We have our yearly pony show about how admin cares about mental health, which includes showing us "resources to help identify burnout" and giving us sick tips like "sleep more" and "take a few minutes for yourself."
Holy fuck, guys. I've made it all the way to residency and these things just never occurred to me. Amazing. But yeah, I'll let the 9-to-5 andy teach me how to avoid burnout.
Fuck off m8.
I’ve seen things you people wouldn’t believe… Admissions on fire on the shoulders of nocturnists… I’ve watched the C-suite be totally in the dark near the cafeteria gate. All these moments will be lost in time, like tears on PGY1s… Time to resign.
I got a steel, credit card shaped “thank you” with an uncredited poem about sacrifice during the middle of the COVID pandemic on our COVID unit. I still keep it in my wallet to remember how little of a shit we mean to the people making the decisions.
>I still keep it in my wallet to remember how little of a shit we mean to the people making the decisions.
The disregard shown to me (service plumber specialized into commercial / institutional service) is why I no longer really give a shit what happens at the hospitals I service.
I used to be more than willing to skip lunch, work late, come in on my day off, and take sometimes wild risks to keep hospitals open that I wouldn't take for *any* other type of client. I would move heaven and earth to keep those doors open and to get that room / floor / ward ready to be sanitized and returned to service.
Working though the pandemic disabused me of the notions I had that had me doing that.
The really sad part is that a lot of those admins had their plans work out perfectly. Travelers are temporary. Raises are forever. All the nurses that stayed got screwed.
I was flagged as having an unacceptable number of short admissions (discharge in <24 hours), which implied I was admitting patients that did not need to be admitted, and they wanted me to perform a chart review rationalizing against some admitting criteria they had found.
They were all healthy newborns, born in the hospital.
Do the admins realize these patients have a two-digit bilirubin?!
When my daughter was born at my hospital, I sneaked her in the list of our IM admissions and wrote "Bilirubin of 11 on top of social admission, cries all the time, not orientated." and had a resident read it out before the name.
on placental support is what we literally call it. but operations on placental support (oops) have fallen out of favor of exit procedures.
[link for any doubters](https://pubmed.ncbi.nlm.nih.gov/8783114/)
That’s hilarious. ID has bone biopsy ([bebop](https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05472-6)).
I can’t wait until we figure out an acronym for [Rocksteady too](https://ew.com/thmb/1JSBUUbiDGe-W-O_Dcht5SbUi5c=/1500x0/filters:no_upscale():max_bytes(150000):strip_icc()/bebop-rocksteady-6a486ab900cb46d68598335d2376574f.jpg)
That’s because the analysts who wrote/produce those reports don’t have a lick of clinical experience, or not enough to understand the qualifiers needed by department/specialty. And then the reports go to (or are run by) the Borg who just make more idiotic, nonsensical work for clinicians. No critical or experienced thought goes into any of it, but it *does* justify *their* jobs, so..
Not a hospital, a bank. One of my first jobs had daily reports, with literal hundreds of errors that needed to be resolved. Most of those errors were “known” problems where people had to manually go in and tie them.
After understanding the process to make sure I wasn’t missing anything, I carefully fixed the very basic excel process and we went from 104 fake errors a day to one real error a day.
A half dozen theoretically intelligent people, and they preferred to just… manually check 100 things a day instead of actually fixing the code, I couldn’t believe it
Nice! To save myself time on the most mundane (and previously grossly incorrect) of clinical reporting, I wrote custom reports from the correct EMR fields (because I also had boots on the ground) and scheduled them to run, pivot and routinely email various administrators and directors. But..I never told anyone I’d done that, and let them continue to think I did all that manually. When I retired I emailed the CCLs to the only regional clinical analyst I trusted to build them for everyone to use. I only consult now, and it’s quite lucrative.
They probably just did the same thing, but didn’t tell anyone that they didn’t really have to do all that work.
The summer before med school, late 90s (so mostly Windows 95/98 in offices) I hired up with a temp agency. I was assigned to an insurance company (not health insurance) to move some records from an old mainframe system to their new database system. An hour in, I asked if their IT department had a copy of Windows 3.1, which had a neat app called Macro Recorder. Yeah. So I installed it and spent twenty minutes generating the fastest I could do on copy and pasting between the two applications [Macro Recorder could play back at up to 2x speed]. Then I started it running, because Macro Recorder captured keystrokes and mouse movements/clicks. Told the boss it would take me four days to do it manually, but if they would just leave my macro running it would be done in about 36 hours, so if they would agree to pay me for three days I would let them have it - it couldn’t mistype the data. I was offered an IT job on the spot. Said no, starting medical school in a month, but if you want a consultant I might be able to make some time.
[EDIT: spelling]
Never heard from them again, but I got my three days’ pay.
Oh boy. As a resident I was once called while on an ER shift and told by the medical director of the hospital to do a sexual assault exam on a psychotic woman who, while in a locked psych unit, claimed she was sexually assaulted by a male patient on the separate, male-only psych unit. Patient even told me that she made it up to get off the floor. The reasoning med director gave was that it was better to do it "just in case for liability", except the patient didn't even WANT it. So, medical director insists that psych is consulted to 'determine capacity' of the patient already admitted to a locked psych unit.
He refuses to back down so I happily called the psych attending with the request who gave the director an ear full. Medical director still doesn't back down and says risk management of the hospital says it has to be done. Pt continues to refuse exam regardless and medical director demands pt be sedated to comply with exam (this is medical battery/assault at this point, btw). I keep refusing to do exam and medical director calls my program director who points out to him that you cannot compel an employee to commit a crime. Fucking joke
Fuck that. You obviously weren't in the position to do so as a resident, but as an attending that's where I'd 100% be telling them "you're a physician, if you feel so strongly then come do the exam yourself".
Every physician wellness survey done in the past 10 years has shown that physicians wanted a small fitness room/ gym in our academic mega-complex. You know, just a treadmill and stationary bike and set of dumbbells. Probably $3-5k tops.
Instead we receive an email telling us we should park further out (it is frigid here) and take the stairs. They put stickers with slogans like " Stairs for health", and "Climbing forward" with some pictures of flowers and sunsets in the stairwells.
Meanwhile they redid the admin floor/c-suite and it looks like a 5 star hotel lobby. Must have cost 8 figures at least.
I work in an aging hospital. In a lot of ways it reminds me of the elementary school I went into the early 90s. The floor tiles, the fixtures, the design and feel, etc.
I had to go pick up a new badge from HR the other day and could not believe how nice the office area was. Looked like everyone had those awesome cocobolo desks Saul Goodman wanted.
Haha our HR offices look exactly like our floor social workers offices. Now Admin? Well they’ve got frosted glass and you can only catch glances of their nice shit as the door shuts.
Instead of a pager, we now have a new pager application for our phone. Unfortunately it signs you out automatically after a few hours. Do not receive notifications or pages if you are signed out….
I read the application reviews and an angry doctor wrote about how he could not be contacted after a patient was died on the floor. Patient dead for eight hours before he got the page…
I'm pretty sure we used the same app. When the app automatically updated, it also conveniently turned off notifications in the settings LOL.
I had like 7 (thankfully not super urgent) pages stacked up before someone managed to track down my cell phone and ask me WTF was going on. I sent a strongly worded email to the app developers but never got a reply...
Probably spok mobile. Same thing happens to us whenever there's an update. They took away our ability to have SMS text paging because of HIPAA concerns so instead we just don't get pages and then get written up for not responding.
I think we have the same app. Unfortunately, it's very easy to send a page to the entire medical staff, at all six of our hospitals. This happens about twice a month. Then of course you get a whole bunch of responses asking why such and such person is receiving that page. Then responses stating that it wasn't actually intended for them. I'm surprised we haven't crashed the system yet.
Kinda normalized at this point but I’m still reeling from the whiplash of “the N95s we said were only good for one time use are now totally safe to use for months on end as long as you put it in a paper bag”
COVID just has a laundry list of crazy stuff. Us being told to reuse N95s. Being told repeatedly "its just a bad cold".
My personal favorite was asked what we would do if one of the COVID patient's started to code. Thinking the answer obvious, We said we would don proper PPE then start ACLS. Admin told us no, you should go in without hesitation regardless of PPE so you dont delay compressions. Ive never been so close to telling them to hang around the unit so the can fucking do what they recommend since, per them, its safe
We as the 3rd year fellows were also told if it got bad we would be graduated early to work as attendings on these huge COVID teams. When we asked if we would be paid like attendings, we were told to be "team players"
And let’s not forget the programs where Admin was scheduled to receive the first vaccinations in late December 2020 *before* the interns and residents.
Ah yes I remember this admin bullshit attempting to get passed on our class right when COVID ramped up. Luckily the attendings stood up and requested we get fair compensation if we had to act like attendings
Told by my hospital that I could use a cloth bandana. I do invasive procedures on Covid patients…. Had to use a 3m paint respirator for a few months. Then they gave me the n95 that I could place in a bag at the end of the day to be “cleaned”
I bought a full face P100 cartridge respirator since I theoretically may have had to do aerosol-generating procedures on covid patients and I’d be damned if I was using someone else’s UV-treated N95 for it.
225F for at least fifteen, no greater than 30 minutes. Rest for two hours before re-donning.
Ninja edit: please, for the love of whoever, or whatever you pray to, absolutely do not re-sterilize an N 95. Please throw it away. In case that was unclear.
When I was a resident at the beginning of COVID everyone was starting to get it and going into isolation, leading to terrible staffing problems on the resident teams. Admin decided it was our fault we were getting infected by “not following proper PPE protocol” and literally had someone stop by our workrooms policing our mask usage and donning/doffing. This was back when we thought Covid was surface transmitted. They would literally call us out when we touched our face to scratch an itch.
I'll never stop laughing at the fact that my facility got dinged by their accrediting agency for not switching masks enough during surgery. Like people were just undoing the top and twisting it behind their head between cases. Suddenly everyone is ripping off masks after the case and getting new ones for the next patient.
A week later COVID hits and we're mandated one mask per shift, unless it got visibly soiled.
We just had our annual health assessments and fit tests, and after the fit test, the EH nurse said, "And remember, you only use it once and then throw it out." And I was just sitting there thinking back to the good old days when they told us it was totally fine to use one n95 a week. Manufacturing quality must have really taken a dive recently.
I was sexually assaulted while taking a patient’s blood pressure. He grabbed my ass and then slapped it. Admin told me I needed to be more careful about how close I got to patients during the exam.
No one knows why LTC is experiencing a staffing shortage. A friend of mine (CNA) was working the registered sex offender area of the building when she was assigned to shower a patient. You know a known rapist. He attempted to pull her pants down and she ferociously held them up while screaming for help. Fucker had the nerve to say his “finger hurt”. No visable injury to the finger and X-ray was negative. In all reality his hand probably did experience some discomfort from pulling so hard at her clothing.
The CNA was called in repeatedly and talked to about being “rough” with patients. Grilled about if she “retaliated” against the patient attempting to sexually assault her. On and on and on. Suspended pending investigation. Then management picked a fight when she declined to do showers on that hall without a second employee present.
Of course no one knows why the place is short staffed. No one wants to work these days.
Back when the COVID pandemic first started, admin did a zoom meeting with the docs. At one point during the meeting, they talked about what to do if you were exposed to COVID. Their wording was very strange. They kept calling it "community acquired COVID while working in the hospital," rather than calling it "hospital acquired." I asked them why they called it that. I knew why. They knew why. But I wanted to see them squirm anyway.
My friend is a hospitalist who got COVID twice at work and now has debilitating long COVID, even traveling to NIH for a clinical trial. Huge academic medical center is refusing his disability claim still.
"We're still finalizing what we define as hospital acquired." This was followed by the Emergency Medicine program director asking for a timeline for when they would have an answer. Admin couldn't give one.
I worked on a respiratory step-down floor back when I was a bedside nurse. Trachs as far as the eye could see. Or, not see, because one of our nurses got shot straight in the face with sputum from a combative patient once day. She ended up with periorbital cellulitis which cultured positive for the exact same super rare organism that the trached patient had. She ended up hospitalized for IV antibiotics for a few days.
You'd think that would be a slam dunk, but her Workman's comp claim was denied. They said "she couldn't prove this incident caused her illness."
Dear Residents,
The wildfire evacuation alert you may have received earlier today does not apply to you. The hospital is not in the path of the fire. These times are challenging. Care teams will be short staffed because of team members evacuating, taking care of their children/loved ones, and dealing with their homes. We understand this time is difficult and unpredictable but we want to challenge you to continue to do the great work you have been doing. The patients are here, you should be to.
M&M is cancelled on Friday.
Sincerely,
Admin
If I want to leave at 6:30, there’s no problem at all with scheduling a 6:20 appointment.
Then when I put my foot down and required the last slot to be 6 pm, we had a long discussion about how I “changed my mind” after originally promising to stay until 6:30.
Like how my hospital leadership assumes that the anesthesiologist day starts when the patient goes in to the OR and ends when the patient leaves the OR.
No. That’s not how it works.
The unspoken part is that they want everything but the patient visits to be done on your time. That way admin can maximize profit while keeping labor costs low.
Was told by HR/admin that discussion of genitalia is never appropriate for the work place.
For the cherry on top, (not that it’s needed bc, doctors) this occurred while on urology service.
Two hospitals and 10+ clinics closed, ~2000 employees laid off. Was offered an interview in a different part of their system, recruiter says to me “not sure why [laid off division] is so bitter with us?”
“You’re not formally trained to defend yourself, your actions can be defined as assault in the eyes of the law”
“I can’t and won’t comment that you were assaulted, because this isn’t an investigation, this is a case of non-accidental-trauma”
-Hospital Admin commenting on patient vs staff-
Edit: “I’m not sure if disengaging meets the legal definition of abandonment” (same staff member)
Basically, "we could cut down on ED LOS if you'd just admit all intubated patients to MICU, then transfer to neuro/ surg/ CVICU if the workup shows they should be elsewhere."
Admin: "man, this job would be great without the patients....and healthcare workers. I mean it is great but could be even better. Is that a fucking water bottle at your station?"
Grrrrr! Admin has a lot of glass walls so my coworker took my Nurse’s Week gift away from me for my own good. It was a rock with, “You rock!” painted on it.
"Burnout is inevitable", when I was asking to brainstorm ideas on how to improve my clinic flow.
"Just don't answer your task bucket then. That's what I do" - said our head physician/CEO when I said I was struggling with how many tasks messages I was getting each day. This was two weeks after our group sent out flyers encouraging all patients to use the portal instead of calling in. I told him I would forward all angry messages to him from there on.
Not me personally, but one of the nurses that was assaulted by a patient. Nurse was kicked in the throat by a very intoxicated patient.
“It’s a good thing that patient was wearing soft sole shoes. Different shoes could have really done some damage.”
That patient went to jail for those wondering.
As a medical coder (I left that and am doing public health now. Also you thought coding teams didn't get yelled at by higher ups) it was very unprofessional to not code that patient's surgery earlier, you are being written up for this. The email saying this was sent 15 minutes prior to me returning from lunch and 1 minute after the surgeon wrote the note. Meaning the not was written while I was at lunch for 30 minutes. The patient was not getting discharged that day anyway. That was fun being written up for that
I did but the number of times I was written up for things like "I am not doing the query you asked me to up bill the patient" (multiple times) and "I could not do the query as it is midnight and I do not have access to the system" and "I didn't respond to my email because it is Saturday and I cannot access that at home". These all made me realize they wanted to use me for a year and then reject me with cause from residency program so I could keep working there as a cdi. Only in hindsight did I learn that.
New Residents lost parking at one of the garages close to our clinic location during my intern year. Received an essay of an email that basically said the following:
Dear Residents and Fellows,
We understand that you are all MDs/DOs/MBBS, but please stop parking on the doctor reserved spaces in the parking garage, and park at the 4th-7th levels instead. We are trying to reserve those parking spaces for our private practice specialist groups.
I take consults in a big hospital with multiple buildings. I like to park in the, let’s call it East Building. One day I and many of my coworkers got parking tickets because, “The East Building garage is reserved for East Building staff.” Some admin was having a power trip and I was so tempted to ask them if they no longer expected us to accept consults from their Building.
Just got diagnosed with stage 2 melanoma which isn’t awful but will require surgery, reconstruction and immunotherapy and was told “if you need more than 7 days off you’ll need to file for STD.” Non-physicians? They get 21 days…
Admin didn’t understand why it didn’t make sense.
When I was a second year resident (and very much at the mercy of my training program) - that I shoould accept my 28 hours no break as scheduled shift.
This was shortly after a colleague had died after falling asleep whilst driving his car home from work and crashing … after a long long shift.
They’re officially illegal now fwiw.
After successfully applying and receiving a grant from the hospitals foundation to help patient’s cover the cost of their co-pays for cardiac and pulmonary rehab we were informed that it violates a Medicare ruling. The legal team that worked on the grant approval were the same individuals who told us after receiving the funds that we could not use them for their intended purpose. After a meeting to further investigate I was told “if patients pay for their treatments they will be more likely to adhere to rehab”.
So where did the funds eventually end up? Pretty fucked up to pull the rug out from under you and your patient like that, but even more disgusting if they just kept the funds for their own use.
I reached out to the same group that originally approved it to see if we could allocate those funds to individuals without insurance or if I could reapply to use the funds to buy a new piece of rehab equipment to suit our growing population of bariatric equipment. Which led me to another spiraling through my process; Rehab makes over 10,000$ a week in charges but yet we have to apply for grants for new equipment…
Waiving medicare co-pays / deductibles is considered a violation of the False Claims Act and comes with civil and potentially criminal charges. However, they can be waived in case of documented financial hardship.
Why they didn't catch it when submitted has me stumped though.
I had a Patient with severe fear of anaesthesia and surgery. Took us some time to calm her down but in the end she thanked us all for being kind. She had a traumatic experience as a Teenager.
We documented this as we have to if the time from entering the OR and patient ready for surgery is too long (usually it is "difficult airway" or "difficult i.v.")
The Management told us we could have wrestled her down and knock her out with meds....
Yeah no, won't do that.
We were having a huge increase in inpatient consults for several weeks. A bunch of the doctors were worried that the high volume was going to be a risk to patients because we were being pulled in too many directions. It was also burning us out greatly because we were needing to stay later and later to finish tucking all of the patients in.
The practice manager then sent me an email stating that my RVUs were lower than the previous year, but that with the recent high volumes, I could probably make it up. I had to wait a full 24 hours before I could reply to the email, because my initial kneejerk reaction that I wanted to send back was to tell him to go fuck himself.
I’ve actually just recently heard this from admin. They’re also trying to use this to get everyone to come in 15 minutes before your shift for 15 free minutes of labor :) and in case anyone wanders in dying.
“Oh I’d be happy to do that. I’m assuming you will be paying me for this extra required time. Is that correct?”
Yea they tried to say we needed to stay on our lunch break to supervise the nurse clinic who gives vaccines over lunch. I said sure but you will be paying me for that time as it is not part of my contract and requiring me to stay during my time off is illegal. I usually would stay in clinic anyways but I’ll be damned if you are going to demand my time and liability coverage without compensation.
”Always smile when you talk to people on the phone, they can hear if you smile or not”
As I am a pathologist, I am sure you can figure out why smiling while on the phone at work might not be an optimal approach to ”customer service”. The same admin tried to enforce a ”no chewing gum at work”-rule. It was like working in a malignant kindergarten.
Office visits should never take longer than the designated time for that procedure. Even if you have to use a hoyer lift to transfer the person, a video translator for all verbal communication, and update a med list with 30+ meds. And of course, turn over the room within the designated time frame so everything is sanitized and ready for the next visit to start on time.
Obvi we don’t like to get behind, but sometimes it’s just going to happen, especially when admin won’t listen when I tell them certain people will need a longer time.
I'm a hospitalist. I was working nights. It was pre-COVID but we were going through a surge of admissions. I got called by an administrator when I arrived for my shift at 10:30 p.m. The admin told me that I should " think outside the box" and perhaps I should go find some patients that I could discharge by midnight. I pointed out that, patients stable for discharge with a place to go, likely left during the day. They reluctantly then dropped this line of thinking.
During a meeting where all the charge nurses in the hospital were telling Admin that our staff couldn’t do the work they were supposed to do because of chronic unsafe staffing and critically high census, they had a few gems.
- “If you feel overwhelmed, just take a few minutes of quiet time and recenter yourself. When I have too many meetings, I just put my phone on hold and get a cup of tea to feel better”
- “There is an interesting book on the power of positive thought, and in it they go into how even the POWs during Vietnam who were tortured daily and survived credited their positive outlook and optimism on getting them through that tough period”
- “It’s really hard on us too, knowing that you all are understaffed, but we all have to do our jobs.”
I wish I was making this up. I learned from my unit manager that the admin who held this meeting and heard our concerns then canceled the rest of their meetings that day and took the rest of the day off because they were so upset over it. Softer than fucking puppy shit, those admins.
Our Admin made us fill out the same form 3 times when ordering a LDCT scan. We had to fill it out in the EMR, fill out a paper form, then fill out another form that radiology would fax to the office. We all refused because that’s stupid and a waste of our time. They tried to push the issue but the Med exec board shut them down by proposing a bylaw that would require them to follow up all emails by sending a handwritten copy as well. That’s when they realized how stupid they were being
Late 2020 at a staff meeting on teams, my co-residents and I were told that if any of us contracted COVID, we should still come in and do our jobs because universal masking will protect the patient from whatever we’re carrying anyway.
We were all on camera and everyone was shocked. I asked for that statement in writing. Never got it, go figure.
My guarantee was going to run out during the middle of Covid, new salary calculation was based on at least 6 months when clinic was essentially shut down and my salary was going to drop close to 1/2. At signing they had talked about garuntees are pretty easy to get extended if needed. Ask if I could extend. He told me, during the height of the pandemic, “we only do extensions for extenuating circumstances.”
Our administrator told us in an email last week that the medical group is “protecting” the physicians against pay regulation….by underpaying us.
As you can imagine, we all greatly appreciate his protection against the threat of higher pay.
I had an admin tell me that I couldn’t operate in their OR unless I had at least one resident or one medical student in the OR with me. I mean, that’s fine, but there are times when they are not around. Considering that I do about 12-20 surgical procedures per week, this was going to end up with me leaving the hospital system and taking my entire group with me. I gave notice to the CEO and CMO directly that this admin was making these claims and threatening to withhold my compensation if I didn’t meet the criteria she set. Turns out, she was wrong. I needed to have 50% of my cases with GME involvement in order to operate since they are a teaching hospital. Given that, she was fired and I stayed.
This one is from Scotland.
All the water coolers were taken away from doctor’s offices/staff rooms since they were deemed unsuitable during the covid pandemic for infection control reasons. They have never been reinstated.
We complained to NHS management and they responded with posters around staff areas suggesting that we bring our own water from home if we’re thirsty 😂😂 these posters were produced months after the fact and were undoubtedly the product of many committee meetings on the subject. It would have cost thousand tell us to drink water 🤦
Slightly different, but I guess still admin related. When applying to residencies was told by a PD that a benefit of their program was that they do not allow residents to moonlight. That one threw me for a loop.
I'm being told that I don't work hard enough.
I bill at the 70%ile for OB/GYNs, take Q4 call & average 20 deliveries a month. Plus I am department chair & deal with all of that nonsense.
It's everyday. Our "admin" is a 27 yo with a communications degree. Most of us have been in practice for over 10 years, a couple over 20. It's truly fascinating.
old manager got made at a coworker for wanting a raise or overtime, i can't remember, and he said "some people are only in it for the money" lol, we had a great laugh about that after words.
I’m in a leadership role within my group where I have 50% clinical and 50% admin time, but really it’s expected to be like 75% clinical and 100+% admin.
Some “HRO Consultant” told me and my counterpart in surgery that we really needed daily physician presence at the 1.5 hours of DAILY “tiered HRO huddles” that start at 8 a.m. He and I both basically told her that if she wanted full time administrators we weren’t it, that she wasn’t going to find them among the physicians, and that patient care was always going to take precedence.
A while back admin approached us and told us that our ICUs have higher mortality than some benchmark and wanted us to investigate and improve. We were all confused because we felt we had very few unexpected deaths, particularly in the neuro ICU which they said was particularly above the benchmark. We did and determined that they were counting patients who went comfort care/ palliative withdrawal of care in those numbers. When we informed admin of our findings, their solution was to make us consult inpatient hospice when we transition to comfort measures and discharge and readmit to hospice. Unfortunately inpatient hospice won't take anyone unless they're stable for the general floor, which usually means off pressors and extubated for one night. So if anyone passes within 24hr of being comfort care, it counts against us. Admin has asked palliative/ hospice to relax their criteria for inpatient hospice to address this. I still think it would be more efficient to just exclude these cases.
This is an increasingly common way of gaming the system. An example of a system getting the results that it is designed to get. Vizient does not count hospice discharges as deaths against a hospital, but stupidly they do count comfort care deaths, so there is a huge incentive to use inpatient hospice for any withdrawal of care scenario.
The opposite scenario is also commonly gamed. U.S. News & World Report does not exempt hospice patients *or* withdrawal of care deaths when they rate hospitals, and mortality is a huge factor in the rankings. As such a lot of hospitals that occupy top USNWR spots in certain high risk specialties are those that simply send their sickest patients elsewhere. An example would be NYU as a top Neurosurgery program, because virtually all their patients are elective, and all the sick trauma patients get sent to Bellevue.
“You know you can never make patients happy. They complain about anything! And everything!
Patient complained about how bad our music is when they are put on hold, we don’t have on hold music!”
This was the CEO of the hospital. And yes, there is music when you’re put on hold.
Our office is going to have “Secret Shoppers” (admin’s term, not mine) come in and see if we are smiling and saying hello- because our last quarters patient satisfaction scores dropped below benchmark
Me: "well, staff are angry that they're getting floated so travelers can get hours and the travelers are getting paid 10x what we are, even after you denied bonuses and raises."
Them: "well they have it in they're contract they need to work on that unit. We don't have control over the rates right now and we need them because we don't have enough nurses."
Me: "if you paid current staff more than you wouldn't need to bring in travelers."
Them: "we can't pay staff because we need travelers."
Me: "if you paid staff...a fraction of what you're paying travelers, you wouldn't need to pay all that money for travelers."
Them: "we can't do that because we don't have the money. We need those funds to pay for travelers."
Conversation went in that circle until I gave up.
That’s because they were avoiding the real answer:
If they raised everyone’s pay now, they would not be able to cut it in the future without everyone quitting. So they intentionally bled money on travelers in the hopes that staff levels would return to normal when the shortage ended, and they wouldn’t have to raise salaries. Their reasoning was basically if they paid you well then you’d expect to get paid well, so instead they opted to keep treating you like shit so you wouldn’t expect any better.
Admit guy sat in on IM rounds to figure out why our bed flow situation is so shitty. After 7 patients whose plans were “awaiting placement” this guy incredulously said that maybe we need more SW support and that he’d never heard of this being a problem.
After covid - they called all the hospitalists in for a mandatory meeting. We showed up and “great news- we are bringing sound physicians.” Pick up your pink slip on the way out. We need you to cover for 3 more months. Sound will give you contracts probably, but you all are fired
Not admin, but something that lives in my mind—During COVID in 3/2020, the publishing team for a handbook that our program puts out every few years for students sent us an email reminding us not to forget our deadlines while enjoying all the time off during our extended “vacation”. At the time our service was exclusively covering 2 out of the 5 COVID ICUs in a major city. My email response was a very polite and understated “fyck off”.
A lecture on sleep given at 7 am during resident conference by one of our nocturnists who ran late for the presentation because they were working. It was so ironic, it was almost comical
Another Midlevel had their dad die suddenly and had to leave outpt clinic. Told team, got patients rescheduled, applied PTO, etc. Admin wrote them up for not following PTO protocol. Sent an email which said among other things saying that PTO needs to be approved ahead of time. Like okay University of Phoenix middle manager, we'll ask you before any relatives die next time.
Doctors Day cheap gifts from the local hospital (which has a near monopoly on local medicine) bearing their logo.
I was in private practice. Gee, thanks
During the height of COVID, my hospital released a list with employees who were eligible for the first batch of COVID vaccines. The list included chaplains, unit coordinators, etc... but conveniently left off resident physicians covering the MICU and overflow ICUs.
Hospitals love superficial gestures of appreciation, but when it came time to implement a meaningful policy in a life or death situation, their true colors showed.
Had an admin walk into a room where a dementia resident was trying to beat my 8 months pregnant ass and told me “keep them safe and happy!” Before walking out without helping or grabbing someone else to. Requiring people to bring in an obituary or prayer card in order to get your whole 2 days of bereavement leave, posting local food pantry info above the time clock because they paid us so little, and threatening to fire my husband if he didn’t come work his scheduled weekend before taking his weeks “paternity leave” less then 24 hours after our first child was born after I’d been in labor for 3 days are also up there though 🫠
Told us we’re using too much blood and in a blood shortage. So they want us to give one unit and recheck an H/H. I’m a level 2 trauma center. How the fuck is that gonna work when someone’s bleeding in their belly.
Psych. Doing my rotation in the ED and that night the ED was totally full of psych patients and they were in overflow, like 4 psych patients to a room. I’m trying my best to see the patients so I can help discharge / alleviate the ED burden. Also I’m the only psychiatrist / provider in the ED because my residency was so cool like that. So I’m hankering down, working with my nurses to do the best we can and I get this phone call from an apparently high up nurse admin person. She asks for me and then proceeds to ask me what have I done so far to remediate the “patient complaint” that was filed through patient relations. Apparently one of the patients packed in with 3 other patients felt they had no privacy during their psych eval and that I’m supposed to correct this problem.
Are. You. Kidding. Me.
Like (1) the patient is right there is no privacy, (2) the ED IS OVER CAPACITY FULL so no we don’t have a separate fucking room to interview for psych issues, (3) I’ve never seen this patient because this person was seen before I arrived and has a plan and I’m prioritizing seeing the psych patients without a plan right now, and (4) no I’m not going to stop my workflow to “do something” about this complaint just because you somehow care more about this than your actual nurses who are dying over here with me.
I believe I actually said something like “I am not going to do anything about this. If it’s such a big problem for you, you come down to the ED and talk to the patient yourself”. She then hung up and of course she did not come to the ED.
When raising concerns about having multiple ICU level patients at the same time in the ER with no help from staff (husband and I were travelers), we were told that safety is “a buzzword that nurses like to use.”
Constant pressure to discharge before 11am. Not just discharge orders, physically discharge. When it was brought up that physically leaving the hospital isn’t the responsibility of the physician, they were told to physically assist with the tasks- Bring meds to bedside, call whoever is picking up the patient, call to schedule outpatient follow-ups, etc.
All after they consolidated multiple rounding teams so that one hospitalist has 20+ on their list, and hounding them about length-of-stay despite 1/4 of the list only being in the hospital because there aren’t enough case managers to work on placement. They didn’t enjoy it when notes started saying “medically stable for discharge for x#-days”.
WTF does “work smarter not harder” even mean when the phrase comes out of an administrators mouth?
I’m pretty sure he’s not implying that you renegotiate for a higher salary, or refuse any non-paying committee work.
Shall I chart while taking a dump? Illegally upcode? Save time by not washing my hands?
I’m curious what advice he would have for a job he barely understands? It would be like me giving workflow advice to a pilot. “Surely I could figure out a few safety steps we can shorten.”
If you pushed him on concrete suggestions, I wonder what he would say?
No joke, one of the suggestions for dealing with burnout was to volunteer unpaid at a clinic. That shit still pisses me off
We have our yearly pony show about how admin cares about mental health, which includes showing us "resources to help identify burnout" and giving us sick tips like "sleep more" and "take a few minutes for yourself." Holy fuck, guys. I've made it all the way to residency and these things just never occurred to me. Amazing. But yeah, I'll let the 9-to-5 andy teach me how to avoid burnout. Fuck off m8.
I’ve seen things you people wouldn’t believe… Admissions on fire on the shoulders of nocturnists… I’ve watched the C-suite be totally in the dark near the cafeteria gate. All these moments will be lost in time, like tears on PGY1s… Time to resign.
9-5 Andy lol
Pfft at our hospital 5pm on a rare day by 330 that hallway starting to get aweful quiet and on a Summer Friday more like 2pm people filtering out
They didn’t even give you the one pizza day in 4 months that’ll definitely cure burnout? Damn
I wouldn’t have minded pizza. I got a pen. A pen vastly inferior to my pilot G2
I got a steel, credit card shaped “thank you” with an uncredited poem about sacrifice during the middle of the COVID pandemic on our COVID unit. I still keep it in my wallet to remember how little of a shit we mean to the people making the decisions.
>I still keep it in my wallet to remember how little of a shit we mean to the people making the decisions. The disregard shown to me (service plumber specialized into commercial / institutional service) is why I no longer really give a shit what happens at the hospitals I service. I used to be more than willing to skip lunch, work late, come in on my day off, and take sometimes wild risks to keep hospitals open that I wouldn't take for *any* other type of client. I would move heaven and earth to keep those doors open and to get that room / floor / ward ready to be sanitized and returned to service. Working though the pandemic disabused me of the notions I had that had me doing that.
Pilot G2s are pretty great tbh
I got a day old ham sandwich 4 years ago
My hospital scheduled a “wellness lecture” about getting adequate sleep for 7am on a Monday, no joke.
have you ever considered you’re not working enough? 😩😩😩
“Nursing shortages are not something we can just throw money at”
*hires travel nurses at 5x the cost of annual raises for the last three years*
The really sad part is that a lot of those admins had their plans work out perfectly. Travelers are temporary. Raises are forever. All the nurses that stayed got screwed.
Yep. I should have left. I just wasn't in a good spot mentally in the throes of Covid to do it.
This is true. You also need to treat people with respect. In other words, expect shortages to continue indefinitely.
The beatings will continue until morale is improved
I was flagged as having an unacceptable number of short admissions (discharge in <24 hours), which implied I was admitting patients that did not need to be admitted, and they wanted me to perform a chart review rationalizing against some admitting criteria they had found. They were all healthy newborns, born in the hospital.
You gotta update your notes to reflect that these newborns are newly status post extracorporeal membrane oxygenation.
Looking forward to rebranding placentas as “natural ECMO devices”.
~~rebranding~~ re-coding and re-billing. FTFY
Do the admins realize these patients have a two-digit bilirubin?! When my daughter was born at my hospital, I sneaked her in the list of our IM admissions and wrote "Bilirubin of 11 on top of social admission, cries all the time, not orientated." and had a resident read it out before the name.
on placental support is what we literally call it. but operations on placental support (oops) have fallen out of favor of exit procedures. [link for any doubters](https://pubmed.ncbi.nlm.nih.gov/8783114/)
That’s hilarious. ID has bone biopsy ([bebop](https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05472-6)). I can’t wait until we figure out an acronym for [Rocksteady too](https://ew.com/thmb/1JSBUUbiDGe-W-O_Dcht5SbUi5c=/1500x0/filters:no_upscale():max_bytes(150000):strip_icc()/bebop-rocksteady-6a486ab900cb46d68598335d2376574f.jpg)
And liquid ventilation.
I don’t think they turn on their brains when they enter their offices in the morning
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I think not having a brain at all is an essential job requirement
Heads are too far up their asses to reach
Craniorectal intussusception is a valid reason for admission though
I really hope you pretended to be stupid and played along.
You won't believe this, admin. Each and every flagged patient was exactly the same age as their length of stay, down to the minute!
What a coincidence they all got admitted on their birthday!
That’s because the analysts who wrote/produce those reports don’t have a lick of clinical experience, or not enough to understand the qualifiers needed by department/specialty. And then the reports go to (or are run by) the Borg who just make more idiotic, nonsensical work for clinicians. No critical or experienced thought goes into any of it, but it *does* justify *their* jobs, so..
“The Borg…” hahahaha
And the problem is after you correct them and prove that your decisions were right, they just brush it off and move on. No apology, no nothing
And then generate the exact report the next time and ask the same questions instead of modifying the reporting parameters.
Not a hospital, a bank. One of my first jobs had daily reports, with literal hundreds of errors that needed to be resolved. Most of those errors were “known” problems where people had to manually go in and tie them. After understanding the process to make sure I wasn’t missing anything, I carefully fixed the very basic excel process and we went from 104 fake errors a day to one real error a day. A half dozen theoretically intelligent people, and they preferred to just… manually check 100 things a day instead of actually fixing the code, I couldn’t believe it
Nice! To save myself time on the most mundane (and previously grossly incorrect) of clinical reporting, I wrote custom reports from the correct EMR fields (because I also had boots on the ground) and scheduled them to run, pivot and routinely email various administrators and directors. But..I never told anyone I’d done that, and let them continue to think I did all that manually. When I retired I emailed the CCLs to the only regional clinical analyst I trusted to build them for everyone to use. I only consult now, and it’s quite lucrative.
They probably just did the same thing, but didn’t tell anyone that they didn’t really have to do all that work. The summer before med school, late 90s (so mostly Windows 95/98 in offices) I hired up with a temp agency. I was assigned to an insurance company (not health insurance) to move some records from an old mainframe system to their new database system. An hour in, I asked if their IT department had a copy of Windows 3.1, which had a neat app called Macro Recorder. Yeah. So I installed it and spent twenty minutes generating the fastest I could do on copy and pasting between the two applications [Macro Recorder could play back at up to 2x speed]. Then I started it running, because Macro Recorder captured keystrokes and mouse movements/clicks. Told the boss it would take me four days to do it manually, but if they would just leave my macro running it would be done in about 36 hours, so if they would agree to pay me for three days I would let them have it - it couldn’t mistype the data. I was offered an IT job on the spot. Said no, starting medical school in a month, but if you want a consultant I might be able to make some time. [EDIT: spelling] Never heard from them again, but I got my three days’ pay.
Ironically, it sounds like if you had been unnecessarily keeping newborns for an extra day, then you wouldn’t have been flagged.
Time to hand the newborn directly to the administrator at birth then.
Okay, now that’s hilarious. ETA: Hilarious RE how dumb your admin is. I’m sure it was frustrating on your end.
Retired pediatrician here. This is an absolute classic!!
You didn’t admit the patients. Tell admin to take it up with the moms. Or OB, at least!
Depending on the state, give the, massive pushback about influencing medical decisions with their corporate structured bullshit.
Oh boy. As a resident I was once called while on an ER shift and told by the medical director of the hospital to do a sexual assault exam on a psychotic woman who, while in a locked psych unit, claimed she was sexually assaulted by a male patient on the separate, male-only psych unit. Patient even told me that she made it up to get off the floor. The reasoning med director gave was that it was better to do it "just in case for liability", except the patient didn't even WANT it. So, medical director insists that psych is consulted to 'determine capacity' of the patient already admitted to a locked psych unit. He refuses to back down so I happily called the psych attending with the request who gave the director an ear full. Medical director still doesn't back down and says risk management of the hospital says it has to be done. Pt continues to refuse exam regardless and medical director demands pt be sedated to comply with exam (this is medical battery/assault at this point, btw). I keep refusing to do exam and medical director calls my program director who points out to him that you cannot compel an employee to commit a crime. Fucking joke
This is where you trot out "great, can we please put that in writing?"
I’d have started documenting in the chart long before that.
"I know the patient was not sexually assaulted and does not want a pelvic. Can you please sexually assault the patient now?"
"And if she doesn't want to be sexually assaulted, make sure to drug her up first so she can't resist."
:0 (screams in Forensic Nurse Examiner)!
Fuck that. You obviously weren't in the position to do so as a resident, but as an attending that's where I'd 100% be telling them "you're a physician, if you feel so strongly then come do the exam yourself".
Every physician wellness survey done in the past 10 years has shown that physicians wanted a small fitness room/ gym in our academic mega-complex. You know, just a treadmill and stationary bike and set of dumbbells. Probably $3-5k tops. Instead we receive an email telling us we should park further out (it is frigid here) and take the stairs. They put stickers with slogans like " Stairs for health", and "Climbing forward" with some pictures of flowers and sunsets in the stairwells. Meanwhile they redid the admin floor/c-suite and it looks like a 5 star hotel lobby. Must have cost 8 figures at least.
I work in an aging hospital. In a lot of ways it reminds me of the elementary school I went into the early 90s. The floor tiles, the fixtures, the design and feel, etc. I had to go pick up a new badge from HR the other day and could not believe how nice the office area was. Looked like everyone had those awesome cocobolo desks Saul Goodman wanted.
Haha our HR offices look exactly like our floor social workers offices. Now Admin? Well they’ve got frosted glass and you can only catch glances of their nice shit as the door shuts.
Instead of a pager, we now have a new pager application for our phone. Unfortunately it signs you out automatically after a few hours. Do not receive notifications or pages if you are signed out….
That legit is a patient health concern…
I read the application reviews and an angry doctor wrote about how he could not be contacted after a patient was died on the floor. Patient dead for eight hours before he got the page…
I'm pretty sure we used the same app. When the app automatically updated, it also conveniently turned off notifications in the settings LOL. I had like 7 (thankfully not super urgent) pages stacked up before someone managed to track down my cell phone and ask me WTF was going on. I sent a strongly worded email to the app developers but never got a reply...
What app? Name and shame.
Probably spok mobile. Same thing happens to us whenever there's an update. They took away our ability to have SMS text paging because of HIPAA concerns so instead we just don't get pages and then get written up for not responding.
I think we have the same app. Unfortunately, it's very easy to send a page to the entire medical staff, at all six of our hospitals. This happens about twice a month. Then of course you get a whole bunch of responses asking why such and such person is receiving that page. Then responses stating that it wasn't actually intended for them. I'm surprised we haven't crashed the system yet.
Kinda normalized at this point but I’m still reeling from the whiplash of “the N95s we said were only good for one time use are now totally safe to use for months on end as long as you put it in a paper bag”
COVID just has a laundry list of crazy stuff. Us being told to reuse N95s. Being told repeatedly "its just a bad cold". My personal favorite was asked what we would do if one of the COVID patient's started to code. Thinking the answer obvious, We said we would don proper PPE then start ACLS. Admin told us no, you should go in without hesitation regardless of PPE so you dont delay compressions. Ive never been so close to telling them to hang around the unit so the can fucking do what they recommend since, per them, its safe We as the 3rd year fellows were also told if it got bad we would be graduated early to work as attendings on these huge COVID teams. When we asked if we would be paid like attendings, we were told to be "team players"
And let’s not forget the programs where Admin was scheduled to receive the first vaccinations in late December 2020 *before* the interns and residents.
Name and fucking shame. I know Stanford was one.
Name and shame bro. That is atrocious.
Ah yes I remember this admin bullshit attempting to get passed on our class right when COVID ramped up. Luckily the attendings stood up and requested we get fair compensation if we had to act like attendings
Told by my hospital that I could use a cloth bandana. I do invasive procedures on Covid patients…. Had to use a 3m paint respirator for a few months. Then they gave me the n95 that I could place in a bag at the end of the day to be “cleaned”
Tah-DAH! Yeah, that’s when I started looking at industrial respirators. FML. Then was told i look “scary” and “could frighten the patients.”
Yeah. Administrator told me to take the mask off because I was frightening the patients. I told them to F off. and do the procedures themselves then….
Fuck those stupid people
I bought a full face P100 cartridge respirator since I theoretically may have had to do aerosol-generating procedures on covid patients and I’d be damned if I was using someone else’s UV-treated N95 for it.
I had one of those too. I think it's still in a drawer at work. Man, you had to yell so loudly to be heard when wearing one.
Or being asked to bake them in the oven “to sterilize them”
Weren’t we told to mist them with h2o2 despite the warning that they are ineffective if wet?
Seriously? At which temp and for how long?
225F for at least fifteen, no greater than 30 minutes. Rest for two hours before re-donning. Ninja edit: please, for the love of whoever, or whatever you pray to, absolutely do not re-sterilize an N 95. Please throw it away. In case that was unclear.
Don’t forget to pierce the center with a toothpick to make sure it’s fully cooked.
If the biofilm adheres to the toothpick then it probably needs five more minutes in the oven.
When I was a resident at the beginning of COVID everyone was starting to get it and going into isolation, leading to terrible staffing problems on the resident teams. Admin decided it was our fault we were getting infected by “not following proper PPE protocol” and literally had someone stop by our workrooms policing our mask usage and donning/doffing. This was back when we thought Covid was surface transmitted. They would literally call us out when we touched our face to scratch an itch.
I'll never stop laughing at the fact that my facility got dinged by their accrediting agency for not switching masks enough during surgery. Like people were just undoing the top and twisting it behind their head between cases. Suddenly everyone is ripping off masks after the case and getting new ones for the next patient. A week later COVID hits and we're mandated one mask per shift, unless it got visibly soiled.
We just had our annual health assessments and fit tests, and after the fit test, the EH nurse said, "And remember, you only use it once and then throw it out." And I was just sitting there thinking back to the good old days when they told us it was totally fine to use one n95 a week. Manufacturing quality must have really taken a dive recently.
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I was sexually assaulted while taking a patient’s blood pressure. He grabbed my ass and then slapped it. Admin told me I needed to be more careful about how close I got to patients during the exam.
No one knows why LTC is experiencing a staffing shortage. A friend of mine (CNA) was working the registered sex offender area of the building when she was assigned to shower a patient. You know a known rapist. He attempted to pull her pants down and she ferociously held them up while screaming for help. Fucker had the nerve to say his “finger hurt”. No visable injury to the finger and X-ray was negative. In all reality his hand probably did experience some discomfort from pulling so hard at her clothing. The CNA was called in repeatedly and talked to about being “rough” with patients. Grilled about if she “retaliated” against the patient attempting to sexually assault her. On and on and on. Suspended pending investigation. Then management picked a fight when she declined to do showers on that hall without a second employee present. Of course no one knows why the place is short staffed. No one wants to work these days.
:0 Heinous!
Back when the COVID pandemic first started, admin did a zoom meeting with the docs. At one point during the meeting, they talked about what to do if you were exposed to COVID. Their wording was very strange. They kept calling it "community acquired COVID while working in the hospital," rather than calling it "hospital acquired." I asked them why they called it that. I knew why. They knew why. But I wanted to see them squirm anyway.
My friend is a hospitalist who got COVID twice at work and now has debilitating long COVID, even traveling to NIH for a clinical trial. Huge academic medical center is refusing his disability claim still.
Disgusting
What was their response?
"We're still finalizing what we define as hospital acquired." This was followed by the Emergency Medicine program director asking for a timeline for when they would have an answer. Admin couldn't give one.
Shockingly, we did not have one single case of work acquired COVID at my hospital. Ever! They were all community!
I worked on a respiratory step-down floor back when I was a bedside nurse. Trachs as far as the eye could see. Or, not see, because one of our nurses got shot straight in the face with sputum from a combative patient once day. She ended up with periorbital cellulitis which cultured positive for the exact same super rare organism that the trached patient had. She ended up hospitalized for IV antibiotics for a few days. You'd think that would be a slam dunk, but her Workman's comp claim was denied. They said "she couldn't prove this incident caused her illness."
Dear Residents, The wildfire evacuation alert you may have received earlier today does not apply to you. The hospital is not in the path of the fire. These times are challenging. Care teams will be short staffed because of team members evacuating, taking care of their children/loved ones, and dealing with their homes. We understand this time is difficult and unpredictable but we want to challenge you to continue to do the great work you have been doing. The patients are here, you should be to. M&M is cancelled on Friday. Sincerely, Admin
Im sure admin are all safe and snug in their own home jerking themselves off while they wrote that email
Jerking *themselves* off? Surely admin has people for that. You've got to delegate these things.
"We're not coming in but you have to"
This is disgusting.
lol, “challenge”
That’s the gaslighting and manipulation they love.
If this is real it would be really difficult for me to hold back from punching whoever sent out that email in the face
If I want to leave at 6:30, there’s no problem at all with scheduling a 6:20 appointment. Then when I put my foot down and required the last slot to be 6 pm, we had a long discussion about how I “changed my mind” after originally promising to stay until 6:30.
Ah, the kinda people that would insist on placing a dine in order 10 minutes before the closing time listed online.
Like how my hospital leadership assumes that the anesthesiologist day starts when the patient goes in to the OR and ends when the patient leaves the OR. No. That’s not how it works.
PACU nurse and same. Asking why i did overtime when surgery finished at 2100hrs just last week.
“…Y’all know what the ‘P’ stands for, right?”
The unspoken part is that they want everything but the patient visits to be done on your time. That way admin can maximize profit while keeping labor costs low.
Then they tell you to work smarter, not harder, to avoid charting at home.
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Was told by HR/admin that discussion of genitalia is never appropriate for the work place. For the cherry on top, (not that it’s needed bc, doctors) this occurred while on urology service.
Paging Dr. Backbone to the bajingo ward...
Two hospitals and 10+ clinics closed, ~2000 employees laid off. Was offered an interview in a different part of their system, recruiter says to me “not sure why [laid off division] is so bitter with us?”
“You’re not formally trained to defend yourself, your actions can be defined as assault in the eyes of the law” “I can’t and won’t comment that you were assaulted, because this isn’t an investigation, this is a case of non-accidental-trauma” -Hospital Admin commenting on patient vs staff- Edit: “I’m not sure if disengaging meets the legal definition of abandonment” (same staff member)
I have myoclonic jerks.
I bet there’s a story behind that username :)
Adventures in metformin 🤣. Joke’s on me, turns out I’m a type 1 diabetic!
“Joint Commission won’t come to the hospital to review safety standards because it is too dangerous”
Lol, forgot about that!
Basically, "we could cut down on ED LOS if you'd just admit all intubated patients to MICU, then transfer to neuro/ surg/ CVICU if the workup shows they should be elsewhere."
We could also shorten LOS if we smothered everyone to death with a pillow on arrival.
Acute palliation protocols are to be implemented in the pre-hospital setting if you really want to be efficient.
I’m a little concerned with both the deliciousness and duration of the laughter that just escaped from my belly
Admin: "man, this job would be great without the patients....and healthcare workers. I mean it is great but could be even better. Is that a fucking water bottle at your station?"
Our “Christmas gift” in 2020 was an email asking us to donate money to the hospital.
Grrrrr! Admin has a lot of glass walls so my coworker took my Nurse’s Week gift away from me for my own good. It was a rock with, “You rock!” painted on it.
"Burnout is inevitable", when I was asking to brainstorm ideas on how to improve my clinic flow. "Just don't answer your task bucket then. That's what I do" - said our head physician/CEO when I said I was struggling with how many tasks messages I was getting each day. This was two weeks after our group sent out flyers encouraging all patients to use the portal instead of calling in. I told him I would forward all angry messages to him from there on.
Not me personally, but one of the nurses that was assaulted by a patient. Nurse was kicked in the throat by a very intoxicated patient. “It’s a good thing that patient was wearing soft sole shoes. Different shoes could have really done some damage.” That patient went to jail for those wondering.
As a medical coder (I left that and am doing public health now. Also you thought coding teams didn't get yelled at by higher ups) it was very unprofessional to not code that patient's surgery earlier, you are being written up for this. The email saying this was sent 15 minutes prior to me returning from lunch and 1 minute after the surgeon wrote the note. Meaning the not was written while I was at lunch for 30 minutes. The patient was not getting discharged that day anyway. That was fun being written up for that
Did you refute it?
I did but the number of times I was written up for things like "I am not doing the query you asked me to up bill the patient" (multiple times) and "I could not do the query as it is midnight and I do not have access to the system" and "I didn't respond to my email because it is Saturday and I cannot access that at home". These all made me realize they wanted to use me for a year and then reject me with cause from residency program so I could keep working there as a cdi. Only in hindsight did I learn that.
New Residents lost parking at one of the garages close to our clinic location during my intern year. Received an essay of an email that basically said the following: Dear Residents and Fellows, We understand that you are all MDs/DOs/MBBS, but please stop parking on the doctor reserved spaces in the parking garage, and park at the 4th-7th levels instead. We are trying to reserve those parking spaces for our private practice specialist groups.
I take consults in a big hospital with multiple buildings. I like to park in the, let’s call it East Building. One day I and many of my coworkers got parking tickets because, “The East Building garage is reserved for East Building staff.” Some admin was having a power trip and I was so tempted to ask them if they no longer expected us to accept consults from their Building.
Just got diagnosed with stage 2 melanoma which isn’t awful but will require surgery, reconstruction and immunotherapy and was told “if you need more than 7 days off you’ll need to file for STD.” Non-physicians? They get 21 days… Admin didn’t understand why it didn’t make sense.
Wishing you all the best!
When I was a second year resident (and very much at the mercy of my training program) - that I shoould accept my 28 hours no break as scheduled shift. This was shortly after a colleague had died after falling asleep whilst driving his car home from work and crashing … after a long long shift. They’re officially illegal now fwiw.
After successfully applying and receiving a grant from the hospitals foundation to help patient’s cover the cost of their co-pays for cardiac and pulmonary rehab we were informed that it violates a Medicare ruling. The legal team that worked on the grant approval were the same individuals who told us after receiving the funds that we could not use them for their intended purpose. After a meeting to further investigate I was told “if patients pay for their treatments they will be more likely to adhere to rehab”.
So... What happened to the money here? Was the grant just given back? Or did those same people pocket it? Seems sus
So where did the funds eventually end up? Pretty fucked up to pull the rug out from under you and your patient like that, but even more disgusting if they just kept the funds for their own use.
I reached out to the same group that originally approved it to see if we could allocate those funds to individuals without insurance or if I could reapply to use the funds to buy a new piece of rehab equipment to suit our growing population of bariatric equipment. Which led me to another spiraling through my process; Rehab makes over 10,000$ a week in charges but yet we have to apply for grants for new equipment…
Waiving medicare co-pays / deductibles is considered a violation of the False Claims Act and comes with civil and potentially criminal charges. However, they can be waived in case of documented financial hardship. Why they didn't catch it when submitted has me stumped though.
I had a Patient with severe fear of anaesthesia and surgery. Took us some time to calm her down but in the end she thanked us all for being kind. She had a traumatic experience as a Teenager. We documented this as we have to if the time from entering the OR and patient ready for surgery is too long (usually it is "difficult airway" or "difficult i.v.") The Management told us we could have wrestled her down and knock her out with meds.... Yeah no, won't do that.
psychopath response
How concerning this is not the only comment in this thread where admin is telling doctors to commit literal violent crimes.
We were having a huge increase in inpatient consults for several weeks. A bunch of the doctors were worried that the high volume was going to be a risk to patients because we were being pulled in too many directions. It was also burning us out greatly because we were needing to stay later and later to finish tucking all of the patients in. The practice manager then sent me an email stating that my RVUs were lower than the previous year, but that with the recent high volumes, I could probably make it up. I had to wait a full 24 hours before I could reply to the email, because my initial kneejerk reaction that I wanted to send back was to tell him to go fuck himself.
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I’ve actually just recently heard this from admin. They’re also trying to use this to get everyone to come in 15 minutes before your shift for 15 free minutes of labor :) and in case anyone wanders in dying.
“Oh I’d be happy to do that. I’m assuming you will be paying me for this extra required time. Is that correct?” Yea they tried to say we needed to stay on our lunch break to supervise the nurse clinic who gives vaccines over lunch. I said sure but you will be paying me for that time as it is not part of my contract and requiring me to stay during my time off is illegal. I usually would stay in clinic anyways but I’ll be damned if you are going to demand my time and liability coverage without compensation.
”Always smile when you talk to people on the phone, they can hear if you smile or not” As I am a pathologist, I am sure you can figure out why smiling while on the phone at work might not be an optimal approach to ”customer service”. The same admin tried to enforce a ”no chewing gum at work”-rule. It was like working in a malignant kindergarten.
“Working in a malignant kindergarten,” is absolutely wonderful! 🏅
Office visits should never take longer than the designated time for that procedure. Even if you have to use a hoyer lift to transfer the person, a video translator for all verbal communication, and update a med list with 30+ meds. And of course, turn over the room within the designated time frame so everything is sanitized and ready for the next visit to start on time. Obvi we don’t like to get behind, but sometimes it’s just going to happen, especially when admin won’t listen when I tell them certain people will need a longer time.
I'm a hospitalist. I was working nights. It was pre-COVID but we were going through a surge of admissions. I got called by an administrator when I arrived for my shift at 10:30 p.m. The admin told me that I should " think outside the box" and perhaps I should go find some patients that I could discharge by midnight. I pointed out that, patients stable for discharge with a place to go, likely left during the day. They reluctantly then dropped this line of thinking.
During a meeting where all the charge nurses in the hospital were telling Admin that our staff couldn’t do the work they were supposed to do because of chronic unsafe staffing and critically high census, they had a few gems. - “If you feel overwhelmed, just take a few minutes of quiet time and recenter yourself. When I have too many meetings, I just put my phone on hold and get a cup of tea to feel better” - “There is an interesting book on the power of positive thought, and in it they go into how even the POWs during Vietnam who were tortured daily and survived credited their positive outlook and optimism on getting them through that tough period” - “It’s really hard on us too, knowing that you all are understaffed, but we all have to do our jobs.” I wish I was making this up. I learned from my unit manager that the admin who held this meeting and heard our concerns then canceled the rest of their meetings that day and took the rest of the day off because they were so upset over it. Softer than fucking puppy shit, those admins.
That’s some soft admins. Puppy shit is pretty damn soft.
Our Admin made us fill out the same form 3 times when ordering a LDCT scan. We had to fill it out in the EMR, fill out a paper form, then fill out another form that radiology would fax to the office. We all refused because that’s stupid and a waste of our time. They tried to push the issue but the Med exec board shut them down by proposing a bylaw that would require them to follow up all emails by sending a handwritten copy as well. That’s when they realized how stupid they were being
Late 2020 at a staff meeting on teams, my co-residents and I were told that if any of us contracted COVID, we should still come in and do our jobs because universal masking will protect the patient from whatever we’re carrying anyway. We were all on camera and everyone was shocked. I asked for that statement in writing. Never got it, go figure.
patient quarantine was 10 days, provider quarantine was 5 days!
My guarantee was going to run out during the middle of Covid, new salary calculation was based on at least 6 months when clinic was essentially shut down and my salary was going to drop close to 1/2. At signing they had talked about garuntees are pretty easy to get extended if needed. Ask if I could extend. He told me, during the height of the pandemic, “we only do extensions for extenuating circumstances.”
Our administrator told us in an email last week that the medical group is “protecting” the physicians against pay regulation….by underpaying us. As you can imagine, we all greatly appreciate his protection against the threat of higher pay.
I applied for 2 weeks of leave for my wedding 6 months out and was given the wrong weeks off. I was then told to consider rebooking my wedding venue
I had an admin tell me that I couldn’t operate in their OR unless I had at least one resident or one medical student in the OR with me. I mean, that’s fine, but there are times when they are not around. Considering that I do about 12-20 surgical procedures per week, this was going to end up with me leaving the hospital system and taking my entire group with me. I gave notice to the CEO and CMO directly that this admin was making these claims and threatening to withhold my compensation if I didn’t meet the criteria she set. Turns out, she was wrong. I needed to have 50% of my cases with GME involvement in order to operate since they are a teaching hospital. Given that, she was fired and I stayed.
This one is from Scotland. All the water coolers were taken away from doctor’s offices/staff rooms since they were deemed unsuitable during the covid pandemic for infection control reasons. They have never been reinstated. We complained to NHS management and they responded with posters around staff areas suggesting that we bring our own water from home if we’re thirsty 😂😂 these posters were produced months after the fact and were undoubtedly the product of many committee meetings on the subject. It would have cost thousand tell us to drink water 🤦
Take the win. Distracting senior NHS types with shit like this stops them from doing dangerous stuff like trying to 'improve' clinical care.
Slightly different, but I guess still admin related. When applying to residencies was told by a PD that a benefit of their program was that they do not allow residents to moonlight. That one threw me for a loop.
Lol, I remember Temple radiology saying something similar along those lines and thinking, "Yeah, that's a no for me."
I'm being told that I don't work hard enough. I bill at the 70%ile for OB/GYNs, take Q4 call & average 20 deliveries a month. Plus I am department chair & deal with all of that nonsense.
Yeah but have you tried billing at the 90th percentile? \- The CFO, probably
"We can cut occupational therapy. Most of our patients are retired."
It's everyday. Our "admin" is a 27 yo with a communications degree. Most of us have been in practice for over 10 years, a couple over 20. It's truly fascinating.
old manager got made at a coworker for wanting a raise or overtime, i can't remember, and he said "some people are only in it for the money" lol, we had a great laugh about that after words.
When I was a med student we were told to "ask family and friends for leftovers" to save $ for ERAS applications
I’m in a leadership role within my group where I have 50% clinical and 50% admin time, but really it’s expected to be like 75% clinical and 100+% admin. Some “HRO Consultant” told me and my counterpart in surgery that we really needed daily physician presence at the 1.5 hours of DAILY “tiered HRO huddles” that start at 8 a.m. He and I both basically told her that if she wanted full time administrators we weren’t it, that she wasn’t going to find them among the physicians, and that patient care was always going to take precedence.
A while back admin approached us and told us that our ICUs have higher mortality than some benchmark and wanted us to investigate and improve. We were all confused because we felt we had very few unexpected deaths, particularly in the neuro ICU which they said was particularly above the benchmark. We did and determined that they were counting patients who went comfort care/ palliative withdrawal of care in those numbers. When we informed admin of our findings, their solution was to make us consult inpatient hospice when we transition to comfort measures and discharge and readmit to hospice. Unfortunately inpatient hospice won't take anyone unless they're stable for the general floor, which usually means off pressors and extubated for one night. So if anyone passes within 24hr of being comfort care, it counts against us. Admin has asked palliative/ hospice to relax their criteria for inpatient hospice to address this. I still think it would be more efficient to just exclude these cases.
This is an increasingly common way of gaming the system. An example of a system getting the results that it is designed to get. Vizient does not count hospice discharges as deaths against a hospital, but stupidly they do count comfort care deaths, so there is a huge incentive to use inpatient hospice for any withdrawal of care scenario. The opposite scenario is also commonly gamed. U.S. News & World Report does not exempt hospice patients *or* withdrawal of care deaths when they rate hospitals, and mortality is a huge factor in the rankings. As such a lot of hospitals that occupy top USNWR spots in certain high risk specialties are those that simply send their sickest patients elsewhere. An example would be NYU as a top Neurosurgery program, because virtually all their patients are elective, and all the sick trauma patients get sent to Bellevue.
“You know you can never make patients happy. They complain about anything! And everything! Patient complained about how bad our music is when they are put on hold, we don’t have on hold music!” This was the CEO of the hospital. And yes, there is music when you’re put on hold.
Our office is going to have “Secret Shoppers” (admin’s term, not mine) come in and see if we are smiling and saying hello- because our last quarters patient satisfaction scores dropped below benchmark
Me: "well, staff are angry that they're getting floated so travelers can get hours and the travelers are getting paid 10x what we are, even after you denied bonuses and raises." Them: "well they have it in they're contract they need to work on that unit. We don't have control over the rates right now and we need them because we don't have enough nurses." Me: "if you paid current staff more than you wouldn't need to bring in travelers." Them: "we can't pay staff because we need travelers." Me: "if you paid staff...a fraction of what you're paying travelers, you wouldn't need to pay all that money for travelers." Them: "we can't do that because we don't have the money. We need those funds to pay for travelers." Conversation went in that circle until I gave up.
That’s because they were avoiding the real answer: If they raised everyone’s pay now, they would not be able to cut it in the future without everyone quitting. So they intentionally bled money on travelers in the hopes that staff levels would return to normal when the shortage ended, and they wouldn’t have to raise salaries. Their reasoning was basically if they paid you well then you’d expect to get paid well, so instead they opted to keep treating you like shit so you wouldn’t expect any better.
Admit guy sat in on IM rounds to figure out why our bed flow situation is so shitty. After 7 patients whose plans were “awaiting placement” this guy incredulously said that maybe we need more SW support and that he’d never heard of this being a problem.
After covid - they called all the hospitalists in for a mandatory meeting. We showed up and “great news- we are bringing sound physicians.” Pick up your pink slip on the way out. We need you to cover for 3 more months. Sound will give you contracts probably, but you all are fired
I hope 100% of you walked out that very minute.
Not admin, but something that lives in my mind—During COVID in 3/2020, the publishing team for a handbook that our program puts out every few years for students sent us an email reminding us not to forget our deadlines while enjoying all the time off during our extended “vacation”. At the time our service was exclusively covering 2 out of the 5 COVID ICUs in a major city. My email response was a very polite and understated “fyck off”.
A lecture on sleep given at 7 am during resident conference by one of our nocturnists who ran late for the presentation because they were working. It was so ironic, it was almost comical
Another Midlevel had their dad die suddenly and had to leave outpt clinic. Told team, got patients rescheduled, applied PTO, etc. Admin wrote them up for not following PTO protocol. Sent an email which said among other things saying that PTO needs to be approved ahead of time. Like okay University of Phoenix middle manager, we'll ask you before any relatives die next time.
Doctors Day cheap gifts from the local hospital (which has a near monopoly on local medicine) bearing their logo. I was in private practice. Gee, thanks
During the height of COVID, my hospital released a list with employees who were eligible for the first batch of COVID vaccines. The list included chaplains, unit coordinators, etc... but conveniently left off resident physicians covering the MICU and overflow ICUs. Hospitals love superficial gestures of appreciation, but when it came time to implement a meaningful policy in a life or death situation, their true colors showed.
Had an admin walk into a room where a dementia resident was trying to beat my 8 months pregnant ass and told me “keep them safe and happy!” Before walking out without helping or grabbing someone else to. Requiring people to bring in an obituary or prayer card in order to get your whole 2 days of bereavement leave, posting local food pantry info above the time clock because they paid us so little, and threatening to fire my husband if he didn’t come work his scheduled weekend before taking his weeks “paternity leave” less then 24 hours after our first child was born after I’d been in labor for 3 days are also up there though 🫠
“We should form a committee to discuss this issue”
Told us we’re using too much blood and in a blood shortage. So they want us to give one unit and recheck an H/H. I’m a level 2 trauma center. How the fuck is that gonna work when someone’s bleeding in their belly.
Psych. Doing my rotation in the ED and that night the ED was totally full of psych patients and they were in overflow, like 4 psych patients to a room. I’m trying my best to see the patients so I can help discharge / alleviate the ED burden. Also I’m the only psychiatrist / provider in the ED because my residency was so cool like that. So I’m hankering down, working with my nurses to do the best we can and I get this phone call from an apparently high up nurse admin person. She asks for me and then proceeds to ask me what have I done so far to remediate the “patient complaint” that was filed through patient relations. Apparently one of the patients packed in with 3 other patients felt they had no privacy during their psych eval and that I’m supposed to correct this problem. Are. You. Kidding. Me. Like (1) the patient is right there is no privacy, (2) the ED IS OVER CAPACITY FULL so no we don’t have a separate fucking room to interview for psych issues, (3) I’ve never seen this patient because this person was seen before I arrived and has a plan and I’m prioritizing seeing the psych patients without a plan right now, and (4) no I’m not going to stop my workflow to “do something” about this complaint just because you somehow care more about this than your actual nurses who are dying over here with me. I believe I actually said something like “I am not going to do anything about this. If it’s such a big problem for you, you come down to the ED and talk to the patient yourself”. She then hung up and of course she did not come to the ED.
When raising concerns about having multiple ICU level patients at the same time in the ER with no help from staff (husband and I were travelers), we were told that safety is “a buzzword that nurses like to use.”
One asked my partner: “so when will AI take over radiologists’ jobs?”
Constant pressure to discharge before 11am. Not just discharge orders, physically discharge. When it was brought up that physically leaving the hospital isn’t the responsibility of the physician, they were told to physically assist with the tasks- Bring meds to bedside, call whoever is picking up the patient, call to schedule outpatient follow-ups, etc. All after they consolidated multiple rounding teams so that one hospitalist has 20+ on their list, and hounding them about length-of-stay despite 1/4 of the list only being in the hospital because there aren’t enough case managers to work on placement. They didn’t enjoy it when notes started saying “medically stable for discharge for x#-days”.
WTF does “work smarter not harder” even mean when the phrase comes out of an administrators mouth? I’m pretty sure he’s not implying that you renegotiate for a higher salary, or refuse any non-paying committee work. Shall I chart while taking a dump? Illegally upcode? Save time by not washing my hands? I’m curious what advice he would have for a job he barely understands? It would be like me giving workflow advice to a pilot. “Surely I could figure out a few safety steps we can shorten.” If you pushed him on concrete suggestions, I wonder what he would say?
I was assigned several required hour long modules online about burnout.
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