I'm complaining - feel free to ignore this

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I know I am tired _ just checked out a few comments I have made on other blogs and I totally missed some pretty egregious typos.
Thanks to all of you that have been stopping by to check in. I have been busy and exhausted. Last week (9/27 to 10/4) I did a birth Sunday at 0700 after an all night labor, attended births over lunch (and after seeing patients in the office the morning and afternoon) on Tuesday and Friday. I also supervise a resident clinic (in addition to seeing my own patients) on Tuesday mornings, supervise a nurse-practitioner student on Tuesday and Friday afternoons, maintain the High-Risk pregnancy list and attend the weekly meeting Friday mornings. I was just appointed to a committee to work on JCAHO certification for our methadone program for pregnant addicts, and that meeting is every other week at 0730 when I am just getting off call. Add in the monthly OB staff meeting and the residency faculty meeting, the office staff meeting, the office clinical management meeting, and I am fried by the end of the week.
Will you all please do me a big favor? Pray for those of us in health care? There are so many pressures on us to be 'productive' (i.e. bring in money) that sometimes I worry that the patient is going to get lost in the shuffle.
I truly do try to see my patients on time so that no one has to wait forever in those skimpy gowns in a barren room. Your time is valuable - I try to run on time. I truly do try to take the time to listen - to hear not just the first layer of the problem but also the stuff underneath. Sometimes these two goals are in pretty direct conflict.
Labor, as in to give birth, is usually pretty time consuming. It is an effective process, and God designed it well. But it is not always efficient in terms of time. The package charge for prenatal, birth, and 6 weeks postpartum is what is called a global fee. The provider is paid the same regardless of what time is required. Lately I have felt like I was being torn in thirds (or more) because time spent with a mom in labor is time not spent in the office seeing other patients, and the economic pressures are incredible to ignore the labor patient (manage by phone and through the nursing staff) in order to see the paying patients in the office.
One effect of this is that many women are encouraged to have their normal labors intensively managed, so as to time the process in order to maximise the productivity of the birth care provider. A normal but slowly progressing labor may be speeded up, a fast and furious labor slowed down. Fortunately most moms and babies have enough resilience to tolerate this kind of intervention. I will confess that I have felt these pressures too - I try to resist them but when I am tired it can get so tempting........and when a mom comes in asking for all the intervention it can get pretty tough to hold my own.
I have been told that it takes 10 births a month per midwife to cover overhead and make a modest salary possible. We also do annual exams (pap etc), routine gynecology, and I have a small practice in PCOS and NFP as well. My home-birth midwife friends consider 4 births per midwife per month to be more than a full load.
Something has to change in the way we provide health care in this country. I don't pretend to know how, only that what we are doing is not working well either for those who provide the care or for those who are on the receiving end.


I'm praying.

You have my sympathies, Alicia, and I don't care about the typos.

Will be keeping you in my prayers....

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About this Entry

This page contains a single entry by alicia published on October 7, 2003 9:24 PM.

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