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  1. I just started a new job that uses Nextgen. I have used epic for 8 years at my previous office. Are there any support sites for nextgen to learn tips or helpful hints. I'm stressed about how complex it seems to be to do any task. Anyone who uses Nextgen, is there a way to send letters to patients that includes recent lab results. On Epic I could just go to letters when I was reviewing a person's labs and send them their results along with any remarks I wanted to include. I haven't seen many if any positive comments about Nextgen.
  2. I think my concern comes from the expectation of the patients that they have the option to see a doctor when they come to our office. It's not the norm in our area to have an office with no MD ever available. I have been practicing close to 20 years now and feel comfortable when working alone or with the other PA. I'm family practice/internal medicine and we have a large amount of medicare/medicaid complex/non-compliant patients. The issue as well comes from having so many more of these patients when the doctor leaves. Our volume of patients can range from 16-26 in a day on average. Its nice to have these types of patients divided up among us in the office, with the MD being able to see some of these patients as well. Patients who require a PCP to be listed on their card aren't always happy about having to call their insurance company and request a provider they don't know, who is not at our office or listed as a provider at our office, who they really don't have the opportunity to ever meet or see. We had to do this temporarily before for several months, but now this appears to be a longer term plan. I guess overall my biggest concern are those patients who would like to see an MD and will not be able to. When these patients start off angry, they look for any reason to find fault with what we do, even if it was appropriate care or treatment. So many doctors are leaving this company that its difficult to even schedule them with an MD at another affiliated office without having to wait weeks or months. Thanks for everyone's feedback! It is disappointing that the most likely motivation behind this is all financial and these decisions are made by people with no healthcare background.
  3. The other PA and myself at my office are soon to be without an MD in our office. Multiple doctors/practitioners, staff are leaving this corporation due to dissatisfaction. Despite giving a 3 month notice and the other MD giving a 3 month notice prior, there has been no attempt to replace either doctor. I feel the "leadership" of the company is planning to stretch the guidelines for on-site supervision as far as they can. They already have another office with 1 NP and 1 PA who have been without an MD for 8 months now. That PA said her new supervising MD has never been to their office. Management has appointed myself and the other PA a supervising physician who is not at this office. I know that is legal. However, my concerns are these "supervising" physicians and our company have no intention of these MDs EVER being at our office. Patients are not happy with the fact that there is no doctor and I feel it is setting us up for a very risky situation liability wise. I am in a large city and really there is no need to be without a doctor indefinitely. We are not in a rural area where the only way we would be able to provide care would be to practice alone. I know state laws are different. I am in Virginia and the guidelines states the supervising has to be accessible in person or by phone within an hour time. I'm looking for anyone's input or experience with this situation.
  4. Interested in finding out more what it's like working for a VA outpatient clinic. There is one not to far from me and I'm considering looking into it as an alternative to my outpt corporate run FP/IM job. I have been told that benefits such as vacation time are good, but I'm interested in the day to day patient load, types of patients, what is expected at a clinic visit - example is this where patients get PAPs, EKGs, X-rays etc. Are there same day sick visits or is it mostly chronic medical conditions such as diabetes, HTN, etc. Thanks!
  5. This is how the following article starts, worthy of a read. Probably won't turn heads of suited admins who count beans. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617939/ The VA is ALL internal medicine - all day long - all the time. Polypharmacy, multiple chronic medical problems, PTSD, etc. My schedule will never see more than 14 patients in a day - period. However, private and corporate practices don't care - money over everything. All the providers have to support non-income producing suits that seem to keep overpopulating like rabid bunnies. I would seriously hate to make a medical mistake because I felt rush or overwhelmed to see 25+ patients a day. No one deserves less of my attention or less accuracy. I hope we can all play a role in reworking this process which is just wrong on so many levels. There is a VA outpatient clinic nearby that I am considering looking into. I am definitely interested in talking with PAs who work there to see what it's like. I know no place is perfect, but wondering if it would be better than corporate primary care!
  6. Anyone have input on working at the VA?I am in Virginia Beach and would be looking into working at the outpatient clinic in VB.
  7. Oh it is a nightmare. Pts can come late to appointments and if I don't fit them in to my already filled 25 pt schedule, then I'm asked by management why I'm "refusing" to see them. Then of course the patients get the surveys if they were seen within 15 minutes of their appointment time, if we spent enough time with them, if they get calls back the same day, if they get an appointment as soon as they ned one. Of course patients are now considered our "customers". All the signs in the breakroom advise us how to keep our "customers" satisfied. Like I said, I'm baffled why they are pushing providers out of primary care when there is a lack of primary care providers. There is a big chance me and the other experienced PA here will leave sooner or later.
  8. Yep I'm salary. So sad that the answer seems to be to leave. Especially since there is a primary care shortage. It almost seems like these corporations want us to leave. Its so bad that an internal medicine doctor who just joined us in February with 25+ years experience is leaving already. He said he can't work like this, and he has been seeing less pts than I do because he is new to the office. Some of these pts I have seen for nearly 20 years and sad that seemingly I will be forced to leave. Going to another primary care office wouldn't be an option b/c its just the same thing different place. I guess I was optimistic that someone could give me hope that they were able to come to agreements on a daily max of pts or just some reasonable guidelines with scheduling.
  9. I've worked in Primary Care for 19 years. 12 years with a private solo doctor until he retired and then the past 7 at a corporate hospital owned outpatient primary care office. There was a merger a few months ago and dozens of providers were let go. Those of us left were given essentially an ultimatum to be at or above the 65% for WRVUs. With the layoffs and subsequent providers quitting, our schedules are being jammed full day after day. The other PA and I have no say in anything with our schedule. No limit to # of new patients in a day, physicals, complex patients, patients who can't get in with their regular MD at another office. Does anyone else have any limits or restrictions to their schedule by choice? Also, and even with all the years of practice I don't know legally our rights to defer a patient to the MD in the office. This has not been an issue until being with this corporate group. There are some patients that have so many issues, recent hospitalizations, non-compliance etc that are being put on our schedules b/c we have availability first that we are becoming inundated with these types of patients. When I say, "maybe they should see the MD" I am told by our office manager "no". If I have availability and the patient is ok seeing a PA then I will see them. There are times when I look at our schedules and it doesn't seem rational. The MD may have a cholesterol follow up and follow up for refill on zoloft while I have a new patient with cirrhosis, edema, heart failure, chronic pain and neither our manager or "higher ups" seem to have any issue with this. We are essentially told "too bad". I am becoming increasingly concerned about liability risks due to the sheer number of patients and their complexities.
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