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About tristatepac

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    Physician Assistant

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  1. So I have decided to start a Telemedicine business from home as a Physician Assistant. The physician supervision requirements in NY/NJ are currently waived due to COVID-19. I left my job, and do not currently have a Supervising Physician. I do not want my patients to have my home address and I have my business address at the UPS store. So, two of the usual standard questions asked by pharmacies when calling in a Rx are who is you supervising physician and what is your office phone # (sometimes address). So, the first is easy enough I can tell them I currently do not have one and with the current COVID-19 situation in NJ it is currently not a requirement. The second question is a little more difficult. I can give them my cell # as my office phone number but which address? The UPS store? WHat if they call there asking for the medical provider? So the question is how can I make this work without giving out my home address. I have young kids and really do not want patients knowing where I live. I will be working from home and not having the overhead of an office is one thing that is making this possible. I thank you in advance for your feedback.
  2. True anomaly and Rev Ronin both make excellent points. There was definitely a time when you needed to translate the handwriting of some providers. If you couldn't translate, or reach them via phone, your third step might have been to go to a nurse that worked with that provider that wrote the note and they'd be able to translate. The issue with this is obvious sometimes it could easily have been misinterpreted. I think I like Rev Ronin's idea the most because it is clear in MS word, yet you can do without all the extra EMR nonsense. Rev, just curious. How do you backup your notes? Do you use MS word online (MS onedrive), or an external hard drive? Thanks!
  3. Hey Darwin, Just something to keep in mind and yes the disclaimer: this is not legal advice. Before EMR's providers would still get sued and the paper formats had slight variation just like today's EMR systems. I don't see EMR as necessarily a way to protect yourself against litigation. You can do that with proper paper documentation. A well written note is a well written note it doesn't matter if its hand written or in a digital font, or what we used to call the American Standard Code for Information Interchange (ASCII), or simply just call text today. Someone once told me when I was a student to always do what is right for the patient and you really cannot ever go wrong. I have stuck to that throughout my career, even against management wishes (sometimes to my detriment), but knock on wood, have not been sued yet. Do what is right for your patient, and do your best to ignore all the other noise. If the noise is too great you may need to look elsewhere for a job. Remember, in the end the patient is suing you. If they know you truly do care about them, and you haven't been negligent, that is most of it. Patients are much less likely to sue someone if they know they have had proper treatment, and that you really care about them. Also your seasoned doc probably has good reason for giving EMR the finger. I am actively doing my best to use it as little as possible. What Joelseff said above has a lot of merit and I suspect Joelseff is an experienced provider. Best to you!
  4. I appreciate all your feedback. I definitely found that EMR's really did not help my patient-provider relationship. In fact, my job became much harder as soon as I started using them. Mind you, I am very computer literate so it wasn't the EMR part. Initally EMR was promised as a paperless system and everyone's chart would be on one system. With all the rules and constraints imposed by insurance companies, we are using more paper now than ever. Meaningful use. LOL.. For who? Patient's were originally in charge of their health, now insurance companies could mandate that providers get a patients's HgB A1c < 6.0. It was no longer the patient's job to take responsibility for their own health. The push for the provider to be responsible for the patient was on. I have enjoyed healthcare less and less over the years as EMR has implemented more and more. I may still use something like Practice fusion for e-prescribing but I am hesitant to implement it fully. Ventana does have a point about getting everything loaded into the system. If someone does request a chart, then it's easy enough to send it electronically. Having said that, if a patient wants to submit a claim to their insurance company will the insurance company make it a big deal if I simply use a template system (i.e. MS Word). In other words, as the provider, is it my job to put it in the insurance companies format (i.e. EMR), or will they do that on their end with my note? I imagine patient's will want to submit claims and I am just factoring this into my reasoning. I don't want to be typing up notes more than once. Part of this message is also just me needing to vent because medicine is becoming such a corporate endeavor. I truly feel sorry for new graduates coming out into this mess. The good news is they won't know any different.
  5. I am looking into just having my own small practice cash only. It will just be me, no additional employees, and no hassle with insurance companies. My question is if I have a cash only practice do I still need an EMR system? Of course I will have malpractice to cover the business and some form of incorporation (likely LLC). It is really the EMR that is throwing me. I get it that I would be charged a % of income annually by Medicare for not using an EMR system, but I don't plan on taking Medicare. What are your thoughts? Thank you in advance..
  6. If you were looking to hire a Supervising Physician for chart sign off how would you go about it? In other words, would you post on indeed, talk with doctors you've worked with, etc? Looking for suggestions. Thank you!
  7. I started working for a large Urgent Care company about 2 months ago. I signed an "agreement" naively thinking it was the contract (hindsight is 20/20), started working for them and three weeks later received a contract. Turns out, HR thought I already signed it but I never did. I had emailed them about it asking them to change something but they said they couldn't. At any rate, for whatever reason I never signed the contract and I am more than two months working for them. If something were to happen, am I covered by their malpractice insurance even though I didn't sign the contract? I am not looking for legal advice and will not hold anyone responsible I am just curious because I am not a lawyer. I like the fact that I can leave at any time but I don't like the possibity I am not covered by their malpractice insurance. Any thoughts on this or who I could contact for further advice. Thanks!
  8. The purpose of the post is to just gain insight from some experienced PA's out there. I've been working as a PA for close to 15 years now. I started in Emergency Medicine, then progressed to Urgent Care and Family practice. I am very good at what I do but I feel very bored. I've really started to not like working weekends because it's the best time to see my kids because they're in school during the week. I'm feeling trapped these days by a job that I don't feel like I get much satisfaction from but I get payed well. I've thought about working in the hospital again (started in ER), so I wonder how different is it working as a hospitalist versus the ER? Alternatively, there are pain management practices, occupational medicine practices that are more regular M through F type gigs. Has anyone else experience this type of boredom and what have you done? I could take another job for $30k-40k less, but then I'd have financial stress. I am in my mid to late 40's so I think age may also be a factor here. I appreciate any input as sometimes I feel paralyzed these days by all the stress and my procrastination in making a change. Thank you.
  9. I appreciate all of your feedback. I have had times in my career where I've worked 3-4 day workweeks and I have to say I have been happier with that. However, currently in Urgent Care some weeks are 5 days and some are 6 days as well. It's those 6 hr split shifts that I find aren't really worth it because with the commute and finding parking it's like an 8 hour day. With my seniority and experience I think I will make a push for longer shifts, and fewer of them. i.e. 3 - 12's. They are long days but I'd rather have more days off to recover, and do something fun - like a hobby What a concept! LOL. Life balance is one huge reason I became a PA and it's possible with a better schedule.
  10. Tristatepac thank you for sharing. It’s funny because I’m in a similar situation however you only have one life to live so I recommend 3-4 shifts per week and enjoy the rest. Monday through Friday will get old quick and a lot times work more hours with less pay. 

    Secondly, may I ask in what region of the US you work. I have worked urgent care for 10 years and sometimes working as much as 215 hours a month and not made $150k a year? No where near that.  I barely made that in the ER full time and working part time as well in urgent care. I am not questioning you I am just happy to see such high wages and it gives me hope. Plus it lets me know I probably need to move out of state. 

  11. I've been a PA for close to 15 years. I've worked in Emergency Medicine and have been doing Urgent Care (with Worker's Comp) and Family practice for the last 10 years or so. I got divorced a couple of years ago, have two wonderful children, and find that I am having a really difficult time being able to find activities outside of work that fit with my schedule. It's really important to me to make new friendships at this time in my life. Due to the nature of Urgent Care there isn't one consistent night I have off every week for an activity. As most of us know it is shared interests and repeat exposure to the same people that help establish friendships. So I am in a bind. I make about $151k per year with likely another raise soon. I can stick with my current position which I do well in professionally, but seems to make it difficult to schedule activities outside of work. An alternative is to work a M - F gig but probably make closer to $140k per year. The extra money now comes in handy with supporting my children but the lack of a social life is really starting to wear on me. I do have a therapist for emotional support but my thoughts are she cannot understand what I am going through like PA's working in the same field. I have to imagine I'm not the only one finding it difficult to carve out a consistent time for a social life. I'm open to suggestions and hopeful to gain some insight here. Thank you!
  12. I'm looking to simplify my Urgent Care charting my incorporating Speech Recognition specifically Voice to Text translation. My current place of employment uses Docutap EMR. What experiences have you guys had with this? I'm specifically looking for hardware/software recommendations. I appreciate your help in advance.
  13. So I’ve been a PA for about 15 years and have made numerous contacts over time. I’ve worked in Urgent Care, Emergency medicine, & Family Practice. I’ve become very good at what I do but I am feeling rather bored these days. I need a challenge. On a personal note, I’m in my fourties so there is also a bit of a midlife situation which I’m addressing through a therapist. With that being said I had some sales experience in my early 20’s and sometimes I miss the daily uncertainty and the adrenaline rush when you do finally close a sale. Something I’ve been considering is starting my own Recruiting firm specifically for Healthcare. I know I could charge less than the larger firms and I have an office at my house. I’d recruit Physicians, PA’s, NP’s, nurses, X-ray techs etc. So my questions to those in the know here are: 1) is there a market for this? 2) could I break even with what I’m making as a PA? I’d probably work 20 hrs/week clinically and 20 hrs/wk as a recruiter. I make about $150k annually as a PA so I’d need to make about $75k annually to monetarily justify recruiting. 3) how much should I charge? My understanding is some recruiters take in anywhere from $10k-20k per client. I’d be willing to charge less and attempt to make it up on volume. 4) do I need some kind of license or certification to recruit? Thank you in advance for your time.
  14. How long have your Locums assignments lasted on average?
  15. One thing I ran across with one Locums company was them telling me that they could get a Physician for $85 an hour. I'd say not a very good one. Some physicians I've worked with that made that kind of salary were asking me to help them read xrays and ekg's. they were asking me what to do next with the patient, or for my opinion. How is it they get payed more when I am doing the same darn work and I'm seeing twice as many patients. Alright, rant over. As an Independent Locum Tenens contractor I will be contacing Urgent Care owners,etc. Any thoughts on countering well I can get a Physician for that amount comment? My thought process is to take $75 to $80 an hour and to slowly increase from there as I learn the market in my area. I also established an S Corporation hoping that Trump will give that tax break. Will keep you all up to date!
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