I recently put in my resignation notice for a toxic work environment. I have been working for 6 years as a nurse practitioner in a private practice which holds four office locations. I work exclusively in one office and am the lead provider there (only two providers work the office). I have been a profitable employee, 2nd in terms of patient volume out of a total of 8 providers. I am paid above market rate for the area and hold 7% ownership in the company through profit sharing which essentially doubles my base income. I have been happy with my compensation but everything else has seemed to slowly fall apart over my time with the company.
I was originally happy with the job for several years. Several major changes have occurred over the past 2 years, however:
- The founder and medical director has essentially retired and no longer practices clinically. She still holds approximately 70% of the ownership and is consulted for very major changes only. Since she stepped down, so to speak, her son-in-law was hired as the practice administrator and, within a year, was promoted to CEO. He holds an MBA and years of hospital administration experience, though no clinical degrees. Though nepotism could be considered a concern, he is well-qualified for his role as the “money guy.” The problem with this is that we no longer have a practice administrator or HR type role within the company to handle employee relations. We have an associate medical director who is the only other MD in the practice and holds that title by default. She does not make hiring or money decisions, but rather is a point of reference for NPs and PAs if needed and makes our schedules.
- There has been frequent staff turnover in the past 2 years. My office fully staffed would include 2 secretaries, an office manager, 2 nurses, and 2 providers. Within those 4 job roles we have lost 10 people in 2 years.
- My office manager was fired/asked to resign last year. She was a foundation of our office, well known and liked in our small community and helpful in bringing patients to build the practice initially. She was supportive of all staff and especially providers, protecting everyone’s wishes and best interests to help prevent burnout or grievances. She was excellent at her job, met all expectations, and worked her ass off. She was essentially bullied out of the practice by two other “mean girl” office managers who had more senior roles and would nitpick her work, such as billing practices, etc. Our CEO even admitted to her that he had been “getting pressure by several people” to fire her.
- Our CEO has been hiring many unqualified individuals to fill the staffing shortage, most notably medical assistants, some of whom are not even certified. Two recent hires have had literally NO clinical skills, including being unable to take vital signs manually (think blood pressure cuff as opposed to a machine, actually counting a pulse and respirations). He has hired people who do not know how to administer injections appropriately. We even had one patient who needed a subcutaneous immunotherapy injection; it was given intramuscularly and the patient had a severe allergic reaction that required a trip to the ER later that evening. Our nursing supervisor has no standard training protocol, no skills checklist or standardized evaluation to make sure the medical assistants are competent and doing what they are supposed to be doing. There is no quality assurance nor standard that any ancillary staff is held to. Our CEO has also tolerated many egregious behaviors among staff without firing them because “there is no one else out there” and the candidate pool is so slim in our area. Examples include a no-call, no-show new hire on her first week of work without a legitimate explanation…our CEO acknowledged this was unacceptable and a huge red flag and we had dodged a bullet…she showed up randomly a few days later and was accepted to commence her employment. There have also been people who have had to take leave for various legitimate reasons (COVID, surgery, bedrest for pregnancy, death in the family), but who never follow up even months later to indicate WHEN or even IF they will be returning to work. We have some medical assistants who refuse to do certain basic tasks that are part of the job (e.g. giving injections, doing specialist referrals ordered by provider, or swabbing for strep/flu/COVID).
- There is no consistency amongst our four office locations. Each location “does things differently” and it is said to be up to each office how to do things (scheduling, responses to standard customer questions or needs, etc). This could be fine, but the problem is that with our frequent turnover and constant short staffing, people in each position are frequently required to provide coverage in other locations, most often the medical assistants but also the secretaries. This creates confusion and frustration amongst the staff, who may be corrected on something they are doing when they were advised to do it differently at another location. I suspect this frustration has contributed to much of the turnover.
- There is extremely poor communication between administration and staff. Information that is pertinent to many people is only communicated to a few and then it trickles through the grapevine. This includes scheduling changes, new hires, resignations, training on new equipment, and more. There are essentially no company-wide announcements or communications. Decisions that involve many stakeholders are only made by a couple of people, and it is usually the wrong people to be making that decision.
- Ancillary staff have been very disrespectful to myself and the other provider (a PA) in my office. Our CEO has told us on numerous occasions that he wants our practice to be “provider-driven,” wherein the providers are the leaders of the clinical operations within their office. We should communicate our preferences and needs to staff to optimize our workflow as we see fit. My PA colleague and I have consulted and are on the same page with our preferences. We have communicated our wishes frequently, clearly, and respectfully to staff but they are blatantly ignored. The most frustrating example has been scheduling. We are an extremely busy practice and it is difficult to see 30-40 patients per provider per day without a carefully considered scheduling protocol. Let alone finish our other tasks (complete encounter notes within 24 hours, write referrals, send prescriptions, answer staff questions, and review consult notes). We have had office meetings with all staff at our office, private meetings with our office manager, private meetings with our CEO, and every combination therein. The scheduling we have requested continues to be ignored. If we remind front office staff (always politely), we get eyes rolls or outright ignored. Our CEO is aware and yet refuses to discipline any insolent behavior. We appropriately apply our chain of command and always address any issues directly with the individual first and then go from there.
- There is constant gossip, talk behind closed doors, tension, and obvious resentment amongst staff. My PA colleague and I have been gaslit by our staff, associate medical director, and CEO for raising concerns and offering solutions/changes. We are constantly in a no-win position. The CEO is guilty of the same behavior; he and I used to have a good relationship wherein he would be in frequent communication with me, providing updates, believable lip service to my concerns, and solicit my ideas. In hindsight a major red flag is that he would also “vent” to me and talk shit/reveal his true feelings about other employees, even people in leadership positions. I realize now this spoke to his immaturity and poor emotional intelligence, but at the time I was flattered that I was the one he opened up to and seemed to respect/value more than other providers. Fast forward to recent months, when I am being given the cold shoulder, gaslit, and my concerns are brushed off.
In summary, I am leaving due to short staffing, poorly trained staff (=liability), rude staff, ineffective leadership, lack of communication within the company, and ignorance of provider concerns. My colleague is also desperately searching for another job for the same reasons.
Unfortunately my contract requires 4 months notice. I put in my notice 11 days ago. I sent my CEO a formal typed resignation letter via certified mail with return receipt. It was 2 lines long stating I was resigning and when my last day would be. I did not provide a reason for my resignation. A few reasons for this: 1) My contract actually states that any termination will be communicated via certified mail. 2) I saw no need to also give my employer a heads up via phone call/text. If he wanted further information, he could communicate with me via those media. 3) I am actually on maternity leave with one month left and an in-person meeting is impractical. 4) My reasons for leaving are all issues which I have addressed with the CEO on multiple occasions and are essentially ignored. It would be pointless to rant my frustrations because there was ample opportunity to remedy things prior to my resignation; no use in rehashing the same stuff. Since sending my resignation, I have not heard a word of response from the CEO or our medical director who initially hired me. My job was posted on Indeed the next day and indicated that 2 positions needed to be filled (mine and that of the PA, who has neither resigned nor been terminated at this point). At least some of the staff has gotten word. Our secretary has already told someone outside of the office who also happens to be a patient’s parent who has “heard they are getting 2 new providers.”
I am dreading returning to work and completing the remaining 3 months of my resignation period. There will at some point need to be some communication with the CEO as my shares need to purchased back by our medical director when I leave. I don’t know how to approach my return. Should I reach out to the CEO or ignore him as he is ignoring me? Was I wrong to resign via letter and nothing else? Am I the asshole? This whole situation has been wearing me down mentally and I need some kind of outside validation that I'm not crazy due to all this gaslighting.