Kaiser Permanente Pain Jobs

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Residency really had an effect on my work ethic, and it was a permanent change. I'm just not satisfied with myself unless I'm working flat out, to the maximum of my potential. The funny thing is, I take a lot of that home with me. I look for ways to be equally as productive at home when I'm off.
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powermd said:
Residency really had an effect on my work ethic, and it was a permanent change. I'm just not satisfied with myself unless I'm working flat out, to the maximum of my potential. The funny thing is, I take a lot of that home with me. I look for ways to be equally as productive at home when I'm off.
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Wait until you retire. It is a shock. My current goal is an 8 minute/mile 10K, then an age group first place in a sprint triathlon.
//Last thing I remember, I was
Running for the door
I had to find the passage back to the place I was before
'Relax' said the night man,
'We are programmed to receive.
You can check out any time you like,
But you can never leave!'//
Written by Don Felder, Don Henley, Glenn Frey • Copyright © Cass County Music / Wisteria Music / Privet Music, Warner/Chappell Music, Inc, Universal Music Publishing Group, Red Cloud Music
 
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SSdoc33 said:
so do i.

im glad it works for you.

i know that i would not be able to handle having to wait for a procedure room to "open up".

isnt it frustrating to see 8 patient a day when you know that you finish that amount of work in half a day (or less)?

also, im not sure how an hour/injection, nor 90 minute lunches are sustainable.
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Even though I see 6 to 8 patients per half day in clinic, it feels busy most of the time. Our system is different. Even though I only have 6-8 in person encounters, I have patients emailing and calling. I'm refilling scripts. I may touch 20-30 patient charts in a half day. We try to do a lot over electronic and phone communication to keep our clinic access open for patients that really need to be seen in person. A big belief here is that efficiency is dependant on seeing the right patient at the right time in the right setting.
 
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SCIronMike said:
A big belief here is that efficiency is dependant on seeing the right patient at the right time in the right setting.
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LOL, the smart applicant busts out that phrase during the interview.
 
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SSdoc33 said:
also, im not sure how an hour/injection, nor 90 minute lunches are sustainable.
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Kaiser not only plays the role of the healthcare provider, but the insurance company as well.

The fewer services provided, the higher their profits.
 
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SSdoc33 said:
if i had to talk to a patient for 90 minutes, i might shoot myself.

i am way happier and content performing 5 procedures / hour. yes, i make more money doing it this way, but the worst thing for me if to be bored at work. i couldnt handle 2-3 procedures in a half day.

i find it intriguing that seeing only a few patient per day is some sort of medical utopia
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It sounds like a utopia after months and months of 150/wk. Ideally I could work 3 weeks at my current job followed by 3 weeks of slower pace. Doubt that I'll find a way to arrange this.
 
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Yo GabbaPentin said:
It sounds like a utopia after months and months of 150/wk. Ideally I could work 3 weeks at my current job followed by 3 weeks of slower pace. Doubt that I'll find a way to arrange this.
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150/week!?! Damn Gabba you're killin it. That's gotta be rough. Hopefully you have a lot of help and easy and quick dictation templates/ services
 
Disciple said:
Kaiser not only plays the role of the healthcare provider, but the insurance company as well.

The fewer services provided, the higher their profits.
Click to expand...
Kaiser is a non profit entity in NCAL. Kaiser is different from TPMG. TPMG is a physician's group. Kaiser would be the health plan. TPMG = the permanente medical group. I think in Socal it is PMG - they dropped the "T" in Socal.
 
SCIronMike said:
Even though I see 6 to 8 patients per half day in clinic, it feels busy most of the time. Our system is different. Even though I only have 6-8 in person encounters, I have patients emailing and calling. I'm refilling scripts. I may touch 20-30 patient charts in a half day. We try to do a lot over electronic and phone communication to keep our clinic access open for patients that really need to be seen in person. A big belief here is that efficiency is dependant on seeing the right patient at the right time in the right setting.
Click to expand...

what flavor is it? grape? fruit punch?

upload_2017-9-26_10-28-9.jpeg
 
SCIronMike said:
Even though I see 6 to 8 patients per half day in clinic, it feels busy most of the time. Our system is different. Even though I only have 6-8 in person encounters, I have patients emailing and calling. I'm refilling scripts. I may touch 20-30 patient charts in a half day. We try to do a lot over electronic and phone communication to keep our clinic access open for patients that really need to be seen in person. A big belief here is that efficiency is dependant on seeing the right patient at the right time in the right setting.
Click to expand...

your post insinuates that BECAUSE the private practice or busier doc doesnt spend as much time with a patient, they necessarily are doing inferior work.

again, it is nice that this situation works for you. others might believe that you havent "earned" your 350k by only seeing a smattering of patients.

btw, i am glad that you opened up about about your personal situation and put numbers to it. thanks. seriously, it helps the discussion.
 
SSdoc33 said:
your post insinuates that BECAUSE the private practice or busier doc doesnt spend as much time with a patient, they necessarily are doing inferior work.

again, it is nice that this situation works for you. others might believe that you havent "earned" your 350k by only seeing a smattering of patients.

btw, i am glad that you opened up about about your personal situation and put numbers to it. thanks. seriously, it helps the discussion.
Click to expand...

For the record I think it's great folks at Kaiser have a nice job and lifestyle. No ill feelings toward anybody at Kaiser. Just makes me consider my situation.
 
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I think Kaiser is harder on PCPs. I've seen the back of neck hairs stand up when talking about their experiences, "team building exercises", etc...
 
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I think as our payment gets more population-based, Kaiser is just a more efficient model than our private, office-based, Medicare/insurance model.

Although we can do stuff way more efficiently in an office, that's just a small component of "population health". There are all the other elements like insurance, pre-auths, tons of admin, hospital stays - including indigent care and RN staffed homeless shelters, etc...
 
what you have hit upon is that the efficiency you have in a private office does not translate to efficiency in a healthcare system
 
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Ducttape said:
what you have hit upon is that the efficiency you have in a private office does not translate to efficiency in a healthcare system that is based on the "health" of a population rather than outstanding, individualized medical care...
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Finished statement for you...
 
SSdoc33 said:
what flavor is it? grape? fruit punch?

View attachment 223857
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LOL. If you understand anything about Kaiser docs, understand this - not all the jobs are equivalent in workload. It is going to be the same in a specific department under the same chief, but will vary enormously from medical center to medical center. You cannot generalize. In addition, Northern Ca Kaiser is a different entity than Southern Ca Kaiser. They are very loosely affiliated but have different retirement and benefit programs for the docs. Since there is no standardized work load other than you have to be there for 8 hours, everything can change if/when your department chief changes. When you interview, you need to be asking the questions that are important to you. A friend of mine told me that in his opinion, once you have been at Kaiser long enough to be vested in the retirement program, it is very unlikely you will ever leave because the benefits become so great with time, no matter how your job changes, you will stay. I do not know the stats, but from my own personal observations, this rings true.
 
willabeast said:
LOL. If you understand anything about Kaiser docs, understand this - not all the jobs are equivalent in workload. It is going to be the same in a specific department under the same chief, but will vary enormously from medical center to medical center. You cannot generalize. In addition, Northern Ca Kaiser is a different entity than Southern Ca Kaiser. They are very loosely affiliated but have different retirement and benefit programs for the docs. Since there is no standardized work load other than you have to be there for 8 hours, everything can change if/when your department chief changes. When you interview, you need to be asking the questions that are important to you. A friend of mine told me that in his opinion, once you have been at Kaiser long enough to be vested in the retirement program, it is very unlikely you will ever leave because the benefits become so great with time, no matter how your job changes, you will stay. I do not know the stats, but from my own personal observations, this rings true.
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sounds a lot like a government job. not that there is anything wrong with this model, but this completely flies in the face of efficiency and productivity. basically, you clock in and clock out like a DMV employee. i want to make more money if i work harded. i dont want to make the same amount as the dufis in the next cubicle when my work is superior.

hyperalgesia makes a great point. this system is excellent in a population health, primary care model. it really isnt great for high quality, individualized specialty care.
 
Benefits can always be cut .....even for retirees
 
SSdoc33 said:
sounds a lot like a government job. not that there is anything wrong with this model, but this completely flies in the face of efficiency and productivity. basically, you clock in and clock out like a DMV employee. i want to make more money if i work harded. i dont want to make the same amount as the dufis in the next cubicle when my work is superior.

hyperalgesia makes a great point. this system is excellent in a population health, primary care model. it really isnt great for high quality, individualized specialty care.
Click to expand...
There is a lot more I could add to this discussion but other than working at Kaiser for 25 years I have no idea if my impressions are relevant or even apply to comparing health care systems. I did spend 5 years in private practice, and the usual University training and VA rotations. There is a book that i read recently you might look at
Mistreated: Why We Think We're Getting Good Health Care—and Why We're Usually Wrong 1st Edition
by Robert Pearl 43 customer reviews

#1 Best Sellerin Medical Informatics
the author is the recently retired MD head honcho at TPMG Robert Pearl. It is basically all the good things about Kaiser. I communicated with Dr. Pearl regarding his book and asked him why there was no chapter on the bad aspects of Kaiser. I do think the Kaiser model is the best one for health care in the USA, but i also see problems that are part of the package and it bothers me that opinions are so polarized. One thing that keeps Kaiser honest is the existence of competing health care systems. I would never advocate having only one option for health care. . Regarding more money to work harder - the incentives to work "harder" include more money for working overtime and increases in pay for meeting goals established by admin. For example i think if i scored >90% on patient sourced doctor evals i would get more money. Admin can also see if you answer patient generated emails within a certain time frame (for example). Admin knows if the patients think you are competent, listen to them, etc. etc. My main irritations with Kaiser were i thought my time was being micro managed ( for example i was told when i finished procedures at a surgery center i had to be back in my office within 15 minutes - this involved a driving a short distance and was basically impossible), and i had to schedule vacation time 12 months in advance, and that time if conflicted with someone else vacation time was decided on a priority system that rotated over the years. OTOH when i was in private practice i had to hire a locum with a guaranteed minimum to go on vacation (so i never went on vacation) and i made up for the 15 minute travel time with the 60 minute CESI time. Got to look at the big picture. Don't let your ego get too much in the way :)
 
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Yo GabbaPentin said:
It sounds like a utopia after months and months of 150/wk. Ideally I could work 3 weeks at my current job followed by 3 weeks of slower pace. Doubt that I'll find a way to arrange this.
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150 patients or procedures/week? Or combined 150 patients + procedures/week?
 
Okay...so seriously...I was talking to some people "in real life" about this thread and the whole idea of a 60 min CESI and seeing 1 hour new patient evals. etc...

In all honesty: What do you do with the downtime? If you finish your 60 min CESI in 12 mins, what do you do for the other 48 mins? Given the circumstances of your employment, you can't "whip the horse" any harder (ie unionized employees, no real formal authority for hiring/firing people, etc). You can't leave the premises and go grab a cup of coffee (see @willabeast post about time being micromanaged). All your admin/business services are handled (this is mostly what I (and @Ligament I presume) do during downtime.

One person I talked to who did some locums for Kaiser in the 1990's said, "You hide..."

Another person I talked to who worked for another HMO like Kaiser said, "You return emails, usually some committee work activities, etc..."

The last person I talked to said, "You just adapt." Meaning, you KNOW that the 60 min CESI is going to take 12 mins...so, no urgency/rush. The case starts 10-12 mins late...you anticipate that...the rad tech is late or the new procedure room RN doesn't know your pick-list...you roll with it...It all goes according to Parkinson's Law: Work expands to fill the available time.

Parkinson's law - Wikipedia

In other words: It takes 60 mins to do a CESI because it REALLY does take 60 mins to do a CESI...at Kaiser...
 
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drusso said:
Okay...so seriously...I was talking to some people "in real life" about this thread and the whole idea of a 60 min CESI and seeing 1 hour new patient evals. etc...

In all honesty: What do you do with the downtime? If you finish your 60 min CESI in 12 mins, what do you do for the other 48 mins? Given the circumstances of your employment, you can't "whip the horse" any harder (ie unionized employees, no real formal authority for hiring/firing people, etc). You can't leave the premises and go grab a cup of coffee (see @willabeast post about time being micromanaged). All your admin/business services are handled (this is mostly what I (and @Ligament I presume) do during downtime.

One person I talked to who did some locums for Kaiser in the 1990's said, "You hide..."

Another person I talked to who worked for another HMO like Kaiser said, "You return emails, usually some committee work activities, etc..."

The last person I talked to said, "You just adapt." Meaning, you KNOW that the 60 min CESI is going to take 12 mins...so, no urgency/rush. The case starts 10-12 mins late...you anticipate that...the rad tech is late or the new procedure room RN doesn't know your pick-list...you roll with it...It all goes according to Parkinson's Law: Work expands to fill the available time.

Parkinson's law - Wikipedia

In other words: It takes 60 mins to do a CESI because it REALLY does take 60 mins to do a CESI...at Kaiser...
Click to expand...
 
For me it worked like this. 50% of the people for injections i have never seen before. 60 minute CESI follows. MA speaks to patient and gets a bunch of primary care stuff done like getting the meds correct in the EMR. ? 5-10 minutes. i talk to the patient for 5 minutes, get consent signed, go over imaging, check labs (really easy with the excellent Epic EMR) while nurse gets patient in the procedure room, some of them start IV in room, some in pre procedure room. Anyway now we are at 15 minutes. Assuming we have a competent xray tech and good hand holding skills by the nurse the procedure gets done with no issues in 10 15 minutes . So we are at 30 minutes now. I go to my office and answer emails, phone calls, or my favorite thing to do, get my consults pre 1/2 done (which are 45 minutes long) 1/2 written in the EMR before i see the consult patient. I can do this because we have a great EMR. Last i heard Admin does not like this, but am anal about consults. Nursing takes out the IV and watches patient 20 minutes. So now we are at 50 minutes. Last 10 minutes would be room turnover like new sheets, new trays, setting up the fluoro suite. Xray tech and nurse do that.
 
Ducttape said:
im guessing patients would prefer a doctor take 60 min to do a CESI than 10...
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completely disagree.

more does not mean better, as demonstrated by the 9 page pile of garbage that most EMR notes have become.

with a cervical ESI i am typically in and out of the patient in MAYBE 2-3 minutes. ask a patient if they would prefer a shot take 2 minutes or digging around for 30. if you know what you are doing, all of these procedures are quick. i would argue that you are more likely to have a complication if you are mucking around in there forever.

if it take me 3 minutes to do a shot, then that means there is 57 minutes of administrative work or paperwork. well done, Kaiser, well done.
 
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SSdoc33 said:
completely disagree.

more does not mean better, as demonstrated by the 9 page pile of garbage that most EMR notes have become.

with a cervical ESI i am typically in and out of the patient in MAYBE 2-3 minutes. ask a patient if they would prefer a shot take 2 minutes or digging around for 30. if you know what you are doing, all of these procedures are quick. i would argue that you are more likely to have a complication if you are mucking around in there forever.

if it take me 3 minutes to do a shot, then that means there is 57 minutes of administrative work or paperwork. well done, Kaiser, well done.
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So it takes you 3 minutes to do a C7 TF ESI? I salute your skill. What do you use for a test dose?
 
lobelsteve said:
Wait, people still going TFESI in the neck? :wideyed:
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I retired 1.5 years ago. I did cervical TF ESI all the time with dex. is that banned now? how about cervical SNRB? if all the difficult stuff is banned no wonder you all take 3 minutes to do your procedures. i am feeling old now...
 
SSdoc33 said:
if it take me 3 minutes to do a shot, then that means there is 57 minutes of administrative work or paperwork. well done, Kaiser, well done.
Click to expand...

Actually, they probably don't care if you do nothing during that 57 minutes. Just don't be doing more shots during that time and increasing utilization.
 
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drusso said:
Okay...so seriously...I was talking to some people "in real life" about this thread and the whole idea of a 60 min CESI and seeing 1 hour new patient evals. etc...

In all honesty: What do you do with the downtime? If you finish your 60 min CESI in 12 mins, what do you do for the other 48 mins? Given the circumstances of your employment, you can't "whip the horse" any harder (ie unionized employees, no real formal authority for hiring/firing people, etc). You can't leave the premises and go grab a cup of coffee (see @willabeast post about time being micromanaged). All your admin/business services are handled (this is mostly what I (and @Ligament I presume) do during downtime.

One person I talked to who did some locums for Kaiser in the 1990's said, "You hide..."

Another person I talked to who worked for another HMO like Kaiser said, "You return emails, usually some committee work activities, etc..."

The last person I talked to said, "You just adapt." Meaning, you KNOW that the 60 min CESI is going to take 12 mins...so, no urgency/rush. The case starts 10-12 mins late...you anticipate that...the rad tech is late or the new procedure room RN doesn't know your pick-list...you roll with it...It all goes according to Parkinson's Law: Work expands to fill the available time.

Parkinson's law - Wikipedia

In other words: It takes 60 mins to do a CESI because it REALLY does take 60 mins to do a CESI...at Kaiser...
Click to expand...


 
there has to be a balance...

I have the advantage of seeing 5 separate private pain physicians at work at the local ASC. 3 docs book 30 min procedures (usually with sedation). the other 2 schedules 10min and local only.

its just my perception, but from casually talking to some of these people while they are in recovery, patients who come in for the shorter time period are less happy - typically "Im spending all that money for something that was that fast? it better work..."
 
So if they were getting the injection in an office and the turn around was quicker, would they be happier or less happy? I don't think it should be our job to play to the emotional state of what makes people happy based on their perception of what's happening.
 
So it isn’t our job to make sure people are satisfied with the service they get, or what they perceive as the service they are getting?
 
Ducttape said:
So it isn’t our job to make sure people are satisfied with the service they get, or what they perceive as the service they are getting?
Click to expand...

Setting expectations. Expect sedation, get local- more likely to complain.

Never fail to mention the extra risk, extra cost, lack of support, lack of benefit, and the fact the other guy is doing it to make money off of your pain.

SML
 
Ducttape said:
So it isn’t our job to make sure people are satisfied with the service they get, or what they perceive as the service they are getting?
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i am not operating a car wash.
 
I think we are getting off topic a bit.

I think it's nice to hear from doctors that work for Kaiser and them sharing their experiences, pros/cons lifestyle etc without having the critics throwing stones.
 
The main problem I have with Kaiser is just like any other employed job - your life and happiness are somewhat dependent on a boss, which seems outside of your control. You might get lucky and have a boss who is intelligent and ethical and understands what you do. If you don't have this, in addition to the considerable stress of patient care, you're daily life could be adversarial.

Once you're a partner, how much say do you have in selecting admin and chief? As a partner, you shouldn't really have a "boss". Even if you elect a "chief", that person should simply be someone with different responsibilities, not an overlord.

My sister used to be a "partner" for a "non-profit" MSG in CA. From what she described, it really didn't sound like she had any say whatsoever in the actual functioning of the group. That was largely determined by legacy docs who held all the clout.
 
hyperalgesia said:
The main problem I have with Kaiser is just like any other employed job - your life and happiness are somewhat dependent on a boss, which seems outside of your control. You might get lucky and have a boss who is intelligent and ethical and understands what you do. If you don't have this, in addition to the considerable stress of patient care, you're daily life could be adversarial.

Once you're a partner, how much say do you have in selecting admin and chief? As a partner, you shouldn't really have a "boss". Even if you elect a "chief", that person should simply be someone with different responsibilities, not an overlord.

My sister used to be a "partner" for a "non-profit" MSG in CA. From what she described, it really didn't sound like she had any say whatsoever in the actual functioning of the group. That was largely determined by legacy docs who held all the clout.
Click to expand...
This is true to a certain extent. You HAVE to get along with your chief. And there are definitely good ones and bad ones. But as an anesthesiologist in private practice your life is worse. You have to keep the surgeons happy. If i compare private practice anesthesia with Kaiser anesthesia, Kaiser is better in terms of how much sycophantic activity is necessary. I was never asked to vote for a department chief so i do not think they are elected. It is an admin decision, made by the MD in charge of the medical center.
 
drusso said:
Okay...so seriously...I was talking to some people "in real life" about this thread and the whole idea of a 60 min CESI and seeing 1 hour new patient evals. etc...

In all honesty: What do you do with the downtime? If you finish your 60 min CESI in 12 mins, what do you do for the other 48 mins? Given the circumstances of your employment, you can't "whip the horse" any harder (ie unionized employees, no real formal authority for hiring/firing people, etc). You can't leave the premises and go grab a cup of coffee (see @willabeast post about time being micromanaged). All your admin/business services are handled (this is mostly what I (and @Ligament I presume) do during downtime.

One person I talked to who did some locums for Kaiser in the 1990's said, "You hide..."

Another person I talked to who worked for another HMO like Kaiser said, "You return emails, usually some committee work activities, etc..."

The last person I talked to said, "You just adapt." Meaning, you KNOW that the 60 min CESI is going to take 12 mins...so, no urgency/rush. The case starts 10-12 mins late...you anticipate that...the rad tech is late or the new procedure room RN doesn't know your pick-list...you roll with it...It all goes according to Parkinson's Law: Work expands to fill the available time.

Parkinson's law - Wikipedia

In other words: It takes 60 mins to do a CESI because it REALLY does take 60 mins to do a CESI...at Kaiser...
Click to expand...

The nurse normally spends about 10 minutes to intake the patient. This includes getting vitals, updating proactive care issues (flu shot, schedule mammogram, schedule PAP, schedule colonscopy, etc). I normally spend about 20 minutes getting a H&P and consent. The nurse then spends another 5 min throwing a IV into my CESI patients. Then we go to the procedure suite, get the patient on the table, do a time out, open a tray, draw meds, do the procedure, get the patient off the table, and wheel the patient to the PACU. The whole thing takes about 60 minutes. In my down time I'm normally answering emails, returning patient messages, doing tasks for committees that I belong to, etc. I'm rarely not doing SOMETHING related to work.
 
hyperalgesia said:
The main problem I have with Kaiser is just like any other employed job - your life and happiness are somewhat dependent on a boss, which seems outside of your control. You might get lucky and have a boss who is intelligent and ethical and understands what you do. If you don't have this, in addition to the considerable stress of patient care, you're daily life could be adversarial.

Once you're a partner, how much say do you have in selecting admin and chief? As a partner, you shouldn't really have a "boss". Even if you elect a "chief", that person should simply be someone with different responsibilities, not an overlord.

My sister used to be a "partner" for a "non-profit" MSG in CA. From what she described, it really didn't sound like she had any say whatsoever in the actual functioning of the group. That was largely determined by legacy docs who held all the clout.
Click to expand...

The chief is selected from within the department. They try to identify partners with leadership skills and send them to leadership training. I wouldn't have a problem with any of my department colleagues being our next chief. I'm good friends with all of them, and I think they are all good physicians.
 
SCIronMike said:
The chief is selected from within the department. They try to identify partners with leadership skills and send them to leadership training. I wouldn't have a problem with any of my department colleagues being our next chief. I'm good friends with all of them, and I think they are all good physicians.
Click to expand...
Over the course of 25 years working at Norcal Kaiser i worked under five different chiefs. The first one was in my specialty (anesthesia), was excellent, and admin ultimately replaced him. The second one (PMR) left Kaiser for private. The third one (PMR) transferred to Kaiser Hawaii (i think Oahu). The fourth one was an orthopedist who stepped down as chief eventually. The last one was PMR and i think is still chief. Some chiefs were good, some average. None of them were bad docs. AFAICT chiefs are caught between trying to keep the regular docs happy and trying to keep admin above the chiefs happy. Seems like a very difficult task to me.
 
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