Blindsided by new duties and need some perspective. Help!

[bashir]

I'm a newish attending at an academic institution that is opening a psychiatric emergency room in a few months. It has been in the works for years and we have always been told we will not be required to work it. Long story short they have not been able to recruit enough people to staff it and the psychiatry faculty are being assigned shifts for "back up"--which clearly means we will be working there at least in the beginning, and possibly forever if the staffing issues of other similar facilities across the country are any indication. Leadership is telling us not to panic, they are still actively recruiting in x,y,z ways, that it won't fall on our shoulders for long if at all. They are offering shift differentials which are not tempting for me personally with young kids at home. Bottom line is it is not optional, and most of us are outpatient docs who signed up for an 8-5 M-F gig with a couple of weekend CL call shifts per year. They are not saying how many shifts we'd have to do, but doing the math, it looks like about a shift per week. The day shifts have been covered so we will be assigned to the 4pm-1am and midnight to 9am shift. Our regular duties would be reduced commensurately.

I have a couple of specific questions for you guys. First, does this kind of thing happen frequently in academic institutions? I was completely blindsided. I was very happy in my job until this happened, and now I don't know what to do. I know things happen in all employed positions and if you don't learn to go with the flow a little bit you'll always be job hopping, but this doesn't seem reasonable to me and I'd like some outside perspective.

Secondly, because some patients would be admitted directly to the PES (others passing through our emergency room), we would be responsible for H&Ps for some patients. I don't have this skillset anymore and am skeptical that a few "refresher training sessions" which they are suggesting would be enough for me to get comfortable with this. Even if I were I think it's less than ideal for that to be in my role as a psychiatrist, but that is subordinate to safety concerns to me. I'm wondering how others would feel about being put in this position.

I hate the idea of leaving my job. I had envisioned staying here forever. I care deeply about my patients and don't want to abandon them. But I'm not willing to work overnights on a regular basis when I have young kids at home, nor will I pretend to be competent at performing physical exams on patients in psychiatric crisis. I appreciate your thoughts/advice. And PM me if you're interested in a highly compensated, exciting position at a brand new PES in a thriving midwestern city! Lol. Seriously though, PM me.

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[Sushirolls]

1) Can happen in any job (academic, private, health system, etc) unless it was spelled out in your contract to the finest minutiae.
2) If you have hospital privileges some place, i.e. you do C/L every so often, you can be called upon to do call as part of the privilege of having privileges... This is usually in the fine print of hospital bylaws, and I highly encourage everyone to truly read those bylaws cover to cover. They got you...
3) Don't fret the H&P, listen to the heart and lungs, do the best you can, and as routine for Inpatient units, place the order for consult IM. If you have concerns for XYZ, pick up the phone and call the EM docs next door to come over and look at your patient. If this PES (I dislike the term PES) is separate from your ED, then that's an issue. I loathe these separate facilities, because of this disconnect from EM/IM services. If you have a patient you can't handle or question if you can handle then you send them back to an ED for clearance first. The admin will quickly note the higher rate of transports back to ED... this could be a good thing and expedite your removal from this call pool.
4) They won't budge, time to leave. Yes its emotional and tough to leave the patients you've gotten to know well. But just as you have had transitions in other more personal relationships in the past, you will get over it and form new positive professional relationships with more patients at your next job.
5) Young kids at home as you noted... time to leave. Let them know its a deal breaker. Hire a lawyer, let them draft your resignation letter, and have it worded in a way that leaves open the prospect that you are willing to stay, but will require a new contract, otherwise consider it your resignation, and to term at your institutions time point (30/60/90/120 days, etc).
6) Except for the few people who do nothing but Psych ED work, and they typically scoop up the week day shifts, residents are the key to staffing PEDs. Better have a residency nearby, and be sure their PD is willing to turn a blind eye to the residents covering those shifts even if violating duty hours. I was working up to 80, and a few times 100 hrs a week as resident doing just that in a psych ED.
7) If this is a true PES, and separate from a hospital and not attached to the ED this can be bad, I'll leave at that, and simply say, my experiences from working an adjacent inner city PED, I wouldn't ever consider working in a PES.

 

[bashir]

Thank you, that was very helpful. It is in the hospital, not physically adjacent to the ED but nearby. They are calling it a PES but I will take your word for it that that term is being misapplied here. They are hoping to get some resident moonlighters, but they are going to pay residents and junior faculty one rate and senior faculty a higher rate, which kinda adds insult to injury.

 

[Sushirolls]

Something else to consider, in my limited sample size, and even social circle of a few other Psych, how often have you ever heard someone gloat/brag "We're appropriately staffed and it's so nice!" I worked a health system job for years that had at least one open position before I arrived, and even years after I left its still open and my position is still open too. For profit hospital in area, same thing, the really did a poor roll out and are continually under staffed. Resident staffing labor pool can fluctuate year after year depending on each classes interest, culture within the residency, and always at the mercy of the PD - who can shut it down with the snap of a finger if any of the hour violating residents cross the PD radar for some nefarious reason. The point of this observation, is don't get your hopes up that they will actually get things staffed and you will no longer be needed in this PES/PED facility. Remember this as you start your job hunt and see thru employers scat to size up their staffing and what that really means.

Or join the private practice club and you'll always be perfectly staffed!

 

[splik]

This specific situation is unusual, but dramatic unexpected changes to your duties etc are typical for clinical staff in academic settings. It is also not unusual at more dysfunctional places for faculty to be forced to cover services that cannot otherwise be staffed. This particular scenario does sound frankly dangerous, especially if they are forcing senior faculty who probably havent seen a sick patient in years to staff the ED! ED work is not rocket science and most of the work can be done by social workers, NPs and PAs. I know everyone loves to hate on mid-levels on this forum, but the ED is one area where appropriately trained midlevels work well. Also sounds like great opportunity for residents (though they will unlikely be able to cover overnight shifts during the week). They could also hire locums or have local psychiatrists moonlight and cover shifts but they probably don't want to pay for it.

I recommend everyone be always looking at what is out there (no matter how satisfied you are in your job) and have your exit strategy planned.

As a lone voice there is nothing you can do. Only if faculty collectively pull together and push back and come up with creative solutions can this be done.

Hopefully it will work out, but you must ALWAYS be prepared to walk.

 

[PikminOC]

Physicians are a different case though. They have to be credentialed wherever they go. Takes months. Not so easy to switch jobs

 

[wolfvgang22]

I wish you all the best in your impending job search. Change isn't easy, but it's better than being taken advantage of like this.

 

[Jules A]

I recommend everyone be always looking at what is out there (no matter how satisfied you are in your job) and have your exit strategy planned.

As a lone voice there is nothing you can do. Only if faculty collectively pull together and push back and come up with creative solutions can this be done.

Hopefully it will work out, but you must ALWAYS be prepared to walk.

^Sage advice.

PES is a big deal, high liability jaundra. I would get a lawyer to review your contract and consider simply responding "no thank you I am unable to assist at this time". Like @splik advised I am always looking for the door, in this business both literally and figuratively.

On a side note if they aren't adequately compensating you for this unfavorable addition my guess is that is likely a contributing factor in why they haven't been able to staff this new venture despite it being in the works for years. Don't hold your breath on their promises to magically produce a doc to relieve you of these new duties if you DECIDE to accept them.

 

[Mass Effect]

I think expecting outpatient docs to do mandatory one night a week overnight shifts is unreasonable and not a good way to hold on to your attendings.

If you're an academic institution, don't you have residents? Do residents not do nightfloat? And if they do, why can't they cover the psych ED like other residency programs do?

 

[dl2dp2]

It's actually very easy to dodge this kind of thing in a big system: sick days.

Just call in sick every shift. It's easier to do if you get a doctor's note. This is usually very easy if you see a psychiatrist yourself, for example for psychotherapy. Say you are unable to do nights for psychiatric reasons, and one can come up with a half dozen of them. By law, they MUST accommodate your request.

They can't fire you or risk a lawsuit for ADA noncompliance, which not only would be tort to you but actually carries a substantial fine to the government.

You might have to use up a few sick days, but by then they might've hired all the staff already.

Your colleague might hate you, but 1) they might not even know who's on call for which nights; 2) at the end of the day, nobody cares, and people will get used to cover you and they might even remember that they are covering you. People who cover you might not have even met you, and believe you me in that case seriously nobody cares. This is actually preferred over making a ruckus with lawyers and contract disputes and blah blah. Nobody wants to be a troublemaker.

I do this now for a number of patients of mine. Works every time like a charm. It's actually best to do this before you get called in for "performance review", as if you have a record of you giving note to the admin, if they fire you, it's an automatic lawsuit.

 

[Mass Effect]

It's actually very easy to dodge this kind of thing in a big system: sick days.

Just call in sick every shift. It's easier to do if you get a doctor's note. This is usually very easy if you see a psychiatrist yourself, for example for psychotherapy.

They can't fire you or risk a lawsuit for ADA noncompliance.

You might have to use up a few sick days, but by then they might've hired all the staff already.

Your colleague might hate you, but 1) they might not even know who's on call for which nights; 2) at the end of the day, nobody cares. This is actually preferred over making a ruckus with lawyers and contract disputes and blah blah.

I do this now for a number of patients of mine. Works every time like a charm. It's actually best to do this before you get called in for "performance review", as if you have a record of you giving note to the admin, if they fire you, it's an automatic lawsuit.

That's also a great way to burn bridges with not only your bosses, but your colleagues. No one is going to be excited about covering for you last-minute because of repeated sick days. Sounds like a terrible way to deal with problems.

 

[Ironspy]

It's actually very easy to dodge this kind of thing in a big system: sick days.

Just call in sick every shift. It's easier to do if you get a doctor's note. This is usually very easy if you see a psychiatrist yourself, for example for psychotherapy.

They can't fire you or risk a lawsuit for ADA noncompliance.

I do this now for a number of patients of mine.

This is not sustainable long term IMO. Your colleagues will get called in for coverage and will become resentful. They can’t fire you but it’ll create a crappy work environment for the OP.

I was offered a similar coverage set up for a new academic job and refused successfully. If it were me I would refuse and walk if they would not negotiate. I am not willing to spend the night in the hospital at this point in my life. YMMV

 

[dl2dp2]

That's also a great way to burn bridges with not only your bosses, but your colleagues. No one is going to be excited about covering for you last-minute because of repeated sick days. Sounds like a terrible way to deal with problems.

No. You have no idea how this works. You call a few times last minute--you might even do a shift or two--and THEN you submit a doctor's note. It shows that you got sick, but then you are not getting better, and that you were initially interested in helping out but you really just can't. Your boss might suspect something, but there's no way for him/her to know whether you are "truly depressed"--whatever does that mean anyway?

Tell your colleagues you are depressed and requesting accommodation. Sure, some people will be jerks, but most of them won't give a ****. They might be "depressed" themselves and requesting accommodation too. This isn't med school. This is real life. Nobody gives a damn, especially when your salary isn't tethered to your performance.

Meanwhile, if you can try to refuse your duty actively, but then they can also legit fire you at will. Don't be naive. Half of your colleagues will do this anyway, and they'll be making more money working less. Who's winning here?

This is not sustainable long term IMO. Your colleagues will get called in for coverage and will become resentful. They can’t fire you but it’ll create a crappy work environment for the OP.

I was offered a similar coverage set up for a new academic job and refused successfully. If it were me I would refuse and walk if they would not negotiate. I am not willing to spend the night in the hospital at this point in my life. YMMV

Disagree there. Have you worked in a big system? People like that are EVERYWHERE in a big system. This is not just "sustainable", I would argue it's the default. Is it a "crappy work environment"? I don't know. I don't think so. I'd like to hope that if I developed psychiatric conditions that require that I be in bed at regular hours that it be accommodated by my employer and colleagues. Perhaps if someone gets sick and all the other attendings gang up against her that'd be the real hostile environment.

In fact, if you see overt signs of this, you should write it down and somehow keep a paper trail. If this happens too frequently, you are again at a position where you can file for lawsuits: for exactly this, hostile work environment. The time it's the EEOC violation.

Also keep in mind: lawsuits are not really what you think of as a very time-consuming court type of situation. Most of these kinds of things involve one lawyer, who negotiates on your behalf, either getting a quick settlement or get a private arbitration. They are usually paid contingent, and the kind of situations above are clear open shut cases, and generally HR would advise the management to avoid these situations, so it's highly unlikely that it'd get to that point. For example, if people are openly hostile, you can complain to management again and have them STFU. You can get THEM fired if it's one person who's frequently annoying, which is usually the case. It's especially easier if you are POC or some other protected class, but in general if you have a psychiatric condition you are automatically easier as an EEOC case.

 

[Mass Effect]

No. You have no idea how this works. You call a few times last minute--you might even do a shift or two--and THEN you submit a doctor's note. It shows that you got sick, but then you are not getting better, and that you were initially interested in helping out but you really just can't. Your boss might suspect something, but there's no way for him/her to know whether you are "truly depressed"--whatever does that mean anyway?

Tell your colleagues you are depressed and requesting accommodation. Sure, some people will be jerks, but most of them won't give a ****. They might be "depressed" themselves and requesting accommodation too. This isn't med school. This is real life. Nobody gives a damn, especially when your salary isn't tethered to your performance.

Meanwhile, if you can try to refuse your duty actively, but then they can also legit fire you at will. Don't be naive. Half of your colleagues will do this anyway, and they'll be making more money working less. Who's winning here?

Orrrr you can, you know, be a real adult and stand up for what you want rather than playing games, lying, turning in "doctor's notes," and pissing off your colleagues. You think your colleagues won't care when they're the ones who now have to cover the shifts you abandoned at the last minute during this manipulative game?

 

[dl2dp2]

Orrrr you can, you know, be a real adult and stand up for what you want rather than playing games, lying, turning in "doctor's notes," and pissing off your colleagues. You think your colleagues won't care when they're the ones who now have to cover the shifts you abandoned at the last minute during this manipulative game?

Yes. I do and I know for a fact they don’t care because many of my colleagues are exactly like this, and in the end a hifts don’t get covered at all and nobody cares. They don’t have a psych ER now, and they can deal with waiting a few more days to wait for money and people to show up. People sit in ERs for days with no dispo. It’s fine. Nobody cares and everyone needs to calm down. The system will overhire time cover for staff inefficiencies, as it should. People like you who have a chip on your shoulder get screwed, super bitter and burnt out, and create a bad environment for everyone. Do the right thing: call in sick and stop going in, like a normal person would.

 

[Mass Effect]

Yes. I do and I know for a fact they don’t care because many of my colleagues are exactly like this, and in the end a hifts don’t get covered at all and nobody cares. They don’t have a psych ER now, and they can deal with waiting a few more days to wait for money and people to show up. People sit in ERs for days with no dispo. It’s fine. Nobody cares and everyone needs to calm down. The system will overhire time cover for staff inefficiencies, as it should. People like you who have a chip on your shoulder get screwed, super bitter and burnt out, and create a bad environment for everyone. Do the right thing: call in sick and stop going in, like a normal person would.

I just can't with this kind of nonsense.

 

[wolfvgang22]

Lol, sluox, I love you man, you really are a devious SoB. Seriously, some of the stuff you post is brilliant, even if it is questionable ethically. You know how to fight dirty.
I disagree with the idea that no one cares about covering call shifts, or that patients will be fine with long waits, but the rest might just work a lot of the time. I do write letters for my patients with bipolar who can't work nights. Of course, one should keep in mind medical boards want to know if you have a mental illness, but that's another debate.

Personally, given the choice between going to war with my employer like this, trying to wrestle the pigs in their own mud, I'd try to just find a better employer or go private practice. Your advice, while risky, is probably only advisable if you have no choice.

 

[dl2dp2]

Lol, sluox, I love you man, you really are a devious SoB. Seriously, some of the stuff you post is brilliant, even if it is questionable ethically. You know how to fight dirty.
I disagree with the idea that no one cares about covering call shifts, or that patients will be fine with long waits, but the rest might just work a lot of the time. I do write letters for my patients with bipolar who can't work nights. Of course, one should keep in mind medical boards want to know if you have a mental illness, but that's another debate.

Personally, given the choice between going to war with my employer like this, trying to wrestle the pigs in their own mud, I'd try to just find a better employer or go private practice. Your advice, while risky, is probably only advisable if you have no choice.

I think we can take this a step further: I think a lot of this talk on confrontation, or aggressive job searching, or starting your own business etc have a flavor of sexism around it. I think my strategy is just "ethical" as yours ==> say you find a better job or start your practice, and leave, the ER will still be unstaffed, and people who stay would be exactly the type of people who act "unethically" so to speak, and now all of a sudden they'll have to fill one empty OUTPATIENT spot. Who's gonna see those patients? Is it really more ethical to quit altogether than do what you think you can do instead? And many of these physicians who can't move will be women and others who can't move for "family reasons". My strategy is just more pragmatic, considerate of family circumstances, and actually follows the letter (if not the spirit) of the law.

The culture of medicine needs to change, and the system needs to change. They can't just think that they can push physicians around and try to will problems away by abusing the tendency of physicians to overwork and tolerate things as expediently. If nobody works, the managers will know to either hire more people or pay extra until people are motivated to work more. Basic econ 101. OTOH the change in the system typically only comes when there is drip drip drip of civil disobedience. Is it really unethical for Gandhi to tell everyone to stop working? If you think for one min, is there really a difference between that and this?

 

[wolfvgang22]

I think we can take this a step further: I think a lot of this talk on confrontation, or aggressive job searching, or starting your own business etc have a flavor of sexism around it. I think my strategy is just "ethical" as yours ==> say you find a better job or start your practice, and leave, the ER will still be unstaffed, and people who stay would be exactly the type of people who act "unethically" so to speak, and now all of a sudden they'll have to fill one empty OUTPATIENT spot. Who's gonna see those patients? Is it really more ethical to quit altogether than do what you think you can do instead? And many of these physicians who can't move will be women and others who can't move for "family reasons". My strategy is just more pragmatic, considerate of family circumstances, and actually follows the letter (if not the spirit) of the law.

The culture of medicine needs to change, and the system needs to change. They can't just think that they can push physicians around and try to will problems away by abusing the tendency of physicians to overwork and tolerate things as expediently. If nobody works, the managers will know to either hire more people or pay extra until people are motivated to work more. Basic econ 101. OTOH the change in the system typically only comes when there is drip drip drip of civil disobedience. Is it really unethical for Gandhi to tell everyone to stop working? If you think for one min, is there really a difference between that and this?

I hear what you are saying, but I don't think sexism has anything to do with this. I don't know what your gender is, nor the OPs, and it doesn't matter.

 

[dl2dp2]

I hear what you are saying, but I don't think sexism has anything to do with this. I don't know what your gender is, nor the OPs, and it doesn't matter.

How does it not matter when most of the time it's the woman who can't just up and move to a different job?

Theoretically, it shouldn't matter when a particular strategy was raised at the workplace to cope or even to advance, but in practice, certain strategies are easier when you are X Y Z. This is by design, as it is thought that when you are not X Y Z it's somewhat easier for you for other reasons (i.e. you could have more leeway to aggressively negotiate for a new job, etc). I don't necessarily agree with all of this personally since I am actually politically more of a conservative, but don't shoot the messenger. The laws are set up for you to take advantage of it, and those who take advantage of it are often in a certain protected class, which, if you believe in The Narrative, perhaps bestow some a modicum of advantage in an ocean of disadvantage. This ipso facto says nothing about either the legality or the ethics of the said laws.

The quotas have become much more overt as of late. For example, if your facility is driven by Medicaid or a federal facility, it typically would have diversity quotas for an administrative supplement. It's *vastly* better as a strategy for everyone involved, if one can advocate getting that supplement somehow by identifying and keeping candidates, basically an extra pair of hands, who fit that profile, even if that candidate works a very half-ass job and calls in sick all the time, than having that person leave. Similar supplements exist for women, but typically only for childbearing.

 

[bashir]

Suffice it to say, sluox, that is not my style. Even if it were, many of my colleagues are friends and I wouldn't dream of doing that to them. There has been a lot of helpful advice here and I appreciate everyone offering their opinions. I plan to tell my employer I am not doing it and be ready to follow through and vote with my feet. There are several of us who feel the same way, which may change the calculus for them toward willingness to pay enough to successfully recruit for these positions. If not, off to a new adventure! Thank you all again for your thoughts.

 

[Monocles]

Why not just band together with your colleagues and collectively fight it? If one person chooses not to staff the ED then they get punished, but if the entire faculty collectively refuses to do it, what are they going to do, fire everyone?

 

[MLT2MT2DO]

Why not just band together with your colleagues and collectively fight it? If one person chooses not to staff the ED then they get punished, but if the entire faculty collectively refuses to do it, what are they going to do, fire everyone?

People have tenure/golden handcuffs/general passivity of all except the most recent hires. Everyone greatly verbalizes their displeasure about the situation, most will struggle to do anything more.

 

[clausewitz2]

I think we can take this a step further: I think a lot of this talk on confrontation, or aggressive job searching, or starting your own business etc have a flavor of sexism around it. I think my strategy is just "ethical" as yours ==> say you find a better job or start your practice, and leave, the ER will still be unstaffed, and people who stay would be exactly the type of people who act "unethically" so to speak, and now all of a sudden they'll have to fill one empty OUTPATIENT spot. Who's gonna see those patients? Is it really more ethical to quit altogether than do what you think you can do instead? And many of these physicians who can't move will be women and others who can't move for "family reasons". My strategy is just more pragmatic, considerate of family circumstances, and actually follows the letter (if not the spirit) of the law.

The culture of medicine needs to change, and the system needs to change. They can't just think that they can push physicians around and try to will problems away by abusing the tendency of physicians to overwork and tolerate things as expediently. If nobody works, the managers will know to either hire more people or pay extra until people are motivated to work more. Basic econ 101. OTOH the change in the system typically only comes when there is drip drip drip of civil disobedience. Is it really unethical for Gandhi to tell everyone to stop working? If you think for one min, is there really a difference between that and this?

You heard it here first, folks. Not lying whenever it would be convenient to you is sexist and if you chronically call in sick and fake a medical condition you are basically the Mahatama.

EDIT: if you are really serious one major difference between what you are suggesting and civil disobedience apart from, y'know, everything is that civil disobedience is about openly defying the powers that be. They try to flex their authority and you just refuse to cooperate, come what may. Your solution is like if the people doing the lunch counter sit-ins got doctor's notes claiming that actually they'd love to respect Jim Crow laws but they couldn't get up when told because they were suddenly paraplegic.

 

[Jules A]

They can't just think that they can push physicians around and try to will problems away by abusing the tendency of physicians to overwork and tolerate things as expediently.

Totally agree but believe it is better to grow a set and say no up front. FWIW I absolutely would be pissed if I got stuck covering for someone who didn't have the stones to refuse additional duties but instead was passive aggressive and called out sick.

 

[dl2dp2]

You heard it here first, folks. Not lying whenever it would be convenient to you is sexist and if you chronically call in sick and fake a medical condition you are basically the Mahatama.

EDIT: if you are really serious one major difference between what you are suggesting and civil disobedience apart from, y'know, everything is that civil disobedience is about openly defying the powers that be. They try to flex their authority and you just refuse to cooperate, come what may. Your solution is like if the people doing the lunch counter sit-ins got doctor's notes claiming that actually they'd love to respect Jim Crow laws but they couldn't get up when told because they were suddenly paraplegic.

Eh, if it were so easy as all that. What is in the newspapers is only the part of the glacier that's above the waterline. Your naivete is showing. We'll see what happens to OP if they openly confront. Maybe management will care, most likely they won't. Secondly, from the eyes of management, there's little difference in calling out sick and just tell them you won't do it, and then don't. Except, if you are doing it and you are the only one, you might get on the chopping block sooner.

For the record, you are also clearly unaware of the history of civil disobedience in both colonial India and pre-civil rights America. In fact, in both cases, the movement started with people refusing to do work, for a variety of reasons, and medical reasons being a big one.

Everyone is constantly lying. Get used to it. I'm surprised that as a psychiatrist you don't know that already.

 

[dl2dp2]

Totally agree but believe it is better to grow a set and say no up front. FWIW I absolutely would be pissed if I got stuck covering for someone who didn't have the stones to refuse additional duties but instead was passive aggressive and called out sick.

How would you know I wasn't actually sick? Are you saying that I'm lying? How dare you creating a hostile working environment? Are you gonna tell that to my face? If so, prepare for my complaints to your boss. It's pretty easy to get people fired these days for things of this type, and definitely not for being passive-aggressive. Do you want to try it?

Secondly lol if you think that passive-aggressive people like that aren't everywhere and require appropriate management, I can only say you haven't worked in a large system.

 

[Jules A]

How would you know I wasn't actually sick? Are you saying that I'm lying? How dare you creating a hostile working environment?

Secondly lol if you think that people like that aren't everywhere and require appropriate management, I can only say you haven't worked in a large system.

Lol, yeah now I'd not only be pissed but also lose all respect for you playing that whiny card And negative, I do in fact work for a large hospital system.

 

[dl2dp2]

Lol, yeah now I'd not only be pissed but also lose all respect for you playing that whiny card And negative, I do in fact work for a large hospital system.

That's exactly the problem. Respect counts little when you work in a large system. Senior management is often the least respect-worthy individuals in the entire system. They get promoted because they most efficiently exploit individuals down under. No. One. Cares. Everything I said I've seen it happen. Everyone's replaceable. In fact, you will likely be replaced by an NP. Let's see how good their work ethic is.

 

[nexus73]

In my experience (anecdotal not data) female physicians are more able than men to leave a job. The female doctors I work with are married to high earning professionals and could easily take 3-6 months or longer off to find a better job.


Edit: IMO you should decide what an ED shift is worth to you ($4,000??) and set the price. The hospital will otherwise be paying maybe that much or more for locums. If they won’t pay you what it’s worth you should decline to do it, and then if they try to change the contract to force you you can leave.

 

[Mass Effect]

For the record, you are also clearly unaware of the history of civil disobedience in both colonial India and pre-civil rights America. In fact, in both cases, the movement started with people refusing to do work, for a variety of reasons, and medical reasons being a big one.

Oh good lord, this is not colonial India nor is it pre-civil rights America. This is not someone who is oppressed. This is a psychiatrist who can walk out the door and have 10 more offers by nightfall. She can hang her own shingle. She can do locums work for a while. She can sign on with a telepsych company. How insulting to compare her plight with that of the groups you mentioned.

 

[clausewitz2]

Eh, if it were so easy as all that. What is in the newspapers is only the part of the glacier that's above the waterline. Your naivete is showing. We'll see what happens to OP if they openly confront. Maybe management will care, most likely they won't. Secondly, from the eyes of management, there's little difference in calling out sick and just tell them you won't do it, and then don't. Except, if you are doing it and you are the only one, you might get on the chopping block sooner.

For the record, you are also clearly unaware of the history of civil disobedience in both colonial India and pre-civil rights America. In fact, in both cases, the movement started with people refusing to do work, for a variety of reasons, and medical reasons being a big one.

Everyone is constantly lying. Get used to it. I'm surprised that as a psychiatrist you don't know that already.

You're such a weird mix of interesting and useful commentary and obvious trolling. I haven't figured you out yet.

 

[deleted480308]

How would you know I wasn't actually sick? Are you saying that I'm lying? How dare you creating a hostile working environment? Are you gonna tell that to my face? If so, prepare for my complaints to your boss. It's pretty easy to get people fired these days for things of this type, and definitely not for being passive-aggressive. Do you want to try it?

Secondly lol if you think that passive-aggressive people like that aren't everywhere and require appropriate management, I can only say you haven't worked in a large system.

That’s a crappy thing to do, do you actually treat your coworkers like that?

 

[michaelrack]

Call in sick too much, and you may be sent for an impaired physician evaluation

 

[dl2dp2]

You're such a weird mix of interesting and useful commentary and obvious trolling. I haven't figured you out yet.

lol maybe I’m a mystery...
Or maybe—dear god I reflect how the real world actually operates?

 

[dl2dp2]

That’s a crappy thing to do, do you actually treat your coworkers like that?

You are extremely naive if you think that your own co-workers don’t treat you like that already.

 

[dl2dp2]

Call in sick too much, and you may be sent for an impaired physician evaluation

Sure that is a risk. Every strategy has a risk. However, I would say if you have a doctor write a note saying u can’t work evenings the risk of you going for impaired physician is very minimal. I’m on my states PHP eval board. It’s more about actua signs of impairment on practice that triggers these things. Also, if it’s a medical condition that interferes with ability to practice in a particular way they must accommodate.

 

[deleted480308]

You are extremely naive if you think that your own co-workers don’t treat you like that already.

Not good ones. And I don’t treat my coworkers like that

 

[dl2dp2]

Not good ones. And I don’t treat my coworkers like that

So you think. You might trigger them in other ways. Let’s just keep it professional at the workplace and stop judging people on a personal basis.

And the bad ones end up in management and boss you around later.

To be fair, I have never felt resentful toward a colleague who called in sick, whether it’s legit or not. If you do, maybe that’s *your* problem.

 

[hamstergang]

You are extremely naive if you think that your own co-workers don’t treat you like that already.

Some of us work at places where co-workers respect each other. There are actually good people in the world.

 

[clausewitz2]

Some of us work at places where co-workers respect each other. There are actually good people in the world.

Yeah, if only there were some word for when you assume that other people share your thought processes or are actually feeling the troubling things you are feeling. I feel like there might be one that starts with a "p', I don't know.

 

[deleted480308]

So you think. You might trigger them in other ways. Let’s just keep it professional at the workplace and stop judging people on a personal basis.

And the bad ones end up in management and boss you around later.

To be fair, I have never felt resentful toward a colleague who called in sick, whether it’s legit or not. If you do, maybe that’s *your* problem.

You are the person responsible for the bad choices you are describing in this thread. Don’t put this on anyone else

 

[dl2dp2]

Some of us work at places where co-workers respect each other. There are actually good people in the world.

Sure. I don't dispute this. However, good people **** other good people all the time. Also, on a more fundamental level, I don't think people are either all good or all bad. What are you, retreating to borderline level defenses? That comment is neither here nor there. I am talking about administrative policies, strategies for employees to cope with bad management, good HR practices and related issues.

You are the person responsible for the bad choices you are describing in this thread. Don’t put this on anyone else

Sure, you can call them bad choice. I'm just pointing out 1) it's a viable alternative. 2) sometimes (and outlining exactly when these times are) it's a better choice, and 3) people who call it bad choices due to "respect" or whatever are often hypocritical and part of a bad culture themselves.

 

[deleted480308]

Sure. I don't dispute this. However, good people **** other good people all the time. Also, on a more fundamental level, I don't think people are either all good or all bad. What are you, retreating to borderline level defenses? That comment is neither here nor there. I am talking about administrative policies, strategies for employees to cope with bad management, good HR practices and related issues.



Sure, you can call them bad choice. I'm just pointing out 1) it's a viable alternative. 2) sometimes it's a better choice, and . 3) people who call it bad choices due to "respect" or whatever are often hypocritical and part of a bad culture themselves.

There are always justifications available to someone willing to do the wrong thing if they want one bad enough

 

[dl2dp2]

There are always justifications available to someone willing to do the wrong thing if they want one bad enough

LOL that's actually exactly what all my borderline patients say when they split. If you think there are no ethical ambiguities to actions, you are a bad psychiatrist.

 

[deleted480308]

LOL that's actually exactly what all my borderline patients say when they split. If you think there are no ethical ambiguities to actions, you are a bad psychiatrist.

As I said, there is always an excuse to do wrong if one wants it bad enough

 

[clausewitz2]

LOL that's actually exactly what all my borderline patients say when they split.

Says the person who, when challenged, starts saying we are all hypocritical sexists who don't understand how the world works and that you are basically the same as Gandhi.

You may be confused as to what splitting is.

Endless derogatory bluster as an alternative to considering the perspectives of others is certainly very au courant but it gets real tedious real fast.

 

[dl2dp2]

Says the person who, when challenged, starts saying we are all idiot sexists who don't understand how the world works and that you are basically the same as Gandhi.

You may be confused as to what splitting is.

You should re-read what I said. I said calling in sick is a form of passive resistance is that is a valid, and healthy coping strategy against bad management, and it is in fact advocated by people like Gandhi in a bad institutional context. I'm not "basically the same as Gandhi".

I'm not calling you sexist. I'm saying that the version of this "conventional wisdom" a la find a new job, start a business, aggressively negotiate, etc., is potentially sexist. You may be a sexist personally, I don't know. I actually think the word "sexist" is meaningless as a personal label. But the institutional culture that cultivates this behavior may be sexist, in that it just reinforces certain patterns of behavior. Maybe we should bestow more respect on people who call in sick, rather than blame them for being bad actors, even if there's a level of "malingering" in their illness. Really at the end of the day, do you know who is malingering and who is not? Do you want to see the medical records of all your colleagues who call in sick? Do you know the fees I charge to render such an opinion for an institution? Do you want to pay me that so you can feel entitled to resent someone who's actually malingering?

I'm guessing you haven't been in management positions. Managers often very much prefer the individuals to call in sick, so they can just have numerics to give to upper managers to request the right amount of funding. OTOH, if a group of employees are hostile and get lawyers, all of a sudden it's the compliance department, the labor relations department, the HR, the C-level executives, media management office, blah blah blah Sure if you want that and fight some large hospital system, be my guest. Maybe you'll win, or maybe you'll get singled out by their PR team and on the receiving end of a twitter storm on how lazy doctors "won't help out". Take that risk. Be my guest.

I've seen all of this happen. This is 2020.

Or you can just call out sick.

Your call. Really.

 

[clausewitz2]

I'm really important and get paid highly and know all the important people and you don't, so you're naive or stupid to disagree with me

well that's quite the germane response that definitely acknowledges and admits that there might be any shades of gray instead of black and white in this situation.

Is it really unethical for Gandhi to tell everyone to stop working? If you think for one min, is there really a difference between that and this?

Oh I see that you meant here that you telling someone to call out sick is nothing at all like Gandhi calling for a general strike. Yeah, that's definitely how me and other native speakers of English interpret it when you ask "is there really a difference between that and this?"

Your situation must be really miserable if you can't conceive of the possibility of responding to a bad job situation by saying "nah, I'm going to find another job" and feel like the only possible strategy is to remain in said job situation and be as passive aggressive as humanly possible. I don't think I'd even be that bothered by this if there was even a glimmer of acknowledgement that it was shady in the least, but something about your brazenness in stating your case and extremely convenient rationalizations of the negative impacts it has on everyone around you is pretty rage-inducing. I'd definitely hate you as a colleague if this is your MO.

Courage is accepting personal consequences in order to act in accordance with your values. Leaving a bad job situation because it jeopardizes your health or your family is courageous. Asking for genuinely needed accommodations for a disability/disorder that you aren't sure you will be granted is courageous. Knowingly and deliberately abusing a system built to protect those people who actually need an accommodation because you don't feel like engaging in a more direct or effective manner is just weaselly. I forgot, though, you feel like only rich white people have ethics, so cue accusations of racism in 5...4...3...2...

Seriously, though, it's worrying that your response to encountering people abusing the system is not 'man, that sucks, this is not how things should operate, what can we do to change it?" but rather "how can I get in on that?"

 

[dl2dp2]

Seriously, though, it's worrying that your response to encountering people abusing the system is not 'man, that sucks, this is not how things should operate, what can we do to change it?" but rather "how can I get in on that?"

This is completely absurd... How is threatening to leave changing anything in the system? Wow. Lol I have to say though your response is not shocking. I guess that IS exactly why people who stay in big systems end up quote unquote abuse the system and induce your rage. People like should may be a poor culture fit for big institutions and I would I would certainly encourage you to quit as quickly as possible if I was your manager.

And yes institutionally it is a quote unquote white male privilege to be all on some moral high horse about not “abusing the system”. Are you seriously for real? Am I a welfare queen? What gives you the authority to adjudicate what is and isn’t an abuse of system? Maybe YOU are the abuser of the system. Maybe you should sit down and reflect on that for a bit. Though of course not all abuser of that whole institutional culture are limited to white males.