It Got Harder

Every few months, just after I felt like I was knocked down and just getting my feet back under me, I would be knocked down again.

I could almost time it to every three months.

6 months in – my coworker goes out on leave of absence.

8-9 months in – I had all of the reappointment files dumped on my desk.

12 months in – exactly – this schlub was convinced to take over the credentialing position at the new facility.

My Director and coworker both came to me and asked me if I would consider being the full-time employee, responsible for all of the credentialing, for the new facility.  My first response to them was, “I am neither knowledgeable enough nor experienced enough to take on a new facility, with new challenges, and be solely responsible for it.”

I was told:
“Nonsense!  You are great at this job!”
“We’ll be right here helping you with the transition.”
“It’s no different that what you are doing now, just for a different facility.”

I talked to my husband.  I talked to my friends and family.  No one could give me solid arguments against taking the job.  They barely knew what I did – *I* barely knew what I did – they couldn’t advise me one way or the other.  They all said the same thing – you’ve always succeeded in what you set out to do – why would this be any different?

I should have listened to my initial gut reaction.

My very first day in Medical Staff was on November 6, 2012.  My official transfer date to the new facility was November 5, 2013.  One year.

Thankfully, I didn’t have to actually transfer offices – my desk just changed.  I still reported to the same office location, still had the same coworker to ask questions to – but my Director was no longer my Director – I now reported directly to the new facility’s President.

Did I mention that I had never even credentialed a new applicant before November 5, 2013?  I hadn’t touched, opened, or looked at a new applicant’s file or application.  I was not taught how to review a reappointment application – so I guess they never thought it would be important to go over new application training either.

Just because I transferred positions and entities, did not mean that any of my actual job duties transferred with me.  I switched desks, they hired a new coworker to take over my original duties, but I continued doing all of the original tasks while training the new employee and credentialing reappointment files from the first entity.  My first coworker continued doing all of the new applicant files for the new entity.

When I questioned this, I was told, “You aren’t ready to take the new files over yet.  When you’re ready, we’ll switch.”

Confusion abounded with everyone outside of the office.  They didn’t know who they should be talking to.  They thought I was their new employee, so they would call me, only for me to transfer them to Coworker – who actually knew what was going on.

In the mean time, I was gaining no momentum in my job.  I kept hitting areas that were causing me to spin my wheels and get nowhere.  I kept asking myself, “Why is this so hard?”  From all indications, we had an awesome software database that should be able to do what I wanted it to do.  From what I could tell, there were advances in many aspects of the credentialing process, so why were we still mailing out letters through snail mail?

I remember distinctly a conversation with coworker:  After I printed a request for Medical Education for a foreign country, she handed me the stack and said, “Good luck receiving the verification back.  Foreign countries almost never respond and when they do, it takes weeks, sometimes months, to hear back from them.”  I was left with the impression that I was doing the correct steps, the steps are just hard to complete.

Several months later, I found out about the ECFMG (Educational Commission for Foreign Medical Graduates) from a completely separate source.  YOU MEAN I CAN LOG INTO A WEBSITE, ENTER IN A COUPLE OF KEYSTROKES AND HAVE A FOREIGN COLLEGE VERIFICATION IN LESS THAN 5 MINUTES?!?

To say I was livid when I discovered this – that is an understatement.  What irritated me most of all was learning that my coworker knew all about this process and did not say something when she discovered I was printing letters to send to foreign countries.  I found out we had an account with the ECFMG for crying out loud!  This is something she did on a routine basis!

Around this time frame is when I finally conceded to myself that my original training had been lacking.  I began branching out of my office, asking others in the industry for advice, help and assistance.  I no longer trusted the advice I was receiving from inside my department.

You would think that things would start getting easier for me at this point.  You would be wrong.

What crazy simple solution did you learn about after you struggled with a task?

 

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Can It Get Any Harder?

About eight months into my employment with the Medical Staff Office, we were hit with another HUGE challenge.

Even though my coworker and my Director both complained that our office was understaffed (which I agreed with whole-heartedly), the Director maneuvered our facility into the position to accept the challenge of credentialing providers for a brand new entity that our company opened up.  That meant we would be responsible for our providers, plus another hospital’s providers.

I will never forget how round my coworker’s eyes became when our Director relayed the information to us.  We were told at the end of June, the facility would be opening up mid-September – we would have less than three months to completely credential enough new applicants/providers to fully staff a fully functioning new hospital.  Did I mention at the time we did not have any Bylaws, no privilege forms, and Databank was not set up (or any other systems set up for that matter) for this new facilty?

When we went back to our desks, my coworker grabbed a pile of reappointment files off her desk, walked to mine, dropped them with some force onto my desk and stated, “These are now yours.  I won’t have time to do them anymore with the new hospital.”

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I sputtered, “But I don’t know what I’m doing with these!”

Her, “Nonsense.  You were working the files just fine when I was gone on leave of absence.  Just keep doing what you were doing.”

Me protesting to both the coworker and Director was met with denial that I needed more training, assurance that I was doing just fine, and the expectation from both that I would take over and complete the reappointments for that month and going forward.

I learned the hard way that I needed to ask more questions.

I didn’t ask for case lists – let alone know how to read them and interpret that there were enough cases for specific privileges.

I struggled with communicating with the doctors and their credentialing staff.  I approached them like I had in my other positions – a weak email request with a “if you wouldn’t mind” tone rather than firm statements with hard deadlines.  I didn’t know that I would need to babysit and follow up with them, sometimes multiple times, just to get them to follow through on simple requests.

I could check the items off my database checklist just fine, but I had no idea if files were considered complete or not.  I had no one suggesting that my files be audited or that I audit myself.  I had no idea what an audit was!

I learned, years after the fact, that I wasn’t even taught how to review an application to determine if it was “complete” or not.

I cobbled together most of my working credentialing knowledge from trial and error, being repremanded that I missed something major, or from overhearing something someone else was talking about at a meeting or conference.

In between learning how to credential a reappointment file, I was also learning about Stark Laws, EMTALA and ER call schedules, planning and booking multiple attendees to out-of-state Horty-Springer conferences, leadership contracts and dealing with a “hostile-take-over” of a department chair position (that was fun).

The only thing that could have made that first 9 months worse was to throw in there a lawsuit and Fair Hearing.  Thankfully, that didn’t happen, but I did learn something about it as we were contacted by the State Medical Board regarding one of our physicians being investigated.

Nevermind the fact that I also attempted to have a life outside of work.

I relay all of this information to assure you, the reader, that you aren’t the only one struggling with this job.  It’s the new millenium for crying out loud!  Why are we struggling to learn these things?

Maybe it’s because, like me, I had people who didn’t know how to train.  Maybe it’s because you have an entity or leadership that is still stuck on doing things the old ways.  Maybe it’s because you, like me, don’t know any better and just doing what you can to get through another day.

What horror stories do you have from your first year?