9.13.2007

What is it like working for Kaiser as a Pediatrician?


*again, what follows is just opinion from a couple of Kaiser pediatricians.

What do you do for Kaiser?
I'm a pediatrician. I've been working part-time/intermittently for about 20 years.

Do you work other places?
Absolutely.

What are the positive aspects of Kaiser?
For children, Kaiser is a great place. Most kids are healthy, and seeing children for health maintenance is Kaiser's forte. They have same day peds clinic appointments, after hours urgent care that actually stays open long enough for working parents to utilize the service. They have caring physicians, caring nurses, and a wide range of pediatric subspecialists concentrated in a couple of 'pediatric centers'.

You make it a point to mention that Kaiser is good for healthy kids, what about sick kids?
Kaiser is good at preventive care and health maintenance. They have some great docs/departments that treat common diseases very well, like diabetes and asthma/allergy. They're making great strides in treating obesity, childhood HTN, and really promoting health education and healthy lifestyles with their 'thrive campaign.'

However, if a child has a not-so-common disease, children's hospital is always better. If a child has a disease that has lots of research dollars (therefore lots of new research, treatments, etc) Kaiser will be behind the times. Kaiser is slow to change its approved drugs/management plans, so the latest/greatest treatments may not be available to a Kaiser patient that fall into these categories (for instance, cancers, autism, cystic fibrosis, genetic/congenital diseases, etc). Sometimes this makes little difference...but sometimes this can be life altering.

Do patients seem happy with Kaiser?
Absolutely. Those who have Kaiser, seem to really like Kaiser. Kaiser is easy, you know? The patient know exactly where to go for services, how much they are going to pay, what's covered under their plan, etc. Other insurance companies have very hard-to-understand 'networks' and such, with percentage co-pays, and it's not always clear which hospitals are covered, which services in the hospital are covered, etc. I've heard many frustrated Blue Shield patients who are constantly receiving bills from the hospital for the birth of their baby. Anesthesia bill. Pediatrician bill. Bill for supplies. Hospital room bill. OB bill. Some services that are covered, haven't been....and they keep receiving bills, threatening their credit score if not paid...but supposedly covered under their plan. Very frustrating for these people.

Kaiser makes it easy. There is one bill. Everything is on that bill. The bill is expected. It's a set dollar amount and not a percentage of an unknown dollar amount. It's clear.

How's the ancillary staff?
I think they're mostly a great group. Pediatrics tends to bring out more positive than negative, you know. Kids have way of brightening a day....if you truly enjoy them.

What don't you like about Kaiser?
I agree with the EM attending...the lack of self-determination. When I started here I had big ideas. As I spent more time here, I realized that the doctors were starting to lose their fire. Their life-force so to speak. The job became 'just a job.' Everyone clocked out on time...and only did enough to not get fired. Typical employee mentality. I never wanted to be an employee...especially if it meant keeping a timecard. I know docs who used to go on health related missions to other countries, volunteering overseas and such. Young, energetic, and full of life. After being at Kaiser for a few years...they demonstrated less enthusiasm, and just kind of settled into...submission. It's like watching your friends walk into a soul transformer...coming out with no spirit.

Why do you think that happens?
I think it's because they do silence you. It's quite clear to anyone who's been at Kaiser that it's not okay to be....yourself. To have ideas and such. In order to 'be okay with being silenced' many just shut down, never expecting to get satisfaction from the job. Perhaps they seek it elsewhere. EM attending is right, it is an extremely political environment...and doctors don't always do well. If you're on the 'right side of politics' you'll likely be more accepting of it.

I hear Kaiser lacks diversity among the physicians, is this your observation?
That has been my observation. Usually there is more diversity among the primary care physicians than specialists. There is a tremendous amount of diversity among nursing, and other staff. But, among physicians...not much.

It's interesting that Kaiser brags about being such a diverse corporation, but the physician staff is not.
I agree it's misleading. When Kaiser states they are diverse, I guess they are counting the janitors and secretaries, giving the illusion that people of color are actually in high places, and in more 'professional roles' such as doctors. That does bother me since most of our patients are people of color, and I think Kaiser should do a better job of recruiting/retaining a workforce of physicians that more accurately reflects the patient population it serves. There are a multitude of reasons this would be beneficial...both to patient, and physician. Many people seek physicians who they connect with. Ethnicity and gender are major 'factors of connection.' Language, cultural understanding, and simply a demonstration of positive role models in a community is very important for children/families. Kaiser does a very poor job in this area, but 'hide' it by bragging on diversity that primarily exists only among low-level staff.

What's the money like?
The money at Kaiser for a pediatrician is actually very good. Easily equal to (likely better than) colleagues on the outside. Peds is a very low-paying specialty, so Kaiser's salary is good. This is why I continue to work per diem at Kaiser, because the compensation is very good for a pediatrician.

Lifestyle?
Good. We have hospitalist pediatricians, so call is non-existent. You do work 40 hrs/wk for 10/10, and you do go over hours at times. But, because Kaiser doesn't want to pay staff/nursing to stay late (overtime and such), there's a big push to get everyone (else) out on time...which means you get done at a reasonable time. There's mounds of paperwork to do, uncompensated time. And email/messages to respond to from patients (also uncompensated). But, overall, you get your weekends off...nights off....and one half day a week for education/CME. You are scheduled for a lunch hour, but you usually work right thru it. And, there are times where you have (very welcomed) holes in your schedule...

What about having to see a patient every 15 minutes?
I actually can do it without much ado. I'm a very 'to the point' type of guy...and really don't relish in the chit-chat of nervous parents. So, 15 minutes for me, is all I need. And actually its less than 15 minutes...

...but I will say I have a colleague who has great patient satisfaction scores (among the very best), and enjoys spending more time with her patients. Kaiser delayed her ability to fully participate as a partner until she 'sped up' the visits. I say this to share that not everyone enjoys speeding thru patient encounters. Especially, when they aren't making more money to see more patients!!

Why have you only worked part-time for so many years, and never signed on full time?
I still have my fire...even after 30 years post residency. I've accomplished so much more than I would have had I 'settled' for Kaiser. I have a business. I've worked in various cities. I volunteer where ever I want, when ever I want. I teach interns and residents, and am therefore on staff at nearby academic institutions. I make enough money thru other mechanisms to really travel and enjoy life.

Would you recommend Kaiser to a pediatric resident/fellow?
I would want them to know the facts first. To talk to me, and other docs who know, and see if Kaiser can offer what they want. For a pediatrician, Kaiser has a nice mix of money and lifestyle when compared to the outside. The pension is certainly a perk, and there is the opportunity to decrease your work hours to 8/10 or 6/10 time (with comparable drop in pay as a result, of course). It is possible to avoid much of the politics depending on the clinic, and the staff are supportive of each other. The patients are wonderful, and the atmosphere is pleasant.

However, if you have aspirations to do 'something else' with your MD other than practice medicine forever....you might want to think twice. Also, if you want to work at an academic center, maybe mix up your practice a bit between ER, urgent care, clinic, hospital...you may not find satisfaction at Kaiser.

Overall, I'd recommend it for most of the pediatric residents I see graduating today.

15 comments:

Colleen said...

That's completely awesome, since I was planning to become a pediatrician, and my friend's father works at Kaiser...

But it seems a little unfortunate to have a fifteen minute rule, especially since parents ask so many questions. I tend to be wordy myself. I would love to get closer to patients, too. Hrmmm.

(What's 10/10 mean?)

ten out of ten said...

I'm really enjoying this series. I think I had vaguely heard of Kaiser, but knew nothing else. This has been enlightening -- thanks.

ER doctor said...

10/10 means ten tenths time. That's full time. (it's kinda confusing) but each 4 hour = 1 unit. Each 8 hr day = 2 units. Full time is 10 units per week...or 8 hours per day...or 40 hours per week. They have other options, like 8/10 time or 7/10 time...which are 32 and 28 hours per week repectively...but you get that same percentage of salary (80% or 70%) if you work less. You get to keep your benefits as low as 6/10 time (again, you're only getting 6/10 of the money).

The pediatricians seem the happiest with Kaiser (of those I spoke with, i.e. my friends).

And thanks 10 out of 10. When I was looking for a job out of residency...there wasn't much honest insight available about Kaiser. And, they have such a huge presence here...that I wish I had some honest, candid information. So, I decided to ask around and post different POV.

Anonymous said...

I wonder if you could tell me where you got the photo of the smiling kids you used in your article "What is it like working for Kaiser as a Pediatrician?"

Please could you mail me.

hugh.abbott@bespokelearningtools.com

Anonymous said...

Do you get health insurance or any benefits if you work per diem at Kaiser? I was offered a per diem job at Kaiser, they wanted to work per diem 40 hours/week for 8 months in a row, but stated that since its per diem, I am not eligible to get health insurance.

ER doctor said...

No, you don't get any benefits working per diem. Kinda sounds like a bad deal to me. You work side by side, equal hours and responsibility as your co-workers, except you're not getting any benefits...for 40hr/wk??

Per diem is good if: the pay is good; and if it's a part-time thing. Ideally so you can have another job with benefits (unless that's not an issue for you i.e. spouse/partner with benefits, COBRA, individual coverage, etc).

Anonymous said...

Burnt out working part time as a pediatrician in a private office for ten years, underpaid and under appreciated; thinking about Kaiser per diem. Any idea about salary for a per diem Kaiser pediatrician in L.A.? Your input is greatly appreciated!

Anonymous said...

I've worked at Kaiser as a per diem pediatrician in the Inland Empire and have found that my schedule was loaded in the late afternoons with double bookings but the staff MD's were not. In urgent care, there have been times where my schedule was set up for every 10 minutes, but that was not the case for staff. You don't get paid for any time you spend beyond the scheduled shift. I am not a clock watcher and always want to give 100%, but am feeling really annoyed with this double standard.
And, at $65/hour, I don't think the money is that good either.

Anonymous said...

Have you posted anything on a KP hospitalist yet? I am not able to find it. BTW, great blog!!!

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