MediMike

Yikes. Solo provider huh? Are there other folks on at night in this location? (i.e. intensivist, ED etc.) Or are you going to be responsible for codes/lines/other procedures? Will it be a while before you're solo? And will you have someone available who can help you out with weird stuff easily?

If you figure in the time to see the patient (who you won't know), write the note, travel between the hospitals...unless you are incredibly efficient I'm pretty sure you'll be getting shafted on this deal. I guess if you are simply doing follow up stuff it could potentially not be that bad, complexity of patient will play a big role. Any benefits? Other big questions would be what's the distance between the facilities? If you're spending 10hrs a day bouncing around hospitals, researching the patients, researching your recommendations and then writing the notes, even if you split the load between 10 new consults (lengthier) and 10 follow ups you're looking at maybe $40/hr. Your current gig sounds pretty decent, if this is a way to get a foot in the door then maybe?

Was the differential already calculated into you salary offer? If so it's probably a little low but the remainder of the offer looks pretty fantastic.

If you count the bonus as Abe notes above into a $94k/yr then math shows you'll end up making ~$48/hr. 52wks - 6wks(PTO+CME) * 40hrs/wk + 48hrs of Saturdays = ~1928hrs Not sure where you're located but in general I have found psych to pay significantly better, although this is all word of mouth, I don't have much documentation to go off of. Gotta take into consideration the learning environment etc I guess (are you experienced? or new grad?) Also agree that a 2yr contract is less than ideal unless you can break it without repercussions. Sounds like stagnant wages for those two years and if you don't get a bump you lose around $2/hr at that point.

I just did a bunch of painful searching and couldn't find a vesting rule regarding timeframes, but it's possible that the IRS just mentally broke me and it's easily searchable.

Maybe finding a good course to take for practice? Is there access to a simulation lab to play around with the equipment (i.e. are you in an academic center?) Found this with some rapid Google-Fu https://surgery.duke.edu/education-and-training/advanced-education/center-surgical-education-and-innovation/courses/thoracic-surgery/2019-duke-masters-minimally-invasive-thoracic-surgery-conference

Oooooh yeah, major plusses there. Another downside though can be a lack of relationships with your consultants. You rarely get to meet them and all they know of you is somebody calling them at 3am.

We are a strange breed.

I think you know as well as I do that there is a significant difference between questioning a potentially lethal dose of fentanyl and undermining the care provider by a PA on a regular basis.

And this, McClane, is where you are wrong. No one, at any point in this thread, has said that orders shouldn't be double checked or that concerns shouldn't be addressed. Nobody said anything about being a "hard ass" either so I'm mildly confused why you put that in quotes. Did you see a dangerous order being written for in any example given here? The example given by the OP, which we are all referring to (please try to follow this thread, if you're not going to pay attention then try to avoid attempts at contribution), referenced the RN not getting what she wanted and as such continually going around the provider in question on a regular basis. That is shopping around. Like, the definition of shopping around in the medical vernacular. And if the attending group that I work with got repeatedly bothered by BS questions and complaints by the same problem child? You bet there would be discussions. I am a big advocate for the team based approach to medicine but guess what? The RN isn't leading the team. We can discuss concerns and address issues but at the end of the day I am ordering an intervention on a patient based on my assessment and clinical knowledge. I'm not sure what your role is where you work but in my position I oftentimes am the medical hierarchy. Definitely feel that this discussion had gotten a bit out of hand and a fair amount more contentious than it should have. Heck. You dropped an F bomb and have a chalk circle all drawn up to summon the moderators. So I'll leave you with this good sir/ma'am, team based care is great, if you want to call the shots though you need to go to medical/PA/NP school.

Dude, what kind of response is this? How is that remotely helpful? Whatever doc you're working with should work you harder since you've clearly got enough free time to flit around the internet being rude for no reason.

Yup. And when that concern is addressed and there is no harm to the patient then you perform the ordered task. You don't get to shop around and choose what you do and don't do while putting patient care at risk. I'm not advocating for giving the patient 100 units of insulin because it was ordered for hyperglycemia. But when I order 100 units of insulin for a beta blocker overdose and explain my reasoning you'd better give the dang insulin.

I get it. You and LOneal have beef. Don't let it derail this thread please.

This isn't a matter of being insulted or put out in my mind, this is a matter of being respected as a profession and the nursing staff doing what they are told to do, which is their job. We write orders, they fulfill them. You can put whatever spin you want on it, but that's what it boils down to. If the provider has discussed this with the individual in question and there is continued push-back after the problem has been addressed then escalation is appropriate. There is nothing ineffective about escalating a repeat situation like this. It shouldn't be an issue of presenting a more cohesive argument. What I DO agree with is if you are not getting support from management or your own attending then I'd get out of that place. Sounds like an environment where the profession is neither valued or respected.

Take it up with her nurse manager. Sounds like you've exhausted the interpersonal approach on this one. I've had similar issues. Most have been with CTICU RNs who I assume are used to dealing with the surgical mentality, so, when dealing with them I utilize the stereotypical surgeon mentality. I've called them out, been quasi-aggro and they get all warm and gooey. I absolutely hate taking that approach because I'M the warm and gooey guy damnit. Seriously though take it up the chain, if you're getting no where with her then bypass her, let it be known she is interfering with appropriate patient care. File some kind of reporting thing on her. Whatever your organization has. You owe nothing to this individual who is preventing you from doing your job. And in regards to them having all this experience and wonderful suggestions...yeah. Some do. And some are absolutely worthless, stuck in the 80s and have no idea what evidence based medicine is. Case by case basis for sure.