splitting time

One of the greatest things about where I work is that every 4 months we rotate units. This keeps me from getting too comfortable anywhere. Just when you've figured out where the extra oxygen tanks are kept and which nursing aide to approach with a "messy" situation, you're packing up and moving on. This also keeps our clinical skills sharp. Just when you're burnt out on the neuro unit, you switch gears to hips, knees, or COPDs.

By now I've rotated through every unit, seen it all. So I opted to be the "splitter", working half the day at the main hospital and half the day at our sattelight unit at a hospital in Dorchester. I don't really have my own caseload, I basically do evals or cover patients when their primary therapist is off or unavailable. And while it can get crazy seeing over 50 different patients a week, it has it's benefits... you don't have to do as much treatment planning, following up with surgeons you can never get a hold of, or go home thinking worrying about that patient you've been treating for the last 3 months. It's a breathe of fresh air. Instead of jumping in the deep end with a few patients, I'm just wading up to my knees with a couple dozen. This may free up some energy to put into some other areas... writing and research! Stay tuned...

weighing in on the healthcare debate

work has been very stressful lately. it's feeling like, well, work. and here in lies the problem with healthcare. it's people's work, jobs, and it's a business. i make a salary based on treating the sick. if there were no sick people, i wouldn't be employed. recently we've been having meetings regarding how to increase our productivity, as an outside company audited our hospital staffing and determined that our department was overstaffed by 3. HA! and here we are working through lunch, unpaid overtime, and have a waiting list to see patients. Yet, the physical therapy department was quoted as being accurately staffed, even though they have 3 additional positions than OT. How can this be?

Well, the auditors looked at units billed. A unit represents 15 minutes of treatment. Not time spent educating, talking with families, or whipping up some crazy piece of adaptive equipment. During those 15 minutes the patient must be participating in an activity. A lot of time is not billable. And it's often during that time that I feel like I'm doing my best work. We don't get paid to think. Only to do.

Doctors work on the same payment system, it's called fee for service. They are paid by how many tests and procedures performed. So guess what the incentive is? Treat more, do more. Quantity, not quality is rewarded. Even if the time and energy might be better spent sitting with a patient and family and discussing the patient's risks for surgery or plans for end of life care. Until the reimbursement system is redesigned, our country is not likely to get any healthier.