u/Bipolar2MD

I am a new attending working at an FQHC, contracted for 4 days per week totaling 80 patients. I am generally happy with my job and happy with my compensation structure (decent salary that never goes away with additional income available beyond a certain annual billing threshold). I could never strive to hit my productivity bonus and still live very comfortably, so this isn’t a money issue. Also worth noting I’m the only physician in my office with 5 capable mid-levels that aren’t my direct responsibility but that I do help out often because they’re good clinicians and nice people.

My clinic has daily walk-ins with each provider expected to cover it once a week. It is a 2hr period with no patient cap, and it is generally understood that we are not to be booked appointments during that time or the hour after without asking. The hour after is intended to finish seeing patients who’ve checked in before walk-ins end and to do documentation.

For the last 4 weeks I’ve continually been booked 2-4 patients during that time, as well as being randomly double-booked throughout the rest of my day without my consent. Tomorrow I have 4 patients during walk-ins, ultimately scheduled for 15 patients during the day without taking any walk-ins into account. I’m meant to work from 8-4 with an hour lunch/admin, so if I get 10 walk-ins I’m seeing 25 patients in 7 hours which is just not acceptable to me. I’m also double-booked an establish care for a patient in their 70s and a hospital follow-up in their 80s in the afternoon.

I have politely requested multiple times that this not be done without my permission and have kind of reached a breaking point on it because I feel like I’m just being treated like a door mat as the new guy. Is it unreasonable for me to say that after this week I’m not going to accept it at all any more? I’m either going to suggest that the person who double-books me without asking can cancel the appt and explain why, or state that I’ll just shut my laptop and go home once I hit my daily patient capacity if I exceed it because of inappropriate scheduling.

Is this unreasonable? Am I being a diva? Looking for genuine feedback because I’m pretty sure I could take my talents elsewhere quite easily

ETA: thank you for the insights! I’ve already asked my office manager to meet tomorrow morning prior to walk-ins and I will essentially say what I said above, keeping in mind that I don’t want the patients to be pawns in my fight with admin. I actually have a vacation the next 2 weeks so I plan on seeing the patients I’m scheduled for the remainder of the week and then giving them 2 weeks to sort it out. I’ll also make it clear I’m ready to walk if this can’t be sorted out reasonably, pretty sure in my neck of the woods I can have a job lined up by the end of my 2 weeks off if push came to shove.

How did all this happen? Stay tuned.

TRIGGER WARNING

This is going to be the first post of 6 or 7 that include descriptions of alcohol and substance abuse, severe mental illness, active suicidal ideation with plan and intent, and a picture of what it’s like to be involuntarily hospitalized (in the clink/slammer/serving my nickel, as I will be calling it from this point on) as someone who has an MD and has a passing familiarity with the DSM-5 and all the medications and therapeutic modalities that we use for psychiatric conditions. If you’ve ever read “One Flew Over the Cuckoo’s Nest” it was honestly a lot like that, and if you haven’t — you should.

As I’ve begun to process everything that has gone on I’ve realized that the signs were there, and were there for a long time. I’ve struggled with alcohol abuse since the day I started drinking at 17 (sober since 7/23/25 and beginning to attend AA now). I’ve dabbled in just about every chemical you can think of that will alter perception or make you FEEL something. I was always the guy that could rage with the best of them, get straight As, hold down a job, participate in sports/clubs, and keep on kickin’. And I did it on 6 hours of sleep or less, guaranteed. In my head I always sort of felt that I was just \~built different\~, and I suppose that in one very particular way I am (for better or for worse).

I’ve always struggled with mild depression and anxiety and for years in my late-teens/early-20s I relished in those feelings. I felt like being sad, anxious, and staring into the abyss while it stared back was a part of the human experience that we should soak up just like any other emotion, maybe even more-so. I thought it made me stronger.

Everything really started to change when I met my now-wife back in 2019. I was a first-year medical student thinking about dropping out. One of my best friends from college had just died tragically. I was SAD, but for the first time really trying hard not to be. She saw me for who I was, understood me, and accepted me — warts and all.

Together we learned how to communicate in ways that worked for us, and slowly but surely med school came and went, residency flashed by, and I was happy. She held me accountable (and continues to do so) in a way that has always come from a place of love since day 1. It sounds cheesy, but she really does make me want to be a better man (sir, a second Jack Nicholson-adjacent reference has hit the post).

She helped me work towards sobriety from alcohol, grow as a person, and develop into the kind of person that is worthy of being with her. She is my reason for being, and the literal reason I’m alive to share this story with y’all.

I saw a post recently on Instagram with the caption:

“Anything can be an altar if you approach it with devotion.”

That is what marriage has become to me. In a way I think that aside from sharing my experience, processing these big feelings I have, and making myself available to others going through similar experiences that this is a way for me to approach her with devotion. She doesn’t know that I’m writing this blog, and I’m not sure if or when I’ll tell her.

There are a lot of details that I’ll share here that we are still working through as a team (read: attending couples’ counseling to strengthen the ship against future storms), and maybe letting it all out will help me organize my thoughts and share them with her in an appropriate setting when the time is right. What I do know is that she saved my life, and continues to do so on the daily. So if you ever read this queen: this one goes out to you, you’re a fuckin’ real one.

This is the first of a series of posts I plan on making on Substack, linked here:

https://open.substack.com/pub/bipolar2md/p/serving-my-nickel?r=krme&utm\\\_medium=ios

If you’re interested in following along as I delve into the intersection of practicing medicine and mental health/substance abuse, physician burnout/moral injury, and the transition from resident to attending with all of its complications — shoot me a follow.

Am I totally off-base here?