During my recent assignment in Virginia Beach, I found myself getting busier and busier. My patient panel exceeded my typical panel size, and I was seeing 20 complex geriatric patients per day. This exceeded the 16 patients max per day I was supposed to be seeing according to my contract. Due to my previous experience with the company, I know what my limits are.
With this company, I often work up to 45 hours a week – 5 hours being overtime. However, in Virginia Beach, due to the reasons stated above, I was working 50-55 hours per week (10-15 hours of overtime which is ridiculous). I tried telling both leadership and my recruiter that I was working too much, taking too much work home, and feeling overwhelmed. This wasn’t the work-home life balance I have come to appreciate being a locum tenens nurse practitioner.
No one seemed to care so I decided to just suck it up for my remaining few weeks. I figured the extra income I was making in overtime would cover the 3 weeks of unpaid time off I was planning on taking after the assignment ended.
Then one day I was notified by my recruiter that the site was contesting some of the over time I had recorded. I had billed them for 54 hours but they suggested I had only worked 52 hours. Fortunately, the agency told me that even if the site contested part of the overtime, they would still pay me for the full hours worked (or that I billed for). Although I was pleased with that surprise benefit, I was disappointed with the work site.
It’s definitely about the principal of the matter. I had already made it clear to them that I didn’t even WANT to work overtime but they did nothing to ease up my load. And I am confidently very efficient as a provider so I knew there wasn’t anything I could do to finish my work more quickly.
Seeing 20 complex all-risk geriatric patients per day leaves me with little to no time after completing my notes – to complete refill requests, review phone messages and call patients back, review lab results and consult notes, and review patients in the hospital and call hospitalists to inquire about patient status.
Not to mention I have worked with this company on and off over the past 5 years and NEVER have had an issue with my hours billed or being paid overtime. I am sure there is a way they can see what time I log off from my work laptop, which is way after the clinic is closed. I think they are oblivious to the fact that their full-time salary providers work close to 60 hours per week.
To be honest, I think it is their way to get back at me for not wanting to extend my assignment. It was only after I declined the extension that they started to decline some of my overtime. Had they not taken advantage of me and overworked me I would have been more than glad to continue helping. Let’s just say I won’t be returning to this market unless there is a change in leadership.
I think this is reflective of the primary care climate in general and the bottom line. Many administrators will push the clinicians to see more and more patients. They do not recognize the time commitment to provide thorough and safe care to complex patients. And as a family nurse practitioner, my training did not prepare me to be an internist. I completely understand where you are coming from. For my work life balance and sanity I left primary care and work in a low acuity retail clinic. Unfortunately, there is no easy answer. I will say that I felt like a cash cow in primary care because they made nearly as much as a physician would bring. I was seeing the same acuity patients as the physician and for a fraction of the financial benefit. I was working easy 55-60hrs per week.
Thanks for posting about your experiences Sophia.
Thanks for sharing. Fortunately I am having a better experience at my current assignment. Safe to say not all primary care offices are horrible but there are plenty of them.
Welcome to healthcare. My assignments have typically been this way!!! The clinics don’t want to pay overtime and question every minute! I’ve found they will dump on the locum regardless of what was discussed! Of course, I don’t return to these assignments. But, I have also found that perm provider friends have the same issues. They are salaried and get NO overtime!!! Healthcare just sucks sometimes 😳😳
On my first assignment as a Locum I had barely arrived two weeks prior and covid hit. I was working at a hospital within an hour of ground zero for covid in the US. So I was essentially stranded because so many places were cutting admissions that nobody else was hiring and the recruiter told me to stay put. I was working alongside another experienced Locum provider. Well one of their staff felt medically vulnerable and decided to go on medical leave until covid was over. And the hospital which in until then had given us a very reasonable patient load suddenly split her patient load between me and the other Locum. And then they complained and complained about any overtime I racked up. That Locum said that she had learned it was better just to suck it up because if you insisted on being paid overtime you just would have more and more trouble getting locums and they certainly would not ask you to extend and they might even become hostile. I still felt on principal I should claim at least part of my overtime and I have to say that I had to negotiate in order to get an extension during covid even though many providers went back home. The agency a well-known one that you recommend did not protect me or negotiate for me about the overtime or for that matter remind the hospital that we weren’t even wearing masks yet and we just knew that covid was a fatal disease you could get in a heartbeat. We didn’t even know how you caught it for the most part and how not to die if you did. But I stayed and worked that $150% load for 5 months and the hospital was not appreciative and neither was the agency. Otherwise I got a good rating at that hospital and the physician I worked with liked my work enough to offer me a reference. So yes you get dumped on sometimes and so don’t forget to put patient load in your contract. I didn’t know to do that in the beginning and the agency of course told me that my patient load was going to be that very reasonable amount in the beginning. And then when it wasn’t anymore they basically just tried to give me the pep talk saying you can do this. Yeah I could do this working 55 hours a week and sometimes until 11:00 at night finishing my notes. It got so that I dreaded walking through the ward to get something because nurses and patients would come up to me wanting something at that hour of the night or I would walk through the nurses station and see a crisis happening and therefore be involved against my will because there really wasn’t a way to walk around the unit to get from my office to the exit door etc. I did try to be assertive but I didn’t want to extend and they weren’t interested in me extending because I claim the tiny amount of overtime they would actually let me claim each week was actually two to three hours and that’s a quote. So there are good assignments and there are good agencies but every good agency is not good for every provider and there are rotten assignments out there.
And lastly I will share that some sites treat Physicians very differently and so do the agencies at times. For example I worked in a hospital that used partly paper charts and partly dictation. And I found out that not only did they provide dictation software for all of the notes for the Physicians but it was the kind that allowed check boxes and it was much much easier to do an admission then dictating a narrative. They also had their own template for narratives and it was quite lengthy. Not only that but the hospital hired someone to do the Physicians discharge summaries and in a psychiatric hospital that can take a lot of time off your load particularly if they have a template that’s three pages long. So it’s best to be aware of that too and get those details in writing. Meaning find out if they have software for certain tasks or assistance or anything else that reduces your workload and if they do make sure they offer it to you as well.