Curbside Consult with Dr. Jayne 4/19/21

I’m less than three weeks from departing my clinical work at urgent care. My employer has been shockingly silent since I gave notice, and at times I struggle to decide if that’s passive-aggressive or just benign neglect. (I’m pretty sure not getting a bonus since then is passive-aggressive, but I’m letting that go.)

In the absence of any communication regarding a formal off-boarding process, I’ve started telling people and saying my goodbyes, since the shiftwork nature of our schedules means that I won’t be seeing most of the people I work with again before I leave. It’s been an interesting experience, because when I share the news, lots of people are admitting that they, too are leaving. Hopefully a not insignificant exodus will send a message to the leadership, but I doubt they will take it as anything that would mean they need to change how they operate.

The in-the-trenches teams I have worked with have been topnotch, and unlike other places I’ve worked, I can say honestly that there have only been two people that I’d never want to work with again. Both of them quickly departed the company, which is a testament to the leadership’s fail-fast ethos.

However, we’ve lost dozens of good people over the last year. On the provider side, most of those who left went to other provider jobs in the same metropolitan area, usually with eight-hour shifts instead of 12-hour days (which always end up being 13 somehow) or more predictable schedules rather than a constant rotation. In most other urgent care or emergency settings, a provider might work at a couple of facilities rather than having the potential of being sent to 30 different locations over a 40-mile radius. Several became hospitalists or tele-ICU practitioners.

Among the support staff, reasons for leaving were mixed. Many of our scribes went on to medical school or physician assistant school, and some of those who failed to gain admission went off to do research or pursue graduate coursework. Some of our paramedics and clinical techs went back to school for additional training such as radiologic technology or were accepted to the fire academies. Others went to lower-acuity situations such as medical offices or social services agencies. Certainly not less stressful, but with fewer people potentially dying in front of you or needing an ambulance transfer to a Level 1 trauma center.

Quite a few left healthcare altogether, with one of the most common reasons being the difficulty in managing childcare with 12-hour shifts. The stress and risk of working in a healthcare facility in the middle of a global pandemic was certainly a factor for others who didn’t want to take a novel pathogen home to their families, especially when personal protective equipment was scarce. One of my favorite paramedics became a personal trainer and another went into real estate. A third one has a thriving beekeeping business as a side hustle and is expanding his colonies in the hopes of being able to get out of the clinical game.

I’m grateful that I stumbled into clinical informatics years ago because it gives me options that my purely clinical colleagues don’t have. My only experience was having been a “paperless practice” pilot and being able to tell a good story, and I’m grateful to the boss who took a chance on a young, sassy doctor who wanted to change the world through technology. I’ve learned quite a bit since then, especially that CMIOs are the “little bit country, little bit rock ‘n roll” of healthcare IT and we can play either genre depending on who we’re sitting with at the table. Sometimes we’re translators and sometimes we’re mediators. Other times we’re punching bags, but having been through medical residencies, most of us developed fairly thick skins.

In hindsight, clinical informatics has saved me more than once. The first time it allowed me to take an administrative role with a health system and to leave a toxic practice environment without having to pay for medical liability tail coverage, do a buy-out, or be subject to a non-compete clause. I literally transferred my patients to my partners and walked away. That was difficult at the time, but it was the right choice, not only professionally, but personally. It saved me again when the health system eliminated full-time informatics positions and I was able to do some work in the EHR industry. In recent years, it has allowed me to work for dozens of healthcare organizations, practices, and technology companies, where I’ve had a front row seat to the evolution of healthcare IT.

Not to mention that clinical informatics has allowed me to write for HIStalk for more than a decade now, which I could never have imagined when I sent Mr. H a “top 10 reasons you should hire me” email all those years ago. I’ll even admit I wrote it on a Blackberry, which should give me some kind of legacy IT street cred. Long live the touchscreen Blackberry Torch, which is still one of my all-time favorite pieces of technology, although I do love the outstanding screen resolution, sound, and functionality of my latest phone.

Clinical informatics has also allowed me to meet some of the most amazing people. How else could I rub shoulders with the biggest names in healthcare IT in the same bowling alley? (New Orleans, I miss you!) Or meet my not-so-secret, bowtie-wearing ONC crush? I’ve had some pretty entertaining “don’t ask, don’t tell” conversations with people who were trying to figure out if I might be Dr. Jayne and I appreciate your graciousness while I dodged your questions.

I’m hoping that the next decade brings equal adventures, although the industry has changed quite a bit over the last year. I’m pretty sure the wild and crazy HIMSS parties are over, and of course there will never be anything that will quite rival HIStalkapalooza. Still, it’s not about the parties. There is plenty of work to do to make healthcare IT a better place for our patients, our families, and the generations to come.

As one of my favorite southern writers, William Faulkner, once said: “You cannot swim for new horizons until you have courage to lose sight of the shore.” I’ve got my swim cap and my goggles and I’m ready to go. Who’s with me?

Email Dr. Jayne.