when you stop and think about how much the OTHER Side of this Business has really changed PLEASE, STOP, and understand this is like the early Super Women over personal Expectations that most working mom's with full careers and no help from a decade yet to evolve spouse, and no daycare centers and after school programs and the like.... It is impossible to do both the "Modern American Business 3rd and even 4th Party Administator" version of medicine and practice management and still have the time or energy to be a "Real Doctor" under the old school model....

"Without the Old School Practice Managment, Business Model, it is impossible to still provide the Old School Medical Pracitce Model...." The former engulfs and blots out, takes over the once natural habitate of the latter, eventually wiping it out almost completely (like we see today); much as when a non-native animal is released into a new ecosystem. With no natural preditors to keep its likes in check, it grows and grows in population size, almost expodentially in terms of numbers, devouring most of the needed resources for its own kind, leaving little if not anything for the orginal native speicies that once were in balance and populated a region or system...

But for this thread I digress too much about the business model part... The point for the moment is that doctors like any other working professionals and tradesmen, all human beings need some amount of reward, breathing room, life outside of the profession, and critical amounts of "Down Time" to recharge their mental and emotional batteries. It is unnatural and unhealthy to do or live otherwise long term... Even short term to cope or survive a crisis period such a way of existance takes a heavy toll on those who must do so... But to make it a part of everyday, all the time, year in and year out life is setting oneself up for a huge fall and crash sometime not so much later....

So, Please one and all, Give yourselves a pat on the back, go have a shot of something, a glass of red or white, a beer, a cup of herbal tea, whatever your pleasure (Diet Pepsi with Lime, or Coffe Please), kick off your shoes, throw the pager in the lake for the weekend and pretend that the phone system went to bed and couldn't be fixed until sometime Monday, and folks like Bert, do that NOW!!!, Right Now, Unmedical Doctors, Psych Doctor Hockey Ref's Orders, or I will personal drive the 450 miles plus to go to Maine and have you Commmited so as to finally force you to take the weekend off...

We care about you very much and this is very concerning to me my friend. Please take care of Bert too. Please....

Paul

Bert: consider training front office staff to carefully screen out letter of necessity etc for patients scheduled after four thirty. PS I wish I had a Maine license as I would gladly volunteer to do a day of locums for you and am pretty sure enough others on the board would too to at least give you a week or 2 of respite.( if your patients would allow FP substitute).

Oh, I forgot to mention. If someone is coming in as a potential SELF PAY ONLY patient, sure we'll do the interview w/o asking for the fee.

Leslie and David,
I couldn't have articulated it any better than what you two just said. I agree 100 % --jimmie

For what it's worth, I mentioned this thread to a hospitalist friend. He said he suffers from the same "real doctor" angst in reverse, having given up his previous primary care practice!! We looked each other in the eye and laughed. It is good to know we are not alone.

That is funny. But, at least that makes for a hospitalist who will work well with the PCP.

@mkweise,

Would take FP in a heartbeat. In fact that brings up a very important point, which I wish they had told us in medical school. Doing FP or Med/Peds makes one much more marketable in many ways. Even in cross coverage. I can't share call with an FP as I can't cover their adult patients.

I have started to consider a part-time FNP or PA to cover a Wednesday and a week here and there. I used to think I would pay only and get nothing in return. But, I suppose I could bill for the patients they saw.

I agree with most above. You have a panel that is too large. The AAFP has a calculator for determining appropriate panel size.(I wish you could send them my way. Our climate is similar!) I've been told to eliminate your lowest payer and focus on the top 20% A soft way to do this is just stop taking new medicare patient and over time the will delclinas the move away

Bert,
I have read most of above and have some tips.
I am a solo provider seeing 25-30 pt's a day
I quickly cut out medicaid.
Why have you stopped taking new patients with private insurance?? They can bring your reimbursement up and you can cut back on your patient volume (if you want).
You need to take at least 1 week vacation a year, no pager!
You NEED to do 1-2 conferences a year, (paid for by practice and gives you sanity)!
You need to think about hiring a NP to help, that will help you take off more and keep your sanity!
Hope that helps, balance in medicine/life is something all us dedicated physicians struggle with but you have to strive for that or you will burn out and ultimately your practice and patients will struggle!
Jack

Thanks again everyone.

The answer to the private insurance sounds silly. But, I figure every newborn I get in the next two months will all develop RSV and/or Influenza A. While this will bring in more appointments, it will bring in more appointments at a time I am overwhelmed. RSV can be difficult to manage.

Where is this calculator? And, if I am 200 patients over, it will take a long time for enough Medicaid patients to drop off.