Joelseff

That goes great with Hot sauce and a piece of toast... Oh bacon gotta have bacon! [emoji16][emoji16][emoji16] Sent from my SAMSUNG-SM-G891A using Tapatalk

I hear ya! The job can be tough but it's got its perks! I just got back from a medical mission in Costa Rica. Took my 16 yr old daughter and had the best Father's day there while working for free seeing patients! Had to put up with a setting like this: Sent from my SAMSUNG-SM-G891A using Tapatalk

Bias warning.... Go PA! Some ppl will say go the other way for better legal standing. I think PAs are making some headway on that with a better AAPA board and OTP. Title change is also coming around. It's a good time to be a PA I think. But again this is a PA board. I'm sure you'll find differing opinions on allnurses.com. Sent from my SAMSUNG-SM-G891A using Tapatalk

Check the Corporate Law regarding medical practice ownership. In California, the medical board doesn't regulate this, the corporate board does but BOM has input on it. I ultimately decided (8 yrs ago) that it was way too much hassle and didn't go through with it. Best of luck Sent from my SAMSUNG-SM-G891A using Tapatalk

https://www.aapa.org/news-central/2019/05/90-of-pas-cite-disconnect-between-official-title-physician-assistant-and-their-role-in-healthcare/ Couple million bucks for that? I could have told you that for half a million lol [emoji12] Sent from my SAMSUNG-SM-G891A using Tapatalk

I do not miss Primary care! Sent from my SAMSUNG-SM-G891A using Tapatalk

If it makes the OP feel any better I am in a similar boat and am not a new grad. I was in GI/Hep my first year out and for the past 8 years I was in Primary Care. I recently went back to GI/Hep and while I don't feel like a fish out of water, I feel like a fish in a new aquarium, if that makes sense... I echo what others have said. Identify your weaknesses and Lots and Lots of after work, before work, during work reading on topics you are weak at. Engage your colleagues in conversations about said topics when possible, even if you think you have it down just to process it with another provider. Attend dinner events if you have reps and attend cme conferences. I am scheduled for 3 CME conferences the rest of this year and have already attended 2 and I've only been at the new job for a month. Own your need to learn and humbly ask your colleagues for help PRN. I wish you the best! Sent from my SAMSUNG-SM-G891A using Tapatalk

There is a post on the Huddle about this and there are only 3 posts on that thread... Its been a week since this development and I haven't even received a CAPA propaganda email about the development... On the huddle no posts from CAPA reps... Is the silence deafening? Sent from my SAMSUNG-SM-G891A using Tapatalk

Hope so but I will ask CAPA at this year's conference. I plan on going in August Sent from my SAMSUNG-SM-G891A using Tapatalk

Maybe post in the Pre-PA section or under the section in the forum for the school? Sent from my SAMSUNG-SM-G891A using Tapatalk

I agree. This version of "OTP" from what i have read only took out the DSA and replaced it with a less restrictive "Practice Agreement." That I think is not a major victory for PAs in California. Was it worth all the stumping I did to my Physician colleagues and getting petitions etc? I dunno... It was a lot of noise that kind of fizzled I think.

Posted this on my OTP thread in the California section of this forum: SO it looks like it passed with *some* revisions.. a lot actually. I haven't read through all of it yet but seems like they kept "supervision" and all that that implies and only really removed the DSA in favor of a "practice agreement" which at least is defined by the practice vs the state...I think that's what happened...anyhoo here is the comparison between the original bill vs the amended bill: http://leginfo.legislature.ca.gov/faces/billVersionsCompareClient.xhtml?bill_id=201920200SB697&cversion=20190SB69799INT This kind of takes the wind out of my sails a little: The PA renders the services under the supervision of a licensed physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California or by the Osteopathic Medical Board prohibiting that supervision or prohibiting the employment of a physician assistant. Looks like nothing really changed as far as autonomy... Also they took this whole section out which included direct billing and reimbursement etc: (M) Prescribe, dispense, order, administer, and procure drugs and medical devices pursuant to Section 3502.1. (N) Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, which include, but are not limited to, nursing, home health care, hospice, and physical and occupational therapy. (b) A PA is authorized to bill for and receive direct payment for the medical services the PA provides. (1) Payment for services within a PA’s scope of practice shall be made when ordered or performed by a PA, if the same service would have been covered if ordered or performed by a physician and surgeon. (2) To ensure accountability and transparency for patients, payers, and the health care system, a PA shall be identified as the rendering professional in the billing and claims process when a PA delivers medical or surgical services to a patient. (3) An insurance company, state governmental payer, or third-party payer shall not impose a practice, education, payment, or supervision requirement that is inconsistent with, or more restrictive than, this chapter or regulations issued pursuant to this chapter or that discriminates against legally qualified PAs based solely on their license. (4) To facilitate more flexible employment arrangements, including, but not limited to, when a PA works with a staffing company or in a medical group structure, the PA may reassign the PA’s direct payment to the PA’s employer. (c) A PA shall practice and collaborate in accordance with the practice agreement or an organized health care practice setting’s established internal processes, by consulting with or referring to, or both, the appropriate member or members of a health care team as indicated by the patient’s condition. This shall be done in a manner consistent with the education, training, experience, and competencies of the PA and the standard of care. A PA shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of the patient is beyond the scope of the education and training of the PA. (d) (1) The degree of collaboration shall be outlined in the practice agreement, which shall be signed by both the PA and one or more physicians and surgeons and kept on file at the practice location. The practice agreement shall contain all of the following: (A) The agreed upon process to ensure adequate communication, availability, and consultation between the physician and surgeon and PA in the provision of medical services to patients. This process should be customized based on the knowledge and skills of the PA and physician and surgeon consistent with their education, training, and experience. (B) Patient referral and consultation. (C) Emergency coverage for absences of a PA, including another PA or physician and surgeon. (D) Methods for the continuing evaluation of the competency and qualifications of the PA. (E) Guidelines for prescriptions. (F) Any additional provisions, as agreed to by the PA and physician and surgeon. (2) Any reference to “protocols” or “delegation of services agreement” in any law or regulation that references this chapter shall have the same meaning as “practice agreement,” as defined in Section 3501, or the established internal process for collaboration in any of the organized healthcare practice settings described in subdivision (e). (e) (1) Notwithstanding subdivision (d), a PA providing medical services in one of the organized health care practice settings in paragraph (2) is exempt from the requirement to execute a practice agreement under subdivision (d) and instead shall collaborate utilizing the practice setting’s established internal process for determining the role and responsibilities for the PA based on the PA’s training, experience, qualifications, and competency. That's a lot of Red! But this seems like one of the few positives: Nothing in statute or regulations shall require that a physician and surgeon review or countersign a medical record of a patient treated by a physician assistant, unless required by the practice agreement. The board may, as a condition of probation of a licensee, require the review or countersignature of records of patients treated by a physician assistant for a specified duration. So don't know what to make of it...What do you guys think? (MODS, maybe we can merge the two threads?)

SO it looks like it passed with *some* revisions.. a lot actually. I haven't read through all of it yet but seems like they kept "supervision" and all that that implies and only really removed the DSA in favor of a "practice agreement" which at least is defined by the practice vs the state...I think that's what happened...anyhoo here is the comparison between the original bill vs the amended bill: http://leginfo.legislature.ca.gov/faces/billVersionsCompareClient.xhtml?bill_id=201920200SB697&cversion=20190SB69799INT This kind of takes the wind out of my sails a little: The PA renders the services under the supervision of a licensed physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California or by the Osteopathic Medical Board prohibiting that supervision or prohibiting the employment of a physician assistant. Looks like nothing really changed as far as autonomy... Also they took this whole section out which included direct billing and reimbursement etc: (M) Prescribe, dispense, order, administer, and procure drugs and medical devices pursuant to Section 3502.1. (N) Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, which include, but are not limited to, nursing, home health care, hospice, and physical and occupational therapy. (b) A PA is authorized to bill for and receive direct payment for the medical services the PA provides. (1) Payment for services within a PA’s scope of practice shall be made when ordered or performed by a PA, if the same service would have been covered if ordered or performed by a physician and surgeon. (2) To ensure accountability and transparency for patients, payers, and the health care system, a PA shall be identified as the rendering professional in the billing and claims process when a PA delivers medical or surgical services to a patient. (3) An insurance company, state governmental payer, or third-party payer shall not impose a practice, education, payment, or supervision requirement that is inconsistent with, or more restrictive than, this chapter or regulations issued pursuant to this chapter or that discriminates against legally qualified PAs based solely on their license. (4) To facilitate more flexible employment arrangements, including, but not limited to, when a PA works with a staffing company or in a medical group structure, the PA may reassign the PA’s direct payment to the PA’s employer. (c) A PA shall practice and collaborate in accordance with the practice agreement or an organized health care practice setting’s established internal processes, by consulting with or referring to, or both, the appropriate member or members of a health care team as indicated by the patient’s condition. This shall be done in a manner consistent with the education, training, experience, and competencies of the PA and the standard of care. A PA shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of the patient is beyond the scope of the education and training of the PA. (d) (1) The degree of collaboration shall be outlined in the practice agreement, which shall be signed by both the PA and one or more physicians and surgeons and kept on file at the practice location. The practice agreement shall contain all of the following: (A) The agreed upon process to ensure adequate communication, availability, and consultation between the physician and surgeon and PA in the provision of medical services to patients. This process should be customized based on the knowledge and skills of the PA and physician and surgeon consistent with their education, training, and experience. (B) Patient referral and consultation. (C) Emergency coverage for absences of a PA, including another PA or physician and surgeon. (D) Methods for the continuing evaluation of the competency and qualifications of the PA. (E) Guidelines for prescriptions. (F) Any additional provisions, as agreed to by the PA and physician and surgeon. (2) Any reference to “protocols” or “delegation of services agreement” in any law or regulation that references this chapter shall have the same meaning as “practice agreement,” as defined in Section 3501, or the established internal process for collaboration in any of the organized healthcare practice settings described in subdivision (e). (e) (1) Notwithstanding subdivision (d), a PA providing medical services in one of the organized health care practice settings in paragraph (2) is exempt from the requirement to execute a practice agreement under subdivision (d) and instead shall collaborate utilizing the practice setting’s established internal process for determining the role and responsibilities for the PA based on the PA’s training, experience, qualifications, and competency. That's a lot of Red! But this seems like one of the few positives: Nothing in statute or regulations shall require that a physician and surgeon review or countersign a medical record of a patient treated by a physician assistant, unless required by the practice agreement. The board may, as a condition of probation of a licensee, require the review or countersignature of records of patients treated by a physician assistant for a specified duration. So don't know what to make of it...What do you guys think?

I have significant hearing loss and wear hearing aids. My previous employer made a contract that I had to use an electronic/amplified stethoscope at work. I thought that was reasonable but they wouldn't reimburse me for it. It was just for formality I think so they can cover their butts if I miss something on exam. Who knows? I also am a disabled vet with multiple MSK issues. This I have not disclosed to any employers. They see me limping everyday though lol. My hearing loss is due to an Autoimmune inner ear issue so I get flare ups every so often of my vertigo (severe) I have an FMLA in place from my physician for this though so it can cover my butt when I have flare ups. Sad thing is Kaiser only covers it for 6 mos and I would have to Re apply q 6 mos. And Kaiser's paperwork system is like the DMV. Sent from my SAMSUNG-SM-G891A using Tapatalk

Yeah that was "the old days" I answered strongly disagree on those I think. I am at a new job so I'm seeing minimal pts right now but definitely ramping up and will be full capacity in a few weeks. the last Job I was busier than most of the docs. Sent from my SAMSUNG-SM-G891A using Tapatalk