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About Bohuntr

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  1. Darwin, I have attached a link below that was an article he wrote for NPs. He has written basically the same article for PAs. One of his "end of year accomplishments" for 2019 published to the TMA was that he was able to stop something like 20+ bills in the Texas house that would have increased the scope of practice for non-physician providers, meaning PA's and NP's. I have tried, but can't seem to search the TMA website and come up with it and it's no longer in my emails from their alerts. At the moment, Texas PA's are facing hostility on all fronts, the Texas Medical Association and Texas Physician Assistant Board. Fortunately, leadership always changes eventually. The next TMA President may be more friendly to PA's and NP's, but the PA board has always been hostile towards PA's, as I mentioned above, when PA schools have instructors telling students to practice in other states, as well as preceptors, something is wrong. Texas used to be a leading state to be a PA in, but a constant lack of leadership from the PA board (which, rumor has it may be heading in a better direction with a new leader this past year) and a TMB President openly hostile to PA's doesn't make me believe that this will happen anytime soon. There somes to be some delusional thinking at both agencies that they can command you to respect them rather than earn it, a thought process so destined to fail that anyone who has ever spent one day in basic training as a recruit would identify this in a second. https://www.texmed.org/TexasMedicineDetail.aspx?id=52583 Stay safe and wear your PPE,
  2. I agree that the Nursing Board does not appear to be in the right here, but the knee jerk reactions of the Physician Assistant Board in Texas are worse. It seems like there was a failure to investigate by the nursing board here. I went to BCM and we had multiple instructors telling our class that the best way to have a healthy career was to practice outside of Texas and that if their spouses weren't tied to industry in Texas, they would have left long ago. When I graduated I found out that this was also taught at other schools in Texas such as UTMB and UNT. I myself was able to talk two Oklahoma PA students that I was precepting for turn down jobs in Texas and return back to Oklahoma to work. With the current leader of the Texas Medical Association being so anti-PA, if you haven't read his rants on the highlight of his year being his fight to limit the advances of mid-level providers, it's worth reading. He pretty much holds PAs and NPs both in absolute contempt and doesn't use any of them in his practice. I practice outside of Texas at the moment and don't relish having to move back, but will have to sooner or later due to family obligations. I know it seems like the grass is always greener on the other side and all, but why does it have to be all or nothing? What appears to be a failed board investigation or knee-jerk reaction devoid of a thought process?
  3. I was more than happy with the thanks from my neighbor I treated with the kit I had and couldn't have done more; I'm grateful I had the experience to treat and that my kit was in the garage next to my range bag. I doubt my neighbor will raise any issues with the good samaratin law after talking with him, he's glad to be alive and was on his way to bleeding out when I got to him. Truth be told, I have no faith, trust or respect in our state PA board could even recognize that it was ethically right to treat, so they are still a concern, but it's been a month so it's doubtful that anything will happen there either and I'm keeping my fingers crossed. Thank you again for all your input. It really sucks that doing the right thing causes so much second guessing and hesitancy...
  4. Well like I said, I never second guessed it until I talked with my co-workers, and they had very valid points. I am by no means holding their points against them, and hope tht if something similar ever happens again I won't think of the issues they brought up. I just took TCCC for the third time this past September for a pending job this spring, which was going to be in Afghanistand and now looks like it might be in Syria, so the training was pretty fresh in my mind. Thanks for all the input!
  5. Last night I was driving home and saw a person exiting my driveway with a walker, turn and start shuffling up the sidewalk... lets go back four weeks to December 27th. I was working in the den in front of the house and heard a loud bang somewhere outside and then some screaming. I have heard enough gunshots to know that this was not a firework, which is so common here in my neighborhood between Christmas and New Years Eve, so I went outside to see what was going on. About three houses down I could see a neighbor on the sidewalk screaming, and another neighbor yelling into the phone about a person being shot. I ran into the garage and got a tiny trauma kit that kept since my last tour in Afghanistan and went down to help. The patient was lying beside his vehicle on the sidewalk, had vomited on himself (yes this is somewhat common), there was arterial spray coming from the medial aspect of the L upper leg, with a large amount of tissue and bone visible though a hole in his denim pants. This person was already going into shock and was having difficulty communicating with me. I had already put on gloves while running down the street, and immediately opened two large rolls of kerlix and shoved them directly into the exit wound, and then placed one on top of the entrance wound (I have no combat gauze in my kit). I had only one Israeli dressing, so I applied this sideways on top of the two rolls of Kerlix, and then wrapped it around the leg using the straps to hold the Kerlix in place on the entrance wound. This was not enough to stop the bleeding, so I applied a CAT tourneqit as close to the groin as I could which stopped almost all the bleeding. I was very grateful for this as I did not wish to go search for or tie off a blood vessel on the sidewalk. I was able to talk to the person who had called EMS, (they arrived approx 12+ minutes after calling) and found out that they were loading rifles into a vehicle to go hunting and that the patients deer rifle, a 7mm magnum that he thought was empty, discharged, striking the victim in the inner thigh. The delay of EMS is due to neighborhood being relatively new, many of the streets are going up faster than they are mapped, and the county EMS station is > 10 miles away. I gave EMS and update on my treatment and they stayed on scene only long enough to place two IVs, three sheriffs vehicles arrived as I had finished gathering my belongings and returned back home. I walked off before I could give a statement, and they never came looking for me. There are only 6 people who know about this incident, including myself, with the exception of the patient and neighbor of course. I told the 5 PA's I work with about this a few weeks after it happened at a work function when we had time away from everyone else at the meeting. Much to my surprise, 4 of them said that they would have let EMS handle this and would only offer comfort and reassurance to the patient, only one of them sided with me regarding treating on scene and he is also an ex-military medic. The reason 4 of the PAs gave for not wanting to do anything was fear of running afoul of the state PA board or running afoul of our states good samaratin law if something went wrong. Providers do not have immunity under our states good samaratin law, which states "someone who normally provides emergency care, such as a nurse or emergency room worker" does not have protection from liability, and our states Physician Assistant board is the original home of knee jerk reactions and I could easily see them trying to charge a provider with performing medical care at a place other than his listed address or working without first telling his supervising physician about the patient. Since I had left the scene before the Sheriff's office arrived and went to pick up by foster girls from school, and never gave my name to EMS my name is on any documentation and I never had to give a statement. With so many of my fellow PAs stating that they would not have treated, but would have only offered supportive care and assisted with the 911 call, I began to second guess myself. Not the treatment, I have treated multiple traumatic injuries and gunshot wounds in the past, but I became very concerned about an overreaction by my states medical board and my liability under the good samaratin law. I was very worried about this over the past few weeks to the point that it was keeping me up at night. Until last night... Last night, that person using the walker and shuffling out of my driveway was my neighbor, who was discharged from the hosptial yesterday after 29 days and had come over to thank me for saving his life. Now I know I did the right thing.
  6. I just read this and it's kind of sad. The Texas PA board is neither competent nor ethical enough to handle this persons problems. I have zero trust or faith that he will get the treatment and monitoring he needs if this board is in any way involved...
  7. You have every right to sue your previous employer if their recommendation cost you a new job... They should have known better and are now on the hook big time for the money you would have been made if you were employed through the time you get a new job. Get a lawyer, this is an easy win. Attorneys should be jumping all over this one
  8. Unfortunately, joining up is not an option. We have 4 brand new grads and this is their first job. Even they signed contracts a month ago and are being asked to sign new ones now, they are signing them just to keep their jobs. I cannot blame them for that. It's all the experienced people that are leaving. One of them interviewed at a new Urgent Care this weekend and was told by the doctor that he is sure getting a lot of applications from our company! All the experienced providers are signing and looking to leave, and most agree with me, the 90 day notice is garbage and most of us will just ignore it. Our previous work histories and the way the change happened will easily be overlooked by any new employer. Most of us have decided to give two weeks notice which we believe is more than fair considering the way the contract was shoved down our throats. I see it as similar to a do not compete clause; as a PA, we don't really bring patients from an urgent care, and there is a clause called "restraint of trade" which will override do not competes in Texas. If we were leaving and bringing 1,000 patients with us, yes it would be enforceable, it would also be enforceable if we were TV or radio talk show hosts moving in the same market, but going to another urgent care in a city of 1 million? Not going to happen. If I'm right, the last time someone tried to stop a PA from working under a do not compete in Texas, it went to the medical board, not a civil court. The Texas Medical Board is a joke, they hand out huge fines for any minor issue (so they can justify their existance) and only meet 3-4 times a year to approve licenses. I'm not too worried about them, I think a decision on do not compete is over their pay grade. Thank you for all your input. It was nice to see that this came from senior members on the site and Moderators. I know that new hires are often scared of losing their jobs and let employers bully them around; I've been around long enough to bully back or make a decision to leave. There are always locums available until I can find a new perm. Much appreciate the input Amigos!
  9. Our company suddenly presented the mid-levels with new contracts that "must be signed immediately." We are an urgent care and were having mid-levels work the same hours as MD's, 9-9, 13 days a month with 3 on call. Now that we are going to extended hours, if you want to keep you job, they are shoving a 8 hour a day contract down your throat, 7am-3pm, 3pm-11pm or 1pm-9pm at the clinics that are not extended hours. They are also requiring two days of on call duty, unpaid, on two of your days off a month, making you work or be ready to work 22 out of 30 days a month. Obviously the CEO was devoid of a thought process when he thought this one up... This screws mid livels over big time. Those of us with second jobs will have to quit, we have no overtime available since we are now going to have to work 40 hours a week, and they aren't raising our pay with the increased days, though not necessarily hours. They also want a 90 day notice if you are going to quit. I know one of my colleagues has already sought out an attorney, and I have told several others to ask for a letter completely dissolving their pre-existing employment contract before they will sign a new one. This gives them have the option of telling the company that they have changed their mind and decided not to sign the new contract, and with the letter dissolving their previous contract in hand, the do not compete clause and advance notice are no longer required. Has anyone else been sodomized like this? This was one of the better employers in Austin, now it's going to go down the tubes because nobody will want to stay with these hours, MDs included. As one MD stated before he recently left, "we feel like we are being held hostage here in a tight labor market!" Bohuntr
  10. Everyone asks about my experience (Military Medic, Private Contractor w/6 tours), some are frightened by the experience and some have offered me more than what they were advertising. I do a lot of locums and some places like procedure heavy PAs, the corrections gigs don't worry about you being afraid and quitting after an hour. I think it depends on what your background is; my best friend is a Family Practice Doc in a medium sized town in Texas for a small hospital and every single PA she has wanted to hire has been turned down by the administrators because they have prior experience. They have given her 3 new grads in the past year and all have quit. She's not hard to work for, but the clinic administrator wants people that he can push around and he feels that experienced PAs will push back. This is a could be an interesting string of experiences
  11. Yes, next time lawyer. Good advice. My biggest regret is that I stayed the full two weeks, even after the first few days I realized that she wouldn't give me any patients, or only those too early or late for her to bother with; she was just keeping me there to keep me from making money elsewhere. I should have just walked out after 2-3 days and never looked back
  12. Thanks for all the info! I guess it's just a lessoned learned...
  13. I signed a contract in January for a salary of 85K that would convert to production of 30% upon completion of my credentialing, however the SP stated that because she realized "it will take 12-18 months to build a practice, I will keep your salary level even until production is greater than salary." To me that sounded reasonable, she knew nobody would be able to take a huge hit on pay and would give me a reasonable transition from salary to full production. At 80 patients a week it would be > 110K per year, which is reasonable for a family practice PA. The Friday before Memorial Day weekend she called me into her office 5 minutes before she left for the day and said that due to ICD-10 pending, she would not be able to maintain my salary and would immediately be moving me to production starting the next Monday. She gave me a handout that said for only 1700.00 of my own money I could place an advertisement in a local high school football program, and that she had already talked to a friend of hers who managed an urgent care and that he could bring me in one day a week, but one day only. I still had to be with her four full days a week in case a patient wanted to make an appointment. It has been slow building a practice, so I am seeing anywhere from zero (0) to 15 (fifteen) patients a day. After a quick calculation I realized this would be a 75% reduction in pay! I gave two weeks notice the next Friday and she flipped out and told me that I could should be willing to get a part time job evenings and weekends in an urgent care or ER so I could stay and "build my practice." Now I may be wrong here, but it's not my practice to build, neither is it my opportunity cost to lose money by sitting there waiting for patients to schedule appointments when I can be getting paid hourly elsewhere. We are hidden in an office park, so there is no opportunity for walk-in patients. Its all word of mouth to increase patient volume. To make matters worse, she knew I just got married two months ago and my wife and I just purchased a house. And she feels that this is the time to cut my pay by 75%.... she said that my wife who is also a PA should be able to afford to "share the financial burden" while I build my practice. Needless to say, for the next two weeks she gave me the first and last patient of the day, nothing more. I just got my final paycheck for my last three weeks, and less a mid-month draw that I had to beg for of 2K, I got a net pay of $8.60 after taxes! She must be so proud, I made less than my MA! When I saw where this was heading, during my next to last day my MA walked in and said that my first patient was ready (my only patient that day) and I asked her if she wanted to see the patient. I said why not, you're making more than I am, and if you get what you pay for, she should be the better provider. My SP flipped out and I laughed my a$$ off before I walked in to see the patient. To make matters worse, I found out that I'm the 3rd PA she has done this with in the past two years. Both the others were told that their pay would not be cut less than their salary when the made the switch from salary to production as well. Apparently, taking a supervising physician at their word is worth jack sh*T! Am I bitter here? She did not violate the contract, it was in writing, I was stupid enough to take her at her word, so that's a lick on me, but when I got my final check, which didn't even cover my monthly expenses, I flipped. If I had to do this over again, I would have just quit without notice when she told me she was switching me to production and then offered to "let me work at another practice part time to make up the difference" and that "it will only be for 6 months to a year while I build my practice in her office." For those of you signing contracts, take a lesson. Your SP may be a gross liar, if it's not in writing, it ain't gonna happen... don't trust them at all. There is nothing I can do to "undo" this situation. I have been taking overtime since July and will work 200 hours this month and next month to make up for the month of June, but can then slow back to normal. I'm grateful that I had current privileges at an urgent care and could start almost immediately at 10-20 per hour more than my salary rate at my previous job depending on working a weekday vs a weekend day. It just galls me that she will do this gain to another provider, she obviously doesn't learn if I'm the 3rd one she did this with... how can I get the word around not to work for this woman without slander? She is actually a "nice" SP to work for, polite, treats you professionally, always there if you had a question, etc..., but she is the worlds worst business person and can't see more than 90 days ahead with her business plan. Everything is short term. I even told one doctor I met last week who I worked for at my last job and the first words out of his mout were "has she quit paying you yet?" Obviously some people know her method of operation... Should I just walk away and forget about it, or figure out how to subtly warn other providers? I know this was a long one here, but I was shocked about me for being stupid enough to trust her and her for doing this to PA's over and over... am I wrong and should I only be mad at myself, or is it ok to be pissed at her as well? Bohuntr, MBA, MSPAS, PA-C
  14. This was my post about loving my job on 6-July this year.... It's amazing how the practice has changed once the hospital got involved and started sending the ER patients that were not high acuity to our clinic to be seen (they have no real fast track or f/u method to speak of, so they decided to use our clinic) for f/u or iniital visits depending on the time of day it is. I feel like we are the ER's dumping ground and the patients we used to get no longer want to come to us due to the other type of patient that lingers in our lobby our outside our doors smoking. I"ve even seen patients waiting to be seen going to the store and sitting outside drinking! 06 July 2014 - 01:09 PM I was like you for the first two years after graduation, I just wanted to forget I ever went to PA school and go back to my previous career. All I could think of was how miserable I was with the never-ending flow of chronic complainers, non-compliant patients who continually make poor lifestyle choices, drug seekers and illegals. Then I found my present job a few months ago. I work at a family practice clinic right across from one of the largest Universities in the country. I do primarily urgent care, but the Medical Director has a private practice that includes a lot of professors and their families so I occasionally get enough of her patients when she’s overbooked to ensure I don’t just see healthy college students. My patients are typically 17-25, healthy, and come in with allergies, ear aches, STD’s, UTI’s, URI’s, fractures, minor suturing, depression, minor anxiety, etc… typically what you would expect from college age students. I get to do a few ingrown toenails, cysts or lipoma removals to keep the basic procedural skills in tune, and can turn down anyone coming in seeking narcotics if I want to, though I have the option of prescribing if I believe it’s an honest need. We are also associated with a hospital about a mile away, so I always have that option when patients need more care than I can give. We have an OBGYN that comes in once a week I can refer to (as far as I’m concerned, that portion of the body is a playground, not an office space), and our Medical Director also does pelvic examinations during the week if it’s needed sooner. The Medical Director is big into the Boston Heart protocol (it bills under preventative care) so she takes most patients with chronic conditions as part of her group; she tosses the pediatrics my way since that is one of my passions. When our Medical Director is out I occasionally get a few of her patients, so I can keep up my knowledge and treatment of chronic conditions up to date, but don’t get pummeled with patients out test-driving their Obamacare after 30 years of poor lifestyle choices. 99% of my patients speak English, but as a campus I do get the occasional International Student who speaks Spanish, French, German, Russian, Arabic, etc… but their English is almost always enough to get them proper care; I have only had to send one patient to a hospital for an interpretive issue. It’s not like the public hospital system where my Spanish-speaking patients with new onset knee pain were illegals who slipped on a mossy rock sneaking across the Rio Grande the night before. I know where you are coming from, but shop around. You picked two fields, Ortho Spine and Occupational Medicine, that nobody should go into without several years in medicine. Those patients are designed to turn people bitter. I had 15+ years as a military medic before PA school and though ER would be the field for me, but I couldn’t have been more wrong. I had the same bitter experience there that you feel right now, and it was all due to the chronic, bitter, ungrateful drug seekers and malingerers; everything that ends up in the fast-track side of the ER because nobody else wants to deal with them. One thing I get in spades is where I'm at is GRATITUDE!, 99% of the people I see appreciate the care and time you spend with them. Most of my patients are genuinely happy you spent the time to listen to them; they aren’t patients who have a government chip on their shoulder thinking they are getting the short end of the stick because they are on some low-income insurance program. Ever since I graduated PA school I have always asked the same two questions when the visit was over: Do you understand our plan? (I will give you a depo-medrol shot and Flonase, you will steam, take OTC Claritin and increase fluids.) Do you have any questions you feel are unanswered? In the walk-in urgent care clinics and ER's I worked many times I was told that they felt I was trying to get rid of them because they brought in a list of complaints and I would only address two. Sorry, the words over the door say Emergency or Urgent, I'm not here to cure your 60+ years of poor lifestyle choices. I shake hands with my patients at the end of the visit, give them a card and am building up a nice little group of repeats. We have identical likes and dislikes for medical care, and I’m sure we aren’t in the minority. Sadly, Obamacare is going to make medicine worse for the providers not better; the ungrateful chronic patients will eventually outnumber the grateful people who make responsible lifestyle choices. Sit down, find out where the patients you want to see are likely to go (maybe Dermatology, Plastic Surgery, a family practice clinic in a resort town, etc…. get creative, make your own niche if you can’t specifically find it) and start looking.
  15. I have found myself seeing more and more patients a day, like most providers. Recently, two of us saw 90+ patients in a 12 hour shift. To me, this was not optimal patient care. We were rushed to say the least, labs that would typically order were not ordered, basically, it was treat and street. I hated that day, and sadly, they are increasing. Our bonus are based on this model, considering we are an urgent care, our out is "f/u with PCP if no improvement in 48 hours" or "pt sent to ER" or "pt provided strict ER precautions" when patients leave our offices. Everyone is checked in, even those with crushing chest pain, even though there is an ER 2 blocks away. We can't do anything for an acute MI but watch it happen and call EMS, we always get patients come in with past chest pain and "want to make sure I didn't have a heart attack" but didn't want to go to the ER due to cost; providers have NO SAY in who gets checked in, the receptionist has orders to admit everyone because we can do something, even if it's a referral, then we bill. We didn't start out this way, nobody does. Has anyone ever drawn the line and said that XXXX number is it ! I can do no more safely or I'm going to miss something and not lost their job? We started out very slow 4 months ago, now we are staying 2-3 hours (unpaid) a night to chart and have been getting unsolicited calls from our switchboard at home to our cell phones for patient calls in the middle of the night. I blew a gasket the last time this happened and got written up for unprofessional behavior for telling the patient to go to the ER without even listening to her. If it's so bad she had to call, she can go see someone who can bill her. What are any of you experiencing? Have you gone from pleasant place to work to a total nightmare in a short period of time recently? I am guessing the ACA is doing it for us, we now have to take patients at the clinic due us being affiliated with a hospital, at most private clinics we would not be taking ACA patients; I know very few who will. Any other ideas? I hate to see other people have this creep up on them and feel that it "just happened" to me. It happened before me or my partner realized it, now we don't know what to do about it. There is nobody we can complain too, we don't have a practice manager (there is one on paper, but he is afraid of sick people so he never shows up at the 4 clinics he is supposed to manage. We are down to one MA per two providers and two providers cover 7 days a week. Again, this snuck up on us. Any solutions that don't involve leaving? Maybe something we can impement with a stealth plan?
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