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  1. I work at an FQHC clinic who has a notoriously hard time retaining providers (mission is great but pay is LOW) so I think they will refrain from provider lay offs as long as possible, but cutting back of hours or furlough starting with PAs and NPs is within reason. I'm working hard to keep up my patient volume as much as I can. I walked into clinic this morning to find out that 50% of the staff were furloughed, including our entire dental department and dentist herself. On a separate note, did anyone see that Boris Johnson (COVID19 Positive) was moved to the ICU today due to deteriorating condition?
  2. You may get a lot of comments on this site from people advising "$50-55/hr, even 60-65/hr, is crap pay" and while I dont disagree that we should be compensated better for our work, the reality is that in certain markets that 50-55/hr rate is a decent wage. Especially considering the other details of that Inpatient offer. It sounds like a GREAT environment, with ample time off, the opportunity for mentoring, and only working 3 shifts per week. I'd accept that in a heartbeart. You could always pick up Urgent care as a PRN gig and work a 4th day of the week for extra cash but I bet you'll be looking at a longer and happier career in inpatient medicine if thats where your interest lies. Just my 2 cents.
  3. While I agree that the pay disparity is a huge issue....I take a greater issue with the current laws that govern our practice. We are far behind NPs and THAT is affecting me personally and others that I’ve spoken with locally, even more than the pay. I’ve been told numerous times that a company is not hiring for PAs, only NPs and when I ask why.... the answer is always the same “Because NPs can practice independently” (which makes my blood boil and I’m done wasting my time trying to explain OTP to employers and why a PA can fulfill that position just as well if not better than an NP. They don’t get it and they don’t care.) I would rather there be a higher quantity of moderate paying PA jobs than a very limited number of high paying ones. In my area of Colorado, there are at least 2x as many NP jobs listed for every PA job. This is telling. This is affecting the job market which affects my ability to both find a job and to have options between jobs/offers. Ive been a member of my national and state organizations but not incredibly involved. I’m done watching the older generation reflect on the good ole days and done watching the newer generation gleefully go forth into a career that is headed towards and off the end of its tracks. Time for me to get more involved. Who knows if it’ll actually accomplish anything but I don’t want to sit back any longer.
  4. They state they bill insurance..... which leads me to.... ... I supposed they can bill insurance all they want but eventually the pt will be stuck with an out of network bill eventually and that will shut down a company eventually. Good example with PediaQ...I'll look into their story. Regarding pay, I live in an area of low pay. If you break down my salary rate to an hourly rate, I'm paid FAR less than 55/hr. Yes, thats atrocious. This is why I've been looking for another job for over a year. Unfortunately the market here is also highly competitive. So when a good job comes available, theres insane competition and with 2 yrs experience I get bumped for the guy/gal with 5-10-15 years experience no matter how much my letter/resume/references sing my praises. And the jobs that I do get callbacks on are awful offers (ie: working urgent care solo with one patient care tech and expected to work the front desk checking in patients and expected to clean the office and perform MA duties with no back up and crap benefits) Thanks for everyones input! Keep it coming if anyone has further thoughts.
  5. Hi all! I'm intrigued by a company located near me that offers "acute care house calls." Vehicle equipped with medical equipment (POCT/I-stats, splinting materials, suture materials, medications, IVFs, vitals, etc.) and staffed by 1 PA/NP and 1 EMT. Sounds like 10 hour shifts, " an average 45 minutes spent with each patient." I have a friend of a friend who works for the company (Dispatch Health) and he enjoys it. Some days they are busy, going from one call to the next and other days they have some down time between calls. I was told starting pay is somewhere in the realm of $55-60/hour. Does anyone out there have experience with this type of service? I know that peoples OPINIONS on this style of healthcare service will vary wildly, but I am curious to know if any of you have personally worked in this type of a setup and what your thoughts are? 1. I'm curious how the model is financially sustainable with fewer patients per day than say a clinic where you have back to back 15-20 minute appointments. 2. Did you feel that you were providing quality care or just wasting time/money/resources? I come from an EMS/ER tech background but currently work in Family Practice. I definitely see how this fits a need in the community. 3. Work/life balance. 4. How was the driving around all the time? (FYI, I spend 1 hour each way driving to/from work 4 days a week currently and after 2 years, its grating on me. This opportunity would be a 30min drive or 35 min. bus/train ride from home but riding around in the car all day between patients) 5. Do you think the model is sustainable? Thanks for your 2 cents!!!
  6. OP, consider 4 day weeks if your employer would entertain the idea . I work 3 regular days and one long day in which I staff our extended hours clinic from 5-8pm with one ma and one front desk staff member. Not only is it extending access to care to patients who otherwise may not be able to come to clinic during normal business hours, but you’ll be getting all your required weekly hours in and make it more reasonable to the employer that they allow you to only be in clinic 4 days a week. Just a thought. since you stated you were a newer PA and unless your family or NHSC paid for your education.... I’m going to go out in a limb and assume you don’t have the financial luxury to retire or quit the profession entirely . If you have the student loan debt that most newer pas have, you’re in our boat where our work as PAs pays better than almost any alternative that we are qualified for without extra education (more expenses) and are more or less forced to put up with the crappier positions in order to pay that debt. if you feel like you have to get out, look for other non clinical jobs you can use your background with. Research, public health. There’s a job near me paying PAs to assist with stem cell research for $75/hour . you could go on an income plan for repayment allowing you to work a lower paying non pa job and afford payments. You’ll pay on those loans for twice as long. Good luck! sorry to be so verbose guys.... too much coffee.
  7. I work FQHC rural family medicine. Family Medicine is taxing and there are a lot of demands on your time. Whilst I somewhat enjoy the respect that patients think of me as "their provider", I find it challenging when they really make the "THEIR" possessive. It sounds like you may be using ECW (you mentioned "telephone encounters" which is why I wonder) which is not the most user friendly. Continue to use templates, avoid using the telephone encounters feature for extensive back-and-forth conversations with patients ("Ms. Smith, your cholesterol is mildly elevated and I would love to discuss a plan on how to address this further at a follow up appointment. See this link I've included for further information." or "Your labs came back NORMAL" or "Your iron level is improving. I want you to continue your supplement at the same dose for 2 more weeks and then return for a follow up appt.") Dont engage with them on "Hey doc, I got this sore throat....blah blah blah...paragraph...oh and i need refills...and about that pet letter......and unrelated nonsense etc." Keep it simple. If its not, encourage them to schedule an appt. We dont get the luxury of billing by the hour for every second that a patient uses of our time. So dont give away your time for free, as much as you reasonably can avoid it. -Dont worry about every little detail. Yes, details are important, but if you get lost in the weeds on every single thing, you'll lose sight of the big picture and lose your sanity with it. Your patients are (hopefully for the most part) fully functioning adults and can take care of things themselves. Just because they waited until TODAY to ask for a refill of their med that they let run out, doesnt make it immediately your emergency and ergo your immediate stressor. (I mean, please fill peoples insulin and practice good medicine) But what I mean is, work with your patients and change your prescribing habits to improve this workflow if you havent already. If a pt is doing well and stable on Lisinopril 40mg daily, just send a year's worth of it to their pharmacy. Dont short change them on their chronic stable meds. Then you dont get a refill request every 1-3 months. Encourage the patient to contact their pharmacy FIRST to generate the refill request. That way they dont come in thru phone messages, letters, and telephone encounters. In general, at least where I work, the system tends to be more efficient that way because the refill requests come thru official channels and into me e-refill tab on the EHR. -Family med is a broad area of practice. Can you find something in it that you enjoy that your employer will support that you can focus on.? That may help keep you interested and engaged. For instance, I like procedures but hate OB. There are only 2 FT providers at the clinic. To keep us both happy (the MD loves OB) and to keep us both proficient in each area, she does all the OB and I am the procedurist who does most of the suturing, the joint injections, trigger point injections, casting, etc. -Pre-chart. Not too much, but a 1-2 liner on the patient's chart for the day can help keep you on task. Its a benefit to scheduled vs. walk in patients. If you know that your 10:00 is a follow up visit on iron repletion...."26yoF w/ ongoing iron repletion in the setting of menorrhagia. Currently undergoing workup for uterine fibroids as an underlying cause. US scheduled Tues. Prior Hgb 1 week ago was 9.0." Of note, need to discuss OCPs today." If your EHR has a "Pre-planning" section like our ECW does, put it there. That way, when you open their chart you know exactly whats going on for that visit and this REALLY helps when you are running behind. Make sure to update anything you type and to remove it if the pt no-shows (unless if automatically deletes) Try not to pre-chart too much as it can bite you in the butt. -I felt very similar to you when I started. I still show up and preview/pre-chart pts for 20 min in the AM and work thru my lunch. BUT, when I am done with my last pt., I spend 10-20 min finishing up loose ends (half the time I spend ZERO time) and then I'm out. I dont work from home at night or on weekends or on PTO. I truly credit my previewing of pts the day before/morning of and pre-charting 1-2 liners as reminders for this. -That all being said (and I probably just rambled on and on due to too much coffee late at night).... I am just finishing 2 years in family medicine and am on the hunt for a different position in a different specialty. Ive cherished all the benefits to family medicine and the broad knowledge base that it has laid down for me during my first 2 years of practice, but I want to branch out to something different. Feel free to PM me to chat further.
  8. I had every intention of paying mine off as fast as possible (which with every cent thrown at it would have been about 5 or 6 years) i still have this intention but I took a pause for about a year to do something different ....I decided I wanted to start investing in some passive side income so I dropped my loan from standard ten year plan to the IBR plan to drop my monthly obligation to it, owe no other debt, and purchased an income property that now brings in almost $2,000 income to me monthly from tenants. Of course there’s costs and repairs associated with owning property but I’m still quite net positive. I continue to pay MORE than the IBR plan requires each month and now have extra money to put towards the loans and retirement. (Not to mention the home’s value continues to grow in a hot stable market) This wasn’t an easy decision to make and can go horribly wrong for you especially if you have a lot of consumer debt or lack the discipline to keep attacking your loan debt (easy to spend extra income on toys restaurants etc) Its not for everyone but just something to think about.
  9. I work in rural FP and have only MA staff. It's a constant battle to get them to help with all of the above bullet point items you listed. When I have the time, I'll do some of it myself but usually I do not. I've explained why it's in everyone's best interest to lend a hand and everyone do their part. I've certainly won some favor because I rarely run behind in clinic and rarely keep staff there past 5pm, our closing time. Our other provider is often running an hour behind and keeps staff late daily which they hate about as much as I do. Try to work with them and explain the reasoning why instead of just saying "it's not my job it's yours".... No matter how true and how frustrating that is. Good luck.
  10. Solid offer. If the location is where you want to be, even if for only a few years, I'd strongly consider accepting that offer.
  11. Some more urgent referrals are ER generated (ie: to ortho for f/u after an ortho injury/fracture for those that can wait a few days comes to mind) but for non-urgent referrals such as this patient in question (referral to neurology for recurrent migraines apparently not responding to typical 1st/2nd line treatments who has repeat ER visits).... this referral should appropriately come from the PCP (not urgent ergo not the ER providers responsibility. Not to mention if insurance/CMS is involved, which typically always requires PCP generated referrals). I understand your frustrations.....I'm currently working in Family Practice/am a PCP for many. Now.... if the ER providers get sick and tired of seeing this person and the pt refuses to go back to their PCP, maybe an ER provider with time on their hands (not likely) would spend the time to get the patient seen by neurology either by arranging OP follow-up or convincing some poor soul in neuro to see them in the ER briefly. However....no guarantees that the pt will go to that outpatient neurology visit either (which also reflects poorly on the ER provider for wasting their time and the neuro's time on a referral/consult and the pt will likely be back in the ER again) And round the world goes.....
  12. Agree. There is no reason that PAs should be treated any differently than NPs in regards to having the independence to practice. We have been left in the DIRT by NPs and admin has taken note for years and now other providers are as well. I find it nearly impossible to even get an employer to CONSIDER my applications for a job because "Oh, we are looking for an NP only not a PA" This even goes for jobs listed for "PA or NP" All the hiring managers and administrators that I've encountered recently here in Colorado have a strong, if not singular, preference for NPs only and specifically quote NP's independence and PAs dependence (on SP/CP whatever we are calling it these days) as the reason why. (Yes, I've only been in practice for 2 yrs but I have great patient outcomes and performance reviews and employers aren't stating my lack of experience as the reason but specifically NP preference) The medical boards get their undies in a wad even discussing OTP with PAs, and definitely kick and whine about independence because MDs are the MEDICAL BOARDS' "Shining Stars". All the while, the nursing boards govern themselves and promote their "Shining Stars" which are their NPs. We will never be held to this level or promoted by the medical boards in the manner that the nursing boards promote their NPs unless we have some major changes soon. Ive gone to AAPA and my state chapters and asked questions, pushed for answers.....no response. So I try to provide education to everyone I meet about PAs, our capabilities, our breadth of practice ("No, we dont need a doctor to hold our damn hands"), and the state laws regarding our practice. As someone with 6 figures of PA School debt (common these days) and unable to obtain another higher paying job to afford my loans due to NP competition due to lack of our independence....something has to change. Maybe I'll get one of those online NP degrees everyone raves about......
  13. "What is the justification for granting autonomous but not independent practice to a PA with more training (6 years and 45 weeks) than an NP who can practice independently?" Preach
  14. No health,dental,insurance. No retirement benefits for 2 years. *Unacceptable in my book for a professional job. Even a 1 year wait time for retirement benefits is not great. You could at least put your own money into an IRA during that time. They aren't compensating you well enough with your salary to make up for no insurance. Hours: 8-5 pm with a 30 minute lunch. Monday-Friday. holidays and weekends off. No call. *Standard hours. If you're the only one at that clinic, who covers for you when you are sick or on vacation? What does your support staff (RN, MA, front desk clerk etc.) look like and what happens when they are out sick or on vacation? Is there an office manager for that location or will you be expected to wear multiple hats? $90,000 salary. *You are already paid VERY low for your work experience of 5 yrs right now, counter with 6 figures. Do not accept less than that. I'd counter with $110-115. Get the AAPA report, show them, discuss it. I second considering locums, moonlighting, etc. Regarding "My problem is that if this is a bad offer and I counter with 120,000, will they just say no and hire someone else? If thats the case then when will I get a decent paying job?" *They could absolutely do that, but they are unlikely to just turn you down flat out. Most likely, they will counter with a less than ideal counter or just he same original 90k and theyll give you a bunch of excuses why they wont offer more. I can't answer your question as to when you'll get a decent paying job but I will say that if you accept a salary thats far less than you feel like you deserve (and you do deserve more than 90k) and thats less than you need to support your family....your current burnout is only going to transfer to the new job and you'll be soon looking for yet another new job in the near future. One way or another, you have to fully investigate why you are burned out and the answer is hardly ever "I just need a change of scenery from my current job" There's usually some very specific things that trigger your burnout (ie: the front desk cannot figure out the scheduling so they're always overbooking me and that stresses me out -or- my MA is incompetent but they;ll never replace her because shes been there for 15 years -or- my SP sits on his ass all day while I work mine off -or- They dont give me CME time and money so I dont feel like my employer is invested in helping me become the best provider I can be -or- I cant succeed at goals in life (save for home, save for retirement, pay off debts, investments, buy a boat, etc) because Im simply not paid enough dollars)) Its important to know what specifically contributes to your burnout so you can ask about those things and avoid them in future jobs. Just some thoughts. Best of luck!
  15. If you and your supervisor/coworkers are on good terms both professionally and interpersonally, then there can often be NORMAL bittersweet sadness when someone leaves. Those people may feel sad or a sense of loss of a team member when you are leaving but are just as likely to be happy for your next opportunities. Your employer... Yes, they trained you but they HAD to train you, just like they would have had to train anyone else for that position. Perhaps you needed more time as a new grad but the training investment is what is expected of any employer of a new employee and not unique to our profession. Not even a seasoned PA can start a new job without some training on that specific workplace. You should try to not feel guilty for leaving an employer. Ultimately, this is a professional and business transaction in which you work for them by performing skills (medicine) that brings cash to the company and then they give you a cut of that income that they make. I tend towards the more emotional/guilty feelings when I leave a job so I can understand and which is why I try to force myself to force myself to think about the aforementioned more practical/transactional approach to the relationship between you and your employer. That being said, we also work in a unique profession where we have these intimate relationships with patients which I think contributes greatly to a sense of guilt when we leave a job (except for maybe terrible toxic jobs). Check out some youtube videos and articles on the guilt that teachers face when they choose to leave a teaching position for similar personal reasons (such as low pay) and you may find some common ground in their feeling of obligation to their students. Best of luck!
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