Reality Check 2

The federal govt doesn’t care about my degree. I am already at the ceiling of govt grade and class. Nowhere to go, no more pay. These degrees won’t improve my patient care abilities. I cannot afford this with kids in college. The only thing that might help me is Healthcare Administration Masters if I ever choose the dark side - queue up the Darth Vader music..... So, it worries me some, but I don’t feel pressured to do anything at this time and don’t have funding to do so. For now, I got a Bachelors and in my 27th year.....

Just about the time you have convinced yourself that medicine sucks and is not worth it - something nice happens. You catch a weird diagnosis or get someone the right care and make their day. Your boss tells you that you rock and a patient complimented your work and care. You ace a diagnosis and make a difference for a patient. Mine was a combo of all the above. Current boss - a doctor - completely unrelated to this old case - 100% supportive and never blinked when I had to deal with this and take time away. Got a thank you note from a veteran for taking the time to explain something that someone should have done years ago. At some point, it all comes back together and you remember why you got into this in the first place. The nasty folks take up a lot of energy and are sadly easier to remember - the whole squeaky wheel thing. The folks you help day in and day out are the ones you have to keep on the front burner - they remind you how smart you are and how good you can be. You have to hold onto those or the others will suck the life out of you. Then go home and hug your kids and your pets and take deep breaths.

I did not pick a private attorney. The group assigned one attorney per provider and then one for the corporate group. I did not pick her but got lucky - she is a rockstar. I paid zero legal fees. Had to use some time off from work but zero money. If I had remained a defendant, the insurance carrier would have reimbursed me $1000 per day in court. I couldn’t take that much time off without pay or my benefits would have lapsed. It is a screwed situation. I would have lost 10 days PTO or more but made $10K from the insurance if the trial only lasted 2 weeks. Not worth it. No idea what the tax issue would have been with that either. Thankfully, I got dropped and only missed 3 days, I think. Either way - it sucked.

I just finished with the one and only lawsuit of my career - going into my 27th year now. It was not normal and I don't wish anyone to ever have to undergo this kind of torture. The plaintiff filed suit at the 2 yr mark after their "event" (which is normal legal action) and then due to the plaintiff having a complete schmuck of an attorney - the next SIX YEARS were spent filing copious motions. They filed suit against the hospital, the nurses, the dining service, the custodial service in the hospital and named everyone they could think of. Then they let people go then they tried to put them back on the list. NOT ONCE WAS I EVER DISPOSITIONED IN THE FIRST FIVE YEARS AFTER FILING. For SIX YEARS I had to answer YES to that credentialing, renewal and privilege question. For SIX YEARS my attorney (from the practice I worked for at the time) had to write a letter about WHY this idiotic process was ongoing and didn't have a disposition. My malpractice carriers quite literally laughed out loud at how stupid this whole thing was. It was humiliating, embarrassing, degrading and despite knowing I did absolutely nothing wrong in my care of this patient - I felt dirty, tainted and less than ok. I told no one about the lawsuit except about 3 trusted colleagues and friends. Every time I got a letter from the attorneys, my stomach balled up and I cried a lot. The wording lawyers use is just uncivil and inhumane. I had to read complete lies from the patient and his wife and BS from "trusted authorities in medicine". Then, three experts - 2 docs and a PA - reviewed my work in the case and I was told my documentation was stellar and I did nothing wrong. I felt about one ounce better. Twice I had to schedule to be gone for 2 weeks to actually go to trial and then have it rescheduled. The judge in the case was quite fed up with the plaintiff attorney and finally said no more. Schedule a date or drop the case. I was prepped by a trial psychologist - yep, Dr Bull but female and very intense. I actually had four attorneys - one representing my personal professional position, one representing the whole practice, one from the insurance company and one from the hospital - they all represented my best interests. Two weeks before the final trial date - I was finally asked to disposition. This schmuck attorney in a room with ALL FOUR of my attorneys - I have never heard "Objection to question" more in my life. Every question he posed was accusatory, presumptive and flat out ugly. I think I spoke a total of 20 words. When the attorney wouldn't quit with his ill formed questions, my attorney touched my elbow and said - "we're leaving". She escorted me out of the room and said I did great. Ok, thanks. The morning of the trial - the plaintiff officially dropped me from the case. EIGHT YEARS after his orthopedic issue and SIX YEARS after filing - he drops me at the last minute BUT I still have to testify for the hospital, et al. I testified and answered his ill phrased questions or didn't answer them since they couldn't be answered - a lot of "what if this happened" BS - Again, I had FOUR LAWYERS in the courtroom with me. My time on the bench was about 15 minutes. Then, it was suddenly over. Just done. Over. I have a statement from the judge (copies of court records and citation of the law) stating I am not ever to be tried or questioned in the matter again - I was released. There is no evidence of malpractice, negligence or any wrongdoing. But, I STILL HAVE TO ANSWER THAT QUESTION "YES" FOR THE REST OF MY CAREER. And I still have to send this final letter to everyone letting them know I did nothing wrong and have legal backing. My attorney has become a friend. We still chat. That is the best thing to come of all this. I hope no one ever has to go through this - ever. I do somewhat believe that if you work long enough and do the right thing enough - it is inevitable to peeve someone to the point of filing a legal claim. It seems to come with the territory. Our legal system has issues and wastes a lot of time and money. It never cost me more than a parking meter for this case - and some time off work. It was exhausting and psychological torture. It made me question myself and really not want to practice medicine for a long time. I would rather have flipped burgers than to go through those motions sometimes. I had immense support from my current bosses and complete backing on needing time off. That was priceless. My attorney was stellar and made the whole thing tolerable. It has left a mark - I wish it hadn't. THAT is my experience with lawsuits......

My motto I can declare you dead and give Sched II drugs but can’t get you shoes... talk to the govt. At the VA DM shoes only come from Podiatry and consult..... Deep Sigh

I stopped taking NP students due to quality and skill issues. Then the NP schools said no PAs. Then they ran out of preceptors and came back and said PAs are ok. Ummm, never mind now. I would not teach on faculty because the education is soooo different and I would promote PA education for students more readily - I walk the walk, know the education standards and have the expectations that can actually be met. Currently training residents......

Until NPs “practice medicine” and fall under Medical Staff and not Nursing Union - they will have nursing support and PAs don’t have that. I get along great with most I work with. When it comes to union and hierarchy - that’s where things fall apart. We have to be on the same level legislatively and managerially to be able to follow the same goals forward. just my old 2 cents

Pretty unbelievable. ZERO remorse from the NP and ZERO medical legitimacy, logic, evidence based treatment or common sense. Her license should be revoked permanently. She showed no concern for her actions. Working for the VA, I am thankful everyday for the national limits and complete inability at my location to mix benzo with narcotics and soma doesn’t exist. Bad provider - period.

Another thing to consider. To get hired by the govt takes several months. My interview was in April. Job offer about 4 weeks later - some approval thing. Physical and drug screen in May. Start date - August. It just works that way. Fingerprints, FBI check, you have to account for every day of your life since birth in a history thing. Three references who have to do it a special way. Confirm they did it - confirm again. Fill out 5 more forms and wait on some licensure thing to triple check who you are. Day one at VA - don't get lost - don't get lost again. Find every dept on a check list - sign stuff, get an ID badge, check in with a bunch of departments who want to give you their intro and then you likely won't see a patient by yourself for about 2-3 weeks. You will likely shadow with a provider ( I do that now ) to learn how to use the system, where to find things, who to call and how to deal with stuff. If the VA you are considering is a ways away - stay with family if you choose the job. Don't uproot your entire family until you know. AND, I will honestly say that you have to give it a year - a year, really. It will take that long to figure things out, set any kind of pattern and get systems under your belt. Our asst chief of staff tells every new hire - ONE YEAR - please commit to one full year before deciding to leave. I really really like it and wish I had gotten there sooner. Hope all works out well for you.

I have always used Dragon Medical. No experience with anything else. Dragon is kind of the gold standard from what I have seen. A one user private license is $1800 with one magic wand hand mic. Corporate accounts have either headsets or magic wands. I have used it for over 15 yrs and really like it. They have lifetime customer/tech support and a 1-800 number answered by techs. Only one user per magic mic - can't skimp on the licenses - they do get you there. Good Luck

I have been with the VA for a bit over a year. I wish I had gotten there many years ago. My pay is great - our director fought to get us a well needed raise that puts us equal to the NPs who have a huge nursing union. Primary Care uses a PACT team - Patient Aligned Care Team - Provider/RN/LPN/Clerk (MSA). You have a panel of patients. Anywhere from 900-1200 depending on location, number of patients to be served, etc. In private practice, I had over 3000 patients, cradle to grave ---- seen in 10 minute appts like a Starbucks drive through. VA is 30 minute to 60 minute appts. I will never see more than 14 patients a day. BUT, that is 14 high intensity internal medicine patients on poly pharmacy with mental health issues and a TON OF THINGS TO DO. The view alerts on screen are heinous - lots of them. Some absolutely meaningless to you but you have to click through them. Lots of questions to answer, consults to place, etc. There is a lot of work. It is NOT a place for a new grad - My strong opinion and I am over 25 yrs out. These are intense patients and you have to know your crap. There is a thing called hierarchy of care and VA LAW on how to do things. If our VA doesn't have a specialty - say ENT - then by law I have to send the patient to the nearest VA that has an ENT dept. HAVE TO. Patients aren't always thrilled but it is the law. If that location cannot see the patient in 30 days then you get to send the patient out into your community - again - hoping someone worth their salt actually takes VA assignment. VA is 80% male and 20% female with female vets being the fastest growing number of vets to serve. I am a designated women's health provider. Some PACTs are not. The EMR is DOS based and older than my oldest kid - seriously. It works if you don't expect too much. I have mastered it and become friends with it to an extent. I know how to make it do what I want most of the time. A new system is rolling out in the next few years - same as active duty DoD uses now. It is 20 yrs newer - it will have its own issues as they all do. I work my butt off but really do like it. Hard mental work, some hard core patients, lots of mental health. But I do good work - I pay attention and have the capacity to do so. Having an RN AND AN LPN is Christmas everyday. Everyone works to the limit of their license. It beats private family practice or corporate medicine hands down. I am treated just like the docs - not kidding. Same expectations, same patients, same responsibilities. I am "not just a midlevel" at my VA. I have some great partners and some not so awesome folks floating around but I drive my own boat. I have great support - our administration is unique, I believe, in that they are ultra supportive. Not that way at every VA. Great benefits, lots of time off, tons of holidays. Not perfect, not at all - hard work, but rewarding to me and a great place for me to be. I wish I had gotten there years sooner. Just my crusty old 2 cents

I still get the occasional yahoo who says “I only saw the nurse, no doctor” Deep sigh - female, not a doctor - must be a nurse..... Not nurse bashing but, good grief, I wear a name tag, introduce myself and sign freaking prescriptions after dealing with 12 chronic problems, health maintenance and order testing. To boot, my license is on the freaking wall. Next......

One guy wrote on mine that I didn’t address his chief complaint and that made him mad. I knew who it was — noted blood pressure at visit and how he looked, asked questions and had him admitted for the STEMI he was having in front of me........ Never mind that he lived.

Govt rate health insurance for my family. Hands down. We now pay ⅓ of what we spent on my husband's union school policies which were better than any private organization. Same company, same coverage - ⅓ the cost. I have great PTO and a sick bank that I never had either. If it has to be tangible - the above is it. Not quite tangible - I am treated with respect and "not just a midlevel" as one of my colleagues put it. I enjoy autonomy and get respect from my colleagues that makes me feel useful and fulfilled.

I wouldn’t have imaged the patient in the original post at first visit with obvious mechanism. I would have suggested PT for modalities, core exercise and body mechanics for injury prevention. NSAIDs if not HTN, muscle relaxant, ice, etc. Neurosurgery/Ortho Spine if foot drop or acute neuro changes but our specialists want films with flexion/extension and MRI before they will even schedule. Drives me nuts. Private insurance won’t ok MRI until 6 weeks AND PT. The VA will do whatever I order. Bad form, lazy, patient could have been a lawyer..... lots to speculate