I have an interview this week regarding a position in which I would be practicing primary care that involves traveling to patients homes. Unfortunately cannot find much information regarding people's experience in the field.

Can someone who works in this field share with me their experience, including the pros and cons? thank you

I work in internal medicine (outpatient) and am going on year 3 and now qualify for bonus. However, my employer told us providers that we can't get "individual productivity bonuses" anymore due to the "Stark Law" making it illegal and said our incentive would have to be shared (instead of individual) based on productivity of all 3 providers (1 MD and 2 PAs). We have an ultrasound company that comes to our office twice a month, do in office DEXAs, exercise stress tests, audiometry, and spirometry. She made it sound as though it's illegal to get bonus based on additional services we order that we perform in our office. It just doesn't sound right... Is anyone familiar with this?

If it is correct information, how else are providers getting individual productivity bonuses? Thanks!!

- 115k salary, with 110k during 90 day probation period with 5 k sign on bonus (half given at the signing contract and other half after 6 months of working)- I owe them the 5k back if I leave before two years

- Nocturnal shifts starting out and then moving up to day shifts. 15 shifts of 12 hours per month with a total of 183 shifts per year 

- NO PTO because they let you ask for days off and work around your schedule ahead of time 

- Two year contract. If I leave before two years, I owe malpractice tail coverage up to 10 k within first year of leaving or 5 k within 2 years of leaving---- red flag??? or is this typical?

- If I terminate the contract before Commencement day, I will owe them 2k within 5 days of termination--- Is this a red flag or typical?

- I shadowed the main PA for a few hours and she admitted that most APPs leave after 2-3 years due to burnout. But said that she isn't planning to leave after 5 years and likes working with the doctors. She said she learned a lot on the job and started out as a new grad herself. 

- Dental, medical benefits. they have a 4% match for 401k 

For the hospitalist PAs here, would you take this job? 

I am currently a physician assistant student at Hofstra University. My peers and I are conducting a research study regarding the fund of nutritional knowledge as an outpatient family medicine provider compared to that of the general public. If you could please take a few minutes to complete this brief survey, we would greatly appreciate it. All responses will remain anonymous. Thank you in advance!

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I am looking for your go to resource(s) to revisit primary care. Currently in the process of switching to a small internal med clinic in a semi-rural community after several years in a specialty that offered little exposure outside of the niche I worked in. I'm able to invest some time preparing prior to formal training so any input or advice is greatly appreciated. 

The ENT place definitely has a better office from what I researched on the place online. I'm still waiting to see how the feel of that interview goes. But as a first job, would it be better to go with primary than sleep med? I just want to make sure I don't lock myself into sleep med, and I have options of switching fields in the future 

Thank you!

Does anyone have information for prescription authority of medical assistants in NC? My situation at a family medicine practice is that our supervising physician authorized an MA to send refills on behalf of the APPs/mid-levels. However, we were never told about this. The MA was under the impression that we were aware and okay with this happening. I would guess each practitioner has to give the "okay" for the MA to refill prescriptions, right? Or is there some way the supervising physician can override this? The medications are still being filled on behalf of the mid-levels with our names on the scripts/medications. Is this more of a legal issue or ethical/workplace issue?

Thank you

i've seen for some patients on these meds, for whatever reason, the TSH, T3, T4, and T3 uptake have been checked - my understanding is that we only need to be checking TSH to adjust drug dose, right? or is that not the case since they're not on levothyroxine?

also, the sweet spot for tsh is between 1 and 3, right? so even if a patient is 0.6 on tsh, we would continue titrating til they're about 1? 

i'm sorry if these questions seem silly - i have some textbook knowledge but am still acquiring real world knowledge and just wanted to get some input. 

Anybody know anything like hours, salary etc?

I'm just a wee pre-PA, so school me! 

New grad in UC. Wondering how best to document SP decision after a discussion on therapy. Recently had one of my SPs gift me a new bumhole because I documented he chose to treat with only one of two medications we specifically discussed per a current guideline. How do I ensure that the record reflects his final decision and also protect myself if someone ever asks me why I didnt cover for something? Another case recently was a patient with sob and rhonchi that another SP didnt feel would benefit from bronchodilators: shouldn't such a decision merit specific mention of this decision? Right now unless I specifically say so, the chart doesnt reflect that pretty much everything I do is the SPs decision. Its a new position and right now I am more scribing than practicing medicine. 

Thanks!

I'm interested in hearing anyone's experience doing residential visits, particularly with geriatric patients. If you have experience in this setting, what do you think of the job for a new grad? Any specific things to consider going into an interview? 

Thanks for your input!

I've been seeing a great mix of type 2 diabetics in the population. I've been encountering some challenges related to diabetes management, particularly insulin administration.

I have not really inherited any patients with whom I have personally made the diagnosis of diabetes, but rather patients who primarily see my SP for diabetes but are non-compliant/difficult to control.

I know the basics of medication management........working on diet and exercise for a while, checking A1C every 3-4 months, starting metformin and have had some patients who we have put on glypizide or glyburide as an adjunct when metformin doesn't get the A1C down. I have less experience with some of the newer agents (invokana, etc) as most of our patients are not covered for these or can not afford. 

My questions related to medication are related to WHEN to add another medication: I usually start the conversation when the A1C is greater than 7.5 because our population is resistant to adding medications, it takes 2-3 visits to convince them when another drug is needed. What are your go tos as an adjunct to metformin?

Adding Insulin has been another issue that has come up for me. I've mostly inherited patients who have been started on insulin and I am then adjusting the dose. Patients will call in with their sugar values for the week. I typically start with Lantus and titrate up to about 60-65 units at night and then split to two doses (morning and evening) once around that value. What does everyone else typically do? Split earlier? Give a larger dose and split later?

I also do not have much experience with starting Humalog. Would love if someone could explain their regimens. I've been reading dynamed and uptodate, but haven't gotten much out of it. 

I guess my main problem is that most of my patients have VERY inconsistent sugar readings when they call in. When they get triaged to me, I struggle with whether or not to increase their insulin. Example: someone goes from having a 92 fasting sugar one day and then the very next day going up to 220 fasting. It's hard to gauge. We do have an endocrinology practice in our building, but almost all of my patients refuse.

Any thoughts would be greatly appreciated!

DC

Here is the link to my website! There is a very short survey in the last tab of the website if you would be willing to answer a few questions about my project after viewing the website, I would greatly appreciate it. Thank you all!     

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