Monday, October 21, 2013

MiM Mail: How do you do it?

Hello Supermomdocs,

I stumbled across your blog when I was trying to decide if I made the wrong choice in choosing an internal medicine position over a dermatology one.  I think it's a fantastic site, by the way.

I'm Jenny, I'm a physician assistant, and currently mom to a furry 4-year-old, 70 lb. boy.  :)  At the time I chose my current internal medicine position, I was leaving a place where I was not treated very well, or respected at all.  So I went with the offer that I felt more at ease with as far as the people I'd be working with.  And so far, I must say, I love every aspect of my job except the work I didn't know I signed up for. 

My patient load here is a lot heavier than my old place, and I see more chronic illnesses than I did at the last place (I saw some follow-ups, mostly acute visits).  I find myself working late, bringing work home, and working on the weekends.  I am preparing to bring this up with my supervising doc, the owner of the practice, but I wanted some feedback from some women in the field, and I thought you all might be able to provide some insight.

The dermatologist doctor has also told me he was looking to hire a second mid-level provider come Spring.  I am tempted, for I feel that derm would not have as much "homework."  Am I wrong in thinking this?  I'd be taking a paycut and possibly vacation cut too, but at this point, I can't be leaving the office at 8 or 9 every day.  HOW DID YOU BUSY DOCTORS MAKE TIME TO MAKE BABIES?!  That is another thing on the horizon.  My husband and I would like to start a family, but we've refrained from "trying," for fear of stressing ourselves out.  So perhaps this is TMI, but we've opted to just try to increase frequency of intimacy instead of plotting calendars and such.  The problem with this-there is never any time!  I'm always working, we're always tired by the time the day is done. 

Internist(s), I feel like part of the issue with my current situation is that it's just the field of primary care.  There's always going to be a slew of labs to go through, and it's never ending.  The previous doctor I worked for never followed up on his labs for months, and then would just ambush them when he took a vacation, or was about to leave for vacation. 

I currently do not take a half day, but I'm thinking about asking for one, to work on labs (so technically I wouldn't be workingless).  I currently work over 60 hours a week. 

Any advice or input would be appreciated.  This is a struggle for me to find a balance between work and home life.  Is it something you still juggle?  Am I just complaining too much?

Thanks for hearing me out.  Again, I'm so glad to have found your site.  Great job!



  1. How many hours a week are you scheduled for patients, and how are you paid? Do you run behind during your patient hours? How long have you been at this practice - are you still getting accustomed to the computer system or do you feel like you have it down?

    To make this work - and you can - you need to manage your time in the exam room well, and be able to triage the paperwork. Learn to do agenda setting with patients by using the exhaustive "what else?" and then explicitly setting an agenda ("We have about 15 minutes together today. What do we need to make sure we get to?")

    Does your office have a system for notifying patients of normal lab results, or are you calling everyone? I ordered labs in general to be done a week before f/u appointments and then reviewed the results with the patient when she came in.

    I am very very efficient but could not cope with more than 35 hours a week of appointments.

  2. DISCLAIMER: I am a Peds Resident who is just starting to look into the business-side of medicine, I am new to negotiations and new to a "real career" (ie, reading some magazines and talking to folks as I prepare for third year job searches):

    Before looking into other work, make sure to talk to your employer. I have heard it said that women make less money in part because we don't negotiate well enough and we don't advocate for what we deserve. Sounds like your last job made you lose your voice and as you move forward you've got to find it to get what you want.

    Sit down with your boss:
    1. reflect on what a great job you are doing (toot your own horn a bit)
    2. discuss major responsibilities and detail what you believed your job requirements were prior to employment and what they really are now
    3. discuss major areas for "improvement/ enhancement" (I am trying to word this positively) (as you stated "working late, bringing work home, and working on the weekends")
    4. ask for honest feedback (does your boss think you are working too slow, does your boss think you aren't spending enough time on certain aspects and too much on others, etc . . .) and be prepared for honest answers
    5. develop with achievable short-term goals (ie, within 4 weeks, I plan to not do work on the weekends) and long-term goals (ie, by the beginning of 2014, I plan to not do work on the weekends or holidays and find time to expand our practice by -----).

    Test this out with your spouse or ask advice from another friend who is great at negotiating.

    Hope this helps! Please keep us posted.

  3. The only solution I have found is to become more efficient, and (unfortunately) spend less time with patients. Unless someone is sobbing in front of me, I have the entire note written by the time I leave the exam room, or if I have to finish a few things, I make sure to finish the note before moving onto the next patient. It'll take me 2 minutes then, but it'll take 5 min to get back into the note, remember where I was, and finish it off if I have to come back to it later. Over 20 patients a day, that's an extra hour of note writing.
    For labs, etc., I send messages to my MA who actually calls patients if they need to be called. I sign off on them first thing in the morning, between patients, during no-shows, during lunch, etc. I never ever stay late unless EMS is on their way, because I have to pick up my kids on time, which is non-negotiable. And since I like my kids more than any patient I've ever met, it keeps moving quickly through the day.

  4. The beauty of being a physician, at least in internal medicine and pediatrics, is that there are a variety of jobs and work situations out there to fit a variety of needs. In terms of your specific situation as a PA, there are also a variety of job options and reimbursement set-ups. I agree with what Mommabee suggested in terms of talking with the supervising physician about what's going on to see if you can improve your hours. If it's a matter of work flow or work load, that can be improved, assuming the physician is willing to work with you, whether it's with cutting back on your patients scheduled, or how the patients are being worked up, or what the nurses do to follow up. After a good effort at improving things, if you still can't meet your needs, perhaps you should look for a different job.

    Work-life balance is always an issue for any working woman/mom. I personally do not take any hospital call, and only do outpatient because it allows me to spend more time at home with the kids. I make less money than my colleagues, and I accept that in exchange for fewer hours. It's possible to find that balance, but it has to be the right job and the right environment in order to make it work!

  5. You should definitely negotiate at least one half-day of "admin time"...all the full-time clinical docs I know (and the NPs, we don't have PAs in our division), do 8-9 half-day clinics/week---it is not possible to do 10 clinics a week and NOT get really really behind on paperwork/phone calls. Trying to delegate as much as possible to support staff (calling back normal labs, easy questions).
    I know nothing first-hand about Derm, but I imagine there are a LOT less labs, and a lot less meds, and overall less illnesses to focus on during a visit---so notes less complicated. Maybe you can talk to the other provider there and see what kind of work-load there is, and if it seems reasonable, go for it!


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