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Lightspeed

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Lightspeed last won the day on July 5

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  1. You are only burnt out in that you are sick of being run into the ground. Your SP has been doing his job forever, and gets to reap the benefit of being a well paid physician with an assistant he can pawn things off to. No comparison to what you are experiencing. He’s ridiculous for suggesting there is one. You are working SO much. That’s not sustainable. So you work all day, then you are chained to that locale the rest of the time, except for 2 days. No way. They surely aren’t paying you hourly, and are laughing all the way to the bank at all of what they get out of you. Beware... the NP is your replacement(unfortunately for the NP). There’s no other explanation unless they have come to you pen in hand to have you sign a revised contract with markedly better conditions. You are training them. They might even have this situation in mind with every new person that they hire. I once heard a surgeon telling everyone around him that they get new grads and work them for a couple years and then replace them when they get burned out. They didn’t hire the Np to help you. Recognize how valuable you have been and take that courage with you to the job search. Just about anywhere else you go will be a weight off your back. Take less money if you have to and use the time off to simply enjoy living free from the burden. Warning sign for everyone... if you express a sincere concern, and the person you are complaining to tells you to essentially buck up because you don’t have it that bad, or else they’ve had it worse, then that person dismissively hostile. They are confronting you. Bad sign. Likely means either you are clueless, or they aren’t, or else they are clueless (or worse, they don’t care), and you aren’t. But no matter what, its not a good omen for the future.
  2. Most likely you’ll be alongside the provider interacting with the patient. You don’t know how the electronic health record works, or even how to get any information from it, so as dramatic as it may seem, you are basically shadowing in such a way that they can get a sense of how personable you are. It’s an uncomfortable situation if you don’t know how to talk to people and adapt to the fact that it’s a test. I think maybe because you are a new grad, they want to know you aren’t going to make them look bad. This may be controversial from here forward, but personally, I think that’s strange for them to ask you to do that. I don’t know if it’s a reflection of where the world has come to for them to feel like they have to screen folks like that, or if it’s disrespectful that they would feel they are so special that they need to test you. It might even be that they are so incompetent that they cant get a sense of you from an interview. Whatever the case may be, it doesn’t reflect well on them as a good clinic to be at. I’d go in and knock their socks off with my great demeanor, and then after they made an offer, I’d turn them down. I may be alone in this. Maybe it’s the new normal to dance for your potential employer. When I was in NP school, I had a potential preceptor who owned his clinic. I was setting up my clinical and looking for hours with them. The owner had me come in and they gave me a little brain teaser test within the interview. Asked me questions like google does... like “solve the riddle, we want to see how you think, not try to find the right answer.” I gave them a great answer that they loved. They were excited also because they thought possibly they would hire me after I graduated and make money off me. I never called them back after I left, and blocked the number. I passed their test. They failed mine. Found rotations with a place that immediately recognized me for what I am, which is a good, disciplined hire that presents well in person, and is respectful. That’s the kind of place I would be willing to work: for adults who recognize adults who can perform well. I had a job offer from every place I did my clinical training at, and offers at every location I applied to beyond my clinical sites. None of them tried that crap.
  3. I’m not diagnosing, obviously, but I also thought about some of the things she brought up, especially when you mentioned his 30 years of practice. And the point about his reaction is spot on, and will be very telling. My thought about the whole thing is that it’s not workable since he already brought up his stance, so I suggested a very uber soft approach that keeps things calm for a physician that is likely to be more sensitive to perceived defiance. I figured you wouldn’t compromise on care, and didn’t mean to imply that you would, if that was ever a question. I feel like there are times to sound agreeable so you can test the waters vs getting in a struggle with someone that isn’t playing at the league they used to play at. Clearly he’s not, and doesn’t recognize it, and that’s the sign something is up. He’s ignoring the possibility that he is a lot older and less fresh on the TSH issue. A clear thinker would give the benefit of the doubt to a fresh face. That lack of self awareness isn’t typical of most folks at the top of their game. You’ll find the same reaction when you push back on anything else, no matter how gentle. But you can handle it very carefully and extricate yourself with more grace than if you set him off. It looks better to act with gentleness to a man that everyone there respects and has a history with than if you lock horns.
  4. This situation is why we ask questions in the job interview when they ask us if we have any questions. One of the questions we ask is “can you take a few minutes and discuss with me what your philosophy and approach to care is for the patients here, so I know what kinds of methodology is expected of me?”
  5. Folks may indeed be quick to jump to the suggestion to move on, but with the circumstances you are up against in practice, that option seems tailor made for you. You have a physician employer that mandates that you practice something other than what the board of medicine will want to see from you. What will you tell them when it’s your turn to answer for yourself? That will complicate your future significantly more than finding a different job. A good approach with the doc goes like this: “Doc, You might have noticed that my approach to treatment doesn’t match yours, and that I’m struggling to keep up with how you want things done. I’ve looked at how I can improve to match what you are doing, and see where we take different avenues in our treatments, and it seems to me that my perspective on practice is heavily flavored by the way I was trained, and the resources I use. I’m just not familiar with some of the approaches that you are familiar with, and I’m wondering what you think would help me align with your perspective.” That sets you up for the exit later on when after a few weeks of trying to keep practicing, you go to him with the realization that you love he environment, and want to keep on practicing with him, but you can’t adapt to using methodology that you aren’t familiar with. Tell him that you only ever have managed things like thyroid issues according to the textbook, and that you can only stay if you can stick to things that you feel like you can defend in front of other people who practice with those same constraints if you are called to the carpet.
  6. First sentence.... ok.... maybe NPs can throw you a bone.... wait, what’s that you say next? Yeah, never mind. NPs will hand you a big ole “GFY” on that. Its all up to you guys. Nobody is going to pull you across the finish line. The reason why PAs aren’t mentioned in the article is because PAs didn’t insert YOURSELVES into the conversation by producing some legislation and finding a champion. It was best said when the subject of $1,000,000 paid for consultation came up. That would have been more effectively spent on one single state to get independence. That’s where you’d get the ball rolling. Yes, NPs have a 26 state strategy (that’s how many states are left to become NP independent), but where do you think the national org is funneling most of their money right now? To all 26 states, or to a couple at a time like they’ve been doing for 30 years? Looks like California is the big prize here, so that’s where the money is at. If we get California and you don’t, then yes, it is all over for PAs. Change your name to “Practitioner, Advanced” to keep the “PA” moniker that everyone knows you by, and have your state chapters do the cheap and easy work of getting legislation to codify that in place of “pwned assistant” like it is now. Then have your national org do the full court press on a small state and get them independent. A million dollars of lobbying and advertising in a cheap media market like Montana will get you what you want. From there you pick a new state the next year, it gains momentum quickly, and things come cheaper. Thats what you all, along with PAFT, should be talking about non stop. Next year, nurses will be back in California with this, and they will have learned from this years work. They will have the entire nursing union apparatus engaged at that point. They won’t be asking PAs for help, and won’t be inviting PAs to join them.
  7. It’s not been the nurses necessarily that have been driving down the numbers due to their naivety. We know how to squeeze a dime out of our employers when we can. As RNs we knew what shifts to work to pick up more cash, and how long to hold out for our desperate managers to start throwing incentives our way. As a rookie nurse, you wouldn’t see me show up for a shift without getting extra incentive beyond just time and a half. I would be expecting to get double time and a fat gift card to show up for a princess shift. I also distinctly remember a required class in both my BSN and a class in my NP degree that was about financial issues and nurses.... literally two classes that were just about the industry and financial well-being, which included negotiations. RNs aren’t EMTs or CNAs, or unemployed struggling PA students when they look for jobs. They can afford to wait before they pull the trigger. But there does seem to be a literal deluge of graduates every year that is bound to swamp the market. When more NPs are graduating than are physicians, like there is now, it’s bound to have a huge effect.
  8. I’m a psyche NP, and have had several distinct jobs within healthcare, and can tell you that getting my workflow down was probably the hardest thing about each of my jobs. With 15 minute visits with patients, that’s barely enough time to get logged in and decent documentation entered. The thing you may need to realize is that everyone in that kind of situation is flying by the seat of their pants. The difference between you and someone that you think is handling it ok is either you being wrong about your perception of them, or else you are more uncomfortable about flying by the seat of your pants than they are. With more patients you see, and the more cases you handle that don’t end in disaster, you’ll start to become more relaxed knowing that you didn’t send someone home to die because you made a mistake. Your ER experience that affected you so badly... no need to analyze that any further. You saw how it was, and formed a correct opinion of the place. You can sleep at night knowing that most ERs really aren’t good for a new PA unless they are supportive. You weren’t imagining that, you lived it. Get comfortable with focused assessments. FOCUSED ASSESSMENTS are what happens in urgent care. Anyone asking for more than that gets a referral to primary care. But that feeling of being an imposter follows every reasonable person into high stakes careers. It even follows people into low stakes careers. The fear of failing causes one to fail, beginning the cycle all over again.
  9. Everyone daydreams about owning a practice, and for a PA, what you are being presented with there is one of the few avenues to do it through. But I would suggest that from what I’ve seen NPs go through, owning a practice is overrated given the stress of basically having three jobs as a business-owner/provider/manager vs just showing up to work and making $120,000 and going home every day. And those are the NPs I know in psyche... the specialty best suited for wandering aimlessly with very little overhead. Additionally, everything I’ve seen about going into business with someone you like suggests to me it is a good way to be destroyed financially and emotionally. When you are emotionally invested in someone else, you are more primed to either ignore things you shouldn’t, or else take undue offense when you think you are being slighted (nobody can hurt you as bad as a friend or loved one because betrayal feels so much worse). I personally like my idea of offering to help out when your friend needs time off or is in a pinch. There’s no reason to get wrapped up in a formal and complex business arrangement. It’s like every time a multilevel marketer wants to rope me in and I ask, “why can’t I just have this awesome product you sell without having to give you my soul and new customers?”. Can’t we all just make some money without having to go all in? If it’s an awesome opportunity, it will still be there later on. He will be trying to expand, and still welcome you. If you are dead set on this, then ease into it. Have him pay you a flat rate to handle his patient overflow on your days off.
  10. I’m a male, with kids, and an NP. There is nobody I’ve ever met through work that is more interesting than any of my kids. Consequently, I work to live rather than live to work, and whatever job gives me the correct work/life balance is the right one for me. It didn’t have to be the NP field. Also, I’m a quantity over quality type person when it comes to parenting, and I don’t feel I can model correct principles to my kids if I’m rarely around. I get more enjoyment out of many simple moments vs fewer big events. I’m greedy that way. My kids are not a mystery to me. I know them well, and that comes from being around them a lot. I think Mr. Ronin has a good point (among many great points) about how finishing PA school marks the beginning of many additional time commitments you may face. You might have more flexibility than others do based on your financials. That’s encouraging.
  11. Maybe we are reading too much into the friend thing here, and I mentioned it, but as a minor segue since it’s coming up and it’s interesting.... I had a business opportunity come up with a physician friend. The possibility tugged at me a little bit. I just can’t see how it ever is successful in the long run. One person could easily end up disappointed by what they see in the other person once they are around them all the time. It’s obviously not going to be a party at work every day. Familiarity breeds contempt. Talking shop is more interesting when you aren’t in the same shop. But back to the subject... everyone in a primary care model for concierge care like that seems to be dabbling in it. I don’t know anyone getting rich. I know a doc in a direct care model who has been doing it for a few years, and it seems like it’s more personally rewarding than financially. Customers come and go, and they question whether it’s worth the money when they only go in a few times a year. The regular users often need more than just primary care. Nobody seems to be getting rich there either. In psyche, I know lots of folks supporting themselves well, but your clinic for that could fit in a small backpack. The way to make money is to go where a lot of patients are, or have the patients come to you en masse, not one at a time. Those minutes spent in travel never pay. If you have even just a store front, you can make enough filling an appointment in the space where you’d otherwise be traveling, and could more than cover the physical overhead. The only way I’d jump in to help your buddy is if everything was equal to what I had in hand, (and would also need it to pay more). If that’s obviously not going to pass muster for him, you could always offer to go PRN and cover for days off, vacations, and extra appointments during busy times. I’d ask for $80-$100 an hour, fixed. No demerits for no shows, cancelled appts, etc. the benefit of “helping out” is that you don’t get sucked into having to struggle over whether you are being valued appropriately. You are instead simply showing up to save the day when they need coverage, and when they otherwise wouldn’t be making money. It puts the ball in the doctor’s court to decide how much his time off is worth to him. You don’t feel like you are a rented mule making money for someone else at your expense. Both of you end up being appreciative of each other. Let him hire a stranger to give him the everyday headaches that come with being an employer of full time workers. Friends do favors for one another. Employers and employees have a conflict of interest when it comes to those (one person ends up doing more work for free). Avoid that by being the friend that helps out sometimes for a fair wage.
  12. I guess another suggestion you could make is something along the lines of “since you will likely be reimbursed for my services at 85% of what a physician employee of yours would be reimbursed, then 85% of what you’d pay that physician would make it appropriate for me to leave the job that makes me very happy.” You’ll find out really quick how much he really respects your value.
  13. Ugh. Acquaintances who struggle with the notion of paying you too much.... kind of a buzzkill for the friendship. I think the only real number you can accept in those circumstances is something well above what you currently make, since he or she made this purely about business. That means your counter offer needs to be purely about business as well.
  14. Depends on how fast you want to run. If the idea is to be a gunner, there’s probably some hope to stand out, but it doesn’t come quick for anyone, and that’s where I would agree that a PA would have a hard time. Most nurses cut their teeth in management lower on the pay scale than what a PA would like to make. They can accrue plenty of face time with the higher ups at below $100k while on the path to the jobs that pay the big bucks that PAs would be aiming to walk into. Administration likes to see a portfolio of boring projects behind a candidate so they don’t feel like they are taking a gamble.
  15. The word “disconcertion” is the wrong word to use. You are backing up the arguments I make, but you don’t even realize it: It’s clear form your background that you cited that you should be independent (I would argue that you should be independent even without all that). But you are not independent. Your scenario, along with your background, should be on the mind of every PA school prospect. The terms are indeed handed to you, and you are fine with how that all plays out as a dependent provider because you love ED, and may always plan to work in that environment. I’m sure you’ll have a job, too. But I think you should be able to jump out and practice on your own in another specialty if you want to. Burnout happens. That kind of retooling shouldn’t involve finding a physician to take you on.
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