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?

 

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?

Thrown Into The Fire

The first serious challenge I faced after arriving in the Medical Staff Office was when my coworker went out on Medical Leave.  It was anticipated that she would be gone for between 8-12 weeks.

This happened less than 6 months after I joined the team.

Remember – I had no real database training, no foundation knowledge regarding what I was doing and why, I had barely learned my own job duties and now I would be responsible for someone else’s as well.

I was panicking inside while those around me assured me that everything would be fine.

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My specific instructions were from coworker – “I’ve already set up all of the reports for the next 3 months, all you need to do is fill in the blanks.”

There was no – “This is where the information comes from.”  I was missing the instruction of “That is why this is important to be included on the reports.”  And there was never a conversation that included “You may run into a snag with this aspect, if so, this is how you fix it.”  Nothing.  Nada.

Up until that point, it was the most stressful I had ever been at work.  Even more stressful than a previous boss volun-telling me to attend a cancer retreat, be the craft coordinator for 80+ people, with no prior experience at doing any of that – the weekend before my own wedding.

It took the full three months that my coworker was gone for me to figure out a system to deal with all of the issues I kept running into.

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At one point, I remember having a conversation with the Director who asked how I liked my job.  Ever the optimist and attempting to be positive, I commented that I really liked the “process list” aspect of MSOW – as it helped me to keep track of what was still pending and what I needed to do.  I also included a comment, “Checking things off the list helps me feel like I’ve accomplished something in my day.”

I received the response from her, “There is much more to credentialing than just checking off items on a list.”

We both missed a great opportunity that day.  She didn’t understand my comment had a much deeper meaning – that I was feeling out-of-control in my job.  And, at the time, I didn’t understand that her comment meant that I hadn’t been trained properly because at that point, I only knew how to check items off the list.

Every time I turned around I was being told that I was doing a great job.  The Director, the Chief Medical Officer (CMO), the Physician Liaison, the Credentials Chair – everyone insisted that I was doing wonderful.

So, why did I feel like a fake?  I felt like I was an impostor, like I didn’t belong in the Medical Staff Office.  I kept asking myself, the people I knew outside of the job, and a counselor (who I eventually started seeing) what was wrong with me.  Why couldn’t I get a handle on what I was doing and why was everything so hard?

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I had the counselor sum it up best after I had been in the job for about a year – I hadn’t actually had just one job; I had been asked and required to learn 4 jobs, all requiring extensive knowledge that I did not have, with next to no training.

But at the 6 month mark – I knew none of what the counselor finally pin-pointed.  I just knew that I was trying to juggle work (with no training), home (with a husband and kids who didn’t understand with their own problems and demands) and self (my self-esteem began to plummet during this time – the start of a three year depression that I’m finally, just now, clawing my way out of).

It took another 3 years before I realized that the problem was not me, that I was not a fraud and that I did have something to bring to the Medical Staff world.

Have you felt like a fraud at work?  What did you do to overcome the feeling?

My First Day

“Welcome to Medical Staff!  We hate to do this to you, but we all have to be at a meeting, so you’ll be the only one in the office for about 15-20 minutes.  That won’t be a problem will it?  Just take a message if the phone rings or someone comes in.”

This is what my Director greeted me with the very first day I walked into the Medical Staff Office on a Monday morning.

No tour around the office.  Nothing.

The silence of the office was intimidating.

Not one to sit idle, I logged into my computer and answered as many emails as I could from my previous position.  That took me all of 5 minutes.

Looking around the main office space, it was dark, dusty and mauve.  VERY mauve.  There were office cubicles with mauve walls.  Coordinating pictures with mauve mattings.  The office accessories – letter trays, staplers, tape dispensers – were all a dark plum/mauvish color.

I looked in the office kitchenette – there was a sink, refrigerator, microwave and coffee maker.  All of which looked like it had been years since they had been cleaned.  The cabinets were over-full with old supplies, a mish-mash collection that I recognized from the cafeteria, catered events, and home supplies.

There were plants in each area of the office – 3 large rooms, the kitchenette, and a private bathroom.  The plants all appeared to be neglected and dying.  The only place there weren’t any plants was in the separate, but attached, file room.  Floor to ceiling revolving file cabinets, horizontal file cabinets and a copy machine filled this area.  Each file drawer filled to overflowing.  Cramped, crowded and stifling hot when the copy machine was in use (I later found that out).

The mauve continued into the middle office area and into the director’s office.  There was a collection of furniture and decorations that seemed to be shoved in places to appear to be useful, but gave the areas a feeling of being cluttered.

In the entire area, there was only one window.  Thankfully, it was right next to my work space.  It provided a little light, but no view.  It was made with glass blocks to ensure privacy.  So I could see outside, but it was always distorted.  That’s how I later came to view my job – distorted.

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I don’t remember much from my first week in the Medical Staff Office – but I remember that first 15 minutes.  They aren’t lying about first impressions.  If I had been honest with myself, I would have known that my first impression of the office would have shown me the chaos I had agreed to enter.