As I've often mentioned, I love my job. I work at a small specialized treatment center that I feel really makes a difference in people's lives, especially those of girls and young women. Most of the clinicians there are so capable and there's this wonderful collaboration. It's a stimulating environment to work in, and when I look back on the 5 months I've been there, it's quite stunning how much I've learned.
Can you hear the "yes, but..." coming? Our break-even census number is 11 patients, and since about late summer, we have not consistently been at that number. I've still had plenty of work, at first it was because I was learning so much, but I've taken on other tasks. I am the liaison to all the insurance companies, so I have to interface with them for each patient about every 4 days and get authorizations for continued stay. It takes time to collect the data from everyone on our team and build the story of what that patient needs. I also do three therapy groups each week and work with two different interns on separate days. I revised all of our medication management policies, which basically was non-existent. I was busy in spite of the low census, and I definitely worked more than 40 hours a week. I went in every Sunday afternoon, and frequently I had to meet with patients who were struggling over the weekend since none of the therapists were there. Sometimes I left early because of that, but not lately. In spite of all that, I knew that the organization was worried about the low census. In the past month, they laid off our HR person and our PR person. And guess who was next? Well, I'm their third-highest dollar employee, right behind the COO and the clinical director. But here's the deal, they really can't lay me off. Nobody else can do what I do - they aren't licensed to diagnose, treat, and prescribe. Only the doctor can, and he works only 8 hours a week, and half of those are meetings. I was thinking that they might consider dropping me to work only 4 days a week, or expanding my role to take on more of the therapist tasks. But they had something else in mind. And it didn't go down well.
So the delightful day before my birthday, the director tells me that they are dropping me from a salaried employee to only 25 hours a week, and keeping all my duties intact. I would work 3 days a week, and they propose that I see patients in a private practice using my office on the other days, and use a 60/40 split for the money I make on those days. The only problem with this is they were "too busy" to get me credentialed with the insurance panels all this time, so I've been billing under the doctor's name. I can't take any insurance patients on my own. And that's a ridiculous split - I would never agree to it. The going split around town is between 20 and 30, and that's with providing billing and insurance processing. They want 40% of my money just for me to use an office that's empty anyway? They also asked me to propose an hourly rate. So I went away and started thinking about this.
The next morning, I see the COO in the coffee room and say, oh by the way, I forgot to ask when you guys want to implement this. He says, next week. My mouth falls open. I can't stop myself. I say "you are kidding". He says, oh I'm under a lot of pressure from Dr. M (our "headquarters" organization is a treatment center in another city; the doctor there owns both facilities). That's just peachy. You expect 2 weeks notice from me, yet you give me 5 days. That's just great. Later, in the weekly leadership meeting (and that they nicely inform me, I'll no longer be attending) our administrative head tells us that she worked all weekend on a proposal to fix financial problems that have recently been uncovered at HQ. Seems that their census has been low for months too, and they had been very sloppy about billing and record keeping when times were flush. Now they're not, and discovering that they have huge problems. Hmmmm. Could there be a connection to their sudden decision to cut my job to the bone?
Anyway, I calculate a rate that basically turns my salary into an hourly rate, I don't add on anything for the lost benefits. I am generous. I tell them the next day what I want, and that I want a 70/30 split and want to be credentialed. I offer to help with that process, filling out forms, making calls, whatever. Reasonable, no? I do this without being pissy, either, in spite of how I feel. And then I wait. And wait. So it's Friday, and all of this is supposed to start on Monday and fucking finally, he meets with me and counters my hourly rate with one dollar below that and they won't compromise on the 60/40 split. I say nicely through clenched teeth, I decline your offer. I can stay for the 3 part-time days but at my original rate and I'll find something else to do on those 2 days off. And incredibly, he says Well I have to run that by the owner. Great. Let me know by the end of the day. I'm not showing up to work without us coming to terms.
And at 2:00, they come back and agree to that.
I'm incredibly sad about all this. I really was doing work that fed my soul. But I can't stay at a place that feels they need to humiliate me. One dollar less? What is wrong with you people? I've had uncomfortable, strong signals for a while that our COO isn't very competent, and this just confirms it. Throughout all this, he kept saying this was not his choice, it was all coming from HQ, it was out of his hands. You fucking ballless wonder. So what exactly do you do here then? And the serious financial mismanagement is not trivial. I don't believe these people are good businessmen and women. I see reaction, I don't see strategic thinking.
I have a job interview Thursday, at an office with a psychiatrist that I've heard wonderful things about. The only downside is the drive. He's up 360 on Spicewood Springs, but that's reverse traffic so I don't think it will be bad. And it avoids Mopac, which is about to become a disaster area for years when they start building the toll road. My plan is to start working there on the 2 days I'm off, he can start getting me credentialed, and then I'll quit and go over there once my practice on those 2 days fills up. Actually, a pretty good deal because many times the first 6 months of a private practice are pretty lean as you build your clientele.
And I'm closing with a picture from the hot sauce fest this past summer. It allows me to do what I wanted to do all week. I look pretty happy.
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