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About wilso2ar

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    Physician Assistant

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  1. Working in pain management this happens all to often. I get people showing up on our doorstep after just running out of their high dose opioids and now I'm left to deal with them. Their previous prescriber who made the mess refuses to properly wean them. Since the CDC guidelines came out, medical providers are so scared to prescribe that they just refuse and don't care what happens to the patient. A local large hospital system won't allow their primary care to manage any chronic opioids regardless of the dose. We are seeing the effects of the pendulum swinging too far.
  2. Who told patients that pain = opioids
  3. Michigan seems like the opposite. It seems like the more populated areas: Ann Arbor and Southwest MI are hiring whereas there are just a handful of posted openings in my town of 30,000. I would look at MAPA's website for jobs. I get regular e-mails and there are always multiple through Bronson Hospital in Southwest MI.
  4. Interesting. We already see CIIs every month anyway so doesn't effect us. I wonder how that would be interpreted for controls that can have refills like Lyrica? I mean it is just one prescription.
  5. Do you know the Public act#? I have kept up with all of the changes and must have missed where all patients receiving controlled substances need monthly visits.
  6. 5 weeks PTO, + holidays, 1 week CME. 8 years into current job. I don't usually use all of it as I have a bonus based on production. My boss literally asked me if I felt like I take enough time off. There are definitely good places to work.
  7. You can send prescriptions electronic. It is just a pain to get the software and undergo the authentication for it, but I assure you it is legal. I was speaking to what I see at the winter clinics that these patients go to ie. seems to be every month and I was wondering if that was the norm everywhere regardless of dosage etc.. We provide our typical length of time that we normally do when they travel and then they need to follow up with their provider in the other state prior to running out. RC2, do you provide up to three prescriptions to last 90 days at visit, or do you have them come and pick them up between appointments?
  8. Just trying to get a consensus on what others do in regards to follow ups. I have some snow birds that travel south for the winter and it seems everywhere they go they are seen every month regardless of dosage/length of time they have been established with that office. Also, we are starting to send electronic prescriptions for controlled substances and are trying to find a way to make the second month work in regards to fill dates.
  9. For those of you that are managing chronic pain patients on schedule 2 medications, how often do you follow up for refills? We always start at 4 weeks or less then for certain patients increase to 8 weeks.
  10. The majority of people I see are of middle aged and still a functioning member of society or thy are elderly and retired. Most of them are good people that just want to have some type of pain management in order to become more functional. For the ones actively seeking disability, I just don't see the point in wasting resources and time on treating them for their MSK complaints. They have no motivation for getting better if they are trying to prove that they are disabled. I was just curious what others would think about the ethics of not trying to treat these people and telling them they need to find someone else to treat them. I mean our goals are not their goals.
  11. Believe me I document as best I can to state the facts, but still doesn't seem to matter. I once had a functional capacity examination performed by a PT on a patient that literally said he could return to his former job as a butcher. A month or two later he came in with the disability card.
  12. I pose this question to see what some other opinions are. I work in an interventional pain clinic with two physicians. As you can imagine I see a lot of patients that are on disability. The patients that I am talking about are the ones that are actively seeking disability. I feel as most of these people are here to check treatment boxes so they and their lawyer have a better case to take in front of the disability judge. Would it be unethical to not accept patients that are actively seeking disability? There have been numerous articles that support that patients do not improve when they are trying to prove that they have a disability. Now I'm not talking psych problem, medical illness, genetic disorder and the like. I'm talking MSK problems that limit their function.
  13. No this is not allowed unless you are billing incident too and meeting all the criteria that it requires. What you are describing is for bc/bs. Sent from my iPhone using Tapatalk
  14. There is not any evidence stating that there are more negative outcomes, but there is also no evidence showing that it is safe to use in conjunction with opioids either. It will be interesting how this plays out as more and more states legalize marijuana.
  15. You are under paid. I'm not putting in that much work and bring in an average of 28,000 per month to the practice. Sent from my iPhone using Tapatalk
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