Jump to content

Search the Community

Showing results for tags 'family practice'.

More search options

  • Search By Tags

    Type tags separated by commas.
  • Search By Author

Content Type


  • Pre-PA
    • Pre-PA General Discussion
    • Physician Assistant Schools
    • CASPA
    • Personal Statements
    • Shadowing Opportunities
  • Physician Assistant Student Forums
  • Professional Physician Assistant
  • International Physician Assistant Forum


  • PA Profession
  • Medical
  • PANCE/PANRE Review
  • Pre-PA
  • Other

Find results in...

Find results that contain...

Date Created

  • Start


Last Updated

  • Start


Filter by number of...


  • Start




Found 23 results

  1. In this day of selivering bad news, I thought that this article that I saved from last year would be a great refresher. Food is food regardless of the source. The Rules for Delivering Bad News to Patients August 27, 2019 The Watercooler: Career Advice The Bookbag: Education The Rounds: Clinical Considerations General 0 Comments I've talked to some colleagues recently who've been a little down about their roles as nurse practitioners. Working in family practice, they have found themselves in the position of delivering bad or upsetting news to their patients. Cancer diagnoses were fortunately made rather than missed, but letting a patient know they've got a serious, life-altering illness or condition is tough, not to mention, this is not something most of us as NPs learn to do in school. Have you ever found yourself in the position of delivering difficult news to patients? How did you feel? Having such conversations as nurse practitioners can make us anxious or awkward. Some of us approach these discussions emotionally while others appear detached and robotic in their delivery of the news. Delivering bad news is an unavoidable part of our jobs as nurse practitioners but that doesn't mean we get used to it. Fortunately, however, conducting serious conversations is a skill that can be learned and there are many guidelines out there to help healthcare providers hone this skill set. Rule #1: Know what constitutes bad news Sometimes I share information with a patient that I perceive as not a big deal. Then, the patient starts to freak out. Or cry. Or to have some other sort of emotional reaction that I didn't anticipate. Bad news doesn't have to be a terminal diagnosis. It can be related to anything surrounding a diagnosis such as timing, personal or professional consequences. Breaking a metatarsal and wearing a boot, for example, may not be too bad in the grand scheme of things, but breaking your foot the day before your wedding is pretty disappointing. Rule #2: Full disclosure is best In the past, healthcare providers operated on a more guarded front. In the 1800's, for example, the American Medical Association even encouraged physicians to avoid sharing news that discouraged patients. Today, however, studies (not to mention ethics!) show that most patients prefer full disclosure. It's our duty as nurse practitioners to share up-front, honest information rather than sugar coat our delivery with excessive optimism, withhold details, or give false hope. Share news with the patient directly rather than directing it toward family members. Honest, trustworthy information is empowering! Rule #3: Prepare yourself Anticipate the conversation you're about to have with your patient. You may even wish to practice your delivery with a colleague. Prepare yourself to feely badly as you share the news. And, don't forget that silence is OK. Avoid the temptation to fill gaps in your conversation rather let the patient process and take the time to formulate questions. Rule #4: Frame the conversation Framing the news you're about to share is essential. Your patient may or may not be expecting to hear something difficult. And, the way you set up your conversation has an impact on the patient's reaction. Using the word "serious" (ex. "I have some serious news to share...") is better than using the word "bad". "Serious" creates a more constructive framework that inspires action and empowerment as opposed to the word "bad" which indicates the situation is helpless. Even if you're delivering a terminal diagnosis, your patient can choose how to react and what steps they wish to take in response. Rule #5: Think SPIKES There are a few well-known methods for delivering serious news to patients, my favorite of which is the SPIKES method. This algorithm lays out considerations for nurse practitioners and other healthcare providers in these situations. Here's the SPIKES protocol: Setup - Think through the conversation you're about to have, anticipating questions the patient might ask beforehand. Prepare for an emotional reaction. Gather any necessary resources that might be helpful for the patient. Perception - Gauge the patient's understanding and perspective on the news you have shared. This is best accomplished by asking questions like "What did you take away from what I just shared with you?" or "What are your expectations of treatment?". This way you know you are both on the same page as far as understanding the medical outlook, next steps and goals. Invitation - Encourage the patient to think further about their care going forward. Find out how much information the patient wants about his or her medical condition as well as who he/she would like to be included in decision making such as family members. Knowledge - This step has to do with how you as a provider deliver information. The best practice is to deliver the headline first, followed by the details. Communicate using language that matches the patient's level of education and medical knowledge. Be direct in your delivery, avoid skirting the main message. Empathy - Understandably, patients get emotional about serious news. Anticipate such a reaction and display empathy. Naming the patient's emotions can help. Asking "Can you tell me more about what you mean by that?" will also help you determine how the patient feels about the situation. Summarize and Strategize - Make a plan for the next steps in both treatment and communication with your patient. Express support and encourage the patient to tell friends and family the news to develop a personal support system. Talk about how the patient can act on this news to accomplish his or her treatment and lifestyle goals going forward. Have you ever delivered bad news to a patient? How did it go?
  2. Hi Everyone! New grad currently negotiating part-time PA position in Family Practice. I've done clinical rotations and scribed at a Family Practice office in NYC and will be working part-time until I start a Residency program in the fall. Trying to figure out what I should expect in a part-time contract if anything in terms of benefits, PTO, CME, etc. Also, trying to discern if it is in my best interest to be a part-time employee or 1099. Thanks in advance!
  3. Hello Everyone, My name is Olivia and I am currently a senior at USF. I am looking for shadowing opportunities to be able to start accruing my 2000 hours that I would need to accomplish by the time I graduate in order to be accepted into a PA program in 2021. If anyone has or know any opportunities that I may be able to apply to..I would greatly appreciate the referral. I can be contacted though this forum. Thank you Olivia N.
  4. I have 7 years experience as a PA (1 year General Surgery, 3 years IM private practice, and now 3 years at my current position in a family medicine outpatient clinic) in rural Kentucky. It is time for contract negotiations after 3 years of work here. I am outpatient only with no call, 4 days per week; averaging 18-20 patients per clinic day. My base salary is $93k, Encounter based bonuses ($16.59 per encounter over minimum 663 per quarter which does not prove profitable for me so basically my salary is less than $97k total), $2500 CME plus 40 hours PTO, 24 days PTO plus 12 sick days, Malpractice and license fees paid. Insurance and retirement are self funded. No 401k. I have continuously had superior provider ratings, increased clinic volume (with the highest in the local system for at least one year), diligent with completion of charts and never take days off. Recommendations on asking for raise?
  5. A friend of mine has been tasked to make a schedule for her to see 24 patients in 8 hour day. When to schedule new and for how long and f/u's and for how long. I should say that this is a new family practice and presently is seeing 3-10 a day!! This is a long term plan. Any suggestions from family practice on how to schedule?? Thanks
  6. Want your opinion please. If you work PRN, hourly, no bennies would expect to be paid for time spent at orientation and some other HR/departmental activities? Thanks
  7. I've applied to a few family practice offices in Dallas and Fort Worth Texas, and was wondering what a fair salary range would be. I'm seeing anywhere from 90-115k/yr. Does that sounds about right?Assuming benefits are standard and full. I have 3 years of family med experience in Pennsylvania. Making the move to down south soon!
  8. Im 9 months into my first job as a PA and working in family practice. Just two providers in our office, myself and the MD. The MD has set certain rules and guidelines for the practice, and one is on return visits. Any patient that has a prescribed medication needs to be seen every 6 months at minimum for management of care. Only acceptation is with OCP. I have denied more refills lately for because they are over the 6 month timeline. Many patients are complaining and aggravated when I see them because they have been on these meds for many years and have been stable (example, levothyroxine). We also continue to see all diabetics and "pre-diabetics" every 3 months with labs. Many of our "diabetics" have never had an A1c over 6.2 and are on minimal metformin doses. Also, on the newest guidelines for cervical screenings with pap's. We still do every year even though guidelines are saying otherwise. i understand that these are the rules of this practice. Im curious as to what other family practices do? Thanks....
  9. Hello, I'm a "new grad" having graduates this last August. I had initially taken a uro job for 75k, working at least 50 hrs q wk. to make a long story short, it was a toxic environment and I resigned after the probationary period . Fast forward to today ... Offered a FP job for 80k, no benefits (health insurance , 401k, no CME reimbursement ). Benefits include 2 weeks vacation, No weekends/call, and only four 10 hour shifts. I'm not a good negotiator either; hate it and I'm terrible at confrontation. Also, this is the first time this particular clinic is working with a mid-level so I'm not sure what to expect or even if my SP knows how the role of the PA will come to fruition. I really need the job as the bills keep coming and I have seriously ill husband who has to take off work from time to time d/t health issues . All that being said, I am starting to think k should have asked for more. The official offer hasn't been made, but I'm told SP simply wants to "check my last reference" And an offer will be coming Monday. He health insurance and no CME funds really Do bother me. The 401k k's projected to start next year , so I can be patient. So my questions: - what more/ how can I ask to get get a little bit more. Ultimately , I am going to take the job bc I reaaaallly need it . And after the last toxic environment I was in, they could lay me in cheese and it would be an improvement. - should I ask projected salary in 6 mos/ 1 year? - has anyone ever been the "PA Guinea pig " and if so , how did that work out? I'm still not sure if it's a plus or a minus . Also, let me add... I live in South FL where two PA schools are located and early everyone wants to live here so there's definitely saturation. If anyone can provide any insight or advice I'd be most grateful !!! Thanks !!
  10. I am a recent new graduate and will very soon begin a job in urgent care. Does anyone have any good reference books they would recommend? Two books that I have found online that look promising are: "Minor Emergencies: splinters to fractures" and "Textbook of urgent care medicine" . Any one that knows which one may be better or any other options for a new grad in urgent care, please let me know! Thanks.
  11. I know this is not a good offer, but I want to know if it's worth neogtiating or too far off the mark. I graduated a year ago, but have not worked yet as a PA due some family issues. I wish this had not been the case but it is what is. Due to this, I am aware that I am undervaluing myself because I have not been in the clinical setting for a while. I had my first interview at a family practice in a small community in NE Pennsylvania. I really like the office and the community it serves. I think the position would be great for experience, but I don't know that they value the PA as they should. It's a Physician owned practice with one other Physician on staff and 2 PAs. The practice has been owned for <10 years. The buiding is owned by the managing physician and is leased out by a local hospital for specialists to have access to the area. The building is also a Quest draw site and has a radiology service and pharmacy on site. The physician states she has 18 people on staff. I received an offer at the interview for $70,000 (I had stated 80K and was told this was the top end for a new grad in the area, which I have seen in one survey somewhere, but that was the only one). It was also reinforced that as a new grad there is no profitability over the first year. (the physician's husband was in the interview because he is the IT guy/numbers guy/helps with management, etc.) Contract is for 3 years. Performance review after first 90days, but no mention of review or contract negotiation in the contract. 40hr/week. 1 saturday every 3-4 weeks with a comp day the week before. Would not work Sat until MD comfortable with me on my own. Call for one week a month for reassurance but they said you dont get a lot of calls. Not expected to take call immediately. I would have to use my own cell phone. Expected to be up to 20-25pts/day after ~3-6 months or when we both feel comfortable. No healthcare coverage. I negotiated to have them cover my premium. After reading the contract it states UP TO $300. I am paying for my own currently and have a high deductible. Was hoping to have a better situation with a job and something to offer the family. 10 PTO, 3 sick/personal days, 6 federal holidays. NO rollover. $800 for CME and no time off for CME. I negotiated 3 days. I have been involved in AAPA HOD and would like to continue this, but this makes it a little difficult. They stated they cover malpractice, but there is no mention in the contract. So I don't even know what or if it covers tail. 401K with matching after 1 year. I asked about professional/licensing/DEA fees and they stated that could be submitted and reimbursed, but again not in the contract, so I don't know to what amount. I know the things that are not in the contract need to be included. This was my first interview, first offer, first contract, so I did not cover all the questions I had up front as I was not prepared for the offer. I did not read the contract until I left. I do have 3 maybe 5 more interviews in the next 2 weeks. Any thoughts? Advice? Thank you!
  12. certified diabetic educator (CDE) certification - lucrative or not? My manager approached me today to excitedly inform me that she suggested me when a diabetes rep came in and mentioned her company will provide free CDE training for a provider in our office. I do really like endocrinology but don't want to work in Endo due to the lower salaries (kind of burnt out right now on long hours and low compensation as it is in family med). I'm trying to read between the lines and see if this is something that would actually benefit me or only benefit the hospital and my workplace. I have a very busy patient schedule and family medicine and work long days and already feel quite underpaid. I like many aspects of family medicine but that one is not one of them. I guess I'm a little bit worried that if I do this training I will have an increased workload but really nothing financially to show for that. Has anyone out there done this? Worth it or not? I kind of feel like this would be something for a nurse and not something that will be financially beneficial for a physician assistant's career. Huge thanks in advance to anyone who can offer some advice or perspective on this.
  13. I need all the help I can get... going from family practice to urgent care. Books/ CME's/ useful apps/ procedure training or is that all on-the-job? THANK YOU!
  14. Hello PAs! I need some advice. I'm a new grad, my last clinical rotation in family practice was wonderful- 100% supervision, very functional office- everyone communicates and patients are seen on time. I recieved a job offer from this site- I worked with the doc already for a month in clinicals I know we communicate well and he liked me enough to hire me! Three interviews including contract negotiation, we had decided on the contract revisions, benefits, salary etc.. and then I get a call from his office manager stating "they looked at the books and decided not to hire anyone right now, they don't have the patient volume they thought they did and financially it just isn't working out." Hold on, the entire time I was there during clinicals they had just lost their third provider and were short handed, he was interviewing to fill the position for months! So I told the office manager I felt mislead, that I had accepted the position pending revisions and she said she'd call me back right away. 45min later the doc calls me and says "I offended him in negotiations by asking for tail coverage" "It feels like I don't trust him (background- I added a section to the contract stating he would furnish me with supplies necessary to perform my job)" "And we just aren't going to have a good working relationship because I don't trust him and I was so egregiously offensive." His tone was almost hostile, It took me completely by suprise. When we had negotiated the contract just a few days prior he was smiling, very agreeable, he was happy to make the changes and we left with a side-arm hug saying "I'm happy to have you work for me." Well long story short I told him I was willing to renegotiate and he offered me the contract again- with a few of the revisions I had suggested and he "never wants to talk about our misunderstanding again." and I should "write the AAPA and tell them their advice almost lost me my contract." So now what? do I accept the job? Before those two disturbing phone calls this was my dream job! The job: $82,000/yr with growth potential max 15 patients/day [and their patient pop is on the younger side] M-F 8-5 One Sat OR Sun per month at the group's urgent care NO CALL EVER! Employer pays 75% of Health/Vision/Dental premium (AETNA!) 401k graded matching (2%/year and 20% if I leave after 1 yr, 100% if I stay for 5yrs) $1500 CME allowance He will reimburse me for all licensing fees including PANCE, TMB app, JP Exam, etc.. another $1k The clinic is new, equipment is in great shape, I get to perform small procedures- skin cancers, testopel; fun stuff Location is great, 20min from my house I don't have any other offers, I have no doubt that with some time I could find another job in my area.. but maybe not with all these perks? Advice??
  15. UPDATE 6/13/14: this essay sucks balls. It is useless drivel; a mere regurgitation of my resume with footnotes sprinkled in to gloss over the suck-factor that is my life. Don't waste your time reading it!!! (I hope to update it with something more appropriate in the next week or two) “Will you go to nursing or medical school?” Growing up in a Filipino household with a physician as a father, I was raised in a culture that viewed picking a career as choosing medicine...or medicine. When I was young, my parents beamed with pride when I'd say I wanted to be a doctor. Little did they know that I only said that because it was what dad did; if he was a garbage man, I'm sure I'd have the same zeal for discarded furniture and old tin cans. But in reality, as I grew older I wasn't sure what I wanted. However, one fact was certain – I wanted absolutely nothing to do with medicine. Being immature and rebellious, I initially went to college with casual intent; I'm ashamed to admit that I'd sign up for classes because they were easy, and drop others if I didn't feel compelled to do the work. Much to my parents' chagrin, I was an ingenuous graduate who worked random jobs. It didn't matter to me; I was thrilled that I had escaped the insufferable constraints of parental expectations to live life based on my terms. But much to my surprise, as much as I tried to avoid medicine, medicine found me. When you're working three jobs in Chicago with no health insurance, if you get sick, without a doubt you'll be visiting a public health clinic. I'd never been to such a facility before – I had always been fortunate enough to have access to esteemed medical care. So I was stunned when I walked into that public clinic to find a security guard looming at the door (what were they expecting to happen?!), a ticket dispenser reminiscent of the butcher shop, and a waiting room that appeared more intimidating than inviting. These conditions merely hinted at what I was to encounter inside; my doctor's visit was hasty and embarrassing, and the overall experience left me feeling deflated and confused. From that point, I was determined to pursue a career in medicine. I wanted to give my community access to the sort of high-quality treatment I was lucky enough to receive while growing up. Everyone deserved positive healthcare experiences, regardless of their ability to pay $5 or $500. I knew that I could provide that caliber of care, but it required returning to school. Over the next few years I completed the prerequisite coursework, but unlike my initial efforts, I excelled from motivation and resolve. I no longer withdrew from multiple courses at once, just to avoid hard work. But spring of 2012 proved challenging. My father – a man I admired, illustrious in my hometown for countless years of service as a Family Practice physician – passed away. I was beyond devastated. I didn't know how to cope. I withdrew for the semester. Eventually, I learned how to manage, and I convinced myself that I needed to emulate my father and finally become a physician. However, as I filled in each line of that medical school application, instead of feeling vigor and excitement, I grew more apprehensive and withdrawn. The visceral rejection to the idea of becoming a doctor was abrupt, but it got me asking a simple question: Why was I really doing all this? I was doing all this because I wanted to provide continuous, comprehensive healthcare to families in my community. Family Medicine had consistently been my ultimate goal, and practicing in this field didn't require a fancy title or going into vast amounts of debt. Becoming a doctor wasn't the most direct means for me to achieve this goal – PA was clearly the best option. This time, as I filled out the PA application, my enthusiasm reignited; only then did it dawn on me that this career choice encompass the veritable culmination of my life experiences. My struggles have thoroughly prepared me for a career as a PA. I know what it's like to have graduated college and find it impossible to land a job, or to work three jobs and live paycheck to paycheck. While others may view such moments as setbacks, those struggles endowed me with the maturity and adaptability required to endure the rigors of PA school. Furthermore, my dedication to the community and work experience are strong indicators of the type of PA I will be – compassionate, persistent, and flexible. As a volunteer for Rape Crisis Services, I know the compassion required to be there while a survivor waits in the ER. Working with hospice patients, I understand that persistence is vital for developing rapport with patients. As a CNA, I must constantly exemplify the flexibility to work both autonomously and harmoniously on a team. As I continue to acquire more PA shadowing experiences, I look forward to observing directly how PAs make deliberate medical decisions, and how they embody the patient-centered approach in their irreplaceable role in healthcare. I'd be honored to get the chance to become a Family Practice PA. Without a doubt, I am ready. Ready to intertwine scientific know-how with the practice of medicine. Ready for opportunities to build indelible relationships with generations of families. Ready to grant every patient the individual attention, respect, and time that each one deserves. Actually, I'm ready to make Mom and Dad proud, because let's face it, every kid – no matter what age – hopes to make their parents proud.
  16. Hey guys! I currently practice in North Carolina (and some of you may remember me complaining a while back about my unhappiness with my current job). Anyway, I am interviewing for a job at CareNow Urgent Care in Dallas Fort Worth (yup, finally got the balls to move and the fiancé's approval, too). Wondering if any of you have any experience with working for Carenow/ urgent care in general/ or live/work around the DFW area. Any advice would be greatly appreciated ---- Especially what kind of questions to ask at the official interview? I have almost 1.5 years in family practice. What can I say that would make me an asset to urgent care? etc. etc. Thanks!
  17. I posted this on the TX forum, but thought Id try here too. Getting ready to interview for an Urgent Care position tomorrow on phone (and hopefully they will call me in for a face-to-face). I currently have about 1.5 years experience in family practice. This position would require me to relocate which I am ok with because I have been looking in my current location for the past 6 months without any luck. So, my question is... what questions can I ask as a PA going from family practice to Urgent care? The practice I work for now is painstakingly slow business-wise. Also, is it appropriate (or how do I ) ask for relocation assistance? Student loan repayment in place of the salary increase? The salary they offer is already a 15k increase, so I don't want to seem like I am asking too much. I always get nervous when it comes to working out the financial part. And if anyone has lived and/or worked in the Dallas- Fort Worth area please share your thoughts!!!
  18. Howdy, Looking for Navy PA's with experience (preferably recent) serving with 2nd Marine Division. Getting assigned there after school & I have a few questions. Hit me up via PM, please. Thanks.
  19. With a trend of Family Practice Physicians shortages, I am wondering what everyone thinks might be a good incentive to attract Physicians back to this area of medicine? I know PAs are supposed to help address this shortage, but without supervising physicians we are unable to fulfill this deficit. Are incentives such as promising shorter hours and increased salary viable options? And if so, will the added responsibilities and cons of this area fall upon PAs driving down their job satisfaction? I would love to hear some thoughts and input.
  20. New Grad in in Texas. $58+ hr with 40-45 hours average benefits included 4.5 weeks vacation and cme included in Peds OR $95k Salary for Family Medicine for 40 hour weeks plus benefits No call I like the family medicine more but the pay is substantially different, so I'm just wondering opinions
  21. I am a new grad, and accepted a really good fam practice/peds offer in NC. I wanted to move and start work ASAP, but the board is telling me FOUR MONTHS for my license credentials. The office is telling me I can't start until then, but I was under the impression that I could be trained while waiting? Anyway, that is the impression they gave me in the interview. The doc seems urgent for me to start, emailing me everyday asking how things are going, but the practice administrator is not budging. I am kind of in limbo with everything else in my life right now (finances, living situation, boyfriend quit his job, etc) soo would it be out of line for me to ask them to give me an estimated date? Now, I am just waiting for the board.. and don't know if I need to get another job, move, etc. while waiting. And does it really truly take FOUR MONTHS?!?! Thanks for your help :) Jenni
  22. I have so far taken half a year off to focus more on school. It has been 6 months since I have worked and have been taking at least 17 units per semester. I wish to continue to do this and not work for about another year to retake some of my classes. Will it look bad to the admissions committee if they see that I have not worked for a year and a half or so when I plan to apply next year??
  23. Hey! Are there any PAs (particularly Family Practice or General Surgery) in the Sacramento to San Francisco Bay Area that will allow me to shadow them? I'm trying to keep myself constantly immersed in the work of a PA so I would be truly grateful for the opportunity. Please contact me at mjrdiaz@ucdavis.edu for any questions! Thanks, Mark D.
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More