If this is true, it does seem like an unreasonable workload:
Among other things, Monke claims she was required to be on call for 19 days without a break, to be on call for nursing homes over 300 miles away on weekends and holidays, to commute 100 miles a day between nursing homes, to make daily rounds at 12 nursing homes and to visit 25 patients per day.
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{ 12 comments }
Sounds like another medical sweatshop and Medicaid mill.
I think it is possible. That is why if a nursing home patient has a sniffle, vomited once, has a zit, had a bloody nose that stopped, gets strapped up in an ambulance for a 2000$ trip to the ER.
This sort of thing really does happen. But how can they “force” her to falsify records? If a doctor is ordered to falsify records, and complies, even under threat of dismissal, they are guilty of fraud, unprofessional conduct, and moral cowardice that renders them unsuitable for an independent professional status. People are always trying to get me to do improper things, it is my job to say no–and I do so on a daily basis. I learned even while still a resident that standing up to authority is essential for personal integrity as a physician–and I thank the quack attending who forced me into learning that lesson.
Regarding the overwork part–it took me longer to admit that “work ethic” is sometimes just an excuse for tolerating abuse–but the rememdy is to quit. It is not someone elses job to decide how hard I can work and stay healthy and effective–nor is it their responsibility to give me a job that is within those limits.
Too many residents are sent out into the world conditioned to follow orders, not think for themselves, and not take care of themselves. A lot of shoddy medical operators are waiting to use them for their own nefarious purposes.
Agreed. She could have walked into a locum job or a hospitalist job anywhere. She is the one with the MD not the coordinators. If she billed a 5 minute vist as a 30 minute vist than she committed fraud….period. Both she and the unethical scumbags she works for should be banned from medicine.
“Medical sweat shop.” Never heard the term before, but I believe they exist.
“She could have walked into a locum job or hospitalist job anywhere”
Oh really?
She probably can’t provide any recent references. Her administrators are probably trying to blacklist her. She’s so overworked she doesn’t even have time to find another job. She’s probably scared the administrators will turn her over to the feds to take the fall for Medicare fraud or similar (assuming they didn’t threaten it outright). Maybe (probably?) the CEO is well-connected and has no fear of any investigation; maybe he’s even had experience in abusing and intimidating other employee-physicians. In short, I bet she’s scared that her entire future is in jeopardy because she dared to disagree with her employer. They hold all the cards. And new doctors are well-conditioned to be obedient and submissive. You generally don’t do well through high school to college to med school to residency if you’re uppity and self-assertive.
Situations like this happen every day, and the only surprising element here is that a local paper actually ran a story about it.
You can’t be serious Dr. Scott. I don’t know how things are in peds but internal medicine (which I do know) has many more positions than applicaants…period. If you want a job you will get one. Medicare fraud is a differnet issue. I have never overbilled for anything in my practice. Certainly not at the insistance of a business flack. Have you?
Anonymous 2:39–
No, I have never committed fraud; however, I did start in a private practice where the owner did, and encouraged me to as well. This owner was very well-connected and had already shaken off one investigation by the OIG. That’s why I can sympathize with this doc: I was very, very afraid I was being set up to take a fall. I was equally afraid he would bad-mouth me if and when I tried to leave.
And yes, there may be a lot of open positions out there, but most of them still want references, credentials, an explanation of why you are looking for a new job. It also works the other way: if you were burned by one practice, you want to be judicious you aren’t jumping into the same thing yet again.
Finally, I didn’t see in the article, but maybe she has a spouse and children to support. More to consider with regards to the new job (salary requirement, location). And all the more reason to worry about losing the current job vs. the trouble of going to a new one, resettling, selling the house, etc.
I would argue that many owners and administrators pressure doctors into unethical situations everyday. I would also argue that it is not always easy to “stick to your guns”–and these crooks know it, and use it to their advantage.
This is a totally believable situation. Who knows what her salary arrangement was. They may be padding her overhead, a very common practice; they may be paying her on a draw arrangement and are threatening her with recovery action if she doesn’t do better in collections. They even could be doing both. If she is doing nursing home work, that is a real trap, as many residents are on state medicaid which in many instances does not pay anything above the Medicare 80% of allowable. Doing that, it is possible to be working to pay only the overhead bill.
Obviously she should quit. My guess is that she went to a lawyer after they threatened her and this is a preemptive tactic to get acceptable termination terms, i.e., monetary settlement and agreement not to disparage.
Make no mistake, there are plenty of greedy dirtbag doctor practice owners out there who do things that are an outright disgrace to the profession, stuff criminals do. It seems like she was working for one of them.
This is why, when we hear of a new physician in town who is on their own, even though they are not positioned to be in our referral network or otherwise cross our paths, we should call them up and invite them to lunch or to breakfast on a weekend, perhaps building a relationship where they can turn for advice in dealing with these kinds of issues. It is not only altruistic, but also self-serving in that we are helping our profession maintain it’s integrity and protecting its prestige and respect.
I have helped a couple of young doctors, as some older doctors helped me (I could have done with more). They didn’t always thank me at the time, sometimes being too proud to admit that they needed the support, but it was worth it and they come to appreciate it later.
This is a tough profession and we should support each other.
Dr. Scott is right. This kind of garbage happens every day. And you’re d**ned lucky if you can get a newspaper . . . or a medical board . . . or the big-gun medical bloggers . . . to care.
Some of us have been screaming about these strong-arm tactics for quite a while . . . and signing our names. Our pleas for help have fallen on deaf ears.
And questions? Please visit http://www.drjshousecalls.blogspot.com
My spouse has ten months left on a two year contract with a community medical clinic. He spends his evenings and weekends doing charts–sometimes working 75 hours a week. The patients he sees are mostly “difficult”, the ones other clinics do not want to work with. Shortly, before he came patient managers were eliminated and time consuming computer charting was started. Every patient provider is in the same situation. Repeated requests for transcribers have been ignored, instead $20,000 raises were given to mid-level management and administrative offices were refurnished. I would love for him to be able to quit this job before it destroys his health. Any advice would be appreciated.
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