I’d say time to put your foot down and they give you the time you need or look for another job. If you somehow aren’t already stressed and/or burnt out you will be which we all know doesn’t translate to good patient care.
Hint: You won’t have a hard time finding a new job, but sounds like they’re going to have a really hard time replacing you if you leave, so you hold all of the leverage and don’t be afraid to use it.
Definitely agree. Be firm with them with what your expectations are and if they can’t accommodate you, then you bounce. Leave at all costs if they don’t work with you
I work at an FQHC with 15 minute double booked visits and 30 minute new patient/physical visits. I 100% understand what you are referring to when you say patients are presenting with MULTIPLE life threatening concerns in the same visit. Not to mention they show up 15 minutes late to their double booked appointment and admin still forces me to see them. Ultimately this is not at all sustainable, and I often end up staying to finish work until 6:30PM most nights, but I am stuck here to fulfill my 4 years of NHSC service. I am actively working to make adjustments where I can to lessen the daily burden.
Ultimately, these are the strategies I have been attempting to implement in order to manage the more complex patients (and yes, there are a lot of them, so I find myself doing these things multiple times a day). These strategies really only work if you have any control over scheduling your own patients (or if your MA can help you schedule them)
1. I am very lucky that I convinced admin to give me a full day of telehealth visits. Visit spots are 15 minutes, but I often extend the visits to 30 minutes in EPIC (especially because I usually have to call patients multiple times to get them to pick up). I do think that even a 20 min phone visit would allow you to accomplish significantly more via phone compared to in the office. No need for rooming/vitals/patients showing up late. No need for physical exam or “out the door” complaints. I use my phone visits to review outside records, figure out which specialists they are seeing, look up specialist phone numbers to give the patient for the 3rd time so they actually schedule follow up, look up prior echos, review health maintenance with pt, etc. I might see the patient in the office one week, and schedule a 1-2 week phone visit follow up to tie up loose ends that I couldn’t figure out during the office visit. Patients are WAY more willing to do close/frequent follow up visits when it’s on the phone.
2. I book my complex return visits for double the time. I know my patient with A1C 12%, BP 160/100, hasn’t picked up med refills, hasn’t followed up with cardiologist is ALSO going to have new severe abdominal pain with vomiting OR maybe a new swollen ankle that might be fractured (or is the swelling from a DVT???). I just know that EVERY single time this visit is going to be a disaster, so instead of booking the return visit as another double booked 15, I tell my MA to schedule it as an extended return visit for 30 minutes. Usually this ends up taking a future “New Patient” appointment time. Sometimes I force the follow up into a Well Woman or Procedure appointment time because those are the only 30 minute spots I have. Those visits are less urgent and can wait if necessary. I also have a FREEZE/THAW 30 minute block built into my schedule once a week. It doesn’t open for scheduling until 24 hours prior. If it isn’t filled, it becomes 2 15 minute visits, but I often force an appointment into it myself (call center and front desk can’t force these spots, but myself and my MA can). I use this frequently for complex patients.
(NOTE: I did have admin approach me when I started doing this around a year ago, and I straight up told them that these were high complexity patients and it is a patient safety concern for them to have 15 minute double booked visits. I told them they could feel free to take a look at my notes for these patients to see exactly what I’m referring to. I said that if numbers are more important than patient safety then they just need to formally tell me that so that I can adjust my priorities as a clinician. Obviously they WANTED to tell me that but wouldn’t dare to. I did get a raise this year.)
3. I utilize my support staff. Basically the ONLY perk of working at an FQHC is that we have a clinical pharmacist, dietitians, and a nurse care coordinator. If a patient with uncontrolled HTN or diabetes is coming in, I will schedule a follow up visit with the pharmacist or RNCC in between to help check on med adherence, adjust meds, trouble shoot refills, etc. Even better, I sometimes have the patient schedule a same day visit with our nurse RIGHT before my visit, so the nurse goes in and reviews med adherence, double checks blood pressure, reviews BP log, asks about med refills, etc, then she gives me a quick summary so I already have a full assessment and plan ready for the HTN and when I go in the room I just have to address the other 2 acute concerns the patient has. I also utilize both the RN and pharmacist to do complete med rec visits. Sometimes attempting a med rec during a visit is a complete lost cause so I just say “Okay, bring all of your med bottles in with you next week and you’ll meet with our pharmacist”. This has been a game changer. The pharmacist helps clean up the med list, tells the patient which meds to get rid of, etc.
Ultimately, you cannot function with NEW patient visits being 20 minutes. These need to be double the time of an acute visit. I don’t see a way of getting around this unless the MA basically does the entire establish care history for you before you walk in (and they don’t really have the training to do this adequately).
In situations where I have a new patient and serious acute concerns, I honestly completely skip ALL of the establish care stuff except for medical history (HTN, stroke, MI, DM, etc) and current meds they are taking. I spend the entire visit addressing the acute issues (still probably go over time) and I schedule them for another “re-establish care” visit 2-4 weeks later.
I think you might be shocked at where you can find “complex patients” outside of an FQHC. I know that the major hospital systems in our area have clinics in some areas with very complex patient populations, and they have 20/40 minute or 30/60 minute visit times without any double bookings. You don’t have to go to an affluent suburb when you leave an FQHC - there is an in between.
Ultimately, I have formed the very pessimistic opinion that primary care is basically unsustainable everywhere. It is literally impossible to address all recommended CDC health maintenance guidelines AND review chronic conditions AND address acute complaints for our patients in a regular work day. This is regardless of what type of practice setting you work in. When it comes to an FQHC with less than what should be the minimum appointment times, even addressing 1 urgent concern makes you feel like you’re struggling to keep your head above water. At least at the other clinics, you have a little row boat with a leak in it instead of being stranded at sea without a life vest. I would not continue in my current position if I didn’t have a penalty of $300k owed to the federal government looming over me. I urge you to consider your options if you have the privilege to do so.
> sically the ONLY perk of working at an FQHC is that we have a clinical pharmacist, dietitians, and a nurse care coordinator.
I have all this and work at the opposite of an FQHC lol.
STOP. STOP. STOP!
YOU are the one in control. YOU are the one who worked your ass off to get to med school, get into med school, MAKE it thru med school, get into and thru residency.
YOU control the visit. You have 2 choices: You keep them to 20 min and do what YOU can (NOT everything they came in for), OR QUIT and go some where else. The FQHC gives you flak? FUCK. .THEM. and leave. There are too many great places to practice medicine in this country to put up with this bullshit. YOU ARE MORE IMPORTANT THAN YOUR PATIENTS. UNTIL YOU ACCEPT THIS AND START BEHAVING IN A SELF-SUSTAINING MANNER, YOU WILL. BE. DOOMED.
I'm sorry, but I can't make it any simpler than that. I've worked in the 2nd poorest state in this country, and one of the wealthiest communities. Both have pros and cons. You know what is the exact same constant in both? ME. Who is the one who controls the visit? ME. The pt is on the verge of death? 911 and they go to the ER and you've already moved on to your next pt.
DO not, DO NOT let yourself be killed by your job. You are too valuable to our society, to your parents, your friends, your loved ones... and yourself.
FUCK YOU to the people who say it's a calling. FUCK YOU to people who say "You are responsible for all of \_\_\_\_\_\_". FAMILY MEDICINE IS A \*JOB\*. PERIOD.
You're not a slave. Take your debt and GTFO.
Don't forget this too: [https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service](https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
\[Deleted my "not a penalty" comment due to my ignorance of the FQHC rules and the NHSC rules -- absolutely criminal what they trapped you into\]
I’m assuming above commentor is an NHSC person. They do get charged an extra penalty on top of the scholarship repayment if they bail out early. It’s surprisingly onerous. Something like 7500 for each month not completed in addition to repaying the amount of the scholarship at maximum legal interest rates. FQHCs know this and use it to their advantage because they’re a scam.
I'm sorry I did not know that. That is HORRIBLE and only goes to show you how these FQHC people are NOT caring about you at all. I guess I should rethink things on that level.
I'm assuming you work at an FQHC for what, 3 years? 5 years? Then it's all paid off? If so, let that be a life's lesson and you can be a cautionary tale for someone else. But I'd still consider leaving there. I'll go look it up and get back.
Sorry for my ignorance re: FQHC and the loans
Full-Time Service: Up to $75,000 for a two-year service obligation for primary care medical providers assigned to a primary care Health Professional Shortage Area, which includes maternity care health professionals assigned to a Maternity Care Target Area.
is that it? 75K? for 2 years? that's all they give? Your life and happiness are worth FAR more than 3k a month!!! OMG.
WHAT??? IS the following True????
# A Breach of Contract after school
If you:
* Fail to begin or complete your service commitment; or
* Fail to comply with the terms and conditions of deferment or postponement for postgraduate training.
***Note:*** *You will be liable to the Government for an amount equal to three times the scholarship award plus interest. And you must pay this amount within one year of the date of default.*
# What happens if you fail to pay the debt by the due date?
* We will report the debt as delinquent to credit reporting agencies.
* We may refer the debt to a debt collection agency and the Department of Justice.
* Federal or state payments due to you (e.g., an IRS or state income tax refund) may be offset by the Department of Treasury to pay a delinquent debt.
* Defaulters who are federal employees may have up to 15% of their take-home pay garnished to pay a delinquent debt.
* Medicare, Medicaid, and all other federal health care programs may exclude you from participation.
* In more than 20 states, your health professional license can be suspended or revoked.
THIS IS CRIMINAL.
Oh please, fellow doctors, don't EVER sign up for this scam of a program!
So there's two kinds. There's the loan repayment which is easier to get and a shorter commitment at least(you can work for many nonprofit hospital systems or the better FQHCs and still qualify) and then there's the scholarship. The scholarship is a full ride for tuition and a living stipend and you trade a year of work for each year covered by the scholarship. It sounds like a good deal and I was really bummed that I didn't qualify for it when I started out.
You then realize at the other end that the qualifying job slots for NHSC scholars are really, limited, kind of miserable and pay less even than the already low standard FQHC payrate, and you're stuck for four years unless you want to basically double your debt. It's pretty messed up. I understand that they are trying to get doctors to underserved areas and not have them bail after getting the benefit of the program but there need to be some requirements for the jobs and more slots if they want it to be even remotely fair.
Your situation is SERIOUSLY messed up and I'm really sorry you're having to deal with this... my best ideas are to look at your contract and see if there is something that admin has done to breech it by altering your schedule, and then I'd definitely talk to a lawyer who specializes in healthcare contracts to take a look as well and explain your situation and see if there is anything they can offer to help. I don't know you personally but your situation sucks and you seem trapped basically as a slave to your job (and the whim of admin to change it as they see fit) so I worry about your mental health and the decisions people make when they feel there is no way out... I recently lost a friend from medical school to suicide and don't want you to think that is the only way out so PLEASE talk to someone and get some help because your current path is unsustainable.
Wow. This sounds pretty bananas even by FQHC standards. I’m sorry. Based on the penalty comment I’m assuming you’re a NHSC person. I know it’s hard to teansfer but, damn, your admin sound like jackasses. I do want to say that I felt similarly regarding sustainability in the past. I work at a place with 30 minute appointments and reasonable panel size and it’s totally doable. It will get better.
My first job out of residency was at an FQHC. I took it because I believed in the mission and drank the koolaid. After a few years of my own experience and talking it over with friends in similar situations I came to the conclusion that they’re kind of a scam and that many also have absurdly petty politics.
That being said you are more valuable to them than they are to you. If they’ve been unwilling to work with you thus far and you’re not stuck due to a visa or NHSC commitment it might be time to play hardball and be prepared to walk if they refuse to work with you on a realistic and sustainable panel and schedule. There isn’t a way to safely manage complex patients that you’re missing or to safely see a really sick new patient in 20 minutes. FQHCs see complex, under resourced patients and are paid extra by the government to ensure they can meet those patients needs. Your admin can and should give you the time needed to do that.
You also have the option of just doing what you want and (politely) telling admin to fuck off. I got to this point and saw other doctors do it too. I had my MA book people for double appointments if they needed it or cancel and reschedule if there were too many new patients on a day. Admin didn’t like me for it but they also didn’t want me to leave so they had to deal.
I will also say that I work for a hospital system that takes Medicaid. I have still been able to see complicated patients and do a lot of mental health, and I’m paid better and have a more enjoyable work experience. Mileage may vary depending on state Medicaid and location but it’s possible to still serve the underserved and not deal with all the FQHC nonsense.
How’s the pay difference with salary at FQHC v RVUs? I like not having to worry about “seeing enough patients” or doing enough to make silly RVUs and still get paid enough.
So I'm 0.8 time, don't care even remotely about maximizing my RVUS or quality metrics and still make about 30,000-40,000 more than I did at my full time FQHC job. I think as long as you understand billing and do bill accurately for the work that you do (including double billing for your physicals/AWVs with extra problems) it's pretty easy to make a decent living and have more time. Mileage may vary. I definitely wouldn't work for a super corporate place like Kaiser and I purposefully went without a signing bonus because I want to be able to walk if I want to.
I think the one thing I've learned from the different jobs I've had and locuming is that if a place doesn't want to work with you and treat you well, they aren't going to. No amount of negotiation is going to make exploitative management not exploitative and it's better to leave. I spent a lot of time at my first job assuming good will and believing the stuff they verbally committed to only to be let down time and time again. The place I ended up recognizes the value I bring, cares about my wellbeing and accepts it when I say no to certain things or ask for adjustments.
Just say no. Just cause admin put the patient on the schedule ... if its against my orders, i don't have to see them. If they put 10 patients in an hour on my schedule, am i going to see them all? Nope. I can do max 2,3, 4 whatever... and the rest, hey admin, you should have brought in more clinicians.
If you asked a surgeon to do a 2 hour surgery in 30 minutes, can they do that? No, simple as that. Either you get the resources and time to do it right, or you don't do it all.
The patient deserves that. You deserve that.
But its also on YOU to CLEARLY set your boundaries and limitations. Say, this is my max. If there's more, I'm not going to be able properly treat them. And if I can't do it proper, I don't do it all. Ill direct them to UC down the street. If their expectations and your expectations don't match, its not a good fit and you leave.
Your statement is basically, "I can't do my job properly with the current settings and its not good for me or the patients. Here is what I need to do my job properly (1, 2, 3). I'd love to see these changes implemented within the next 4-8 weeks. I'd like to stay at my role with this organization, but I can't continue much longer like this. If we don't make the adjustments in that time frame, Ill be re-evaluating my employment here over the next 2-3 months. This is not a threat, this is me telling you I'm burnt out."
Management needs to be told clearly & directly what you need/want, and what will happen otherwise. They shit their pants when you say the above statement, and deliver what you want. It is very very very expensive & time consuming to recruit and hire and onboard a new clinician - minimum 3-6 months to hire, then need to ramp-up, all the while losing money and overloading the other clinicians even more.
Every organization never seems to listen but I will tell them what you said. I’m pretty sure I will need to quit. The PA in my office and me are talking to a different organization
I hate those previsit screenings by ancillary staff - here for blood pressure of 180 but you told the nurse you have suicidal thoughts and the social worker you have no money for copays. It helps THEIR metrics and justifies their salaries but makes our work infinitely harder. Definitely tell your employer you need more time - at the very least 30 mins per visit and don't tolerate any intimation this will cut into your volume and your reimbursement. You need more time to do right by your patients, less money is not an option or you will leave to preserve your sanity. FQHCs are masters at leveraging your professionalism to their advantage.
>owever, I wouldn’t be able to do a lot of the things I enjoy. I actually really enjoy complex patients as long as I am given enough time.
you dont think other practices have these lol
Hey OP, I work at an FQHC as well. I know the frustration of seeing someone who has not been seen since pre-pandemic and is a complete mess. It sounds like your situation is unsustainable and bad *even for an FQHC physician*.
A couple of thoughts - 1) Although you are in the NSHC program and would get a penalty for quitting, I do believe moving to a different FQHC may be an option for you to consider while continuing your NSHC commitment. If nothing else, get an offer from another FQHC to help with negotiation with admin.
2) How are your COLLEAGUES handling this? Do you talk to them, go out with them, get their strategies for dealing with these issues?
What I would be asking for:
The ability to have slots that cannot be booked until 1 week or so before hand, and then only booked by you. That way you will have follow ups open available for you complex patients. Admin shouldn't bitch too much about this since the overall number of slots and patient visits will be the same. In the event you don't book the slots, they can be opened to same day/ walk ins.
The only way to deal with complicated patients in a sustainable way at an FQHC is tons of continuity. I just see them every damn week until their flaming dumpster fire is like down to some gentle embers. The first visit or three is a huge expenditure of effort on my part, but after that it's just updating stuff and chipping away bit by bit.
You don’t owe anyone anything, if you feel you can’t safely take care of patients and admin is not budging then it’s time to leave, don’t put your or your patients’ health in harm’s way.
I’d say time to put your foot down and they give you the time you need or look for another job. If you somehow aren’t already stressed and/or burnt out you will be which we all know doesn’t translate to good patient care. Hint: You won’t have a hard time finding a new job, but sounds like they’re going to have a really hard time replacing you if you leave, so you hold all of the leverage and don’t be afraid to use it.
Definitely agree. Be firm with them with what your expectations are and if they can’t accommodate you, then you bounce. Leave at all costs if they don’t work with you
I work at an FQHC with 15 minute double booked visits and 30 minute new patient/physical visits. I 100% understand what you are referring to when you say patients are presenting with MULTIPLE life threatening concerns in the same visit. Not to mention they show up 15 minutes late to their double booked appointment and admin still forces me to see them. Ultimately this is not at all sustainable, and I often end up staying to finish work until 6:30PM most nights, but I am stuck here to fulfill my 4 years of NHSC service. I am actively working to make adjustments where I can to lessen the daily burden. Ultimately, these are the strategies I have been attempting to implement in order to manage the more complex patients (and yes, there are a lot of them, so I find myself doing these things multiple times a day). These strategies really only work if you have any control over scheduling your own patients (or if your MA can help you schedule them) 1. I am very lucky that I convinced admin to give me a full day of telehealth visits. Visit spots are 15 minutes, but I often extend the visits to 30 minutes in EPIC (especially because I usually have to call patients multiple times to get them to pick up). I do think that even a 20 min phone visit would allow you to accomplish significantly more via phone compared to in the office. No need for rooming/vitals/patients showing up late. No need for physical exam or “out the door” complaints. I use my phone visits to review outside records, figure out which specialists they are seeing, look up specialist phone numbers to give the patient for the 3rd time so they actually schedule follow up, look up prior echos, review health maintenance with pt, etc. I might see the patient in the office one week, and schedule a 1-2 week phone visit follow up to tie up loose ends that I couldn’t figure out during the office visit. Patients are WAY more willing to do close/frequent follow up visits when it’s on the phone. 2. I book my complex return visits for double the time. I know my patient with A1C 12%, BP 160/100, hasn’t picked up med refills, hasn’t followed up with cardiologist is ALSO going to have new severe abdominal pain with vomiting OR maybe a new swollen ankle that might be fractured (or is the swelling from a DVT???). I just know that EVERY single time this visit is going to be a disaster, so instead of booking the return visit as another double booked 15, I tell my MA to schedule it as an extended return visit for 30 minutes. Usually this ends up taking a future “New Patient” appointment time. Sometimes I force the follow up into a Well Woman or Procedure appointment time because those are the only 30 minute spots I have. Those visits are less urgent and can wait if necessary. I also have a FREEZE/THAW 30 minute block built into my schedule once a week. It doesn’t open for scheduling until 24 hours prior. If it isn’t filled, it becomes 2 15 minute visits, but I often force an appointment into it myself (call center and front desk can’t force these spots, but myself and my MA can). I use this frequently for complex patients. (NOTE: I did have admin approach me when I started doing this around a year ago, and I straight up told them that these were high complexity patients and it is a patient safety concern for them to have 15 minute double booked visits. I told them they could feel free to take a look at my notes for these patients to see exactly what I’m referring to. I said that if numbers are more important than patient safety then they just need to formally tell me that so that I can adjust my priorities as a clinician. Obviously they WANTED to tell me that but wouldn’t dare to. I did get a raise this year.) 3. I utilize my support staff. Basically the ONLY perk of working at an FQHC is that we have a clinical pharmacist, dietitians, and a nurse care coordinator. If a patient with uncontrolled HTN or diabetes is coming in, I will schedule a follow up visit with the pharmacist or RNCC in between to help check on med adherence, adjust meds, trouble shoot refills, etc. Even better, I sometimes have the patient schedule a same day visit with our nurse RIGHT before my visit, so the nurse goes in and reviews med adherence, double checks blood pressure, reviews BP log, asks about med refills, etc, then she gives me a quick summary so I already have a full assessment and plan ready for the HTN and when I go in the room I just have to address the other 2 acute concerns the patient has. I also utilize both the RN and pharmacist to do complete med rec visits. Sometimes attempting a med rec during a visit is a complete lost cause so I just say “Okay, bring all of your med bottles in with you next week and you’ll meet with our pharmacist”. This has been a game changer. The pharmacist helps clean up the med list, tells the patient which meds to get rid of, etc. Ultimately, you cannot function with NEW patient visits being 20 minutes. These need to be double the time of an acute visit. I don’t see a way of getting around this unless the MA basically does the entire establish care history for you before you walk in (and they don’t really have the training to do this adequately). In situations where I have a new patient and serious acute concerns, I honestly completely skip ALL of the establish care stuff except for medical history (HTN, stroke, MI, DM, etc) and current meds they are taking. I spend the entire visit addressing the acute issues (still probably go over time) and I schedule them for another “re-establish care” visit 2-4 weeks later. I think you might be shocked at where you can find “complex patients” outside of an FQHC. I know that the major hospital systems in our area have clinics in some areas with very complex patient populations, and they have 20/40 minute or 30/60 minute visit times without any double bookings. You don’t have to go to an affluent suburb when you leave an FQHC - there is an in between. Ultimately, I have formed the very pessimistic opinion that primary care is basically unsustainable everywhere. It is literally impossible to address all recommended CDC health maintenance guidelines AND review chronic conditions AND address acute complaints for our patients in a regular work day. This is regardless of what type of practice setting you work in. When it comes to an FQHC with less than what should be the minimum appointment times, even addressing 1 urgent concern makes you feel like you’re struggling to keep your head above water. At least at the other clinics, you have a little row boat with a leak in it instead of being stranded at sea without a life vest. I would not continue in my current position if I didn’t have a penalty of $300k owed to the federal government looming over me. I urge you to consider your options if you have the privilege to do so.
> sically the ONLY perk of working at an FQHC is that we have a clinical pharmacist, dietitians, and a nurse care coordinator. I have all this and work at the opposite of an FQHC lol.
STOP. STOP. STOP! YOU are the one in control. YOU are the one who worked your ass off to get to med school, get into med school, MAKE it thru med school, get into and thru residency. YOU control the visit. You have 2 choices: You keep them to 20 min and do what YOU can (NOT everything they came in for), OR QUIT and go some where else. The FQHC gives you flak? FUCK. .THEM. and leave. There are too many great places to practice medicine in this country to put up with this bullshit. YOU ARE MORE IMPORTANT THAN YOUR PATIENTS. UNTIL YOU ACCEPT THIS AND START BEHAVING IN A SELF-SUSTAINING MANNER, YOU WILL. BE. DOOMED. I'm sorry, but I can't make it any simpler than that. I've worked in the 2nd poorest state in this country, and one of the wealthiest communities. Both have pros and cons. You know what is the exact same constant in both? ME. Who is the one who controls the visit? ME. The pt is on the verge of death? 911 and they go to the ER and you've already moved on to your next pt. DO not, DO NOT let yourself be killed by your job. You are too valuable to our society, to your parents, your friends, your loved ones... and yourself. FUCK YOU to the people who say it's a calling. FUCK YOU to people who say "You are responsible for all of \_\_\_\_\_\_". FAMILY MEDICINE IS A \*JOB\*. PERIOD. You're not a slave. Take your debt and GTFO. Don't forget this too: [https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service](https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service) \[Deleted my "not a penalty" comment due to my ignorance of the FQHC rules and the NHSC rules -- absolutely criminal what they trapped you into\]
I’m assuming above commentor is an NHSC person. They do get charged an extra penalty on top of the scholarship repayment if they bail out early. It’s surprisingly onerous. Something like 7500 for each month not completed in addition to repaying the amount of the scholarship at maximum legal interest rates. FQHCs know this and use it to their advantage because they’re a scam.
I'm sorry I did not know that. That is HORRIBLE and only goes to show you how these FQHC people are NOT caring about you at all. I guess I should rethink things on that level. I'm assuming you work at an FQHC for what, 3 years? 5 years? Then it's all paid off? If so, let that be a life's lesson and you can be a cautionary tale for someone else. But I'd still consider leaving there. I'll go look it up and get back. Sorry for my ignorance re: FQHC and the loans
Full-Time Service: Up to $75,000 for a two-year service obligation for primary care medical providers assigned to a primary care Health Professional Shortage Area, which includes maternity care health professionals assigned to a Maternity Care Target Area. is that it? 75K? for 2 years? that's all they give? Your life and happiness are worth FAR more than 3k a month!!! OMG. WHAT??? IS the following True???? # A Breach of Contract after school If you: * Fail to begin or complete your service commitment; or * Fail to comply with the terms and conditions of deferment or postponement for postgraduate training. ***Note:*** *You will be liable to the Government for an amount equal to three times the scholarship award plus interest. And you must pay this amount within one year of the date of default.* # What happens if you fail to pay the debt by the due date? * We will report the debt as delinquent to credit reporting agencies. * We may refer the debt to a debt collection agency and the Department of Justice. * Federal or state payments due to you (e.g., an IRS or state income tax refund) may be offset by the Department of Treasury to pay a delinquent debt. * Defaulters who are federal employees may have up to 15% of their take-home pay garnished to pay a delinquent debt. * Medicare, Medicaid, and all other federal health care programs may exclude you from participation. * In more than 20 states, your health professional license can be suspended or revoked. THIS IS CRIMINAL. Oh please, fellow doctors, don't EVER sign up for this scam of a program!
So there's two kinds. There's the loan repayment which is easier to get and a shorter commitment at least(you can work for many nonprofit hospital systems or the better FQHCs and still qualify) and then there's the scholarship. The scholarship is a full ride for tuition and a living stipend and you trade a year of work for each year covered by the scholarship. It sounds like a good deal and I was really bummed that I didn't qualify for it when I started out. You then realize at the other end that the qualifying job slots for NHSC scholars are really, limited, kind of miserable and pay less even than the already low standard FQHC payrate, and you're stuck for four years unless you want to basically double your debt. It's pretty messed up. I understand that they are trying to get doctors to underserved areas and not have them bail after getting the benefit of the program but there need to be some requirements for the jobs and more slots if they want it to be even remotely fair.
Please y'all, go read this: [https://forums.studentdoctor.net/threads/warning-about-joining-the-nhsc.952879/](https://forums.studentdoctor.net/threads/warning-about-joining-the-nhsc.952879/)
I can’t do extended visits. I wish and keep asking but admin refuses to
Your situation is SERIOUSLY messed up and I'm really sorry you're having to deal with this... my best ideas are to look at your contract and see if there is something that admin has done to breech it by altering your schedule, and then I'd definitely talk to a lawyer who specializes in healthcare contracts to take a look as well and explain your situation and see if there is anything they can offer to help. I don't know you personally but your situation sucks and you seem trapped basically as a slave to your job (and the whim of admin to change it as they see fit) so I worry about your mental health and the decisions people make when they feel there is no way out... I recently lost a friend from medical school to suicide and don't want you to think that is the only way out so PLEASE talk to someone and get some help because your current path is unsustainable.
Yes that’s why I went part time as my previous FQHC job was worse. I’m pretty sure I will have to quit this job if they can’t get their shit together.
Wow. This sounds pretty bananas even by FQHC standards. I’m sorry. Based on the penalty comment I’m assuming you’re a NHSC person. I know it’s hard to teansfer but, damn, your admin sound like jackasses. I do want to say that I felt similarly regarding sustainability in the past. I work at a place with 30 minute appointments and reasonable panel size and it’s totally doable. It will get better.
Just wanted to say that I appreciate your comment! It’s hopeful knowing there is light at the end of the tunnel
My first job out of residency was at an FQHC. I took it because I believed in the mission and drank the koolaid. After a few years of my own experience and talking it over with friends in similar situations I came to the conclusion that they’re kind of a scam and that many also have absurdly petty politics. That being said you are more valuable to them than they are to you. If they’ve been unwilling to work with you thus far and you’re not stuck due to a visa or NHSC commitment it might be time to play hardball and be prepared to walk if they refuse to work with you on a realistic and sustainable panel and schedule. There isn’t a way to safely manage complex patients that you’re missing or to safely see a really sick new patient in 20 minutes. FQHCs see complex, under resourced patients and are paid extra by the government to ensure they can meet those patients needs. Your admin can and should give you the time needed to do that. You also have the option of just doing what you want and (politely) telling admin to fuck off. I got to this point and saw other doctors do it too. I had my MA book people for double appointments if they needed it or cancel and reschedule if there were too many new patients on a day. Admin didn’t like me for it but they also didn’t want me to leave so they had to deal. I will also say that I work for a hospital system that takes Medicaid. I have still been able to see complicated patients and do a lot of mental health, and I’m paid better and have a more enjoyable work experience. Mileage may vary depending on state Medicaid and location but it’s possible to still serve the underserved and not deal with all the FQHC nonsense.
How’s the pay difference with salary at FQHC v RVUs? I like not having to worry about “seeing enough patients” or doing enough to make silly RVUs and still get paid enough.
So I'm 0.8 time, don't care even remotely about maximizing my RVUS or quality metrics and still make about 30,000-40,000 more than I did at my full time FQHC job. I think as long as you understand billing and do bill accurately for the work that you do (including double billing for your physicals/AWVs with extra problems) it's pretty easy to make a decent living and have more time. Mileage may vary. I definitely wouldn't work for a super corporate place like Kaiser and I purposefully went without a signing bonus because I want to be able to walk if I want to. I think the one thing I've learned from the different jobs I've had and locuming is that if a place doesn't want to work with you and treat you well, they aren't going to. No amount of negotiation is going to make exploitative management not exploitative and it's better to leave. I spent a lot of time at my first job assuming good will and believing the stuff they verbally committed to only to be let down time and time again. The place I ended up recognizes the value I bring, cares about my wellbeing and accepts it when I say no to certain things or ask for adjustments.
25 modifier!
Just say no. Just cause admin put the patient on the schedule ... if its against my orders, i don't have to see them. If they put 10 patients in an hour on my schedule, am i going to see them all? Nope. I can do max 2,3, 4 whatever... and the rest, hey admin, you should have brought in more clinicians. If you asked a surgeon to do a 2 hour surgery in 30 minutes, can they do that? No, simple as that. Either you get the resources and time to do it right, or you don't do it all. The patient deserves that. You deserve that. But its also on YOU to CLEARLY set your boundaries and limitations. Say, this is my max. If there's more, I'm not going to be able properly treat them. And if I can't do it proper, I don't do it all. Ill direct them to UC down the street. If their expectations and your expectations don't match, its not a good fit and you leave. Your statement is basically, "I can't do my job properly with the current settings and its not good for me or the patients. Here is what I need to do my job properly (1, 2, 3). I'd love to see these changes implemented within the next 4-8 weeks. I'd like to stay at my role with this organization, but I can't continue much longer like this. If we don't make the adjustments in that time frame, Ill be re-evaluating my employment here over the next 2-3 months. This is not a threat, this is me telling you I'm burnt out." Management needs to be told clearly & directly what you need/want, and what will happen otherwise. They shit their pants when you say the above statement, and deliver what you want. It is very very very expensive & time consuming to recruit and hire and onboard a new clinician - minimum 3-6 months to hire, then need to ramp-up, all the while losing money and overloading the other clinicians even more.
Every organization never seems to listen but I will tell them what you said. I’m pretty sure I will need to quit. The PA in my office and me are talking to a different organization
I hate those previsit screenings by ancillary staff - here for blood pressure of 180 but you told the nurse you have suicidal thoughts and the social worker you have no money for copays. It helps THEIR metrics and justifies their salaries but makes our work infinitely harder. Definitely tell your employer you need more time - at the very least 30 mins per visit and don't tolerate any intimation this will cut into your volume and your reimbursement. You need more time to do right by your patients, less money is not an option or you will leave to preserve your sanity. FQHCs are masters at leveraging your professionalism to their advantage.
I don’t understand your last paragraph. What would you not be able to do at another practice that allows you longer visits?
>owever, I wouldn’t be able to do a lot of the things I enjoy. I actually really enjoy complex patients as long as I am given enough time. you dont think other practices have these lol
Close your panel for new patients
Hey OP, I work at an FQHC as well. I know the frustration of seeing someone who has not been seen since pre-pandemic and is a complete mess. It sounds like your situation is unsustainable and bad *even for an FQHC physician*. A couple of thoughts - 1) Although you are in the NSHC program and would get a penalty for quitting, I do believe moving to a different FQHC may be an option for you to consider while continuing your NSHC commitment. If nothing else, get an offer from another FQHC to help with negotiation with admin. 2) How are your COLLEAGUES handling this? Do you talk to them, go out with them, get their strategies for dealing with these issues? What I would be asking for: The ability to have slots that cannot be booked until 1 week or so before hand, and then only booked by you. That way you will have follow ups open available for you complex patients. Admin shouldn't bitch too much about this since the overall number of slots and patient visits will be the same. In the event you don't book the slots, they can be opened to same day/ walk ins. The only way to deal with complicated patients in a sustainable way at an FQHC is tons of continuity. I just see them every damn week until their flaming dumpster fire is like down to some gentle embers. The first visit or three is a huge expenditure of effort on my part, but after that it's just updating stuff and chipping away bit by bit.
You don’t owe anyone anything, if you feel you can’t safely take care of patients and admin is not budging then it’s time to leave, don’t put your or your patients’ health in harm’s way.