Running Out Of Time

And then the floor fell out.

I finally convinced the Director to allow me to take over the files for the new hospital.  Not because I had received training that they knew nothing about, but rather because I insisted on it.  If I am going to be responsible for something, let me be responsible for it – victories and defeats and all.

I took over the new hospital on March 1, 2014, four months after I accepted the position for the new facility.  I won’t sugar coat it – it was hard.  I had to learn how to credential new applicants in a hurry.  I was told, it’s just like doing a reappointment application – it’s not.

I kept wondering why everyone had such confidence in me – I had none in myself.  Here I was, a high-school drop-out (with my GED), with no college education determining if a physician with 10+ years of school was qualified to do his job.  I was reporting to people who had more letters behind their names than I had in my entire name.  I wasn’t even certified to do my job – I had barely started studying to become a CPCS.

It took me much longer to review a file than it took my coworker.  I didn’t have the advantage of 20+ years of experience to determine what was important and what wasn’t like she did.  I didn’t have the knowledge to know how to quickly assemble a file for department chair review.  I was attempting to come up with processes that made sense to transport files 20+ miles away for the new facility and department chairs to review.  The process coworker had started appeared incomplete and not up to Joint Commission standards.

The new facility started questioning if I was qualified to do the work.  They would point out, correctly I might add, that it was taking me 3-4 months to finalize a new application when it had only taking my coworker less than a month, two at most.  I didn’t have an answer for them, just that I was doing my best to ensure that each file was complete and thorough.

I started looking into beginning the reappointments for the new facility.  Coworker stated multiple times that I was jumping the gun on reappointments as it wasn’t necessary yet.  They weren’t due to recredential for another 14-18 months.

I looked at the time-lines – she had credentialed approximately 150 in those first few months and automatically put them on a 24 month reappointment cycle.  There was no way I would be able to recredential that many a year later without missing someone and them going over the 24 month maximum requirement by Joint Commission.  As far as I was concerned, I hadn’t started early enough at looking at the reappointments.

Thankfully, the facilities in our hospital system (18 wholly owned non-profit hospitals) have a sharing agreement across the entities for physician files.  Because of this, I was able to tack on many of my physicians as a “piggy-back” process to the primary facility’s reappointment process.  This allowed me to not have to focus on the entire reappointment file, just the items I needed specifically for my entity.  This allowed me to begin the reppointment process with a number of my practitioners with relative ease each month.

And then our Director was given a choice – retire or be fired.

At least, we weren’t told that, but reading between the lines, that’s what happens when the director of a department for 20+ years is there one day and then gone within less than a week.

I remember the CMO talking to us, but I don’t remember what she said.  I’m pretty sure she was attempting to be encouraging, but I sat there with tears streaming down my face and didn’t hear most of it. I kept attempting to will myself to stop crying, but I couldn’t.  I was at a loss for what I was to do.  The Director who was now gone was who had convinced me that I was perfect for the job.  Now whoever came in next would take one look at me and know I was a fraud.

The CMO asked me what she could do for me since I hadn’t said anything during her meeting with us.  I managed to choke out that I wanted to have a one-on-one meeting with her, she immediately agreed and scheduled the meeting for the next day.

I went home that evening and wrote down all of my questions and concerns.  I showed up to the meeting with the CMO and, based on her facial expressions, I shocked her multiple times.  I first told her that I was not upset for the Director leaving, that I viewed that as a business decision and that it was probably a good step for the department.  I admitted that I felt lost, that I hadn’t had proper training and that I thought multiple issues were going on in the department – that I wasn’t experienced enough to know what, but that the next Director would have their hands full with correcting years of issues.  She was appreciative of the honesty and asked me to give her time to get me the training I needed and the Director I and the department needed.  She just needed time.

Time was something I was fast running out of.

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?