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SmokeyBear

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  1. This is a long wall of text. Only read if you're bored. Backstory About me: I've been practicing for about 9 years now. I worked for 5 years in an FQHC which was super informative in the whole aspect of sink or swim, you learn to tread water super fast when your SP is 50 miles away and never available by phone. I did not love this job, but was in it for the loan repayment. Left as soon as I'd maxed loan forgiveness with the state. I then spent 3 years working in a tiny retail clinic outside Seattle, walk in only, could only schedule online, same day stuff. Not UC, so no EKGs, no imaging on site, no labs other than POC stuff. I LOVED this job. Worked 3-12's and absolutely loved having 4 days off a week. Pay was good, patients were low acuity, and anyone who was really sick was punted to an actual UC or the ED. Everyone got the "follow up with PCP" comment, which felt so good not to be that PCP that patients needed to f/u with. Neither of these jobs had very much interaction with SPs, so I was basically practicing independently. SP oversight was them signing off on 10% of my charts per month, which I'm not even sure if they technically did this. In these 8ish years, I had 3 SPs. In those 8 years I met face to face with an SP maybe 4-5 times. I never even met my third SP, ever. We emailed a couple times, that was it. Then Covid hit and the company closed all the retail clinics. It was scary... super scary... I applied to 42 jobs that I was overqualified for, and it took 7 months to get an offer. Who knew there'd be such a hard time to land a new job as a medical provider in the middle of a pandemic? Everyone had hiring freezes. That finally thawed, and I landed in House Calls. I'm not in love with house calls... The patients are... oof... Seeing the way these folks live in situ is bizarre. I'd never have guessed so high a percentage of the general pop are hoarders. In the first few months I'd been exposed to Covid, scabies, roaches, mice infestations, massive pitbull in my face, many tiny dogs in my face, ungodly amounts of animal excrement, the list goes on and on. Needless to say other opportunities are looking better and better as the days go by. I've never run a business. I have business owners in the family and have support from their aspects, however none of them work in healthcare. The closest thing to a business I've personally done is running an eBay store, which is essentially just a side gig/hobby and has been for 20 years. It brings in less than $10k annually, but its spending cash and pays for fun things like airfare or cruises. The Idea and questions: I'm now in a state which now allows for independent practice with 10,000 hours experience in a specific field. As I have well over the 10k hrs in Family Med, I'm kicking around the following idea: Super small same day family practice care. Very similar to the retail clinic I was working in. Our local UCs are so bombarded right now that people are waiting 2-4 hours just to be seen. My goal would be to siphon some of those patients to my small practice. By small, I'm thinking solo... if not solo, then maaaaybe an MA. Small like possibly having my wife get licensed as an MA... Small like a single room clinic without a front desk or a break room and the likes. When I was in the retail clinic we had two tiny rooms, each with an exam table, a computer and printer in each room, a tiny supply closet... that's about it. Personnel wise It was just me and occasionally an MA, so I'm used to doing the check in and registration and vitals and all the parts of an entire visit from when the patient presents to the front door. That part doesn't scare me. Insurance companies do scare me, failure also moderately scares me, and un-planned or un-accounted for costs associated with business also scares me. Initially I thought "Cash pay-all the way!", in the retail setting the cash pay patients were always so easy. However, I'm in an area where the vast majority of the population is insured in one way or another. The folks are usually frugal, and are going to weigh a cash pay option vs the wait time in the UC where their insurance will be billed. Pay me $100 and get seen now, or wait 2-4 hours at the UC and pay almost nothing (depending on what their ins is, where they're at with deductible and OOP for the year etc...) I'm just not sure that cash pay is the right way in a population that is heavily insured. If I was back in FQHC territory, I think cash pay would be the ticket still. So.. That leads me to insurances. I'd have to apply as an independent provider to be credentialed with at least the big 3-4 insurance providers in this area. Should I even bother with Medicare/Medicaid? These two are giving me the most heartburn when I think about my plans. Not accepting medicare instantly cuts out a huge swath of insured patients with super easy complaints like cerumen impactions and simple derm procedures. However this population is also more sick, and even if only dealing with one simple complaint, there's a ton of polypharmacy to consider when treating anything from strep throat to diarrhea. Is it worth credentialing and dealing with federal HA? Or avoid the headaches with the state/fed payors and go with a cash pay/private insurance model? What do reimbursements even look like for things like 99213 vs 99203? I literally don't know what payments look like as I've just "seen the patient" for 9 years. I've tried looking this up for private insurance, but the google searches always throw medicare payments at my search results. The info is out there, but buried I'm sure. Is private insurance a higher reimbursement than medicare? Or do they typically follow the medicare pricing model? Just going off the medicare pricing though.. If I could see just 15 patients per day, i'd still make quite a bit more than I make now. I realize the number I get doing the maths on this isn't my potential salary. There's overhead/costs like building lease, office supplies, power, internet, other utilities, my own malpractice policy, taxes... Not to mention I'd now have to come out of pocket for personal and family health and life insurance, my own 401K without matching, CME, plan for PTO and all the stuff that's offered by my employer... But even if all of those things added up to 50% of the reimbursed amount, the other 50% is still more than my current salary... I'm also not sure how you delineate business income vs personal salary?? Do business taxes become your income tax? I realize yall aren't my lawyer(s) here, but before I contact a lawyer and draw this up for real, I want to flesh this out for a minute. You've made it to the end! Congrats for wasting so much of your day. Now hit me with your thoughts! I've probably forgotten something I wanted to say. But this is the gist of it. So, poke holes, tell me I'm foolish, it'll never work... But give reasons why... Not just "you're crazy..." Thanks in advance!
  2. jmj11, I first read your post about getting to #6 in Seattle, and then read this thread to see this comment made 3 years later. Granted it's been 4 years on from when you made this comment, and 7+ years from when the HA clinic was pushed to #6... But curious how long you ran/owned the clinic and was insurance the biggest reason you got out of it? I'm kicking around the idea of running a same day family practice clinic. Kind of like UC, but without the EKGs and Imaging and onsite lab. Just routine FP stuff, UTIs, HEENT complaints, coughs, colds, pinkeye... Sports physicals.. I actually worked for Swedish inside their Walgreens clinics in the Seattle area and did this and really enjoyed it. Most enjoyable job I've had in 9 years. Super low acuity, follow up with PCP, generally nice and happy people. When chest pain or broken bones walked in they got punted to a real UC or ED. I'm no longer in Seattle, and now in UT where PAs can practice without an SP if they have more than 10k hours experience in a certain field.
  3. Wondering if this would be applicable in states where PAs are eligible for independent practice like Utah, or North Dakota. If a PA is given independent practice in those states, would they still have to follow CMS as thats federal? Do you have a link or source on them dropping the 1% rule? Full disclosure, I'm in Utah and meet eligibility to practice without an SP, and really considering it, and wondering if it's worth it to even bother with Medicare. Would this be a similar rule with Medicaid?
  4. Undergrad Ed School: Brigham Young University Cumulative Undergrad. GPA: 3.69 Science Undergrad. GPA: 3.42 Age at application time : 27 GRE: Didn't take it. Direct Patient Care : 1500 hours working as Wilderness First Responder with the US Forest Service. Extracurricular/Research Activities: Entomology Assistant and the Monte L. Bean Life Sciences Museum. Research on Desert Iguanas determining phylogenetic differences between subspecies. Schools Applied: Texas Tech, Saint Francis (PA), Chatham, Salus, University of New England. Application Submitted Date: August 31, 2010 Schools Received Application Date: October 8th 2010 Interview Invites: Saint Francis, UNE, Chatham doesn't do interviews. Denied: Texas Tech, my social science classes didn't meet their reqs. Withdrew Application: UNE, Saint Francis, Salus Waitlisted: N/A Accepted: Chatham, classes start August 1st 2011. Class of 2013. First time applying. I am living proof that you can get in to PA School without taking the GRE or interviewing!
  5. Well.. little did I know.. while I was writing the above message there was an email in my inbox from the admissions department of Saint Francis in Loretto. They want to interview me! Wahoo! So, even with a seemingly large mistake and a couple other smaller ones on the application, I've still managed to impress them enough to want to interview me. Also let it be known that this year there are only 10 seats in the program. If they've chosen my mistake filled CASPA application and considered it good enough to have an interview, than I wouldn't really sweat it for you others. Hope that helps calm your nerves a little.
  6. Haha.. This is a good thread. I too made a few of mistakes and didn't catch them til afterwards. One was actually pretty big, and I am planning on applying again next cycle. As someone stated above I was just kind of adding things as I went, here a little, there a little.. Well, somehow I totally spaced the shadowing duties. Months ago, just to put words in the empty box, I wrote something like "Assist the PA in any capacity as seen fit by him, and the organizations guidelines." And that's it.. literally that's it. A crappy single sentence. Another mistake was spelling, not the end of the world, but I spelled 'clinic' as clinich. And yet another was that I had stated that I had accrued over 80 hours of shadowing, yet elsewhere on the app I stated that I only had 40. I looked over the app, my wife looked over the app, and we submitted it. Somehow neither of us catching those. Oops. Life goes on.
  7. Good Job! Congrats! I couldn't agree more re: the grades. I hate the grading situation in schools. I wish there were another way.
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