"Hey, so..." I exhaled. "This second job is getting on my nerves. Wait, I don't think I told you. I got a second job a few weeks ago."
There was a pause on the line, then my best friend said, "What?! Why?!"
Let me tell you why.
Looking back, I only ever worked one paying job at a time when I was younger, and then somehow I got in the habit of having a side gig. I was a TA and did some tutoring in medical school. I did some urgent care and ER moonlighting while I was in residency. As an attending I did a little teaching at my alma mater medical school as a lab instructor. If I'm being honest, I always felt like I was working too much, but I liked my side jobs and we have several hundred thousand dollars of debt, so I kept them. When I was diagnosed with CMT, though, one of the big things I did was cut back on how much I was working. I had been doing about 1.2 FTE at my main job and teaching a couple days a month. I resigned from my teaching position and cut out a couple shifts.
For a while, that was fine.
Then I started to get antsy.
Am I doing enough? Maybe I'm not working enough. I need to expand my skill set. I need something that is less physically taxing. I started looking into my old residency-era leads for non-clinical jobs, relics from when I was trying to get out of medicine. And I remembered one path that had seemed promising before but wasn't an option for a new doc with little experience: chart review.
Chart review is basically an insurance thing, although it generally isn't under an insurance company directly. Instead it's through something called an independent review organization. When something gets denied for coverage by a person's insurance company, it usually gets appealed. Those appeals go to an independent review organization, where they are reviewed by a doctor in the same field as the original doctor. The reviewer looks at the documentation provided and makes a recommendation as to whether or not the service/ medication/ what have you should be paid for by the insurance company. So basically, you sit on your butt at home and read through some charts and do a little typing.
I copied a physician blogger I read (sadly, his website is defunct now) and went onto the website where all the accredited chart review companies are listed, compiled a list of options, and emailed my CV out. I shied away from ones that quoted Medicare jargon on their front page or that seemed like they would expect a specific outcome from my work (i.e. expect me to side with the insurance company all the time). I emailed them whether they said they were hiring or not. All in all, I'd say I contacted about 20 companies. The worst they can do is say no, right?
I had two job offers in like four hours.
Getting a chart review job felt like plucking a job off the proverbial job tree.
So I sold out. I turned to the Dark Side. I took a non-clinical side job.
At first, giddy with the easy win, I threw myself into it. I completed orientation and started reviewing cases as soon as possible. With the company I work for, they text you to offer you a case and you can decide to accept the job or not. I started hitting 'accept' on nearly everything they sent me. And surprisingly, I've found I don't mind the work. Most of it is low-stakes stuff about if a blood test was necessary or something. Sometimes it's interesting. Sometimes I find a reason a service should be covered and I know I'm helping the patient. As desk jobs go it could certainly be worse. The company was appreciative; I got a couple of emails and texts praising my work ethic and accessibility.
Then I realised I was grumpy all the time, and also that I never had a day off. I mean never - on days off from my main job I was spending a couple of hours a day doing chart review. Sure, that's no 12-hour shift, but it's also not the same as truly not working. I was getting texts every day from the chart review company, asking me to do cases. You're so much more available than the rest of your panel, they said. Then they asked me to review a massive case with over 100 pages of documentation, on a topic I've never managed before. I said no. They asked again. I said no. Then they asked a third time and I caved, and it was, predictably, horrible. I spent hours just reading up on the topic and digging through relevant literature, then another hour or two reading through the chart notes. Then I spent another hour on the phone with one of the medical directors answering my questions and providing guidance. Then I had to call the original doctor as per the insurance company's requirement. Then I could, at last, spend an hour typing up my conclusions and submitting my report.
Did I mention they only give you a 2-3 day turnaround time?
Did I mention I get a standard flat fee per case reviewed, regardless of the length/ complexity?
Did I mention this is not my main job?
My friend was not sympathetic. "I mean, Zoe, it sounds like you're working too hard again. You should probably stop that. Just start telling them no."
Affronted, I started to argue, then let her criticism sink in. It jolted me into a little self-awareness. What was I complaining about? No one made me take this job. This place didn't recruit me; I basically cold-called them. I don't, strictly speaking, have to do this. And I certainly don't have to do this at 100 miles an hour.
"Uh, yeah. Yeah, you're right. I'll work on it."
I could picture her nodding in approval. "Good. Stop working so much, I feel like we've talked about this a million times."
The whole ordeal reminded me of some things.
1. Companies are not there to take care of you. At best, they care about getting the work done.
2. You need to set your own boundaries.
3. Sometimes you will have to defend those boundaries against your employer.
4. Your employer depends on you for #2 and #3.
I think the last point is the most important one. If you say yes to some kind of work, your boss will assume you said yes because you're okay with doing it. If you're not okay with doing something, guess what? You have to say no.
So I started doing just that. I made a little pact with myself: no more cases over 50 pages long, no more cases where I don't already know a lot about the topic at hand, and no more cases where I have to call other doctors. I've already had two other instances where they pressured me to take another beast of a case, and I replied simply, "I'm sorry. I can't," and that was the end of it. They texted me once while I was at my regular job and I politely informed them that I do not take cases on days when I work and reminded them that my unavailable days were given to them per their request. I've decided that I am keeping the job for now; I'm learning some new stuff and making a little extra money, so it's worth it. But from now on it'll be on my terms.
I get fewer texts from them now. I get some days off.
And I am a lot happier.
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