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chatcat

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  1. I've been on a first name basis with the Docs I worked closely with in the past. I've also asked one MD who was much younger than I if I could call him by his first name and he was offended . (Bless his young ego!) I currently have multiple SPs whom I address as Doctor. Only one of my current SPs asked that I address him by his first name. I have no problem with using "Doctor" in the professional setting and leave it up to the MDs to direct me to their preferences.
  2. Please do not put yourself in this precarious situation as a new grad. Quite honestly, I question the judgement of this management who would hire a new grad to do solo work with a 2 week training period. This will be stressful for you and you will not be supported in any way beyond the presence of a MA (who could possibly be an additional stress that you have to supervise ) The ever present management will be looking to see how you meet expectations and will not care about anything but the bottom $$. Jumping into the first job always requires a steep learning curve...this is even with on site supervision. Availability of SP via phone or e-mail will provide the needed supervisory requirements but it will do nothing in terms of helping you learn as you enter medicine with "hands on" supervision. Above all else in your decision ,think about how you want to create this first chapter in your career as a PA. I hope your decision will be based on acquiring solid clinical skills to gain experience and putting yourself in a supportive environment that will allow you to grow,succeed and thrive. The salary and benefits will never trump job satisfaction so choose your setting with great care. Good luck!
  3. This pretty much sums up my opinion of EMRs also. That $30 billion investment could provide a lot of health services and programs throughout the country...yet.. we continue to ignore the fact that more administrative costs do not equate to better patient care outcomes. As a newbie on EPIC I have been asked how I like using it . My reply is that it's a lot like entering Home Depot to find just one item..... searching to find the right aisle, then having to filter through all the other products selections to find the desired item and make sure it fits the required specifications, taking that one item to check out to find that purchasing one item requires other information about the customer in order to generate a receipt of the transaction. The purchase can be delayed without the proper digital code and everything comes to a screeching halt in the process if there are any issue with the computers which results in a major inconvenience to all parties involved in the purchase. The single act of one purchase is influenced by too many other hoops and hurdles for the customer! Our belief that digitalization has made our lives easier really isn't valid in so many realms including medicine. It is what it is and EMR is here to stay....hopefully in 5 years there will be significant gains in providing clinicians with programs that actually help us do our jobs more efficiently.
  4. I know many of us have been out practicing prior to the switch to EHR and have endured the often painful process of learning curves during the transition. I've embraced the digital age with enthusiasm but am finding that EHR negatively impacts my daily work flow and productivity and actually does very little to add to the quality of patient care. I'm a new user on EPIC and cannot believe the complexity of this system that is being used by so many large institutions. It's affirming to know that so many others find EHRs a difficult hurdle in patient care. It's disappointing to discover that EHRs are in fact such a cause of stress for many of us in healthcare. HealthCare IT News Whereas it's relatively safe to generalize that most technologies improve with each new iteration and user feedback yields changes that customers ultimately appreciate, one has to wonder if today's crop of electronic health records software are among the exceptions to that pattern of progress. Yes, the top-tier EHR vendors are for the most part improving certain aspects of their products, notably usability, workflow, UI, load and response times as well as other features designed to improve both the user experience and productivity. But do the clinicians, physicians, nurses and specialists actually using the software like EHRs any more than they did five years ago? No, they do not, at least according to the results of a study published by the American Medical Association and the American College of Physicians' AmericanEHR division. Physicians, rather, have are grown increasingly dissatisfied with their electronic health records software during the last five years. "While EHR systems have the promise of improving patient care and practice efficiency, we are not yet seeing those effects," said Shari Erickson, vice president of American College of Physicians. The survey, "Physician Use of EHR Systems 2014," found that about half of all respondents reported a negative impact in response to questions about how their EHR system improved costs, efficiency or productivity, the American Academy of Physicians reported. What's more, the majority of respondents said they were dissatisfied with their EHR system, in fact, and only 22 percent indicated they were satisfied. That percentage dropped down to 12 when asked if they were "very satisfied." In striking contrast, a similar study conducted by AmericanEHR five years ago found the majority of respondents satisfied – with 39 percent answering satisfied and 22 percent saying they were very satisfied. That said, for a little perspective it's important to understand the EHR landscape five years back. The HITECH Act and its incentives for hospitals to implement the software and for EHR makers to meet certain criteria were nascent. Adoption rates have skyrocketed since then, however, and the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT have disbursed more than $30 billion under meaningful use. Given that, what accounts for clinicians being less satisfied with EHRs than they were before all the incentives even began? Was it just a matter of not having pressure to use the software after a fashion that meets federal criteria? Or is this a case of expectation adjustments such that five years ago doctors were happier with less sophisticated technology than they are today?
  5. Yet another hoop to jump through...and yet another distraction for clinicians (cause we don't have enough administrative mandates already!) Seems like the perfect day to share some of the most bizarre codes ICD-10. It's entertaining reading until you think about the fact that this is reality for us. http://www.poweryourpractice.com/revenue-cycle-management/the-most-bizarre-icd-10-code-awards/http://www.poweryourpractice.com/revenue-cycle-management/the-most-bizarre-icd-10-code-awards/
  6. YIKES! Don't know what state this is in but it's a rather big deal not to have all the documents in order per the rules and regs of Medical Boards. That said..a state Medical Board that approves a PA license before all required documentation is in order obviously isn't doing a thorough job of approving a license. Sorry to hear about this sort of incident especially when it sounds as if this was just an oversight and without intentional omission. Wondering why this is an issue if the PA is no longer associated with these MDs ... what prompted this sudden interest in a past working relationship if the PA is abiding by the rules in their current situation.? How in the world did it ever become discovered?
  7. Listen to your intuition and remain professional to the end of your employment with this employer. I've never received compensation for unused sick time when I left a employer and know how difficult it can be to endure those last days on a bad job. Hang in there...and good luck with your next job!
  8. Right! Employers can only verify employment and dates of employment when contacted about a previous employee from a legal standpoint.
  9. Let me preface my response by saying that I absolutely want to see all PAs thrive in the current market and get due compensation for services rendered. That said...new grads should be informed that you are negotiating from a place where you cannot expect to get top dollar when you don't have any experience to justify the premium salary. I certainly don't suggest new grads take jobs that are below market value,however, the focus should be on finding the right niche to gain experience in a supportive clinical practice. Very few PAs stay at their first job for extended periods so making the first job about experience should be the focus. I've seen new grads turn down jobs over a few thousand dollars yet are willing to extend the job search ultimately discovering that the salary driven job search doesn't pay off in terms of gainful employment in the vast majority of cases. Unless you work in a large institution with set salary ranges and make a transfer within the institution, potential employers do not base their salary offers on previous salaries of other employers.
  10. 1. How long ago did you graduate? 30 years 2. How many different jobs since? 5 3. How many specialties in those jobs? 3 4. How many states practiced in? 1 5. Do you see changing jobs in the next year? Yes..currently stating a new position in a few weeks. After working for a contracting company for 8 years, the company had a merger and did a clean swipe of all employees and hired new,younger staff (for less $$). I certainly didn't see that one coming after continuous employment as a PA for 30 years. It's been a very interesting & humbling experience being back in the job market at this time in my career as a PA .I have definitely felt a bias in hiring trends towards those who will require less compensation. (The majority of management level folks I have encountered have one focus...it's all about the $$) ​Oh the stories I could tell ..but for now suffice it to say that I would absolutely ,without a doubt support PAs being independent and in better control of our livlihood!!
  11. Indeed! My happiest days in medicine were working in a small, privately owned office without the need for over involvement of administration. Sadly, independent providers have little advocacy in the chaos of todays' administration driven environment. We do have the resources to provide much needed expanded clinical services which are restricted by administrative requirements. By far my biggest frustration in the current environment of 2015 is the imbalance that we have in the union of management and clinicians. Somewhere along the way the boundaries have become blurred in what is inappropriate involvement of a largely nonclinical administration placing undue demands and interference on clinical staff. I resent having anyone without a medical license telling me how to practice medicine or suggesting that I compromise my clinical practices to suit a management/administrative agenda. Yet, it's become widely acceptable for administration to micromanage clinical medicine largely without the balance of clinical perspective. Is it any wonder there is an unprecedented "burn out" rate in medicine which I attribute to this loss of professional boundaries? It's become acceptable to create a very complex layer of administrative costs and input into the practice of medicine. Administration places endless influence on clinical medicine and yet there is absolutely no data that supports better outcome with increasing administrative influence.(or cost) As clinicians we are accountable for our competency through life long learning and testing , adhering to both state and national standards of practice and ethics while being transparent and accountable to the population we serve. Anyone who goes into medicine as a profession assumes a huge degree of accountability which we accept with our role in medicine. On the other hand, the administrative influence in health care has very little accountability beyond following the mandated guidelines for such things as HIPPA etc. We all have faced the long credentialing processes required when entering new employment and know how long insurance companies can take in approval of claims for our patient's care. Large institutions often breach professional boundaries with their adminstrative projects that place the burden of their projects on already overburdened clinical staff. Where is the accountability for the administrative arm of medicine?
  12. I took this on-line course. I liked that it was self paced and the material was well organized for studying into modules. There is also a required web-inar which can helpful for specific questions . I did well on the exam. Good Luck! ACOEM On-Line Training.
  13. It just baffles me how people can put faith in nontraditional therapies and ignore the potential harm by using the internet as a valid point of reference ! Case in point: I was alarmed to come across a posting on Facebook by an acquaintance who was recently diagnosed with breast cancer. Her post boasted about her decision for forgo the recommended western therapy and embark on the use of a "black salve" to treat the cancer. She referenced the endorsement of others who had used this therapy with good results and cited Suzanne Somers as a celebrity reference who treated breast cancer successfully with alternative therapies.( Mind you, Suzanne Somers is a cancer survivor and banking money from her book on the topic to anyone who will buy it. I have no idea what is in her book as I don't support celebrities playing the role of health expert by virtue of their celebrity status. Steve Jobs is another celebrity case that used alternative therapies for his choice of treatment and we all know how that worked out for him) With the best of intentions I added a comment suggesting it would be valuable to first explore what she is dealing with in terms of staging of the breast cancer and then discuss her options with her oncologists. In reply there was a flurry of links that cited the efficacy of black salve all of which were blogs, anecdotal tales from people who were probably paid to market this product and support from other lay people who acted quite confident in dishing out information to this person whose life depended on sound cancer treatment options. This woman was using the internet as her trusted "reference" of treatment ! I have great respect for personal choices concerning our health decisions however, I find closed minds are primed for making some dangerous choices when it comes to choosing alternative therapies at the exclusion of evidence based treatments. Just as an FYI for anyone who doesn't know about "Black Salves"
  14. By far this approach by patients is one of my biggest pet peeves also! There is not only a huge trend against big pharmacy drugs but also an alarming group of individuals who claim "expertise" in treating some very serious medical conditions with herbal and homeopathic treatments. These claimed "experts" are usually found in health food stores and have a high school degree with training that consists only of anecdotal observation…and yet,way too many people put their faith in their potions and pills. Then there is the wealth of information placed on the internet that claims alternative therapies can prevent/cure cancers , protect from influenza and a myriad of other miraculous cures. For some conditions dabbling in alternative therapies will do no harm…but there are the serious conditions such as hypertension and diabetes that can be devastating without the proper drugs used in western medicine prescribed by professions actually trained in medicine. I found it quite helpful to learn a little bit more about the alternative therapies my patients were using so I could be better informed and hopefully be an advocate for their lack of evidence based therapies that could result in potential harm.(The "expert" at the health food shop just doesn't know how dangerous some of these therapies can be to some individuals.) I have found that many patients appreciate a fact based approach to their alternative therapy choices even if I am the one who burst their bubble of the effectiveness and safety of their choices. Likewise, I have an excellent acupuncture referral for people with conditions that are known to respond to this type of therapy. Inevitably I will have the occasional patient who resists FDA approved medication in lieu of going "the natural route". I can't help but point out that death is also a "natural" process that has been around for a very long time that we are having great success in delaying with some evidence based medications & therapies. ;>) This is a very useful index of some herbal therapies that are being used frequently by some folks . Herbal Medicines : http://www.nlm.nih.gov/medlineplus/herbalmedicine.html
  15. Absolutely let your employers know that you aren't comfortable going solo yet ! If this isn't negotiable then put out the expectation that you will need to have immediate phone back -up for the time you are there. A smarter initiation into this would have been to let you work with someone else during weekend clinics to get your feet wet before throwing you out alone. Welcome to the world of medicine in 2014 where our worth is measured by the funds we can generate. Good luck!
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