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mgriffiths

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mgriffiths last won the day on October 1 2019

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About mgriffiths

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  1. I usually skip these types of threads and conversations...now I remember why. I'm not crying...you're crying, or maybe just the onions are stronger today...working FM in a rural, poor area for multiple years so many. Probably the worst for me was hearing an automobile accident that occurred just a short way down the road from my clinic. I'm not even sure why, but ran down the road to see if I could help...lady (patient of mine) lost control of her vehicle and hit a construction worker - dead on impact...childhood friend of mine. Lady knew the worker, knew I was close to the worker...made for some hard visits before she finally broke down crying after a solid 6 months and admitted she was texting...to make matters worse she committed suicide another ~4 months later while IN a hospital on a psych hold - that I initiated by sending her to the ED and calling ED ahead of time. I (and obviously the lady) probably should have gone to counseling after that...but just as patients say - who has the time, insurance coverage is terrible, and then there is the stigma (ESPECIALLY as a medical provider)...then living rurally it would have been minimum 1 hour drive each direction to someone who did accept my insurance because the local group received a federal grant so could ONLY see medicaid patients. I was so angry when they accepted the grant. They literally threw a party when it finally came in (and I do understand why with increased reimbursement, steady patient stream, etc.) but made me sick as it felt like they were throwing a party while just dumping dozens of patients they had been seeing for YEARS who had no other options in the area, even if they wanted to self pay.
  2. There is always a cap on income...one of the oddities of being a provider is that unless you start at a job with low pay and/or change specialties, generally your base pay starting out will be in the ballpark of what it will always be (the main exception is productivity bonuses). It's the same for docs... My first job (ortho) I started at $95k, but offered a productivity bonus that was at best nebulous. Second job (FM) my base was $85k, but I also received $10k loan repayment + productivity bonus (usually $10-$15k). Third job (FM) base pay $110k, with bonus that probably would have been minimum $10-$15k, but before I even had the chance to accrue the bonus I transitioned to fourth job (ortho) with base of $120k and unless my surgeon screws my productivity I will likely earn minimum $15k bonus... Jobs #1 and #2 were BAD base salary, especially job #2. I worked so hard for that bonus...averaging 20+ complex patients per day with another 6+ per day of simple walk-ins...I was the highest producing provider (out of 34 total providers - MD/DO, PA, and NP) in the practice by far...end of rant...sorry.
  3. Not exactly your typical NP student...
  4. 1. I do not tell patient, as others have said I may not know all of the information (almost guaranteed) 2. Assuming recent, absolutely...I've had to do it. It is never, "WHAT WERE YOU THINKING?!?!?!" It is, "Would you be so kind as to walk me through your process because I am confused?" 3. I have, and while it sucks I would do it again. It is my duty to protect patients, and to turn a blind eye to an impaired provider to support the practice. To clarify, impairment can include alcohol or some other substance abuse, but can also be an impaired mind from dementia, impaired surgical skills from tremor, impaired medical decision making because a provider has decided to accept non-evidenced based medicine into their practice such as essential oils, dangerous diets, and other untested or worse disproven treatment methods
  5. I do not know of anything specific regarding PA and pharmacy licenses, just an assumption (as I stated). But, I do know that in the state of Michigan it is required by law to update your address on your driver's license when you move and if you don't your license can be suspended (don't know the deadline). Again, I don't know if it's the same with a name change, but I would actually expect a name change to be more important than an address change, and if true for a driver's license I would expect it to be true for a PA/pharmacy license. But again, just an assumption OP (and anyone else) should confirm with their state's licensing board.
  6. I can't give any advice about the process or anything, but you should absolutely check your state's rule/regulations as it may be against rules/regulations to continue to have your maiden name on your PA and pharmacy licenses after you have changed your name. I would assume (but could certainly be wrong) that it's the same as your driver's license and other forms of ID that you are expected to update once your name is changed.
  7. I was allowed to do this when I covered at clinics to be helpful, but I think they would view these other two clinics as my "usual locations" because they would be weekly and scheduled. But, it is a route to potentially explore.
  8. DogLovingPA and jmj11 With a night to think about it and after discussing with my wife, I think this is the route I will take. The further clinic is an extra 22 miles (44 miles per day)...but again don't think it's worth souring the relationship. Part of this is I don't think it was an intentional "bait and switch" more just an oversight and possibly just a simple (albeit frustrating) omission. As the clinic schedule is put together I do plan to make a comment if driving time is not considered at all, as I specifically do not want an extra 60+ minutes of driving time taking away from family responsibilities.
  9. So, I posted a few months ago that I was transitioning from FM to orthopedics. The transition has gone smoothly and the department is great. The 2 current surgeons are awesome and great teachers, and I have had some great conversations with the surgeon joining the practice soon (who I will be working with almost exclusively). Overall an awesome switch. But, I learned today that the real plan for me (and the third surgeon who starts in ~2 weeks) is to have 2 clinic days per week in some of the other clinics. One is an extra 22.6 miles (45.2/day) and the other is an extra 11.9 miles (23.8/day). That is 69 miles per week. Overall, ends up being approximately $600/year in gas and "wear and tear" based on general numbers I've looked at online. Using the IRS mileage rate of $0.575/mile for 2020 it's $1,785.38! This is ignoring the time to drive an extra 69 miles each week. I do think our clinic days will be slightly shorter to make up the driving time (they do this for some of the other specialists who drive), but that also then cuts into my productivity, and we are paid a productivity RVU bonus. With all of this, I am pretty frustrated. This was never discussed with me when I looked into transitioning, but definitely discussed with the new surgeon. Now during this transition from FM to ortho I negotiated a $10,000 raise, and I am very aware that I am the HIGHEST paid APP within the entire hospital system (not including any RVU bonuses). They do plan to increase the other ortho PA's and the ortho NP's salaries to match mine at the end of our fiscal year this year though. My question, is this something to fight over? Obviously I wouldn't start argumentatively, simply fact finding and casually ask about the clinic schedule and then mention the distance, but does that make sense? The biggest thing is that I don't want to sour a good thing. I make $120,000 base and assuming the surgeon doesn't screw me over in clinic (which I really do NOT expect based on our conversations) I will make a decent bonus. Is it really worth it to fight over 600 "real"dollars, as the IRS mileage is an inflated number generally? Just looking for some advice before sticking my nose in places. Thanks in advance.
  10. my father is an MD and is retiring in ~2 years...he had to redo his board certification this past year because (according to what he was told by his practice manager) his reimbursement would decrease 25% from most insurance companies if he did not maintain his board certification
  11. Part 1: Not sure if would be state specific, but in MI you do not have to be board certified to be licensed as a physician. Therefore, it should not affect you. Part 2: Would depend on the malpractice plan, but highly unlikely. You (or really your SP) would have to ask the servicer. Part 3: As long as the physician is in good standing with licensing and the reason for loss of board certification is not doing paperwork (or just simply choosing not to spend $300+ to maintain board certification), then I would personally have zero issue continuing to see patients. Lastly, board certification is mostly an insurance/AMA thing. Many insurance companies will not reimburse nearly as much for billing from a non-board certified physician because the AMA has convinced them that they should do this, maintaining their strangle on physicians - much in the same way as the NCCPA has a strangle on us. Why you might ask? MONEY!!!!!
  12. When I worked private practice FM, I gave my MA a nice Christmas gift/bonus...plus I also bonused her throughout the year. I received a monthly RVU bonus, and I gave my MA 10% of any bonus I received. This was for 2 reasons. Because she was so good made it possible for me to make a bonus without working extra hours or days Because when I made a bonus it meant she worked harder To me that means she deserves a piece of that bonus. Plus, it made her the highest paid MA within the practice, and kept her from hopping to the next open MA position if it paid $0.01 more per hour. As for Christmas, we were good friends (changed jobs about 1 year ago), and I would give her a smallish cash bonus - in the $100-$200 range and a small gift. The owner docs would take care of a decent lunch and then we also had a Christmas party each year.
  13. Great post...found while searching for info on learning to cast on the forum. Do you by chance have any suggestions on resources to learn these skills other than just gaining exposure while on the job? Specifically casting for ortho, but also US as would be helpful for certain injections.
  14. I'm not sure if you are trying to become a PA and therefore use medical scribe as patient contact hours...but many schools do not count being a scribe as patient contact hours. I had multiple classmates who had been scribes, but while we were in school they changed their policy to not include scribe hours as patient contact hours. So be aware of that.
  15. If you mean signing off as in you did the work...absolutely illegal. You aren't doing the evaluation and the point of you signing off is stating that you have done the work to bill the insurance AND the treatment is YOUR plan. If you mean co-signing, similar to what an MD/DO does with PA/NP then that would depend on your state laws. Assuming that signing or co-signing the chart is legal (questionable at best), then at a minimum this is true. Again, by putting your name on the chart you are signing off on the history, ROS, PE, and Assessment/Plan. If there is a bad outcome you definitely would be party to any malpractice lawsuit and likely as an "over-signer" (made that one up) would be the main person targeted. Bottom line from my perspective, I would not do this...hard stop...end of story.
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