My final patient at the urgent care chain had new onset dysphagia after a URI. It was mild enough not to warrant a full dysphagia workup just yet, so I ordered a COVID PCR. My suspicion is high (because COVID —> weirdness), but I’ll never find out, because I’m outta here!
I ran the numbers:
- 17,952 patient encounters
- $5,105,187 Billed
HR had warned that my email/intranet access would be cut off *as soon as* my final shift ended, so I asked the scheduling team to give me a light patient load for my last afternoon. I hoped for time to comb through 8 years of emails, contacts, files, tax docs, and insurance paperwork. Also, I needed to look into insurance/COBRA, and rolling over my 401k.
And after billing more than $5mil for them, they said no!
Mind you, I didn’t ask for any time off. I requested a light patient load. For the afternoon only.
They said no…and then several colleagues filled my schedule with breaks and brought me lunch. I got the time I needed, and some yummy chicken teriyaki!
The experience was a decent metaphor for my time there: the company rarely acted beyond its immediate interest, but my medical colleagues more than made up for it.
The deal was: see patients, get good reviews, don’t have bad outcomes. In return, get high pay, a great schedule, a great patient population, and surprisingly varied medicine. To step into their shoes for a minute, I was a shift-worker, after all. I was there to produce 99214’s, and why should they pay me for one minute that I wasn’t?
As a company, they weren’t soul sucking… they were just soulless. Not immoral, but amoral. My 8 years there were a transaction. If I recommended them to a colleague, it would be with the caveat of “Everything they do is for their own short-term benefit, so make sure you always look out for your patients and for yourself.”
There was the time that they ran out of money and almost couldn’t pay payroll (we heard about that in the news, rather than from the company). They were playing chicken with our paychecks and people started panic-quitting, but the investors blinked first and coughed over more money.
They were sued by their investors.
There were occasional protests outside clinics.
Things did stabilize a bit, when the company was bought out “after years of legal and financial trouble, but they brokered a deal which threw out all the employee stock options they’d promised.
Boy, don’t I sound cynical! Perhaps in this regard I am, unfortunately. It was for-profit, pay-per-service healthcare, without a lofty mission. But I don’t resent it. I’m not burned out. I loved the patients, the medicine, and the staff! I enjoyed my work most days, and I worked with smart and dedicated clinicians. I had an incredible clinic partner, and I wish that I could bring my stellar medical assistant with me into the foreign service. I was always learning. I will ever be grateful to my mentors, patients, and colleagues.
Jen is concerned that I’m *too* excited about the mission behind my new job with the FS. She warns me that working for the Gov’t will also have ups and downs, just like any company. She’s right, of course (she always is!)… but I am thrilled that I’ll be able to focus more on the parts of medicine I love (partnering with patients on improving their health, catching diseases, suturing cuts, setting fractures, etc.), and less on the parts I don’t like (billing and coding).
And I’m happy to be in between jobs for the next few weeks, while we revel in our family and friends, and prepare this transition.
"… So long honey, babe
Where I'm bound, I can't tell
Goodbye's too good a word, babe
So I'll just say, "Fare thee well"
I ain't a-saying you treated me unkind
You could've done better but I don't mind
You just kinda wasted my precious time
But don't think twice, it's all right."