Tag Archives: work

Part time doctor

So I am back on the hunt for a job, and it’s not been easy. Apparently, no one is wanting to hire a part time doc. I mean I understand that patients want reliability and availability, but I don’t think that’s an impossible thing to accomplish as a part timer.

My last two jobs I was part time, and it worked out well.  The last job I worked three days a week, and rarely had an issue with being able to see all my patients when they needed to be seen. If it was urgent and they couldn’t wait, there was always another doctor to see them in the office, and for quick issues most patients didn’t mind seeing another doctor. It was like seeing a doctor at an urgent care center, but with the benefit of their chart  already being there. And I took phone call, so if they ever had questions I always available to answer, and had their chart on my mobile app. My patients loved me, and always made it a point to only see me.

So, how do you feel about having a part time Doctor? Would it be an issue for you? What would it take for you to be comfortable having a part time Doctor? There being another doc in the office? Having a special email or phone number for the doctor? Feel free to be honest, I really wanna hear your thoughts!

Just Because You Can…..

Doesn’t mean you should.

As a family practitioner, my scope of practice is pretty broad. I can deliver babies, do GYN procedures, and even perform minor surgery. Technically my license states that I can practice medicine and surgery in the state of New York. Perhaps, I could do an appendectomy? I’ve heard of country doctors having to do these kind of surgical procedures because the nearest hospitals is miles away. But I would never do anything like that because I’m not comfortable and I live in a big city.

I feel in life, especially in living with lupus, I am faced with the dilemma of deciding if I should do something just because I can. I can go out late for drinks and dancing, but am I willing to be stuck in bed achy and exhausted the next day?

I can work full time, but would it be at the cost of my health and sanity? I remember when I did work full time. It was so stressful, I was constantly exhausted, and every day felt like a battle. I was constantly agitated and always had some kind of lupus symptom. I made a lot more money, but was it really worth it?

I can go on a strenuous hike or skiing while on vacation, but am I going to be in pain for the rest of the week. Will it keep me from enjoying the rest of my trip?

I guess my issue is that I hate limiting myself. I hate the idea of lupus holding me back. I like to believe that I can do anything I set my mind to, and encourage others to do the same.

But sometimes I just have to be realistic. I am not limited in what I can do. I just realize that maybe I don’t need to do everything. It’s my choice, and I’m okay with that.

“Work is killing me.”

So I know it’s been awhile since I’ve posted. The other doctor in my office was out of town so I was covering for him and then I got sick last week and am still feeling pretty crappy.The weather went from a blazing eighty five degrees to a rainy, dreary seventy in just a day and I had patients coming in with coughs and colds and sore throats for a week.

A few days later I started feeling chills and general fatigue. I figured it was a viral upper respiratory infection and started taking vitamin C. I had an appointment with my rheumatologist, who ended up doing a throat culture and nasal swab. I didn’t think anything would come up positive and figured I’d be feeling better by the weekend.

Over the past weekend, I developed a horrible cough, and it got me thinking. The purpose of my lupus treatment is immunosuppression. I take Imuran, and my last white blood cell count was about 2. This makes me really susceptible to catching some nasty bug. I should be avoiding sick people but instead I’m surrounded by them all day. They cough and sneeze all over me. I look inside their mouths and noses while taking swabs and cultures.

I remember when I worked in the hospital during residency. Any time there was a suspected case of tuberculosis or meningitis in the ER, I was warned to steer clear. I couldn’t even go into the ER to see my patients who were there for noninfectious illness, because everyone who went into the ER was at risk of contracting the highly- contagious disease and had to be given prophylactic antibiotics.

I work in an outpatient office now, so the likelihood of having an extremely sick patient is not as common, but it’s still a risk. I could never work in a hospital again.I could wear a mask at work, but that would make my patients uncomfortable, and make my staff suspicious. After getting sick this last time, it made me wonder how at risk I am putting myself everyday.

My throat cultures came back positive for bacteria, most likely strep. I’ve started antibiotics, but I’ve been so short of breath that my doctor ordered a chest X-ray to rule out pneumonia. I should get my results back today, which hopefully will be negative. I’m still going to work this week because I don’t get any sick leave (doctors aren’t supposed to get sick) and I shouldn’t be contagious anymore. I’m exhausted and weak from coughing all night, but I still have to keep going.

I’m optimistic that I will get better soon, and I am going to take better precautions to prevent getting sick again but this gives new meaning to the phrase “Work is killing me.”

First day!

So yesterday I had my first day at the new job. It was a slow day, but still quite exhausting. Basically,  it was about getting all my paperwork in order and getting acquainted with the staff and environment. I only saw one patient, but it took awhile to finish because I was still trying to figure out the electronic medical record system.Despite the slow day, I still left work drained.

I had become comfortable with not working. My body was used to sleeping in, and being able to nap whenever I didn’t feel well. I had enough time to take care of my chores and errands and plenty of time for exercise and my other hobbies. I never really needed to plan anything out, since I just did whatever I needed to whenever I wanted.

After only one day of work, I’ve realized I am going to have to make some adjustments in my lifestyle to be able to maintain my health and minimize stress. First, I’m going to have to go to bed earlier, which means no more late night TV. I am also going to pay more attention to my diet and eat foods that will give me more energy during the day. I will plan out my chores and errands better, so that I can do little things on the days I work, and save bigger projects for my days off. I’ll need to switch up my exercise routines so that they days I work, I do a little less, and make up for it on my off day. I’ll also have to accept there’ll be days when I just won’t be able to work out at all.

I’m happy to be working again and know it will take time to get in my groove. I’ve never been one for change, but I’ve learned that sometimes it’s not such bad thing and with every change in my life comes new experiences. I look forward to my new job and hope to have new stories to share with you!

Work Environments

As many of you know,  I have been job hunting. My first job after residency was a complete nightmare, and I am terrified of getting into another situation like that.In my interviewing process, I’ve come to notice there are three types of work atmospheres- profit driven, patient centered, and physician friendly.

My first job was very profit-driven. My employers were so focused on the bottom line that  patient care and my physician well-being was suffering. The administration would make sure the schedule was double-booked and I would be pressured to order unnecessary tests and referrals. Medicine becomes like factory work, just putting forth product to pay the bills.Every day was a battle with my ethics and the miserable feeling of coming home knowing I was unable to care for my patients the way I wanted to.

In the completely patient centered environment, the focus is on the patients and providing the best care without regard to money or cost. A doctor could spend as long as the patient needed and handle all issues in one visit.The doctor would always be accessible. They would stay late, come in every weekend and holiday, and always be on-call. seems like an ideal practice model, but leaves a lot of room for a physician to be taken advantage of, and not be able to make the money necessary to run the practice.

In a physician friendly atmosphere, the doctor’s lifestyle takes priority. They would only have to see ten patients a day and still make enough money. They could choose only to see the friendly, compliant, and easy patients and refuse to see the demanding, untrusting, and challenging ones. They wouldn’t work weekends, or evenings, or ever be interrupted at home for a patient calls. A great situation for the doctors and their families, but not so great for the patients.

I think the ideal practice is a combination of all three. There has to be a drive to work harder and have the ability to earn more and be rewarded for going above and beyond.There also has to be an environment where a patient can have the access to quality care, and have the time to discuss most of their issues. And there has to be an environment where the doctor is not overworked or over stressed, and can focus on giving the best care possible. I truly hope I can find a balanced practice, and that wherever I go, I will be able to practice medicine the way I believe.

Moving

Well, I am moving in less than a week for my husband’s job, and I am starting to stress out big time. I’m not good with change, and this is a lot of change all at once. We are moving to a completely different city one hour away from where we were before. It’s taken the four years that we’ve lived here for me to finally get comfortable and make friends, and now we’re moving. There isn’t a bone in me that wants to move, and I’ve seriously been dreading moving day.

We will have a new home which I love, but I will admit I’m nervous about because of the stairs. Normally stairs aren’t a problem. I do the stair master at the gym, which, BTW ladies does wonders for the booty. But when I’m having joint pain, or a really bad flare, I worry about getting in and out of the house. It was a concern before I chose this place, but it was the best choice due to location and space.

Then there’s the job hunt. I’ve interviewed at a few places, but I haven’t signed a contract yet. I have this huge fear about about getting stuck in a miserable practice that is completely profit driven, instead of patient centered. I had a really horrible experience with my first job that I was at for two years. I’ll tell you the story sometime, and you’ll understand.

And the packing is making me crazy. It isn’t just that it’s physical labor but it’s emotionally taxing. I am very sentimental and I save everything. I’m talking receipts from a romantic dinner my husband took me too three years ago and clothes that I wore in high school (they will NEVER fit me again). Moving is the best time to de-clutter, and I’ve had to grudgingly throw away a lot of things that I’m seriously attached too.

With all the stress and change, I’m starting to worry about having a flare. And that’s when I realize, I just need to stop, take a deep breath, and know that everything is going to be OK. Life is going to be full of change, especially when I have lupus. I just have to have relax and have faith that I’m on the right track. God’s got a plan for me far better than I could even imagine.

My Story: Part 6- Lupus Educational Meeting

Feeling isolated from my friends and family, I decided to seek support at a lupus meeting. My husband drove me into the city to go to a educational meeting, and I remember being so nervous walking into the room with him. I was excited to finally be meeting people like me, but I just didn’t know what to expect. I hadn’t managed too many patients with lupus before, as they usually went to see a rheumatologist.

I walked into the room and my heart dropped. There were people of all ages, mostly women. I watched as they hobbled in with canes, others sitting looking disheveled. There were a couple who looked put together, but the majority really looked like they had struggled to make it out of their home.We sat at tables in groups, and no one was talking to each other. There was an emptiness and sense of hopelessness in their eyes.

After the guest speaker presented, she started to answer audience questions. If I was feeling uncomfortable before, then now I was really a fish out of water. The majority of the questions were not so much about the disease itself, but about the social issues. How to apply for different disability services, where to find free care. Some just simply stating that they felt lost.

I wanted to run right out of there. No. They were not like me. I would not be like them. I would continue working. I had plans. I had a life. Fear crept inside my heart. Anxiety about becoming so disabled I would not be able to continue my career as a physician filled my head. Years of hard work would get flushed down the toilet.

I tried to ease my anxiety by talking to the the presenter after the question and answer session.I asked her what my options were.Are there ways I could make my career work for me? Medicine is a high stress job, and I was wondering if there was something I could do within the field that was less taxing. What if I couldn’t work? What would happen to my loans? Or if I decided to work part-time, would there be a way for me to get health insurance?

To my dismay, she didn’t have any answers. She suggested I speak to social services. I left that meeting more terrified and isolated than before. I decided then that I wanted nothing to do with the lupus community, and I would just deal with my problems on my own. It was just too scary to face my future with this disease.

My Story: Part 3- Residency Continued

Although I was glad to be able to finish residency, it was not easy. There were days when the pain in my knees would be so bad I would be limping from room to room. The fatigue had gotten better with the high dose of steroids sending me into a state of jittery high, but after I had spent all my energy, I would crash hard.

I remember one overnight call, where it was an especially busy night. I was stuck in the ER doing admissions. The floors were also busy with critical patients, and nonstop codes. Perhaps it was a full moon. I kept finishing one task, hoping to be able to sneak off to the call room , eat something, and take my meds, but only to have another urgent task awaiting me. I watched the clock, 10 o’clock, 11:30, midnight.

I eventually caught fifteen minutes to eat, but after that it was back to the grind. The work seemed endless, my body ached, and I could barely keep my eyes open.  I remember finishing up my admissions, and as I was walking out the ER at 4 AM, the ER attending tells me he’ll have another patient ready for admission in another hour. I went to lay down for the hour, and prayed that would be the last one before sign out.

There was also the time when my left eye vision became blurry. I was in the middle of interviewing a patient in the ER, and I didn’t want the patient to feel I was incompetent, so I finished the interview, squinting to write my notes. Twenty minutes later, after I finished the admission, I ran to the clinic to speak with my attending. She didn’t know what was wrong, and told me to call my rheumatologist.

I went to the ER at a different hospital, and after a neurology consult and MRI, it was determined that I was having migraine auras. It turns out the constant lack of sleep and stress was causing me to have these painless migraines. I left grateful that it wasn’t any serious problems with the blood vessels in my eyes, which is what my rheumatologist had feared.

There were several other incidents here and there, and sometimes I had to be seen in the ER I worked at. Many times, I’d lay in that ER bed, embarrassed as my colleagues and other attendings would walk past, catch a glimpse of me in a hospital gown, then ask what was wrong. I never looked sick, and I always feared they would think I was just trying to get out of work.

It was a tough journey, but I made it through with lots of prayers and the support of loved ones.

My Story:Part 3- Residency

During this initial diagnosis period, I hadn’t taken any time off. I was lucky that my Rheumatologist had evening office hours. But now the time came to tell my supervisors and colleagues. I expected to be met with sympathy and support, but instead I received a jumble of mixed emotions.

During residency training, you work so closely with the other residents. You spend countless hours in the day with the same people- working as a team, eating most of your meals together, and sleeping in the same call room. Even when you’re not working, you’re spending time together, because after alienating all your other friends with your crazy work schedule, these people are the only friends you have. You go through weddings, births, divorces, deaths in the family, licensing board failures, career change considerations, and suicide contemplations together. It’s being a part of a family.

But some of my family let me down. At the end of the year, I had considered becoming co-chiefs with another resident for the third year. It’s a lot of responsibility with planning schedules and arranging lectures, but it meant no on-call and it looked awesome on resumes. When I realized I would not be able to handle the added stress, I stepped away from the idea. The new chief, who had been one of my best friends in the residency, turned against me. She went to the Director of Medical Education, and stated that I should to take a medical leave of absence because I would become a liability. She explained that I was not capable of running, and climbing stairs fast enough to make it to the codes. Apparently, you need to be an athlete to practice medicine. Also, what if I had an emergency, or needed to leave for an appointment or test? Who would cover me? This coming from the woman I drove to work and covered for multiple times when she left early. I suppose her points were somewhat valid, but she lacked any empathy.

Luckily, the director was far more kind. He allowed me to continue working so I wouldn’t fall behind in my training. He had me placed on an easier rotation in the clinic instead of the hospital floors since I had already met my medical wards requirements. There was only one month left in second year, and he asked my fellow second year residents if they each would volunteer to cover one overnight call for me. They all obliged with the exception of the soon-to-be chief. Since chiefs don’t take call, I’d never be able to repay her. So, I only had one more overnight call in the second year, and after that I’d only have one call a month.

Although, this was a trying experience, it taught me a valuable lesson on trust and being too open. I have learned to keep my disease a secret from my employers to avoid discrimination. I hope one day that can change.

Job Hunting Tips

While we are the topic of work, I’d like to take a break from My Story, and talk about job hunting. I am moving in a couple months and I’m in the process of looking for a job. For those of us who are able to work, here are a few things to consider.

1. Flexibility- This is huge. As a patient with lupus, you need something that allows you to be able to take time for doctor’s visits and tests, as well as sick days.

2. Low stress- One of the causes of lupus flares is stress. You want to work in a drama free environment where you can work at your own pace.

3. Ease of work- You want to choose a job where you aren’t standing for hours of having to lift or push heavy things.

4. Good coverage- Emergencies happen. It helps to work in a place where you aren’t ‘t the only person who can do your work. Employers are less likely to be upset if you call out, if there is someone who can cover for you. Also if you have to be out of work for a longer amount of time, they are less likely to replace you because they have someone there to do your job, and may just hire temporary help if needed.

5. Health insurance- Health insurance is expensive, and as patients with chronic illness, we need health insurance. Frequent doctor’s visits, lab work, and costly medications are nearly impossible to pay out of pockets. If I had choose between a good health insurance plan, and a higher paying job, I would choose insurance.