my coworker gets mad when I follow my boss’s instructions

A reader writes:

I am a receptionist at a radiology clinic. Our sonographers (the techs who do ultrasound) get a bonus every time they do three ultrasounds in an hour. One of our sonographers, Meg, prefers to spend more time with patients so only does two an hour, and seems to be supported in this. I see my grandboss, Victor, sometimes tampering with her appointment times but he’s never given me hassle when I’ve changed them back, and he’s mentioned being reluctant to overwork her before. Because of this, this sonographer is more than happy to do urgent scans when they come, and even does walk-ins on occasion. She knows her limits, moderates her workload, and she takes on extra work when required because of that.

The senior sonographer, Piper, is a different story. She wants the bonus, so I’m instructed to pack her schedule in.

This is not a problem until urgent cases come in and throw the whole schedule out of whack. Piper flat out refuses to do them unless they’re referred by specific doctors, claiming we have no obligation to do them otherwise; Victor disagrees and tells me to schedule them in and tell her “call Victor” if she has a problem with it.

The problem is, Piper knows he won’t budge, so she doesn’t bother; she just leans on me instead. She doesn’t accept “call Victor” as an answer. Other coworkers have even stepped up and told her to lay off me, that it was his call, but she’ll continue staying mad at me for it and demands to know when she’s expected to take breaks, how she’s supposed to keep up, etc., from me and will not bring it up with him. I’m certain that she’s choosing me as a target on purpose.

Victor just keeps saying, “Tell her to call me.” He has said she gets paid a shit-ton of money and if she wants a lighter workload they’ll have to readjust compensation accordingly.

If Piper is burning out, I don’t want to contribute to that, but I can’t go against Victor either. At the same time, urgent patients being turned away is horrifying, and putting them through and delaying less urgent patients is part of the job. And Victor needs to give me better tools to deal with her other than telling her to call him, because she won’t do that, she’ll just keep coming down on me instead. (I look like someone who’s fresh out of school and am learning to stand up for myself; I’m pretty sure she’s taking advantage of that.)

Until I figure a way around this, I’ve been reserving slots especially for urgent cases to keep Piper off my back, but I’m expecting Victor to get rid of them when he sees them.

Not sure if it’s relevant, but I also want to note that while I haven’t worked with both of them long (two months). Victor seems to be a bit of a people pleaser, so it stands out to me that he’s dying on this hill because he’s normally the kind of person who’s very reluctant to say no.

Do you have any suggestions/scripts for how to handle this?

Three things:

1. When Piper complains but refuses to call Victor, call him yourself. Say to Piper, “Victor was really clear that he wants to be looped in when this happens, so I’m going to call him and can put you on with him.” Then do it.

2. Talk to Victor again. Say this: “You’ve told me to tell Piper to call you when she’s complaining about having to take urgent appointments, but every time she refuses and just keeps leaning on me, insisting that I change the schedule and then is hostile toward me afterward. Since just telling her to call you isn’t working, can you talk to her about you want her to handle urgent appointments? Otherwise she’s going to keep pushing back on me every time it happens.” If he again tells you to have her call him, say, “I do and she refuses, so what’s our next step?”

3. Decide you don’t care if Piper is upset. If she seems mad, say, “I can’t ignore instructions Victor gave me. You should raise this with him if you want me to handle it differently.” If she’s still snippy, ignore it (but keep looping Victor in — as in, “Piper got angry again today when X happened but refused to call so I’m looping you in”).

I know you said that if Piper is burning out, you don’t want to be contributing to that — but you’re right that you can’t unilaterally ignore instructions from your boss’s boss. If Piper has concerns about her workload, she needs to address it with management above her (and, if that doesn’t work, decide if she wants the job under these circumstances or not). It’s not okay for her to be hostile to you for doing your job in lieu of the more practical actions she should be taking. And if she is trying to manipulate you because you look young and/or she can tell you have trouble standing up for yourself, that makes it even worse. Piper is not without options; being a jerk to someone without a lot of power shouldn’t be on the table.

{ 299 comments… read them below }

  1. t-vex*

    Call Victor, say Piper wants to talk to you! and hand her the phone. I bet you’ll only have to do it once.

    1. goddessoftransitory*

      Yes! The LW needs to take herself out of this loop; both Victor and Piper are using her as a convenient rest stop for complaints.

      1. Mrs. Pommeroy*

        Both Victor and Piper should communicate directly but instead put the LW in as a sort of buffer. Which is convenient to them because this way neither of them has to change anything.

      2. Some Words*

        “I’m not an owl!” Hermione Granger, when Ron Weasley and Harry Potter refused to communicate directly.

        1. Elizabeth West*

          I hate that a disgusting transphobe wrote such a perfect example of this, but it really does fit.

      3. rebelwithmouseyhair*

        More like a buffer, she’s in the middle and they are each bashing her from either side.

    2. Alisaurus*

      This! I’d put him on speed-dial if I could for this specific reason.

      If she starts in on you, just say, “Piper, hold on just a moment,” and then call him. Or, better yet, I wouldn’t say anything. The minute she started yelling about it, I’d just deadpan pick up the phone and hit the right button while she’s launching into whatever lecture she has.

      1. Goldenrod*

        “The minute she started yelling about it, I’d just deadpan pick up the phone and hit the right button while she’s launching into whatever lecture she has.”


    3. Capybara Manager*

      This is the way. Victor’s continuing to say “Have Piper call me” because he knows she won’t, and Piper’s continuing to not call Victor because she’s getting some type of psychological reward out of bullying LW instead. The only way out of the middle for LW is to make the connection and then step away from it.

      1. Alisaurus*

        Not sure if it’s a psychological reward so much as just the easy option. LW is right there for Piper to bully into changing the schedule. LW sets the schedule and is on-site/in front of Piper vs Victor who is in his office/at another location/etc. It’s quicker and easier to Piper to take this up with LW – I guess similar in a way to “a bird in the hand is worth two in the bush.” Why bother taking the extra steps to call Victor and talk it out with him when LW is RIGHT THERE and (as Piper sees it) can change the schedule with enough “persuasion.”

        1. I went to school with only 1 Jennifer*

          That *is* a psychological reward. Piper is angry and gets to direct that at the person right in front of her, right now. (The other option is to take her anger to their mutual boss, who she knows would shut her complaints down.)

        2. RadReceptionist*

          I’m pretty sure this is it. Piper knows that while I don’t have the authority, I do have the *power*, and she knows it’s easier to get me to do something than to get Victor to do it. Easier to badger someone who’s right there than call up someone who might not even be available to pick up the phone.

          The trick is changing things so it’s actually *more* effort for her to bug me than him, but I grew up as a highly sensitive doormat so while I’ve gotten better at the initial “no”, it’s hard for me to actually endure it when she drags it out. That’s not to say I’ve given in and turned patients away, but I’ve definitely made compromises in other areas where I shouldn’t in order to appease her, and I shouldn’t be doing that.

          1. Just me*

            “The trick is changing things so it’s actually *more* effort for her to bug me than him”

            Yes! Yes, exactly!

            Now, executing your vision is not easy for you, and that’s fair. You learned over and over as you grew up — a huge and formative chunk of your life — that you should do the opposite of what you need to do now.

            But that’s why I’m so excited that you know what you need to do! You’ve already dismantled a bunch of the old patterns in your brain! That shows such strength! You’ve got this. I’m cheering you on.

          2. Caroline*

            What a horrible situation. Next time it happens and she refuses to call Victor, hold up your hand – literally hold it up – and say ”Piper. We have been through this many times. I will not be engaging further. I can call Victor or you can. Which would you prefer?” If she carries on rattling on, ”again, which of those two options would you prefer? There are no other options and I will not continue to entertain this. Our boss has made a decision and issued an instruction. If you don’t like it, take it up with him.”

            Then stare at her.

            1. rebelwithmouseyhair*

              I’d maybe just call Victor in case Piper just walks off airily repeating what she wants me to do.

          3. Capybara Manager*

            I feel this self-description so hard!!

            It sounds like you’ve problem-solved this in your brain, but knowing what you need to do is one thing, and actually doing it is way harder. Would it help at all to imagine what Piper is saying as the “wah-wah-wah” noise that adults make in Charlie Brown cartoons, while you auto-dial Victor and hold out the phone to her?

          4. Andie Begins*

            I know in these sorts of situations it helps me to reframe the issue – Piper is giving you a hard time for *doing your job* because she doesn’t want to do *her* job [as it has been detailed by management]. That would piss me off! And when I’m pissed off that someone is being wildly unreasonable at me, it’s much easier to hold the line. (And if they are unreasonable enough, I can actually get some petty pleasure from not caving just because they’ve decided to throw a tantrum at me. It’s easier to see the pressure as pathetic instead of distressing.)

            Maybe I’m just petty, but I too tend towards the highly sensitive doormat end of things and I think it could help!

            1. SopranoH*

              This is spot on. I’ve worked in jobs where the expectation is that several people will push boundaries and be disrespectful. I’ve been called every name in the book. It got kind of fun at one point to sit and look at them with an unperturbed smile while they were cursing at me then say no again and walk away.

      1. Not Me*

        It seems petty, but I would want to report Piper to HR for harrasment and go over boss’s head if somebody’s over him.

        But first, I would try the calling Victor first, maybe twice. Then HR.

    4. Squirrel*

      This would work in an office environment but not in healthcare, healthcare just has a completely different culture to office work.

      1. Sara*

        Maybe Maggie from the reboot?

        But also Piper would never act like this. Prue would refuse to talk to Victor though.

      2. Myrin*

        Yeah, Meg was who threw me off and made me think I might be wrong (I almost never get naming references so it wouldn’t be the first time).

          1. ThatGirl*

            yep – Victor is Piper’s father, actually, in the original version. Still not sure if Meg is a reference (I haven’t watched the reboot). Just a fun change from The Office or Game of Thrones.

          2. Ask a Manager* Post author

            Huh. I picked the names (there weren’t any in the letter and I thought they were needed for clarity) but I’ve never seen Charmed and had no idea it would sound like that; I just picked them randomly.

    1. RadReceptionist*

      I googled “victor piper meg” to see what this was in reference to and got results about “Victor’s secret romance with Piper” and now I want to pour bleach into my eyes.

  2. Pool Noodle Barnacle Pen0s*

    “demands to know when she’s expected to take breaks, how she’s supposed to keep up, etc.”

    -Your breaks and your schedule are not my problem, Piper. If you need help balancing your workload, talk to your boss. Here, let me call him for you right now so you can resolve this.- She’ll either walk away or talk to him, either way, it addresses the issue in the moment.

    Also, this work distribution system doesn’t make much sense to me. If Meg’s schedule stays more open, and she ends up being able to take more urgent walk-ins, shouldn’t that be helping to balance things? Or is everyone expected to rotate and take the same number of urgent jobs?

    1. Alton Brown's Evil Twin*

      “pack my schedule so I can get a bonus”
      “when am I expected to take breaks?!?”
      medical office that deals with emergency cases

      Pick 2 out of 3

      1. WellRed*

        I’m so confused! She wants a bonus but then doesn’t want patients?? Do urgent cases not count?

        1. JR*

          I think the issue is that urgent cases throw off the schedule enough that she ends up with fewer patients total, and therefore less of a bonus.

          Or maybe it’s that doing 3 in an hour is sustainable for her, but doing 4 in an hour isn’t, and that’s what has to be done when you already have 3 and then an urgent case shows up.

          1. mlem*

            Or that if you pack your, say, 8-hour schedule with 24 (or more) patients, but you’re then assigned 2 urgent cases to wedge in, you end up staying more than 8 hours to finish everybody up, with some of the non-urgent cases running late. My suspicion is that Piper wants both the maximum churn during scheduled hours but not to exceed scheduled hours; but this isn’t a job that allows for that.

            1. SHEILA, the co-host*

              This was how I read it. She wants max numbers during scheduled hours, but also wants her breaks and lunch and to leave “on time.” But if an urgent case then gets added, she now either has to have it cut into break or leave later, because she’s already full to the max.

            2. RadReceptionist*

              She’s also tried to pressure me to not schedule the last half hour of the day because “I don’t like driving home when it’s getting dark.”

              1. Caroline*

                ”Again, Piper, I need you to talk through these scheduling requests with Victor, because I am not in a position to do what you want me to do and am no longer engaging in these conversations. You are not going to get what you want.”

              2. Zarniwoop*

                Elsewhere LW says of Piper “in her late sixties or early seventies.” Given common effects of aging on eyesight I think she’s asking for a reasonable accommodation.

                But she’s asking the wrong person. Forward her request to Victor and HR.

                1. Zarniwoop*

                  To: Victor; HR
                  Cc: Piper
                  Re: Piper’s schedule and night driving
                  Piper has asked me not to schedule her for the last half hour of her shift due to desire to avoid driving in the dark. This sounds like a reasonable request to me but it’s outside the scope of my the authority. Would someone with the authority to address this issue please do so?

                  Thanks in advance, RadReceptionist

          2. wordswords*

            Yeah, that was my read. Maybe urgent cases take longer, but either way, Piper wants her schedule packed as a baseline so she can get the bonus, but that means there’s no flex room for adding in an urgent patient, and she also doesn’t want to stay late or make whatever other compromises are necessary to fit in extras on top of the packed schedule. Presumably she wants Meg to take them all, but that doesn’t necessarily make sense with scheduling (and isn’t necessarily fair to Meg, but that depends on more factors we don’t know about).

        2. Jane Bingley*

          I suspect urgent ultrasounds are often more complicated than routinely scheduled ones. I’ve had both on various body parts and routine ones generally know exactly what they’re looking for and where, whereas urgent ultrasounds can be more of a search and find adventure.

          1. Phony Genius*

            Yes, I agree. Plus, if it’s a scheduled ultrasound, the paperwork has probably been filled out ahead of time and the procedure room and equipment are already prepped for that specific patient. For an urgent case, these things have to be done on the spot, which takes time.

          2. Kevin Sours*

            Maybe. It mostly sounds like Piper is packing her schedule to the point where there simply isn’t any slack to deal with any additional work. Which is a normal occurrence. And she wants to make that somebody else’s problem.

        3. Kevin Sours*

          Basically Piper wants to pack her schedule to the gills in order to maximize her bonus but doesn’t want to deal with the consequences of that. Namely when urgent cases come in she doesn’t have any slack to deal with them so she has to scramble/skip breaks/stay late to handle the overall load.

          It sounds like a combination of the bonus schedule creating perverse incentives and management refusing to take an active role dealing with scheduling difficulties. But it is emphatically not OPs job to solve this.

          1. Armchair Analyst*

            agreed that the complaining employee is one problem

            and yes the incentive program which only works on the employee who complains, anyway, and doesn’t motivate the other employee, is another problem

            1. rebelwithmouseyhair*

              Yes. The other employee is probably providing a much better level of care, because she’s providing quality over quantity. Piper is providing quantity over quality, which worries me.
              But then I don’t run a clinic and I’m looking from a patient point of view rather than “we have a business to run here”.

    2. Liz the Snackbrarian*

      I’m guessing it could get tricky if one of them is out or they happen to get a lot of urgent cases? It seems like everyone taking the same number of urgent jobs would be a good idea but I’m not knowledgeable out this field. Piper sounds like a pain.

    3. Samwise*

      Probably because urgent cases don’t distribute themselves tidily so that Piper never has to do them. Maybe Meg is out. Maybe Meg is already working with an urgent patient.

    4. Sunflower*

      Agree, it seems like you should be able to just yes-and her complaints. “ When am I supposed to take my break?” “Great question, let’s call Victor and confirm what he wants to do!”

  3. Magenta Sky*

    Piper isn’t the problem. Victor is the problem. He needs to mange his employee, not shift his job onto someone who doesn’t have the authority to do it for him – you.

    1. Samwise*

      But Victor DID manage his employee — he told the OP to refer Piper to him. Victor probably can’t just stand around the reception desk waiting for urgent cases to come in and Piper to get snippy. He may not even be in the same location.

      Alison’s suggestions help the OP reinforce Victor’s directions, and give OP a way to bring Victor in when Piper won’t comply.

      Piper is the problem.

      1. NeedRain*

        they can both be problems and they are, you don’t have to pick one. An employee trying to micromanage their own scheduling at the expense of other employees is a problem. A supervisor who expects another employee to deal with it and hasn’t addressed the problem employee directly themselves is also a problem.

        1. StressedButOkay*

          Both, both are good. Victor needs to have an actual sit down meeting with Piper regarding his expectations – and he needs to tell her to back off of OP. Piper’s attitude towards OP and ignoring Victor’s ‘tell her to call me’ is also a huge issue. But one that Victor also needs to manage as well.

          OP, there are a lot of good advice here on what to say to Piper and do but, ultimately, Victor needs to step up and step in.

      2. Lady_blerd*

        Magenta Sky’s point is that Victor should to more than just tell OP to tell Piper to contact him. Victor should having having a frank discussion with Piper to remind her of how the schedules are processed. It would seem that no matter how often OP tells him about the situation, he hasn’t told Piper to stop bugging OP about it. So at the very least, this is both a Victor and a Piper problem.

        1. NotAnotherManager!*

          This is what needs to happen. Victor already knows that Piper is pushing back on OP rather than him. He needs to get OP out of the middle and have a direct conversation with Piper himself. That doesn’t require his standing out at the desk waiting for an incident, it’s a scheduled meeting whereby the discuss their respective positions and come to an agreement, even if that agreement is that Victor is the boss and Piper needs to do what he asks.

      3. BoxBreaker*

        I agree that Piper is the primary problem. But Victor is also a problem because he’s throwing OP in the middle rather than dealing directly and proactively with Piper.

        This should not be a “have her call me if there’s a problem”. This should be, “Piper, come see me in my office now so we can deal with this.” And then maybe – MAYBE – after Victor and Piper are on the same page, it might then become “call me if there’s an urgent patient and you need help adjusting”.

      4. Kevin Sours*

        “But Victor DID manage his employee — he told the OP to refer Piper to him. ”
        Management doesn’t and can’t stop there. Piper isn’t following that directive and Victor isn’t managing that. That’s on him. Piper is “a” problem, but Victor’s refusal do deal with it is *the* problem.

    2. NaN*

      Also sounds like this bonus structure is the problem. It’s incentivizing some questionable behavior.

      1. NeedRain*

        THISSSSSSSS. I do not want to be getting an urgent medical test from someone who’s more concerned with hurrying up to get their bonus than with doing a good job.

          1. southern ladybug*

            Because healthcare is a business in the US. The bottom line is $, not quality of care or health outcomes.

              1. ThatGirl*

                It’s true that money talks, although patient satisfaction and health outcomes DO matter – it’s not quite so cut and dry as “quality doesn’t matter at all”.

                1. Your local password resetter*

                  Depends on if those patients are coming back for more healthcare, and if they have other options available.

      2. goddessoftransitory*

        I hoped someone would mention this! That bonus structure sounds like code for “get ’em in and out as fast as possible” and that’s not a good policy for prenatal care!

        1. Alisaurus*

          Or any care! You can get ultrasounds for more than just prenatal reasons.
          (But this is the problem with healthcare currently… much of it has become all about the money in how it’s processed (e.g., insurance).)

          1. TeratomasAreWeird*

            I had a rather alarming experience where I went in for a diagnostic ultrasound, and halfway through the tech asked me how far along I was in my pregnancy.

            Me: “What?…I’m not pregnant.”
            Tech: “Oh. Hmm. No, you’re right, the uterus is down there.”
            Me: “?!?”

            On the bright side, the large ovarian tumor they found was benign.

        2. Resident Catholicville, U.S.A.*

          There are a lot of other reasons to get scans than prenatal care. I had one on my liver two years ago.

          1. Endorable*

            I got one on my liver, and serendipitously they discovered a giant ovarian cyst that’s roughly the size of a full term baby! Thank god it’s NOT cancer, but now I know why I have such a big belly compared to the rest of me! Now I have to ‘wait’ for surgery… grrr… Anyway I’m starting to think that ultrasound is a seriously underutilized test, and I’m REALLY mad at my old doctor who just dismissed everything as fat!

            1. TeratomasAreWeird*

              My benign ovarian tumor was 8lbs before they found it! *high-fives*

              I also spent 2 years struggling with constipation, incessant nausea and inexplicable weight gain before anyone did an ultrasound.

              Could be worse, though. My gynecologist once removed a 50lb benign ovarian tumor.

          2. NeedRain*

            I had one on my thumb earlier this year. (I’ve also had a million ultrasounds on my uterus that had nothing to do with prenatal anything, I’ve never been pregnant.)

          3. ThatGirl*

            I had an ultrasound on my breast last year to rule out cancer (it was a teeny tiny cyst that the mammogram only picked up as “possibly suspicious”)

          4. RadReceptionist*

            The majority of our scans aren’t prenatal. Ultrasound is basically the go to test for muscular injury!

        3. NothingIsLittle*

          Hate to be a pile on, but I literally had an ultrasound yesterday for my ovarian cysts. I felt very relieved to just be in and out as fast as possible, because that feels like it’s less likely my scan was abnormal! The difference is that my sonographer also had good bedside manner. I think as long as the sonographers aren’t compromising patient comfort, “as fast as possible” for diagnostic ultrasounds is probably a good thing.

        4. Capybara Manager*

          It isn’t, but it’s also not a good policy for any of the many, many other things ultrasound is used for.

          I had some ultrasounds during pregnancy, but those were maybe 10 of the probably 100+ ultrasound exams I’ve had in my life — the rest were related to diagnosing and following up on ovarian tumours, plus one for a breast lump that turned out to be nothing. My daughter’s congenital inguinal hernias were diagnosed via U/S when she was a few weeks old, and my spouse just had a U/S exam of his liver last week.

        1. RadReceptionist*

          I think this is a great idea. Piper isn’t the only sonographer I’ve had to browbeat into taking urgent cases.

          1. RadReceptionist*

            Having said this I’ve absolutely met people who’d talk doctors into sending them “urgent” cases to get more money if they had the opportunity…

      3. Just Another Zebra*

        I didn’t want to say this, because it may be a bit derailing, but 100% this. Like, don’t rush through my ultrasound so you can get a few extra bucks in your paycheck. Patients should get the care they deserve (and, if they’re in the US, pay through the nose for).

      4. Nysee*

        Yep. Stop that bonus nonsense now and pay a decent wage.

        Urgent cases being turned away be because tech are trying to make a few extra dollars is horrifying.

        Wait until someone sues, or goes to social media to tell about their bad experience.

        1. SHEILA, the co-host*

          Victor’s probably not the only setting the policy – the US insurance companies are. If you want to be reimbursed the max amount, you have to get through a certain number of cases per day. Victor probably could restructure how he doles that out to his techs, but it’s the insurance companies that are driving this madness.

          1. RadReceptionist*

            We’re not in the US, I’m a bit confused as to what I said that everyone is assuming we are.

            1. Rosyglasses*

              Most people assume that LW are US based unless they specifically clarify in their letter that they are not. US seems to be the default here.

              1. RadReceptionist*

                The US isn’t “default”, people just assume it is because of US-centrism. The rest of the world doesn’t assume their country is the default.

                1. ..*

                  No, it’s because this is a site run by an American where the readership is something like 75% American, I think AAM has said. It would be like writing to a column in the Irish Times and then accusing readers of Irish-centrism for assuming they’re based in Ireland.

                2. birch*

                  The blog is authored by an American with expertise in American working life. That’s why people make the assumption.

                3. ...*

                  It’s an American site written by an American who’s writing about American work culture. AAM has been very clear that she can’t speak to norms or culture outside the US so of course readers assume an American context unless you say otherwise. It’s not about US-centrism.

                4. blue rose*

                  The internet may be global, but the site Ask a Manager is American, so yes, it does have that commonality with a newspaper. It’s published by an American, and mostly written from an American perspective. Alison is very familiar with the American workplace, and can advise on that. She’s also knowledgeable about what makes a functional workplace, and advises on that, too, but she’s less familiar with the legalities outside the US, so she speaks less authoritatively there than she does about the US.

                  Sometimes letter writers will say “Such-and-such is going on at my work, can they do that?” and Alison will reply with “In the US, here’s how it would play out.” Sometimes she can speak to rules and regs in other places, but the US context is her area of expertise.

            2. Juggling Plunger*

              It’s because the system that you’re describing sounds a lot like American health care, and a lot of Americans assume that we’re the only place that operates in such a screwed up way. There’s also the US-centered bias to the site, but I bet a lot of it is because what you’re describing is so typical of American for-profit ;or non-profits acting like for-profit) health care.

            3. Capybara Manager*

              I’m not in the US either but I’ve discovered over time that a large majority of AAM commenters are. I once asked why anyone would have an OBGYN appointment if they weren’t pregnant, which is how I discovered that in the US, women / AFAB people go to an OBGYN for things like Pap tests and routine physical exams that in Canada you see your family doctor for.

      5. bk*

        Bingo, not only is it horrifying on a personal level that someone is incentivized to rush you through this procedure, but right in front of OP is a literal example of how this policy is causing problems.

        1. RadReceptionist*

          Yep. Every time Victor compliments a doctor for being “very efficient” with their patients I make a mental note to never, ever see that doctor.

          I’d also never let Piper do an ultrasound of mine unless I couldn’t get Meg.

          1. Zarniwoop*

            Elsewhere you say of Piper “The woman’s a god damn wizard and I’ve never once had a complaint about her missing anything.

            She also uses a physical calculator because she doesn’t like the one in the software and she has no bedside manner, but you win some you lose some, I guess.”

            If I had to choose I think I’d prioritize “Never misses anything” over bedside manner and go with Piper.

      6. RadReceptionist*

        Personally I’d only see Meg because of this. The other sonos are often stressed because of the workload, but Meg’s insistence on taking her time makes her really good with patients in a way the others don’t match.

        1. RadReceptionist*

          Meg is the only sono the patients frequently compliment and it’s absolutely because of this. She paces herself, has good bedside manner and really takes the time to set them at ease. The other sonos just have a revolving door.

    3. Richard*

      I had the same feeling. I’ve known a lot of people in scheduling/reception getting hassled by coworkers about the schedule and then bosses are hands-off about it. He’s basically offloading one of the most annoying parts of managing people onto someone who probably makes 1/2 of what he makes. He may need to be annoyingly pinged into doing something about it, but he might be lazy and just take it out on OP.

  4. Swampwitch*

    I love her response and another good one is “please don’t put me in the middle, work it out professionally between the two of you.”

    1. Sunflower*

      Or even better, “ I won’t get in the middle” rather than “ please don’t put me in the middle”. You’re telling her, you’re not asking her.

      1. Not Tom, Just Petty*

        Oh, you mean what Victor did? Not criticizing you or your comment, just jumping in to say, Victor knows Piper won’t call him. Victor know Piper won’t do or say anything to him. He’s abdicated his responsibility, because he is a jerk.

        1. Not Me*

          Thank you! I feel the same way. I am petty enough that I would stop packing her schedule and balance all ultrasounds betwen the two of them, no mtter what they prefer. Actually even pettier, every time she yelled at me about it, I’d schedule 2 to 1 against her.

          1. Not Tom, Just Petty*

            Not Me, You ARE me. I’d stop trying to customize the schedule.
            1 for Meg, 1 for Piper. 1 for Meg, 1 for Piper.
            No more, 1 for Meg, next three Piper. Sorry. You blew it.

  5. AnotherLibrarian*

    If your boss, Victor, is reasonable (and it sounds like he is) than I would 100% second doing what Alison suggests regarding calling him on the spot. You have every right to do that and he should back you. I know it’s super hard to get over the “but I don’t want anyone mad at me” thing, but you can’t control how other people feel or act. You can only control how you act. I’d also add Piper is an adult and if she doesn’t want to burn out than she can make different choices. Deciding to bully and be unkind to you is not okay and you shouldn’t have to put up with it. Your boss is trying to let you rely on them to help you, so please do so. It sounds like you have a decent boss. Let him help. As a boss myself, I would want you to call me.

    1. AngryOctopus*

      And if you call Victor whenever Piper acts up (regardless of if she stays around to talk or not) then I’m guessing it’s only going to take a day or two of calls before Victor is onsite laying down the law to Piper, because now the time for the calls is affecting him personally. Piper knows what he’ll say so she doesn’t want to talk to him–by calling anyway, you’re forcing the issue in a way that hopefully ends with Piper not taking it out on you anymore. Good luck!

    2. Not Tom, Just Petty*

      I would have said that Victor is reasonable up to the point where he said, have Piper call me. Maybe he should boss a little more bossily to Piper.
      “I tell her to call you. She refuses and is rude to me.”
      Victor throws up hands. “Whelp, howdy. You know Piper.”
      Victor can tell Piper to cut it out.

    3. somehow*

      ” It sounds like you have a decent boss. Let him help. As a boss myself, I would want you to call me.”

      …which LW has done ad nauseum, and it isn’t working. I don’t see how Victor is “decent” by continuously pawning his responsibility onto the LW.

  6. Ray Gillette*

    It sounds like the bonus is intended as additional compensation for busy times when the technicians have to do additional work, but Piper has decided she wants it all the time, as her baseline. As a result, she has no additional breathing room to take on additional work. This is why our base salary isn’t (or shouldn’t be, in a healthy workplace) compensation for working at 100% capacity all the time. If Piper set her baseline work schedule at 80% capacity, she’d be able to handle the emergency appointments. So, if Piper gets burned out, that’s not your problem.

    1. Ginger Cat Lady*

      Yes, this is an example of how a bonus program can cause more problems than it solves.

      1. Lizzie Borden*

        As a healthcare provider, I have seen that if there is not an incentive system in place, many outpatient radiology techs are not motivated to be efficient. Which means that patients are kept waiting, and the support staff has to manage upset patients and stay late.

        1. Not Tom, Just Petty*

          That is a thing?
          “If health care providers are not given an opportunity to earn bonus money over their salary for meeting the general requirements of the job, they will not do their jobs to the best of their ability. They will make patients suffer and leave support staff to do damage control.”

          1. Lizzie Borden*

            It is something that I see in allied health professions that do not have ultimate responsibility for the health and well-being of our patients. There is very much a mentality of “it is my break time. No, I cannot see an urgent patient before I get a coffee.”

            1. Jackalope*

              So if the patient’s life is in danger then that means dropping what you’re doing if you’re the respondent who helps people in that situation. But most of the time ultrasounds aren’t going to be such an emergency (especially given that the OP said above that they use them to detect issues with your muscle systems) that the patient can’t wait for someone to finish their break. Health care workers are human, and are burning out at a staggering rate. I would HOPE that their norm is to take their actual breaks and drink as much coffee as they need to be able to handle patient urgencies. Every patient should be treated with courtesy and respect, but while for the patient it’s an emergency, for the health care worker it’s a Tuesday. They can’t be in high alert ALL the time.

            2. Ace in the Hole*

              How often do they have patients that actually NEED a sonogram within 30 minutes? “Urgent” and “emergency” are not at all the same thing. Someone should not have to interrupt their breaks to deal with urgent issues. An interrupted break – or even a break that you expect to get interrupted! – is not really a break at all.

              It’s fair to expect some flexibility in timing of breaks, but my experience with many employers is that the boss expects an unreasonable amount of flexibility… moving a break 20 minutes later is reasonable, moving it 2 hours later is not, and I’ve seen supervisors say it’ll just be 20 minutes but then keep pushing it back until the employee misses their break entirely. Once someone’s had this happen a few times, they understandably lose trust in their supervisor and become more rigid about times to avoid being yanked around.

              Emergencies are different. If there is a real life-threatening emergency, that does warrant interrupting a break. But this should not happen often! If it’s happening more than once in a blue moon, the employer needs to increase staffing so there’s adequate coverage for break times.

            3. Grim*

              It’s one of those boiling a frog situations. “You should deprioritise your break in favour of seeing to an urgent patient. No, just one more, I promise.” sounds reasonable until you’re skipping your break every day because there’s always something else that you could be doing instead. There’s *always* an urgent patient, especially if you work in a high acuity area like emergency. But people need and deserve to be taking the breaks that they are entitled to as a condition of their employment. And the world is not going to end just because the allied health staff slips out to get a coffee.

        2. Ginger Cat Lady*

          People can be managed without incentives. Decent pay, clear expectations, and letting go techs who don’t work efficiently.

          1. RadReceptionist*

            Staffing is a huge issue here. We’re still trying to replace a sono that left two months ago, and she would have been fired in any other industry because she was egregiously late to work every single day. In healthcare they don’t let you go unless they have a gun to their head.

            I don’t know how much Piper earns, but it’s been hinted to me that she’s paid the most out of all the people I immediately work with. If she wanted a new job she could walk out of here, walk into a competitor down the street and immediately snap one up.

            Not saying the bonus system isn’t fucked up. It is, and I’d never want to see someone like Piper because of it. But when there’s a staff shortage, if they don’t want to stay, there’s very little you can do. Not short of selling your soul to them. I don’t know how we can afford to give free healthcare tbh because none of our competitors can any more.

        3. Hastily Blessed Fritos*

          As a patient I’m fine with being kept waiting if the alternative is that they’re rushing through critical medical tests and potentially missing something serious.

        4. RadReceptionist*


          We’re publicly funded and we have trouble hiring and retaining staff. We’re also the only company I know that provides these scans for free. The bonus system is fucked up but all our execs are former HCW themselves who are trying to keep things free because all our competitors either closed their doors or started charging.

          I think the bonus system was put in out of desperation, tbh. If a tech walks it takes months to find someone to replace them. I don’t know how we’re even able to do this for free, nobody else is.

  7. daffodil*

    Who is instructing OP to pack Piper’s schedule? Piper or Victor? I think reserving a few slots for urgent cases is a totally reasonable way to address this issue.

    1. Momma Bear*

      I agree. If one way or another you need space for urgent cases, set that aside. A lot of businesses do that so they can handle an emergency or urgent but not actively in crisis case.

      But other than that, return this to Victor. Piper doesn’t get to shove you around because of choices she made.

      1. Sunflower*

        I would even say that clinic wide each provider should have a slot or two per day for urgent scheduling. Or a coverage system that denotes who’s going to put holds on their schedule that day for urgents and rotates. Your clinic needs to plan for urgents and take responsibility for them as a group.

      1. Weaponized Pumpkin*

        Definitely Piper is. But it threw me a little when the OP said sometimes Victor messes with Meg’s schedule…which tells me he seeks schedule-packing even if he walks it back verbally.

    2. MicroManagered*

      Yeah I was surprised not to see this addressed. The obvious answer here is that Piper needs fewer scheduled appointments so that she can handle urgent ones when they come in. She can’t just pick the work she likes, or only have all bonus-eligible work, etc.

      She also needs someone (Victor) to clarify her job expectations for her, including that urgent requests must be processed and not only accepting “certain” doctors’ requests, etc. God imagine needing an urgent ultrasound and THIS is going on behind the scenes!

        1. MicroManagered*

          I think it was a missed opportunity to write back and ask “who instructs you to pack Piper’s schedule” because if it’s Piper, stop doing it. If it’s Victor, talk to him about tweaking that. The fact that Piper’s schedule is so packed with scheduled appointments that she’s unable to handle walk-ins and is now under the mistaken impression that she it’s not her job to do them, is the problem.

    3. RadReceptionist*

      I tried that as a compromise. Boss got rid of one (not Victor) but let me keep the other.

      Urgent slots got discarded entirely when I used it and she STILL argued about doing it.

  8. Alex*

    I’m kind of horrified (although not surprised) that healthcare workers get a bonus to rush through what could be a life or death test for a patient.

    I think the bonus is what is causing this–Piper wants her schedule to be at the bonus level, no more (or else she feels overworked), no less (or else she doesn’t get her bonus). Meg is OK taking less money sometimes so that urgent patient care can be figured in when needed. What if they were paid the same regardless of how many patients they see, and if they more slowly than the boss thinks is reasonable, that is just seen as a performance issue? Wouldn’t that take the pressure off considerably?

    Of course, OP has no power over that I’m sure so I’m not sure my comment is much help, just that, Victor or whoever made this policy is causing this unnecessary problem.

    1. Jennifer Strange*

      Yeah, that jumped out at me as well. When I was pregnant with my daughter* there were concerns about her having a two-vessel cord which required extra ultrasounds with a specialist. I’d hate to think that something important might have been missed because the tech was rushing to see more patients for a bonus.

      *daughter was born perfectly fine!

    2. SereneScientist*

      I agree with you, Alex. The pay structure here is incentivizing the wrong kind of behavior, at minimum.

      1. goddessoftransitory*

        Yeah, it’s definitely rewarding Piper’s way of doing things, but leaving no wiggle room for the known factor of “urgent patients get priority on the regular.”

    3. Alton Brown's Evil Twin*

      This is medical, so there’s also the issue of reimbursement rates.

      Victor’s costs = labor (which scales roughly with revenue) + fixed costs (amortized equipment, rent, utilities, etc.)
      Victor’s revenue = number of procedures x reimbursement rate

      If the fixed costs amortized over the # of procedures are significantly more than the bonus he’s handing out for 3 procedures/hour versus 2, then he’s going to run his business to squeeze in that extra appointment when he can. Sounds like he’s set the bonus rate with that math in mind.

    4. Awful*

      Yep. This is exactly how my BFF’s baby died a year ago yesterday. The sonographer missed something, that if seen, could have been confirmed with a simple test, and been treated. She was in a hurry and my friend was her last patient for the day. She blew off my friend’s concerns and three days later my friend woke up with the umbilical cord hanging out. The baby lived 24 hours after emergency delivery. This is horrifying.

      1. Gyne*

        I’m sorry for your friend, but what you have described is not something that could have been diagnosed on an ultrasound. I’m assuming you either changed all the details for anonymity or there is a whole lot left out here? (I’m an obgyn, who also reads and interprets ultrasounds, and have seen cord prolapse many times over the years.)

    5. WellRed*

      Here’s a suggestion: don’t incentivize the using of patients like we’re a bunch of commodities to rush through.

      1. Long Time Fan, First Time Caller*

        Hear, hear, to all this. And “Awful,” I am so, so sorry about your friend’s baby. <3

      2. Insert Clever Name Here*

        Seriously. I mean, I understand that it’s a business and that you have to get through patients because that is how you’re paid. My best friend is an OB/GYN and she talks a lot about the fine line between “taking time to be thorough, relational, and address all concerns” and “having to get through all these patients because it’s how I support my family.” She would be UTTERLY horrified at this type of bonus.

      3. Dover*

        Victor is just responding to the incentives he’s been given. It’s a systemic problem with the for-profit healthcare system in the US (I’m assuming).

        1. RadReceptionist*

          I’m not in the US. We’re publicly funded per scan and offer free scans. All our competitors started charging to survive and I don’t know how we haven’t failed yet.

    6. Shynosaur*

      Yep, I freaked the heck out when I read “they get a bonus for rushing patients through.” I had to get an ultrasound for the first time last year and the man who did it was so patient and kind, and the process was actually much slower than TV had prepared me for, so I had a really strong reaction of “holy crap, it would be so easy to miss something if you’re chasing Patient B out so you have time to get Patient C in before the top of the hour so you can buy that motorcycle you want…”

      1. Saddy Hour*

        A good sonographer makes so much difference. I’ve spent the last two years getting periodic ultrasounds, and they take a LONG time because I have a dozen (literally) fibroadenomas and an uncountable number of cysts. The sonographers have to match up every fibroadenoma and snap a similar picture to accurately compare size and confirm that nothing is growing at an unusual rate. My appointments take at least 35 min, sometimes more. I have no idea what Piper would do with me.

        1. TooFast*

          wait, what? are they even doing an ultrasound in that timeframe? I’ve had all sorts of ultrasounds on all sorts of body parts and I don’t think any of them lasted less than 45 min (and that doesn’t include the prep portions of the appt). Some have been well over an hour. 3-4 in an hour is insane.

          1. RadReceptionist*

            I’ve worked at another ultrasound company and 30 mins is standard for most scans. Were yours vascular? Those are the ones that tend to be a lot longer.

            1. The Rural Juror*

              When I had my thyroid scanned, I think I was there less than 20 minutes (even with checking in and getting situated in the room).

              I’m assuming some are quick and some need more time. I didn’t feel like the quality of care was degraded even when mine was quick.

          2. Seashell*

            I suspect it varies. I’ve had vaginal ultrasounds (prenatal and not), and they were probably 10 minutes if you count clean up time. I would have cried if there was 45 minutes of that thing in me.

            I have also had breast ultrasounds every time I get a mammogram for the past few years. Those seem to last an eternity, as I spend every second worrying that they’re looking closely because something is wrong, but it’s probably more like 15 minutes.

            1. RadReceptionist*

              Breast ultrasounds have high rates of litigation compared to the rest, so that’s probably why they’re extra careful on those.

          3. NothingIsLittle*

            I think my thyroid ultrasound a few years ago took 15 minutes? And I had a full right abdominal ultrasound yesterday that took around 30 minutes. Some parts of the body are just smaller and/or more easily imaged than others.

      2. goddessoftransitory*

        This is why that gross fad of home sonograms a few years ago was so dangerous (remember that Tom Cruise/Katie Holmes thing?) Sonograms are a medical test that need to be administered and interpreted by trained professionals. It’s not just a neat way to get a picture of your baby.

    7. Saddy Hour*

      Yes, this is a really bad policy. Even for Piper! She gets paid more but she’s going to stress through the first 2 appointments of the hour, every hour. Or she’s going to rush and neglect care for patients who need it, which is stressful for her and also obviously bad for the patients.

      I know this isn’t actionable advice for OP, but if she’s new to healthcare scheduling I do want to point out that this is a really weird setup. When I was scheduling, we were pushed to squeeze in as many appointments as we could, for sure, but the clinical staff didn’t formally have a say in it. They could ask for us to shuffle stuff around but they weren’t able to just…reject appointments. That’s ridiculous. And they definitely weren’t getting paid more for doing the appointments as scheduled.

    8. iccck*

      I agree – this is horrifying and I will be asking all my providers if they get a bonus for hurrying.

    9. Lilac*

      I came here to say the same thing. I know it’s not OP’s fault, but I’m frankly kind of appalled that medical professionals are being given an incentive to rush through their work. Good for Meg for doing what’s best for her patients even if it means leaving money on the table. (Although she shouldn’t have to choose between providing the best possible care or earning more money.)

    10. Sunshine*

      Sounds like the bonus should be set at something like two appointments per hour, like Meg is doing. The three per hour bonus rewards Piper for scheduling appointments at a frequency that is messing up the business. And Meg is doing the right thing, recognizing the overall needs of the patients and the business, and Meg is not getting the bonus. But Piper is.

      I feel like Meg deserves a bonus actually, for recognizing how the scheduling should go, and doing that, even though she won’t get a bonus for it.

    11. RadReceptionist*

      > I’m kind of horrified (although not surprised) that healthcare workers get a bonus to rush through what could be a life or death test for a patient.

      Radiologists (not to be confused with radiographers) also get paid per scan, so the faster they rush through a scan the more money they get. And they’re a lot more crucial and important than the actual sonographers, since they’re trained, specialised doctors. I knew a guy who was otherwise really good, but the one time he made a mistake the patient died. I also knew another guy who I swear had dementia and should not have been practicing at all and everyone rallied to protect him because “he’s so sweet.” He was being actively investigated last I heard.

      I lost a lot of faith in the healthcare system when I got my first healthcare job…

  9. Observer*

    OP, *nothing* reasonable you could do here would be contributing to Piper’s burnout. You’re being polite and professional; you are being transparent about what is happening; you are scheduling things in a reasonable way. It’s not clear that she really is dealing with burnout anyone. But even if it were, it’s not due to anything you are doing.

    And also, even if she were dealing with burnout and it were Victor’s fault, it would *still* be wrong of VIctoria to react like this. Leaning on you to disobey your boss’s (perfectly legal and reasonable) instructions is just utterly out of line.

    Alison is right – if she refuses to call Victor, call him yourself and hand her the phone.

  10. Juicebox Hero*

    Piper is A Problem, but only a symptom of The Real Problem, which is Victor being a weenie who isn’t doing his job. You were hired to perform receptionist duties like answering the phones, checking patients in and out, scheduling appointments – and in my opinion you’re already going above and beyond by scheduling to the preferences of both Meg and Piper.

    You weren’t hired to manage Piper’s temper, emotions, or spleen. Manging her is Victor’s job. But Victor isn’t doing his job by using you as the middleman in a situation he won’t deal with himself. Meanwhile, Piper knows darn well you don’t have any authority over her and there won’t be any real consequences for ripping into you, because Victor won’t do anything about it.

    In addition to kicking the problem right back up to Victor when she starts in on you, I’d advise you to start documenting Piper’s nastiness. She’s already being awful to to the point where your coworkers have told her to back off you, and she’s liable to blame you if she gets any kind of censure at all from your bosses. Document, document, document, and cover your ass in case this winds up escalating to HR or something.

    1. goddessoftransitory*

      And all those problems have their root in this scheduling/bonus setup. It prioritizes all the wrong things and almost guarantees a terrible mistake is coming down the pike, if it hasn’t already. I would bet Victor’s medical insurers would not be too happy to hear about the rushed packed schedule he’s so urgently advocating.

      I get how close to the bone clinics can run financially (My late dad ran his own practice for a while) and that Piper could genuinely need every single penny she earns for bills and student loans or whatever, but neither of them are going to come out well if a missed diagnosis results in a lawsuit that destroys the entire practice.

        1. Sacred Ground*

          I think goddessoftransitory was referring to your own malpractice insurance carrier, not patients’ health insurers.

          Rushing through diagnoses could increase your risk of a misdiagnosis and with it your risk of liability. I don’t know where you are but in the US malpractice insurance is a major expense for every healthcare provider. I guess a policy that raises liability risk would raise your premium or even lose your policy.

  11. Emily*

    “Piper, concerns about your workload and your breaks are not something I have any control over. You need to address that with Victor.”

    I also loved Alison’s scripts for talking to Piper and Victor. The next time Piper complains, but won’t call Victor, get Victor on the phone and hand it to Piper, but also Victor needs to have a more serious discussion with Piper instead of just saying “have her call me”, which does put OP in the middle, and I think Alison’s script of “I do and she refuses, so what’s the next step?” is a good one.

    I also have a people pleasing boss, and it is very frustrating because he tries to make me handle things he should be handling with a similar “tell them to talk to me”, but doesn’t do anything about it when they refuse to do that and keep bothering me. I do think Victor is the real problem here.

  12. Officious Intermeddler*

    Your friendly neighborhood health attorney has some problems with a probable bonus for volume arrangement as a violation of the Antikickback Statute, which is another way to say…contact a qui tam relator’s attorney and drop a dime on that workplace and get out.

    1. Three Cats in a Trenchcoat*

      I’m a little confused by this comment, its incredibly common to see bonuses for meeting productivity goals in RVU based systems.

      1. Officious Intermeddler*

        Physician productivity arrangements need to be crafted expressly fall under either an AKS safe harbor or Stark exception, in a contract, in writing, and subject to a compliance program. Again, I’d drop a dime. And furthermore, radiology is a designated health service under the Stark Law, which is a strict liability statute. This is something I’d be running away from.

          1. Lizzie Borden*

            Radiology technicians are not physicians and are not covered under anti-kickback or sunshine statutes.

            1. Jessie Spano*

              I don’t know about other places in the world, but in the US, it’s Technologist, not Technician. I’m not being nitpicky about word choice, there really is a difference between the 2 titles. Ultrasound Technologists in the US require formal education.

      2. Jaydee*

        But shouldn’t productivity take into account both quantity and quality? Like, if I make 10 widgets an hour but have a 20% error rate, I’m not actually more productive than my colleague who makes 8 widgets an hour with a 0% error rate. It seems like the number of patients seen could be one component of a bonus structure but there should also be other factors like satisfaction scores on patient surveys, patient wait times, timeliness of chart entries, etc. that help to measure the quality of the care received too.

        I understand the reality of appointment scheduling and that 20 minutes might be adequate for most ultrasounds. But I’m betting there are some appointments that take longer for a variety of reasons. I would hate to think that any medical provider is rushing through their time with me (or any other patient) to meet a quota and earn a bonus.

      3. Jaydee*

        Aso I just looked up RVU and it seems that involves weighting of different procedures based on the amount of time, skill, complexity involved. So productivity isn’t measured on a strictly per-patient basis. If you see 10 patients for simple procedures, that might count the same as seeing 5 patients for more complex procedures or 2 patients for highly complex procedures. That makes a lot more sense. The provider isn’t getting penalized for seeing fewer patients if those patients have more complicated needs.

    2. Ominous Adversary*

      I’m sure there are also some friendly neighborhood medical malpractice attorneys who would be interested to hear about this bonus structure.

    3. RadReceptionist*

      I don’t know why you guys are so convinced I’m in the US. Other countries have flawed healthcare systems too.

      1. Seashell*

        People online tend to tell the Americans that healthcare is so much better everywhere else. However, I have heard of situations that seem worse than they would be for me, an American with good health insurance.

        1. RadReceptionist*

          The US does do some things better than my country does. HIPAA sounds really, really strict over there, whereas over here people can be way more careless about it out of sheer laziness.

      2. Elaine Benes*

        You wrote in to a website run by an American woman. There are people writing in from all over, but the majority of questions come from other Americans, as do most of the comments.

        There is a also a LOT of shock and awe in comments from other countries any time anything about the American healthcare system is written about, so a lot of Americans on this site have concluded that if someone is describing something terrible in a health setting, it’s probably within the US.

    4. Gyne*

      I think you’re assuming a very different kind of setup here. Do sonographers and other non-physicians even fall under Stark? Also, OP isn’t in the US so… also not an issue for that reason.

      Also, with regards to Stark, I have never seen or heard of a physian contract that didn’t include some component of a productivity-based bonus (RVU, wRVU, or % of collections after salary and operating expenses were paid) and all have been written by lawyers, reviewed by lawyers, and negotiated by lawyers. I’m not sure how Stark has anything to do with that?

  13. Sara without an H*

    LW, Piper’s feelings/workload/odds of burnout are not your problems. They are between her and Victor.

    Pass the pain up the chain. When Piper comes down on you, call Victor and hand Piper the phone.

  14. Sally Rhubarb*

    Ah yes, the lazy ass doctor/tech who refuses to follow hospital management protocol and makes life hell for the receptionist. Don’t miss that crap.

    LW, you are far more magnanimous than I ever was but you have to put your foot down. This isn’t even about Piper’s ego, this is about patients being underserved.

  15. Dr. Rebecca*

    OP, not to add to your burden either, but if you get the feeling that she’s taking out her “overwork” on patients, please figure out who to tell and tell them. From a patient’s perspective, a grouchy, rushed tech is distinctly not pleasant when one is worried already.

  16. BellyButton*

    I was going to suggest #1 in a less polite way… dial the phone and when he answers hand the phone to her. Ha!

  17. Cinnamon Hair*

    Ugh, just here to commiserate with you on being a receptionist. I am in a non-medical field, at least, so I imagine OP has it even worse than me.

    My direct boss, Millie, has explicitly told me I am not to screen anyone’s calls. I answer the phone, direct the call to that appropriate person–and then it’s up to them from there. They also have assistants who can handle things for them. However, I have several coworkers who want me to screen their calls, take messages for them, etc. I have told them repeatedly that Millie has told me I’m not to be doing that and that everyone is responsible for handling their own calls. They continue to ignore me (and Millie) and get annoyed when I don’t screen their calls the way they want.

  18. Janice*

    She may be burning out but that doesn’t mean that she should burn you as well.

    Be cold and pass the phone to her.

  19. Alisaurus*

    I once worked front desk for a car repair shop where we scheduled estimate appointments for customers – so not the same as this LW, but similar. There were a couple of estimators who only wanted X number of appointments per day so they could take care of other tasks, but the shop manager (my grandboss, the estimators’ boss) told me to schedule Y number. This was more than the estimators wanted, and one in particular would get really worked up every time he saw I had put more than his desired X number of appointments on the schedule for a day.

    I reframed it in my mind as, “Okay, you’re upset about this part of your job. That’s literally not my problem, and he knows it.” It was really easy to let his complaints roll off my back when I looked at it the same as a coworker letting any other part of their job slide. Sure, it was annoying for him to fuss at me for it. But I could just shrug and say, “This is the job. Talk to Shop Manager if you have a problem.” I knew that if Estimator refused to do an appointment that it would really show badly on his part because Shop Manager knew I was doing my job and that’s all that mattered for me personally at the end of the day. Estimator was annoying, but I was not about to risk my job for him.

    LW, the more easily you can reframe Piper’s outbursts as, “Wow, Piper is unreasonable, moving on with my job that I will do faultlessly,” the easier this’ll be until Victor can get her sorted out.

      1. Alisaurus*

        You’re welcome! I will admit, it may have been easier for me because I might be a people pleaser in some areas but I also am a major rule-follower and that usually wins out if they conflict. lol But that’s really what it came down to for me.

        “What I am doing is the correct procedure. Piper wants me to break the rules, and that will mean I’m not doing my job. The nerve.”

  20. McS*

    I get you’re junior and this is way above your paygrade, but what’s happening here is that the bonus is a broken incentive. Piper and your grandboss are doing exactly what they’re incentivised to do. If you have any ability to bubble this up to someone who can change the bonus to maybe a limited number per day or limit total appointments per day, this is feedback they should be getting.

  21. Iridescent Periwinkle*

    Call me crazy but I think the bonus structure needs to be seriously reconsidered and the workload for each sonographer needs to be distributed equitably (barring the emergency appointments, which there should be some leeway for, right)?

    I don’t want someone rushing through my ultrasound appointment – those tend to be more serious and require a careful approach, correct?

    Victor definitely needs to be a stronger manager in this.

    1. RadReceptionist*

      We have one sono on each day, so distributing the workload isn’t something we can really do without delaying patient care further. They’re already upset about waiting a week and a half with the current workload.

      1. Alisaurus*

        In that case, I think the immediate solution really is to keep holding those emergency spots. Piper sounds unreasonable regardless, but if walk-ins are a part of this job, you can’t take care of them if there’s no wiggle room in the schedule. Can you have a meeting with Victor and explain all of this as well? If he won’t change the schedule/will back you up/even communicates this “new policy” to the team, that could go a long way.

        Of course, none of that replaces his duty to actually manage Piper, but it’s a thought in the meantime.

  22. AreYouBeingServed?*

    Piper “burning out” isn’t remotely your problem or your fault. As you said, she “wants the bonus”, so she is choosing this herself. Her whining isn’t your problem either. If she can’t do what the grandboss, Victor, requires, she’s perfectly free to find other employment.

    This is Victor’s problem to solve. My recommendation would be to explain him very clearly, and let him know that her harassment and lack of professionalism is impacting your ability to work.

    I can be “not most tactful person in the world”, so personally, the next time she pulled that, I’d politely tell her that her harassment needs to stop and that she needs to talk to Victor. And if she keeps it up and does it again? The next time is some version of “Stop whining. Shut up and do your job.”

    Of course, if Victor doesn’t solve the problem and she keeps this up, making your job difficult, since you control the scheduling, you can take the more Machiavellian tack of either scheduling her less so that she loses her bonus or the opposite tack of intentionally burning her out to induce her to leave. either way, she’ll either get the message or go to Victor and complain, which gives you the opportunity to get in the same room with both of them and try to put a stop to her behavior.

  23. Jessica*

    One thing that struck me in this letter is that Victor is the LW’s “grandboss,” but I see no mention of who the LW’s boss is. where’s the layer of management that’s between LW and Victor, and what is that person doing? or where do they fit into this picture?

    1. Sally Rhubarb*

      If it’s anything like where I worked, there’s the practice owner and/or office manager that everyone reported to, then there was a tech manager who the techs/assistants reported to, and a front desk manager who managed the receptionists.

      So it’s kind of like working in Sales and having an issue with Marketing. Going to your boss might not do much since they don’t have control over anyone other than their own team.

      However, the LW’s manager might have more capital to push back. When the staff @ one of my past jobs got like Piper, my manager would tell us to ignore the tantrum and she’d send the problem child right back.

    2. RadReceptionist*

      So my boss is… let’s call him Bob because why not. Victor is more in charge of personnel and actually giving out instructions, whereas Bob is more logistics, payroll and scheduling. I get the impression both of them play to their individual strengths and delegate to the other.

      Bob’s attitude is also “tell her to call me.”

      1. Observer*

        Bob’s attitude is also “tell her to call me.”

        So tell her to call either or them. If she refuses, pick up the phone yourself and call Victor. If doesn’t answer call Bob. And then just hand her the phone.

        If she refuses to take the phone, you will still have accomplished something because now you’ve *shown* them how unreasonable she’s being.

  24. Been There Done That*

    Just want to say….these are all three GREAT solutions from Allison!!! Will be anxiously awaiting an update!

  25. irianamistifi*

    Yeah, return all that nonsense to Victor, but I’d also say that the bonus structure is all wrong for what Victor wants and it’s up to him to adjust it. OP can always raise that as well. What gets rewarded is what gets done.

    Focusing the reward system on volume so that patients are rushed through and perhaps not getting the kind of focused care they deserve means that you’re already setting this team up for packing the schedule as tightly as possible. I assume you’re in the US and your practice gets more money the more patients you see. The whole healthcare system is kind of messed up like that.

    But if Victor wants patients to have the best possible outcomes, that means allowing the techs to spend as much time as needed to allow for patient care. That might look like talking to patients, allaying their fears, explaining procedures and what you’re seeing to them, or taking some extra time to look at the sonograms to make sure you haven’t missed anything. The bonus structure specifically requires the techs to look at patients as a number that leads to money, rather than a human being who is going through a nerve-wracking medical procedure.

    So it’s clear that Victor’s focus is money, not patient care. I don’t know that OP can change that. But if he wanted to make patient care the focus, he would change the bonus structure to be based on patient feedback on a questionnaire or other internal measurements rather than just sheer volume.

  26. I'm Just Here For The Cats!!*

    Oh this is so hard! I really think you need to call Victor when this happens. He might not understand how hard she is being on you. Also, if any of the other coworkers have seen this, would you be able to ask them to tell Victor what they have witnessed? You shouldn’t be bullied at work for doing what your boss has instructed you to do.

  27. Mouse*

    The incentive structure is the real enemy here. Victor should look into redesigning the bonus plan to incentivize the behavior he wants to see.

  28. bunniferous*

    Others have good advice but my advice is to follow your boss’s instruction. In your place I would simply refuse to discuss it with Piper, period except to tell her to call Victor and that if she hasn’t called Victor the conversation is over.

    It is ok if Piper is angry with you. Google “grey rock” and grey rock her on this. Because this is not your circus or your monkeys. If she wants to be scheduled for bonus, that is on her.

  29. Ardis Paramount*

    Am I the only one who is outraged at the idea of an ultrasound technician rushing through three imaging sessions in one hour…FOR A FINANCIAL BONUS??
    A google search shows that they typically take 30~40 minutes for many procedures, perhaps even up to 60.
    (I realize that various types of ultrasound are different, to say nothing of patient history and all the surrounding factors.)

    This really makes me mad. Don’t incentivize medical employees to rush ANY procedure.

  30. Emily*

    For the commenters complaining about the bonus structure, you’re basically doing the same thing Piper is doing, complaining to OP about something she has no control over. Telling OP that the bonus structure should be changed is not actionable advice for her.

    1. bk*

      I’ve never seen the comment section be restricted to just actionable advice, and if it was then IMHO it would be a much less interesting place

    2. RadReceptionist*

      Not really surprised tbh, I get it all the time at work as well. Honestly surprised that one of the commenters here seems to think I can just rock up to upper management and say “get rid of the bonus structure” and they’ll just go “ok” because a random receptionist told them to.

      But when people find out I’m in healthcare they immediately assume I have a lot more power than I do, and when I tell them I can’t change (insert big terrible thing here) they make the assumption I’m refusing to change it because I get kickbacks or just can’t be bothered. No, mate, it’s because I’m a damn receptionist. You may as well tell a maid in Parliament House to tell the Prime Minister to fix the housing crisis.

      1. Nightengale*

        I am a doctor in a largish US health system and I have almost no power to change anything either. Some day to day things affecting my patients, sure, but certainly not bonus incentive programs that are made many levels of administration up. I can only send my commiseration.

      2. Emily*

        RadReceptionist: Thanks for taking the time to reply to comments. I’m sorry some of the commenters are being so unrealistic about what you do and don’t have control over. I work in a law office (admin, not lawyer), and it’s ridiculous how many things people think I have control over that I have absolutely 0 control over.

        I saw you said in another comment that Piper is coming back from leave this week. I hope Alison’s scripts are helpful in dealing with her and Victor. Please update us if you can!

  31. RagingADHD*

    LW, whichever option you choose, adopting the mindset of #3 will enable the others.

    Whether or not Piper actually calls Victor is really not your problem. I think it’s likely Victor said that (as many managers do) a bit rhetorically. It’s a way of reinforcing that this is not your decision, it’s coming down from the grandboss, and you may wash your hands of it.

    If Piper wants things to change, she has a path forward. You can just use “take it up with Victor” as a kind of wash-rinse-repeat phrase. And IME, when it is clear that you are not bothered and aren’t trying to solve this for her anymore, she is likely to stop approaching you about it. The fact that you are even trying to look for another solution, or worried about what you should do, is giving her false hope that she can get things changed by leaning on you.

    Relegate it in your mind to the same category as if she were complaining about her own car, or a leak in the roof of her house: Not a blessed thing you can do about it. She can solve it for herself, and if she chooses not to solve it, then she is choosing to put up with it.

  32. Happy Pineapple*

    I’m guessing the bonus is in place to incentivize the technicians to volunteer for emergencies that come in to the clinic. In other words, it’s a perk when you occasionally need to do extra work, but it’s not intended to set a faster pace all day, every day. Piper is abusing the system because she’s no longer reliably available for emergencies. She’s also doing her patients a major disservice by rushing through exams. Ultrasounds can be tricky, especially if they’re internal, and I would not want a tech who is more focused on the clock than my comfort and wellbeing!

  33. Tesuji*

    I’m surprised that the advice doesn’t point that out that LW overruling her grandboss to give Meg the schedule she wants is just as much a red flag as the Piper situation.

    LW has set herself up as the arbiter of the schedule, with the power and willingness to ignore whatever Victor wants. She shouldn’t be surprised when Piper is treating her as the actual authority, given that’s exactly how she’s behaving.

    If LW doesn’t actually want to be in the middle of all of this, she kind of needs to step back and *not* be in the middle of this at all, letting Victor run the schedule even for the employees she likes.

    1. RadReceptionist*

      Hi, I’m the LW. The written instructions I’ve been given say that Meg has to have longer appointments; Victor is going against these instructions when he messes with them. If he wants her to have shorter appointments then he needs to remove the instructions that are written into the scheduling software, but he’s never done that.

      1. Polly Hedron*

        Hi Rad,
        I’m eager to hear more.
        1. Who wrote those written instructions?
        2. Do you have a great-grandboss or HR whom you can ask for clarification?

        1. RadReceptionist*

          Good questions, I’d have to chase this up. I don’t even know who Victor’s boss is or who HR is beyond a couple of individuals in head office whose roles are unclear to me.

  34. RadReceptionist*

    Hi this is LW! Thanks so much for responding — I have to run out to work right now so I will respond when I get home in my timezone, but Piper’s actually coming back from leave next week so this is perfectly timed. Thank you Allison!

  35. bk*

    Plenty of good advice here, but if you need a blunt one-liner to try to disengage, try invoking who pays your paycheck. “Sorry Piper, Victor is the one who signs my paychecks, I can’t risk that by going against his instructions.” Won’t work for everyone, but for some breaking it down like that would be a conversation ender.

  36. Dasein9 (he/him)*

    What I want to know is how to make sure I get Meg and not Piper when I’m in need of care.

    1. RadReceptionist*

      Ask the receptionist who they recommend. If a patient ever asks, I always recommend Meg, but 9/10 patients want it done faster and in less time rather than wait until Meg is next available. Their reaction is always dismay and “never mind, fit me in sooner.”

      1. Gyne*

        This is how I chose my first job out of residency – I was looking for a medical practice to join so I quietly asked all the nurses which doctors *they* would recommend and joined that group!

      2. fine tipped pen aficionado*

        I’m a day late but this is extremely helpful advice. Thanks RadReceptionist and best of luck with this very frustrating situation which you have very little control over.

  37. Just me*

    It would be my guess that Meg is most likely doing more complex appointments that require the extra time. Piper only wanting to do appointments from certain doctors makes me wonder if those doctors are ones whose specialties require less complex procedures. This would actually make sense of the situation. Of course that doesn’t mean that my conjecture is relevant.

    1. RadReceptionist*

      Piper does the more complex appointments; Meg doesn’t have her capabilities or qualifications, as much as I adore Meg.

  38. Zarniwoop*

    “Our sonographers get a bonus every time they do three ultrasounds in an hour. “
    Christ on a crutch what a stupid policy!

    I can understand wanting an incentive to keep the expensive equipment running as much as possible. But do it based on number per day with a sliding scale, not number per hour with a sharp cut-off.

    1. Zarniwoop*

      And even from the most cynical money grubbing point of view, this is supposed to reward Piper for working fast, but instead it’s rewarding her for getting the quick procedures.

      1. Karen*

        I’ve never performed an ultrasound before, so maybe this is off-base but: Wouldn’t this also incentivize doing a less thorough job to get each scan done more quickly? Seems like a weird policy.

        But, it’s not the OP’s policy and she doesn’t seem to be in any position to change or influence it, so she has to live with it as it is and figure out how to manage Piper’s tantrums and snits over things that are out of the OP’s control.

        1. Zarniwoop*

          “Wouldn’t this also incentivize doing a less thorough job to get each scan done more quickly? Seems like a weird policy.”
          Ethically questionable, risky from a malpractice lawsuit point of view, but all too plausible.

  39. All Het Up About It*

    I seem to be in the minority here, but I’m honestly not sure what additional tools Victor can give to the OP? Even if he has a meeting with Piper, she can still be a huge jerk to the OP about scheduling. Co-workers who are jerks, are jerks no matter what. Decent human beings and co-workers KNOW that people like the OP are following orders and they do not harass these individuals. Piper is not a decent human or co-worker. Even if Victor talks to her and she stops, she’s still a bad co-worker.

    I feel like the OP needs to develop her own tools of pushing back when Piper is complaining. “I’m doing my job as directed by my boss. Its not my job to listen to you harass me. Stop now.”
    “I’ve told you Victor’s directive. Only Victor can change it. If you aren’t going to call him, then you can go do the scan or not do the scan and deal with whatever consequences come of that. I’m going to continue to do my job.” People like this cannot be reasoned with because their behavior is not reasonable.

    1. Zarniwoop*

      Victor shouldn’t be giving OP tools to do Victor’s job. He should be doing the job himself, contacting Piper directly and telling her to stop harassing OP for following Victor’s instructions.

  40. somehow*

    Piper: “[whine]”
    Me: “You’ll have to talk about that with Victor.”
    Also me: Gets up and walks away.

    Tues.-Fri. – See Monday.

  41. Jade*

    I’ve worked in hospitals with radiology departments for years. I’ve never heard of anyone being able to adjust their schedule based on their current situation ideal workload. I would never change the schedule of an ultrasound provider without checking with the department head. Going from three to two is not your call and you do not want to be blamed for it.

    1. Gyne*

      Yeah, I’m wondering what kind of practice this is – diagnostic or therapeutic ultrasounds? Everyone is hating on Piper for getting 3 scans done in an hour but it reminds me of the old joke where [insert professional here] comes in and fixes their widget in 5 minutes and hands the client a bill for $300. The client complains about the price for a “five minute job” and the [professional] explains, “I spent 20 years learning to do this in five minutes. You owe me for the years, not the minutes.” An experienced sonographer who is good with a probe can get the pictures they need quickly, and any ultrasound of a body part has a pre-defined set of images (“views”) that you need to take, it’s not like they’re just scanning around looking for whatever. The 20 minute vs 30 minute scans is kind of a red herring and really an unnecessary thing to focus on when her behavior towards the OP is the problem. And is problematic enough to stand on its own, no matter how good at her job she is!

      1. RadReceptionist*

        Piper is absolutely the $300 professional in this metaphor.

        Like, Alison had to grab *a* name for Piper to make it easy for readers to follow, since I didn’t name her in my email, but I think it’s triggered a lot of assumptions from the commenters. In the comment section people are speaking as if she’s in her mid twenties and new to the job, even going so far as to assume she has student loans and high rent and having trouble making ends meet. People probably have a mental image of some young white girl. That’s the kind of ideas that “Piper” evokes.

        In reality, she’s an Iranian grandmother who’s in her late sixties or early seventies from my guess who’s probably been doing ultrasound longer than I’ve been alive. An unhurried and laid back Piper is faster than Meg when Meg’s trying to catch up on measurements between patients, and Meg’s been doing this for a couple decades herself.

        It’s been insinuated to me that Piper gets paid a *ton* of money, possibly even more than Victor. It’s for good reason. The woman’s a god damn wizard and I’ve never once had a complaint about her missing anything.

        She also uses a physical calculator because she doesn’t like the one in the software and she has no bedside manner, but you win some you lose some, I guess.

        1. Squirrel*

          Wow, I never knew she chooses the names herself! That’s quite problematic, given how racially loaded and age-specific names can be.

          1. Elaine Benes*

            Alison doesn’t always, just if the letter writer hasn’t specified that they already used fake names in the letter.

            I see your concern, but is it any less racially/age biased when the letter writers are choosing fake names? I think it’s a potential issue no matter who is doing it. Also, I suppose you could make the argument that choosing something that is more accurate to the person’s age/race would be inducing bias. Humans are tough.

          2. Hlao-roo*

            Depends on the letter, I think. Some letter-writers write in with (fake) names included (there was one case where the letter-writer wrote in with the real first names of the people involved, so AAM changed then to fake names after the letter had been posted and the LW noticed).

            Others write in with initials, which get changed to names because it’s easier for a lot of people to follow a story about “Archie” and “Betty” than about “A” and “B.”

            And some letters don’t need names (think a simple “my coworker’s pen-tapping is annoying, how do I get them to stop?” letter).

            In this case, there are enough people involved with the situation that names are helpful.

          3. nl*


            What would you suggest when a letter needs fake names and they weren’t included? Every name will send a signal of some kind, whether the letter author chooses them or AAM does. Your shock is a little weird.

        2. Gyne*

          It’s always interesting to me what inspires the commentariat to extend grace to others and what doesn’t. I suspect a lot of these details (publicly funded, non-US, employee in multiple protected classes) would have redirected some of the discussion, but maybe not.

  42. Indolent Libertine*

    If the bonus comes from doing 3 scans in an hour, what the heck difference does it make if one or more of those three is an unscheduled emergency rather than a pre-scheduled appointment? It’s still a scan, isn’t it?

    1. RadReceptionist*

      Because if there’s three scans booked in an hour, and an unscheduled one comes along, now she has four scans to do in an hour and one or more of them are going to be late.

      1. Indolent Libertine*

        And does being late then negate the bonus? If Alice is scheduled at 9am, Betty at 9:20, and Charles at 9:40, and Zeke comes in as an unscheduled urgent case and Piper is asked to handle him at 9:40 and does so, has she not done 3 scans in an hour?

  43. Captain dddd-cccc-ddWdd*

    The bonus is the real root cause of this, as it is incentivising the wrong thing. Who came up with that? was it Victor? Or are they part of a “chain” (I’m not sure how these things are set up) where the bonus policy has been set by a HQ of some kind and is applied at OPs workplace and others that are part of the same company?

    If it has just come from “locally” – I think OP needs to pjck this up with Victor as well. Yes, the individual issue at the moment is Piper being shitty when she’s asked to take on an emergency case. But the issue with incentivizing the wrong thing is going to present as a much broader problem (Piper won’t be the only one who does this, etc).

    It only takes one incident to end up in the news – terrible outcome x happened because the clinician was in too much of a rush due to the way bonuses are structured.

  44. Betsy S.*

    If Victor is the grand-boss, who’s the boss in this scenario and where are they in this picture?

  45. Yellow cake*

    The compensation system is the problem. You pay Piper to do 3 ultrasounds per hour. If she does not have that volume through – she gets less compensation. Piper wants to maximise her earnings during her work day. This is not unreasonable and is entirely predictable.

    You then want her to take on emergency cases – but the company has structured this so she must either (a) work unreasonable overtime, (b) skip meal and rest breaks she is (I hope) legally entitled to, or (c) lose income.

    Frankly I can completely see why Piper objects to this. Stop paying bonuses on such a regular timeframe (if someone earns a bonus every day – or 8 bonuses a day – that’s their standard income now – it’s not really a bonus). Set the schedule to be X scheduled plus emergency cases each day. You can give some techs the slower patients and they do fewer but more complex, others the fast ones so they do more but all routine. You can pay the staff who being in more money over a year more or who are more senior and can handle more computed cases etc.

    But stop paying per patient if you don’t want her to prioritise a full schedule – as relying on emergencies to get paid for the day is unreliable.

    It really doesn’t matter that Piper is the most highly paid. She’s quite simply just doing what the work requires for her to be paid. That’s her compensation arrangement – she deserves to be paid (especially if she was told she could book at max rates to earn the income she agreed to)

    I would not be surprised if Victor is saying have her call me because he knows she’s won’t – and this way he doesn’t hand to address the real problem.

    The problem is mostly Victor and the company, although Piper should be more polite and take her argument up with Victor not the LW. Even if that is saying – I was told I’d have 24 patients on my books each day to get paid the rate we discussed. I’m not available for overtime (unless the pay is …) and if that’s not something you can continue to provide then take this as my notice.

    1. Alisaurus*

      I was also thinking this in regard to the pay structure and Piper’s preferred schedule. Of course she wants to maximize her bonus! The problem lies in how it’s being handled by those who actually have the power to do anything about it (Piper, Victor, and whoever is above Victor).

  46. BeFirm*

    This has an easy fix: Piper’s schedule no longer gets packed. From now on, time is automatically built in for urgent cases.

    When she gives pushback, the answer is: “You’ve indicated that you can’t handle the urgent cases that come in when you have a packed schedule. Handling urgent cases is part of the job. You can either have a packed schedule and stay late to accommodate urgent cases, or leave on time, but you cannot have both.”

    1. Karen*

      This is really what VICTOR needs to say to Piper, not the OP. The OP seems to be the low person on the totem poll and she doesn’t seem to have the authority to lay down the law with Piper in such a way. Though I agree in a perfect world, Victor would empower the OP to say that and run with it.

  47. Mighty midget*

    If the “call Victor and hand over” approach doesn’t work, could it be moved to email, copying in Piper?

    My understanding is that appointments should be scheduled like #this#, but Piper has advised it should be like *This*.

    Please confirm which is correct.

    I will continue with #this# unless advised otherwise by yourself

    1. Mighty midget*

      This means that you can carry on as you are unless Piper actually gets Victor to tell you otherwise and if Piper complains, you can point out that Victor hasn’t said otherwise

  48. Mighty midget*

    This means that you can carry on as you are unless Piper actually gets Victor to tell you otherwise and if Piper complains, you can point out that Victor hasn’t said otherwise

  49. Zach*

    This is a microcosm of the US healthcare system why healthcare goals shouldn’t be profit based.

  50. Two Pop Tarts*

    “Our sonographers get a bonus every time they do three ultrasounds in an hour.”

    You want to solve the problem? Get rid of the bonus.

    The bonus is designed to incentivize people to act in a certain way. You can’t blame Piper for following the incentives management has created.

    When you pull Piper off ultrasounds, you are taking money OUT of Piper’s pocket. Are you surprised she gets upset when take money out of her pocket? You do understand the reason she works there is to make money, right?

    As long as “Victor said” is perceived as “Piper is making less money today” she’s going to push back.

    1. Karen*

      This is true, but the OP doesn’t seem like she is in the position to change or influence that incentive structure at all, though she could suggest it’s part of the problem to Victor (though that might get ALL of the sonographers to hate her haha).

      And, it’s not the OP who is taking money out of Piper’s pocket — the needs of the job she signed up to do are doing that. It really sounds like Piper needs to get a grip and grow up.

    2. rebelwithmouseyhair*

      Yes, this bonus is maybe good for business, because they can bill more patients, but it’s produced this weird problem.

      They should offer bonuses for fitting emergencies in, then Piper would change her tune. Then the other employee who takes things smoothly, spends more time with patients and is more flexible when needed, will also be rewarded for her excellent attitude. (I bet her work is better all round than Piper’s).

  51. MCMonkeyBean*

    Obviously this doesn’t help OP, but that bonus structure seems like a terrible idea on its face. Rewarding people for *fast* medical care does not seem like a very good way to incentivize *good* medical care. Is that common?

  52. Grogu's Mom*

    This reminds me so much of a radiology office I visited for years under a variety of circumstances that I’d think it was the same if it was in the US. From a patient’s perspective, it was reeeally obvious and super-awkward. At least here, it sounds like it’s only being taken out on poor RadReceptionist and not both the receptionist and the patients? Ugh.

    In this situation, it sounds like it’s absolutely poor management on Victor’s behalf causing the issue. (Although I note that he’s the grand-boss; where’s the boss in all this and can they help at all?) In my case, I think the issue was driven by the fact that my “Victor” only supervised the front-office staff, not the sonographers who had a completely different reporting line, so he had the authority to set and move around the schedule but not to push back when the senior sonographer refused to follow the schedule. Just one example of how it was taken out on me as the patient: One day I had a scheduled prenatal scan 90 minutes prior to an OB appointment (same building, different floor), both sonographers were running behind and my OB appointment was about to start so I asked the receptionist whether they were running late enough that I had time to duck out to the OB appointment and come back vs rescheduling the OB appointment. Receptionist said check with the manager “Victor,” he approved me going to my OB, then when I got back I was reamed out for several minutes in the hallway by the senior sonographer: “you can’t just go by what Victor says, you have to check with me. I called your name FIVE times.” Sorry, didn’t realize that and as the patient I am happy to do what I’m told but I was told to talk to Victor. “Well, receptionist does what Victor says so that is why she sent you to Victor.” Okay….. After that I only allowed myself to be scheduled for radiology after my OB appointment, not beforehand. Similar to RadReceptionists’s office, I would also regularly overhear senior sonographer say that they only had to prioritize urgent cases from certain doctors. Sucks if your overhear that and it’s not your doctor! The senior sonographer was clearly the most skilled so I did still prefer when I had appointments with her to the others, unfortunately, even if it meant being yelled and complained at.

    I’m not sure if I have advice (other than definitely bring it up to Victor if patients are being exposed to all this), but I am really sorry you work with such frustrating people. I work in higher ed and I think it’s similar in that the super-star professors who students love are often the absolute dirtbaggiest of dirtbags when it comes to how they treat administrative staff (and throw their own faculty colleagues under the bus behind their backs, too!).

  53. Cranjis McBasketball*

    Since you’ve already told her to call Victor, next time Piper starts up ask “What did Victor say when you spoke to him?” (Because OF COURSE she spoke to him). If it turns out she didn’t, then it must not be that big a deal to her.

  54. Mrs. Hawiggins*

    Oh the memories. When I was first a receptionist before I became Mrs. Tudball’s secretary, everyone would fight THROUGH me. “Well if he/she says this tell him to call me.” They used to think this was my pat answer to get them to go away, rather than being the messenger. “You know you need to accept what I’m doing as part of the game plan,” one of them told me. So, I retorted, “Pay me what YOU get paid and I might.”

    I would complain and complain to my boss about it all and it was always, “well that’s how he is, or well that’s how he is.” So, I showed them how I am, wrote a resignation letter saying that I was tired of abusive conduct, knew that my type of position was the ‘easy out’ and wished them the best. I left it on my boss and all “offenders” desk late on a Friday afternoon. It was an on the spot quit. I had a couple answering machine messages to the extent of, “what can we do to resolve this,” but seeing as how they didn’t care before, I presumed they wouldn’t care after.

    The SEC did however, but for different reasons.

  55. rebelwithmouseyhair*

    This is a case of incentives having a negative effect. Three appointments an hour might be reasonable, but the other sonographer is spending more time with patients, and that usually leads to a better level of care IME.
    The practice of leaving slots in case of emergencies is pretty nifty and I know they did that at the maternity where I gave birth, because the midwife gave me an emergency slot at one point. I imagine that if there are no emergencies, the sonographers get a bit of a breather and can maybe catch up on some paperwork or whatever until the next person is ready for their appointment. So OP is doing this well AFAIC.

  56. RadicalTherapist*

    I’m 1000% behind Piper on this. I’m hearing that she wants her bonus, and also has a limit to exactly how many people she will see in any given day to allow her to take breaks and perform self care to prevent burnout, while also making enough money to survive. Piper is enforcing her boundaries as much as possible within the system of oppression that is the healthcare system, which routinely does this to ALL healthcare providers under the guise of urgent/crisis/emergency with the unspoken and heavily implied statement that any pushback means that the provider doesn’t care.

    op should not be caught in the middle, and it does need to be between Piper and Victor. however, bravo to Piper for holding steady. when my admin continuously tried to do this to me at the boss’ instruction by scheduling over my blocks, I’d personally call the client and cancel the appointment, and they’d get my next available appointment which was 4 months later. what were they gonna do? fire me? hah! I quit over 2 years ago, and they literally can’t get my previous position filled, which resulted in them losing millions of dollars in contracts. and why did i quit? because as a fully licensed clinician, I made $22 an hour, and I found out that an intern THAT I WAS PROVIDING CLINICAL SUPERVISION TO, was being paid $50 an hour (and in the entire agency of everyone at my level, I not only had the HIGHEST productivity even holding my boundaries, I was also the only one who’s documentation could pass an audit at any given moment. my documentation actually was the ONLY reason the state didn’t fine the agency hundreds of thousands and force them to close a program). I brought it up and told them that they could either raise my compensation to match or allow me to do part time while keeping all of my benefits and salary, or I’d immediately walk. They said no, I walked. And then the agency experienced the consequences of their greed. The contracts the agency lost, plus all the fines they wound up paying during their next audit was glorious. in healthcare, letting this boundary slip even once, means you get locked into it for the duration of your employment.

    ah, I still get the occasional call from the guy in charge of one of the federal contracts my agency lost begging me to accept it and take it on.

    Victor is upholding the system of oppression. I have no empathy for him.

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