In July, I left Company A to work for Company B, taking a $5k paycut to return to clinical work … kind of. Company B actually had really low minimum base salary (20% less), but I was only expected to see 5 patients per day and I earned an extra $18k (which would cover the difference) if I serviced 6 patients per day, matching my productivity when I worked as a clinician for Company A. In mid-January, Company B changed expectations to cut their own costs, mandating 6 patients be seen for minimum productivity while at the same time struggling to admit a sufficient number of patients to afford therapists to consistently see 7 patients (not to mention that seeing 7 presents with some quality of care/ethical dilemmas and they were already beginning to remove autonomy from therapists regarding patient care as well). So, folks like me who were working an 8 hour day providing quality care to 6 patients per day each had their ‘effective salary’ reduced by nearly $20k. I couldn’t afford that.
From an email that I wrote to a friend
I quickly began looking for different work and applied with Company C, who hired me less than one week after I submitted my application after an interview with my soon-to-be-boss and the VP of the hospital that the agency is a part of. Company C has been managed by Company A for the last decade, but the 2 companies are cutting their ties on July 1. Company C was now in need of someone to run their rehab team, because Company A has been doing that for them. Until July 2019, the individual who had been responsible for running the rehab team for Company C was yours truly.
The good news is that I negotiated a great salary, better than what I was making in the same position for the larger Company A. They are thrilled to have me come on board and they are in dire need of the intellectual capital. There will be only one person above me in the agency, so I am less middle management, more lower-upper management. I will be able to be decision maker and will have more authority and leverage with this company than I ever had with Company A. The bad news of course, is that it is still management.
So yeah, when I accepted this offer, I thought that I knew what to expect. Now I’m not so sure.
Company C is Oswego Health Home Care. Oswego Health is a small regional hospital in a rural county in Upstate New York. For out of towners, you oughta know this is MAGA-country. You can think of Oswego County as a hybrid between 2 common stereotypes: think Quasi-Ohio rust belt (1of 2 small cities that once thrived has been decimated, the other is struggling but remains buoyed by a small state university) and Kansas farm country (the patchwork of small rural towns that surround the 2 small cities). Anyway … Oswego Health is the only hospital in the county. It has 164 beds for its 120,000 residents. By comparison, the adjacent county to the south and home to the city of Syracuse (Onondaga) has four times the number of residents (460,000), but 10 times the number of beds (1700) across 4 hospital campuses. #gulp
The good news is that – historically – the reason that the hospital in Oswego is so small is because Syracuse is only a 45-60 minute drive from the farthest reaches of Oswego county. If they need orthopedic surgery, folks go to Syracuse (I wouldn’t, but they do). Interventionist cardiology? Syracuse. Trauma? Syracuse. Basically – you’d go to Syracuse for almost anything that isn’t a simple fracture, and Oswego is rarely near capacity as a result.
The bad news is that – in a worst case scenario – Syracuse is likely to reach capacity quickly. It is surrounded by 4 counties, and each travel to Syracuse for their care, same as Oswego. The county that I live in (Madison) has 225 beds for its 75,000 residents. Cortland has 140 beds for its 48,000 residents, Cayuga has 180 beds for its 80,000 residents. So across the region of 5 counties, there are about 2,400 beds for 785,000 residents, or 1 for every 325 residents. By comparison, NYC has 1 bed for every 347 residents. Neither proportion is comforting.
On the other hand – we have had mandatory social distancing throughout the state for 1 week and – while Syracuse and Onondaga County continues to have rising positive COVID cases (81 total as of yesterday), the more rural and less population-dense surrounding communities have reported 8, 4, 3, and 3 cases, respectively. Maybe – just maybe – upstate NY has gotten ahead of this thing in a way that NYC did not.
If not … well, that is the scenario that – starting Monday – I am now going to be responsible for planning for. If the hospital becomes understaffed, will we send our staff in from the agency? If the hospital starts to pump sick-patients to home to make room for (or prevent infection from) COVID, how do we manage the increased numbers? What happens when one of my therapists tests positive for COVID and they have to quarantine, which means that their wife (who is one of my other 2 PTs) has to quarantine as well? Oh, I didn’t mention that there are 2 PT openings and I don’t yet have an OT? How do we leverage the PTs that I do have to help serve our community beyond their traditional scope? Do they complete med pre-pours? Do they take on a greater role with chronic wound care to free up nurses? How do we integrate telehealth, and with what kind of platform? To prevent the staff from becoming potential vectors, how do we prioritize which patients need to be seen and – if so – how often?
These are the things that kept me up last night; I don’t think that they are yet being discussed at the agency. Perhaps they are, but last week the Director (my immediate boss) was only just then dusting off the Emergency Preparedness Plan and he was concerned that referrals were declining. Meanwhile, when I went to the Oswego County Health Department’s website this am to do some research, the site was down.
#buckleup