July 9, 2021

by drplasticpicker

I’ve been asked to pass on a huge part of my Assistant Boss portfoilio. It’s access and per diem physician management. It’s the right thing to do, because I have too much on my middle-managment plate (hence the frequent cursing silently and sometimes not to silently in my office – Dr. Dear Friend knows – at departmental emails). Given that there are so many meetings I have to attend, I get paid precisely 2 hours to do about 10 hours of work. Other people are getting paid the same amount, and the work should be shared.

This is absolutely the right thing to do for the department and for my family. I can now concentrate on new projects and helping move vaccination and other quality metrics forward. I can now work on physician leadership development within our department, and trying to figure out more ways to insert pediatricians into our HMO upper management leadership structure.

But I wanted to document on this blog, that this per diem pool work was something I never wanted. Access (making sure there are enough appointments) was never anything I had asked to know about. I happened upon these two things because honestly no one else at that point in time wanted it, or had the creative space to figure out a problem that could not be figured out. Being 100% honest with myself, Chief Boss understood the problem as she had done it while she was Assistant Boss. She has contributed to this work quite a bit. But otherwise, the robust number of parti-time physicians that works here and there for our department and who have been an integral part of our department has been almost all my efforts and our departmental secretary.

But what I’ve realized that just like children, you raise them and they grow up. I helped fix a departmental issue, and the department does not belong to me – it belongs to everyone in it and the patients who we serve. My children do not belong to me. They belong to themselves, their friends, and the world. And the best thing that a parent can do when something is raised the best that they could, is to let them go. Let them grow up.

The work processes involved in this part of my middle-management portfolio are the same. I’ve put many hours and days and creative thinking into the management of these 25 physicians. But being so immersed in my own part of middle-management, I have to acknowledge that my fellow Assistant Boss and everyone else also were hopefully immersed in their own work and projects. Just like I know no one truly is aware of the details of all the work I put into my little corner of the HMO machine, I likely was not aware of the details of what they did in their corner. But we all benefit from eachother’s work in making a department run more efficiently.

So I will hand this over. I’ve done it very well. I did it my way. But I never wanted either, and have done it with passion and adding some of my own creativity the last four years. I did put a clear requirement, because I have noticed the tendency to come back to me when I hand something over and it does not go over well. I told Chief Boss and I’m telling the world, if you take it – you take it all. No give backs. And that is it. I created it or at least greatly modified it. I’ve written it down as much as I can already what I’ve done. I will take the next month to pass it off. This is what the team wants, and there is truly no I in TEAM. But I chose not to be part of this aspect of the team. This part is stressful because I felt stressed when the numbers did not come out well, and I felt (and it may not be true) that everyone looked at me for the extra appointments. I was supposed to magically create more appointments which for the most part, my team did. And the way I did it, is that I took control of it all. I was the one up at 630 every morning watching the access numbers, and knew what triggers we could pull to get more appointments. I knew who was available and who wanted to work, and where we had nursing. There was no magic to this. It was just time, sweat and tears – and a lot of text messaging. But it was never sustainable.

So I wash my hands of it now. I will hand over this pool. They’ll figure it out. And I’m sure they will do well. The end result will hopefully be better than what I created, but I did a pretty darn good job. My goals was always to make everyone’s lives a little bit easier for the time I had this under my responsibility as Assistant Boss. My goal was for the young physicians to be able to be with their babies more, and more of us to stay married to our original spouses by not working. My goal was for us to share the burden of the after hours clinic, and no longer create unliveable positions that only the young new doctors would take. But there were repercussions, which is that the systemic problems were unsolvable by one person or the team I had. The system needs the whole department leadership team. And they want to do it now. The job that 100% no one wanted before that was essentially “dumped” on me, they want back after I reimagined it the last four years. And that is a very beautiful thing.

But I was very clear in some middle-managmenet emails, I won’t recreate the pool and rebuild it up. All those hours of meetings and recruiting and text messages supporting these young physicians. I have my own children and my own premed interns to concentrate on, and young fully-hired physicians in our department to concentrate on. I need to move on to sustainability work and physician leadership development. And this is part of my leadership development, learning how to pass the baton. And I’m passing it on. And actually I’m SO EXCITED!!! I resisted this for two years. I did. I fought it. But now I realize I AM GOING TO HAVE SO MUCH TIME!!!

I reached my 500th bag and since I no longer will have to do access and per diem management after a few months, I WILL REGAIN MY FREE TIME BACK. Because all of that was on unpaid time. I was wondering when I would be able to reach 1000 bags so I could write my book. Things are looking good! More of my free time back means more time on the beach, and more time to do EARTH WORK. Because there is work work, and there is climate work. And you know Dr. Plastic Picker – my heart and eyes are on the bigger prize. Averting complete planetary destruction. ONWARD!!! Okay, onto the final edits of the paper. Yes I have one more round of edits!