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Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
Why Your PA is Running Behind
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Running late? Groundbreaking. We know.
In this episode, we’re diving into the real reasons your PA is behind.
Between double-booked schedules, “quick” visits that turn into anything but, insurance hoops, add-on patients, and trying to actually give time to the person in front of us… yeah, things stack up. Fast.
We talk about the pressure to move quicker, see more, do more—and somehow still be the perfect, attentive provider every single time. It’s the fine art of running behind while doing the absolute most.
So if you’ve ever wondered what’s going on behind that closed exam room door… this is your answer.
Spoiler: we’re trying. A lot.
Tempo: 120.0
SPEAKER_00Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. Let's get back to it. What a week. What a week. That I just had some technical difficulties that drained the shit out of me figuring that out.
SPEAKER_02Um now we started last podcast diving in so quickly to what we wanted to talk about, but we did our weekly recap at the end.
SPEAKER_00Yeah. So let's get back to the the weekly recap. Yeah.
SPEAKER_02How was your week?
SPEAKER_00It was it was pretty good. Yeah. Uh we had a very busy Tuesday, had a BioPro. So we did our our second uh Bio Pro CMC. Um we had a uh uh did we do that this week? Yeah, I guess that was this week. Or was it last? I don't even know what week we are in anymore. Yeah, week flies. No, I did. Yeah, that that did happen this week. It was very busy. Um we did a total wrist. Oh that was super cool. Yeah, that's cool. Um, so just like a lot of different things that we don't usually do. Um, a big dupatrence excision, those are like my least favorite things in the world. Why? Oh my god, the closure.
SPEAKER_02Oh, my dad, my dad had one of those. My dad actually was supposed to have one of those and then got his finger stuck in the door and then literally ripped it himself.
SPEAKER_00Oh, nice. And then self-resolved.
SPEAKER_02He had self-resolved, and then years later had to have it actually fixed, but maybe Yeah.
SPEAKER_00I mean, if they're super extensive, like this guy had like probably closer to 90 of his ring finger um contractures, it ended up being this weird situation where it wasn't all due to dupatrins, so he had some other um his flexor tendons were just super, super tight, so we couldn't get like a full release on everything, but um got all the dupatrins out, but his fingers are still really tight and contracted down, and it's this big, huge zip on two fingers, so it extends from like the PIP joint down into the palm or on two fingers, and the fingers are bent down like that. So my head and neck are like turned sideways and the fingers are overlapping each other. I can't see anything. The tourniquet's down, there's blood everywhere, and I'm like, it's like 45 minutes later, and I'm like sweating the whole time.
SPEAKER_02Um but it came out perfect.
SPEAKER_00Oh yeah. Um we'll see. TV. So so that was a good day, busy day, long day. Um, or was the rest of the week, I should say, flowed very smoothly. So um we had a total, we had uh a couple other cool cases, um, a big elbow capsule release, everything went well. So I was overall pleased. Yeah, yeah, but successful. How about you?
SPEAKER_02Um, yeah, we had a good week. It was busy clinic-wise. Um, OR wise, we have three OR days. I do two of them. So my first R day was stacked, it was full, it's great. The second hour day, which is not my OR day, fell apart like over the weekend, and then Monday. It was a nothing day. There was one case. So during clinic on Monday, which again we'll get into this, but during clinic on Monday, as I'm trying to see patients, trying to do my thing, I'm also like masterminding the schedule behind you know my curtain. So uh Wednesday was a full day. I we somehow pulled it together. So I'm trying to, you know, come up with ideas, communicate with my scheduling person, communicate with the patients, make sure they all have pre-F, blah, blah, blah. Anyway, it was a great day. So um filled up that day, and then ended um the week with another good surgery day. I was a bit under the weather. Um this is totally my. Can we talk about that? We can't talk about that. It was mind over matter. I um I had a soccer game Thursday night. We won, and it was late. Like, we get home late. I know what I'm doing to myself. I know the turnaround between Thursday night and Friday morning is is not a lot, but I got so sick, I don't know what happened. Like two um fret Friday morning at like two o'clock. I was like, projectile vomiting. And that that went all the way until I had to show up in the OR. And I looked at my husband and I was like, I need to get an IV. Like, that's the first thing I'm gonna ask when I get there. And I didn't. I I got there and I was like, No, you're you'll be fine. You'll be fine.
SPEAKER_00She can do it.
SPEAKER_02And I just took Zophrin all day, and I just mine never mattered. I don't know what else to say.
SPEAKER_00Yeah, like what else do you do in that situation?
SPEAKER_02You don't, but the weird things like between the fact that you call out, but like, no, no, I wouldn't do that. My youngest and my linguist was like, Why do you work? I was like, like in general? Or yeah, like she goes, No, like Friday, why did you go to work? I was like, Well, I didn't have anybody who could do my job, I guess. Like that day. I mean, there's people who can do my job, but um, but no, all the all the stuff. So like the Thursday night from the game, which I felt fine, it was 90 degrees, probably a little dehydrated, then literally dehydrating myself. Like today, like my forearms are sore, like my muscles hurt. I feel like I'm in wrap out, but um, but no, that was insane. It is insane. It felt insane.
SPEAKER_00There's well, 100% there's nobody that can do your job the way you do it. Um, but like I don't know, I also just don't want to like I don't want to give up that easy. No, I know, but like I would do it.
SPEAKER_02I know, but would I rather spend my day operating or laying in bed?
SPEAKER_00Yeah.
SPEAKER_02Like I made a choice, right?
SPEAKER_00Yeah.
SPEAKER_02Um, so I don't I thought if I I actually thought if I spent my day doing something else, I wouldn't think about how terrible I felt. Turns out I still turns out I thought about it the whole time. But but no, it was uh it was okay. But as I tell my kids, do hard things, right?
SPEAKER_00Yeah, that was a hard thing.
SPEAKER_02It was a hard it was a hard thing.
SPEAKER_00Well, you know, it's like something new to add to your rubber, like you had to shake things up a little bit. Have you had a day where you had to deal with that? No, but now you have. Like that was a new experience for you.
SPEAKER_02No, no, and my husband was like, I was like, yeah, I mean, when's the last time you've really vomited? I'm like, I haven't. He goes, Yeah, you just have that feeling, like all that vomit, it it like runs the enamel off your teeth. I was like, that's exactly what it feels like. That's exactly how my mouth felt all day yesterday. I was like, I need something to happen in here. But anyway, um yeah, so that was that. But uh now we're glazing over what we um what we did this week at mid midweek.
SPEAKER_00Yes, yeah. And then we uh we guest episoded, I we guest starred. We guess starred. We did a guest spot, right? I loved it. Um so that was super, super cool. Yeah, we were great opportunity.
SPEAKER_02We were inadvertently discovered by the PA of Orthopedic Surgery podcast um hosts, and they reached out and they asked us if we would just come chat with them. So we'll we'll dive into that at a later time. But that was really cool.
SPEAKER_00It was super neat. Um very excited about that and any and all future experiences where people may want us to come hang out on their podcast.
SPEAKER_02So um, but the workings of this week and the things that happen this week in our private practice um affect us, you know, beyond what we talk about. Like we're in our little micro worlds of clinic and OR, but again, being in a smaller company, uh, there's certain demands that we have on ourselves and in orthopedics in general. So we're gonna kind of talk about that. Um, the balance in medicine about you know being fast and being good, but not losing your mind. And don't, you know, don't run late. Be fast, be good, be efficient, be productive, see more patients, don't run late, don't be an a-hole, don't lose your empathy. Yeah. So um we'll pile on demands and you just continue to need to perform. So like when add this, add that. So when is productivity counterproductive? Right. So where's the line? Um, and we'll just kind of talk about certain scenarios and certain things that we and like how do you make deal with every day?
SPEAKER_00Happiness and satisfaction and all that. Um, and like what are the things that people maybe don't realize from either a management perspective or from a patient perspective of like what is going into our day. So I'll start things off. Um, not I don't know that this is necessarily what prompted this, but relevant. Um, I had a recent bad review about being late.
SPEAKER_02Love that. Love when people review you, but also review how the visit should have gone versus how it went.
SPEAKER_00And I will I will say I wasn't even that late. Let's be honest. I think if you poll most people, there's a certain expectation level of how long you're gonna wait when you go to a doctor's appointment. Um now I try to not be late at all because I also I also don't want people to have to wait around for me um and be aloof to that and like say, oh, like you know, they'll they'll wait if they want to be seen kind of thing. So I'm gonna be convenient.
SPEAKER_02So I'm gonna stop you right there. What do you consider late?
SPEAKER_00Um, if I I mean, like I really would prefer to see people within 20 minutes of their appointment time.
SPEAKER_02Okay, I agree with that. I think a 20-minute window, yeah, like let's say the appointment's at three, maybe they get brought back at 3.05. Maybe there's a five-minute intro. Like, why are you here? Now it's 310. Maybe they get x-rays. Yeah. 3.15. I think 320. Even if it's you bring them back at 3 and then they wait in the room for about 10-ish minutes. I feel like a 15 to 20 minute window is completely appropriate.
SPEAKER_00Yeah. And now, you know, that's given that the patient shows up on time, then there's a lot of other factors that go into this. Like, oh, did you know the patient actually showed up 30 minutes early for their appointment? And now if I'm 20 minutes before seeing them from their appointment time, now it's 50 minutes since they showed up and they perceive that as me being much more late when really they were early, or the opposite effect when somebody shows up 15 minutes late, which is like our practice's threshold for acceptable lateness, right? Um, then that throws things off because I might have already started seeing other people who were on time, and now I'm even later seeing them or the next person. So a lot of things obviously that can throw that off. But um, needless to say, like a lot of things go into the reasonings why you are running behind. And I don't know, maybe this is just like a self-defense episode, like, hear me out. This is not me being lazy and slow. Like there's there's a good reason behind all of this. Um, so yeah.
SPEAKER_02So my um, I I I totally hear you. I I feel the the pain. And when you look at a scheduling template, and we again we work in a smaller practice, we have the ability to kind of create and tweak our templates. Like I want to be double booked, you know, at this spot because I know that I can, as one patient is checking in, I can see the other one, right? So double booking is not done because you know, I'm going to intentionally make myself late. It's actually done pretty um uh what's the word?
SPEAKER_00It's it's intentional.
SPEAKER_02It's yeah, it's intentional. Like there's actual reason behind it, right?
SPEAKER_00Yeah, because we recently changed to like two double bookings at a 15 and 40, like two double bookings on a slot instead of every 15.
SPEAKER_02So I will have a pre-op where someone and pre-ops for us are 30-minute visits, right? I will have a pre-op and then someone is Spanish speaking. So now I have to get a translator on the phone. Now everything I say has to be repeated by the translator, and everything the patient says then has to be repeated. So that right there, that's a lot double visit. Yeah. Yeah. So do I book an hour for that slot? No, I don't do that, right? Um, I have a post-op patient that's a knee, and post ops are quick and easy, 15 minutes, probably less. But that day, that post op comes back in in a wheelchair, can't get up on the table, takes 10 minutes to get their brace off. Now they're crying. Now I got to take their stitches out. Oops, there's no supplies in the room. Now I gotta run down the hall to get supplies. So, I mean, there's stuff that goes into things that are unexpected that make these visits longer. And if I could control for that and have like a safety mechanism on the back end, that'd be great. But we can't.
SPEAKER_00Yeah, there's just no way. And I think this is something we've learned just tweaking the schedule so much. Um, because we used to do, you know, four or five an hour, right? Every 15 minutes, I would see a nine, nine fifteen, nine thirty, nine forty, five, ten. Um, but then your nine o'clock doesn't show up. The nine fifteen shows up on time, but the nine thirty shows up really early at nine ten. The nine thirty gets brought back first. The nine fifteen then is waiting to be brought back. Now the nine forty-five shows up in the middle of all this, and then oops, the front desk called and the nine o'clock actually showed up. And they showed up now too. And so now I'm going into the 10 o'clock hour like totally fucked. Yeah, yeah, definitely.
SPEAKER_02And and there's certain spots like 10 o'clock and 2 o'clock for me, bottlenecks. Yeah, they just are like eight o'clock hour, fine, nine o'clock hour. It's late nine o'clock hour into 10 o'clock that it gets totally effed. And then same thing with like 2, 2:30. Yeah. Um, but you know, being on the back end and when I will have like students or whatever, where you see what happens behind the scenes, you're kind of like, oh, okay, that makes sense. But again, being a patient, for example, my dad has a hip issue. He's seen the hip guy up here. He's coming in next week for a hip discussion. He got his MRI out of town. So will they have the MRI? I don't know. Yeah. So that's going to be something else. So he'll come back at his 11 o'clock appointment, and then they'll be like, where is it? I can't find it. So my dad says, Well, if my hip looks okay, will I get a shot? Okay, the shot's gonna require floro. I know he's in a 15-minute spot. Yeah, yeah. And he goes, Okay, but if my hip's okay and I get a shot, do you think I can talk to the doc about my knees? And I was like, do not bring up your knees. Don't say anything. Yeah. He was like, Well, but but I'm coming out of town to come in. Like, I want to be seen from my knees. Like, Dad, like that's not part of the gig. But also, let's say you have a patient who's been your longtime patient and you're like, okay, quick, quick, quick follow-up shoulder, and then they're like, Hey, so my hand. Yeah. It's your decision to like, yeah, you know, and you and a lot goes into that. Like maybe today, I'll see your hand because I got like an extra couple minutes. But when I'm running behind, like, I'm sorry, I can't.
SPEAKER_00And a lot, like we've talked about this before. You want to be able to do that, especially as the PA. Yeah. You know, you don't have a title behind your name that supports you running behind and getting to, you know, sometimes seem rushed. Like you just don't get that luxury. So you need to be on timer early. You need to make an accurate diagnosis. Um, you need to be pleasant. You need to be very pleasant, you need to be more personal than personable than the doctor would be spend more time with the patient, but also not run late. Like you need to do all of those things perfectly in order for them to be satisfied that they saw you and not the doctor. Yeah. So there's just like so much more pressure that goes into it. And I mean, you you might have a couple complex patients in a row. Somebody who's very emotional and difficult to, you know, bring back down to earth in reality and have to like go through more than expected. Um somebody who speaks a different language and you need an interpreter, somebody who brought their um their mom in with them and they are like, wait, I have a similar issue. Can you talk to me about this? Can you add me on? Um, and then don't then not to mention like delays from an actual clinical standpoint. Like we do a lot of casting in our practice. So um our medical assistants might be busy putting on a cast or a splint and can't get to discharging a patient in time, and that leads to a room bottleneck, or we have only two x-ray rooms. Yeah, two x-ray rooms for sometimes like seven to ten providers, and there's a bottleneck there. So there's so much that can go wrong, and I try to control for all of the best I can be.
SPEAKER_02But how do you feel like all of the pressure? And again, going back to the review, like the patient reviewing you saying, I had a nine o'clock appointment and I was slightly irritated that I wasn't taken back until 9:30. Like, do you feel the immediate desire to be like, let me explain to you all the reasons why? But also you, you as the patient perceive me, the provider, is lazy. Yeah.
SPEAKER_00Or that I'm behind. Or I don't care about your time. Or that, like, oh, I book I overbook my schedule so that we can see more people and make more money.
SPEAKER_02Yeah, but no. Okay, but a higher level question though, but higher level question, higher level question though, is we as providers and not just ortho, but more so um private practice, we are forever tasked with see more patients, do more procedures, make more revenue. Yeah, you know, and some people feel that differently than others, meaning my threshold for what more is is different than someone else's threshold, right? So if I thrive and I can be productive and I can make correct diagnoses and I can still have a good attitude, if my number for a patient clinic day is like 35, great for me. But my colleague may be a 24 type person. Yeah, 24 patients per day. That may take my colleague to the max. And beyond that, the decision making sucks. Yeah, the attitude sucks. He's missing things, right? So, I mean, you kind of have to figure out what your what your level is. Yeah, yeah. So I don't think, and again, making the jump to management and those that are like, see more, do more. I don't think that you can communicate that appropriately with you don't understand, like my patients have a better experience. I do a better job when I'm working in my safe zone. Right. But from a, you know, from a manager myself, but I want your safe zone to be your max output. I need the two to coexist. I need the two to coexist. So there is such a thing as having a comfort level, but also pushing that a little bit. And that's a very, very thin line. Do you agree?
SPEAKER_00Yeah, yeah. I think that you have to like the the more experience you have too, you have to get more comfortable pushing that line. That's a way of growth. Yeah.
SPEAKER_02But I also think that if you ask management who the more valued providers are, they're never the low volume providers.
SPEAKER_00Yeah.
SPEAKER_02So that's kind of beffed up a little bit.
SPEAKER_00It is. You know, I mean, that and that doesn't necessarily mean they're not like very good and very accurate and very personable, and patients love them, um, unfortunately, just nature of a business. And then, you know, I could get into the business side of medicine all day. That's something that they don't teach you in PA school. Yeah. And a lot of a difference that goes into private practice versus hospital medicine and having to think of things on those terms. Um, I love to blame everything in my life on insurance, but that truly is the demon that haunts us all. I mean, that's the reasoning. Yeah, one of the things, but a big reason for a lot of it. Like lower reimbursements year to year means that in order to make the same revenue to support clinical staff, supplies, the building that we exist in, um, you have to see more patients to make that same amount. Yeah. Um, so I think people don't necessarily realize that. I I think maybe it's people realize it more than they used to. But I think there used to be like a and maybe still a mindset of like, oh, well, you work in medicine, so you know, you make really good money and you get to feel bad for you. Yeah, yeah. It's it's not it's about you just being greedy and wanting to make more when you're overbooking your schedule and rushed. But like you're trying to rush through this so you can see more people so that you can make more money. And that's totally not a good idea.
SPEAKER_02Yeah, like I promise you, I'm not feeling that. No, but um, what do you think is the first thing to give when you are overbooked, patients are mad at you, you're a little frustrated. Like, is it your accuracy? Is it your uh interaction with your team? Like what gives? Like when you know that you're kind of like a little bit over that ledge of like too much, where do you see it? I think do you sweat?
SPEAKER_00I'm like, I don't like always. There has been a couple days though that I have asked from like one of our other uh assistants here. I'm like, oh my god, I know you keep deodorant in your bag. I need it. I need it right now. Um, no, I like I think fortunately, my I don't think that my accuracy necessarily drops down. I think that I find myself just being more and I hate to be more rushed with people, but there's certain things that I know don't take me a lot of time, but people need a little bit more time from an emotional standpoint, right? So, like if I am doing a post-op carpal tunnel visit and everything is going standard, I know that I can catch myself up by going in the room, literally looking at them, like spending 30 second in 30 seconds, I can gather everything I need to for that or less. Um, I can be in and out and done. It just does not take a lot to make sure that everything is going as it should be at that for that visit. But I feel guilt doing that. I don't want to pop in. And even if they're like, oh, everything's fine, I'm perfect. I feel guilty that they drove here and checked in and waited in the waiting room for 15 to 20 minutes to be brought back for me to go in for 30 seconds and be like, Yeah, it looks good, see ya. Yeah. Because that's not a good experience. So I will then kind of like uncomfortably force myself to what else do I talk about? Like, how much shit can I make up to make it take up the time a little bit more so they don't feel like they had a bad experience and it was a waste of their time. Um, and there's gotta be Better way around that too. But that is an area I feel like I break down a little bit. I kind of start trying to overcompensate in some ways, knowing that I'm behind. Um, and I get a little bit antsy, like I have caught, have your caught yourself? This is terrible, but we're, you know, this is the place where we're gonna talk about the terrible things. And somebody is just like talking so much, and I've gathered what I need to, and I'm not in the mindset of like needing to pay attention to make the diagnosis anymore. They're just talking, and I've got my computer in the room, and I'm like, I gotta look at the x-rays for the next person, like while they're talking, or I'm like looking at the next person's chart so I can prep so that I don't have to go stand at the counter and prep for that patient after this visit. I'm like gonna go room to room. Yeah. So this person's talking to me, and I'm like, uh Yeah, no, I've done that.
SPEAKER_02I I'll bring in my computer to go over x-rays with some people, but when some people go down, like I had this lady who was coming in for a post-op knee, and she wanted to tell me about her trip to Costa Rica, the boyfriend that's taking her fishing, and her tummy tuck, and she just keeps talking. And I sat there and I I literally responded to like a couple quick emails as she was talking. Yeah. Mm-hmm. Yeah. Like, I mean, but for her, she left and she's like, I love you, and I love you. And I love it. That's a great conversation. And I'm like, it worked. Yeah. I mean, but it's it's one of those things. Like, I feel like when I'm when I am stressed and let's use running behind, because that seems to be like, you know, what what happens. I had a patient this week who came in for injections, and we've been seeing her for the past several years for injections. She's a bit high strung before she gets her injections. I send her Valium. Like that's just she needs that. So she gets a ride, it's a whole thing. We have to do a time that she can do it. So she comes to check in and um she comes to the desk and she's got a crazy balance. And they were like, You can't be seen today. She's like, What? Like on her Valium, right? Like, what I'm on, I'm here. So at the same time, her husband has an appointment with me. So they check him in. He's got no balance, he's not gonna pay her balance, right? So the front desk decides that. So I see that my patient drops. I asked my medical assistant what happened. They said, Oh, she's got a balance, she can't pay. And I was like, That's gonna be weird because her husband looking at me like, oh is she coming back in the room with her husband? Like, I ask that, and they were like, She's already back in the room. Oh my god. So I say to myself, All right. So I go in the room, talk to the husband, and then I say to the wife, I was like, Oh, and I guess you're not being seen today. And she's like, I know. They said I had to balance and explains me the whole story, which again, I they talk billing and I glaze over. Yeah, literally. Like, I'm on a vacation in my brain. I'd like this makes I can't do anything about it, whatever. So she says, Is there anything you can do? I've already been medicated. I'm like, Yeah, I can inject your shoulders. But they told you no. But here you are in my room, yeah, medicated. So I end up injecting your shoulders. So I come out of the room. Of course, now for my one patient, her husband, it now is taking longer. Now she wants to talk to me. So she basically stole his visit. So now I'm in there longer. Now I stole his. I expect my team, my medical assistant, who now is on the outside of the room, she sees my patients piling up. I expect my medical assistant to now prep all of those. I want three other patients back teed up, ready to go. So I come out of the room, and where when I get stressed, like where it goes, is I get like I get into like fix-it mode, and I expect everybody to be right behind me on my coattails. But when it doesn't happen, I get like irrationally irate. So I came out of the room and I was like, well, because you guys fucking set me up, yeah, now I have to inject her, so I need all that stuff. So then they're they see I'm mad, right? So they're all like, you know, doing all their stuff. So I go in the room and then I come out and I was like, as I was in that room as she was talking to me, I know I have a gel shot in this room, I know I have a pre-hap is a gel shot ready. I haven't brought them back yet. And I'm like, I'm going to live. I'm going to throw my computer across a room. Yeah. Like I need you guys to understand the urgency. Yeah. So I am only in control of what I'm in control of, but I expect those around me to like fall in line when you see things go awry.
SPEAKER_00Cause and it like doesn't end up landing back on anybody else. Like nobody else is having to go and stand face to face with the patient and like, you know, have that awkward interaction for why you're behind and explaining yourself as I'm so sorry. Like I've seen a lot of um things online about this, but people describing what it's like working in healthcare to somebody who doesn't work in healthcare as like, oh, you have 30 important meetings today that you have no ability to prep for. Yes. And you have to, you know, be on time, be on your best game face, and come up with a plan and a solution within five minutes, all while still in the conversation. Like you don't get time to step back and think about it. Um, you have to have that face-to-face interaction in the moment. Like that part's hard.
SPEAKER_02It part's really hard. No, I think turning things off, like the emotional toll that it has. I think you and I are very good at compartmentalizing our emotional things.
SPEAKER_00Like some things better than others. I don't know. Okay. But you might be better at it than I am. Give it some time. Well, I think though it's a deal, like, and this is maybe I maybe I need to flip the script a little bit, but I break down in my teamwork communication the opposite way. I feel like instead of getting like outwardly angry, I'm like a hermit crab. Like I become a real I internalize. And so when things are frustrating me and I feel like communication is breaking down and I'm busy, and everybody else is like, like today's so great. We're having a great day. I am like internal. Like I internalize it. I pull myself away physically and mentally. Like I go hide somewhere else. I literally separate myself. I can't. And then everybody's like, what the fuck's wrong with you?
SPEAKER_02I don't, I don't like blow up. I just like I need efficiency immediately. I don't need the overcompensation from my team. And I think what they're doing is they're waiting to for me to give them direction. And when I don't give direction, I just expect it to happen and it doesn't happen. I get really pissed off. So like I need this, I need this, I need this. Um if someone just wants to help me, does anybody want to help me today? Yeah. Anyone? Anyone want to help me today? You know, and I know that's not productive, and I know that people don't respond well to that. But that's what happens. That's what happens. That's just what it is. But, you know, maybe, maybe a good way to kind of pull this all together is uh giving, giving, you know, those that are PAs or those that are really resonating with this topic, like, what are some strategies to avoid the trap? And okay, we can't avoid it, but how do you like get through it? So documentation, right? So we talk about the real-time stuff. So now that you're like the nine is the 9:30, the 945 is the 10, and now your bottleneck 10 o'clock hour. A dot phrase, I will dictate on my phone, I will walk down the hall to get water as I'm dictating. Like I will maximize my time and try to make the dictation efficient so that the overall load is not ridiculous. Yeah, I still do that later, but that's not not a good solution. Delegation. Delegation in a productive way, which I have been told in the past I'm not the best at, but you know, stopping and saying, Listen, I'm very feeling very stressed out right now. This is what I need from you. Very direct communication.
SPEAKER_00Yeah. Right. Yeah.
SPEAKER_02So I mean that's another good one. Um, understand some slowdown triggers, right? So, like if you have a patient that you see is needs needs some time because they're crying or whatever, you need to spend more time with that person. Right.
SPEAKER_00Yeah, I'm like physically not gonna walk out of that situation. Like you can't.
SPEAKER_02Your quick visit, maybe you small chat talk, you know, your banter, maybe that one you kind of and you feel out the people, right?
SPEAKER_00Like I have, you know, the little ladies who really want to tell me about how they got back to crocheting and what they mean. They wanted to scroll through their phone and it's taking them forever to find the picture of what they were able to make. Like, I'm gonna sit there and do that. But then I have, you know, the 60-some-year-old farmer who's like he appreciates the brevity. He he would love for me to come in for 30 seconds and be like, cool, you good, you good? Yeah, he's happy with that. So feeling out those situations who who you can um share and not share that extra time with.
SPEAKER_02But I think um, you know, if you find that you are being productive, you're being efficient, and you are slam dunking your diagnosis, you're in the sweet spot. Yeah. You're in the sweet spot. Yeah, the time to push it to maybe be more productive is when you have time, when you close up at the end of the day and you have nothing to do. I mean, seriously, right? Yeah. I think that's the time to maybe add a couple more patients. However, if productivity makes you a worse clinician, you start to get all your bad reviews, the you know, patients request to see the doc because you're not quite getting it, it is time to recalibrate and time to just, you know, pull back, yeah, slow down and figure out what the issue is. Like if I'm trying to be so productive, but I am you know losing my accuracy, I need to slow down. Or you need to build in some time to, you know, figure out, talk to talk to a mentor, talk to an experienced clinician about how do you get through this? What do you do? I will tell some of my new providers, like who work in our injury express, when you see a patient and you want to give them your all, and then they start going down the train of like, you know, when I was abused as a child, and now you're like, oh my God, I can't do this. Tell your medical assistant, 10 minutes, man, knock on the door, knock on the door and say, Hey, you have a phone call. Perfect. Like some escape mechanism that'll help you reset.
SPEAKER_00Yeah, yeah. You need it. Um, so yeah, I think that's good and helpful information. I think that if anything, it's more a shared experience. So, yes, there's no perfect solution to all of that because insurance companies are still gonna continue to screw everybody over and force us to have to see more and more and do more and more for the same outcomes, um, document more and more. Yeah. Like, I mean, this is another thing we've been dealing with the past couple of weeks. Like, we have to do certain things a certain way. Yeah, like we have to document this extra thing, take this extra step, put this here in the chart um in order to get reimbursed and build for it. Um, and so like just all that extra extra stuff on top of the actual patient care aspect of it.
SPEAKER_02Um, you know, it's yeah, I think, I think, you know, again, ending on a little bit of a hopeful note, I think it is important to understand the reality. The reality is the expectation is always gonna be more. I mean, we're we work in healthcare. It's never gonna be, hey, you guys can coast. This is never gonna be that. So I think um, you know, setting some boundaries when you can because you need to is healthy. I think if you are a new provider coming in and you have strict boundaries based on a hypothetical what you will or won't be, very discouraged. I do not dis I do not encourage you to do that. Um, and you will, you'll feel like you're kind of, you know, set to your limit and then you back off that a little bit. Yeah. Um, but that's that's the game and that's what keeps us coming back for more. How close can we get back for more? I don't know.
SPEAKER_00Yeah.
SPEAKER_02Do you want to touch the boiling of water?
SPEAKER_00Maybe. Yeah, yeah, we're gonna have to get so close. I don't know. I feel like I'm still so early in my career. I'm like, what is this gonna look like 20 years from now? Like, what am I gonna be doing in 20 years? Like, if I'm increasing so rapidly, if I have to keep leveling the fuck up, what level am I gonna be at? Uh it's undefined. Yeah, it's undefined. The limit does not exist. Yeah, to quote mean girls. All right, perfect. Well, until next time. Bye.
SPEAKER_01Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.