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  1. I have been working in a specialty private practice since graduation that I really loved and felt that I performed well in (was never disciplined, received performance raises, commended for growth/development). Always had good rapport with all providers in practice and basically thought of them as extended family. However, over the course of numerous months conditions deteriorated (working roughly 100 hour weeks that included driving 500 miles). This had never been the norm during my time with this practice and certainly was not what “I signed up for” when employment contract was signed (roughly 40 hour week and 20 mile drive daily max). It also became obvious during this time I was the only one being burdened with this schedule/commute. I tried to address concerns with management as it was significantly impacting my quality of life. I had always been a “team player” helping the practice in any way I could and had never complained, but I thought my concerns were legitimate and really just wanted some type of resolution be it alteration of schedule or compensation to make my life slightly more manageable (heck even an adjustment to call times to avoid the 2 hours I spent in rush hour traffic would have been a great start if possible). However, I was repeatedly ignored. Only when I literally felt at the end of my rope from exhaustion and was seriously considering leaving do I finally score sit down with practice owner. The owner knew exactly what my concerns were as we had a conversation via text about it. I was straightforward but very polite in stating my concerns, and they seemed amenable to discussion and we scheduled a date to further discuss details. I wasn’t concerned in the slightest because we had always had a good relationship/no issues communicating with each other. Fast forward to the end of my last scheduled shift and owner starts texting me in what I perceive as a hostile manner and comes off as dismissive in regards to topics of discussion for upcoming meeting, which was entirely out of character. I am careful to not engage too much because I clearly want nothing to do with bad mood of owner. Several days later I am terminated via text before meeting ever occurs (who knows maybe there was never an intention to have an open discussion). I was completely shocked. Two weeks go by and I hear nothing from practice admin whom I was told would contact me for dissolving contract. But, I ascertain it is time to move on with my life including beginning the search for employment. Additionally I had filed for unemployment during this time. First individual I reach out to results in immediate job offer by phone as they are familiar with our service. However they want to contact former employer to get ok as they wouldn’t want any drama with previous practice by hiring me (which I completely understand). I was brief, but honest about what transpired and avoided any blame or derogatory language. I said there was a scheduling issue that unfortunately couldn’t be resolved and added the positives about how it had been a great position that I learned so much from etc. Within 24 hours practice admin of former employer calls to schedule appointment to pick up w-2 and last paycheck which they claimed could not be direct deposited as it had been before (heard of the post office?). Before hanging up there is also the mention of signing a form, which could very well be some type of formal separation agreement (which I am under the impression I do not have to sign). As I wait to find out what this is all about physician who previously offered job calls to rescind offer and doesn’t want to offer details. Clearly, I feel prior employer likely said something negative to prospective employer to prompt them to rescind offer. I am deeply concerned that if prior employer can help it they will try to prevent future employment if at all possible. I practice in a large metropolitan area that is nonetheless tight knit and I am concerned regarding my ability to find meaningful employment and protect my professional image. In particular I expect they will likely aggressively pursue compliance with non-compete (which given the broad scope my former job entailed should still leave plenty of opportunity even if I can’t work in my specific specialty for a little while). However, it is safe to assume I will not receive a fair or accurate representation from former employer and I don’t know how to address/overcome this issue moving forward. I am also worried about what may come of my credentials that I received as part of working with former practice specifically if at least one institution may withdraw privileges and potential for event to be reported to NPDB (former practice owner was on board for at least one of the hospitals I was credentialed at). From what I understand if this happens it could impair or prevent future credentialing at any hospital and significantly reduce job opportunities for my entire career. Finally, it appears unemployment is awaiting decision because former employer is claiming I am ineligible because I was discharged for some type of misconduct, which is honestly just another slap in the face. I am honestly at a loss for what to do from here? I really just want to move on and support myself, but I am incredibly discouraged. I never saw this coming, but I imagine many others who found themselves similarly situated didn’t either. Any advice about how to proceed and also ensure I am looking out for my best interests would be greatly appreciated.
  2. I started my practice in an ED at a level one trauma center and was informally trained in bedside ultrasound on the job. Over my 3.5 years with the group, PAs were brought into the same rigorous training standards as the EM residents with the goal of securing credentialing for all PAs. I ultimately completed the requisite exams and was technically credentialed at that point. I left that position shortly after and began working with another area organization in EM. Bedside ultrasound is culturally used less as the average practitioner with my current group has less experience, however many of the staff are ultrasound trained. I'm running into issues with ultrasound documentation in that we are allowed to perform the exam, bill and document only if we have a credentialed physician looking over our shoulder while we perform the exam. We have been asked not to document the ultrasound in our note for both billing and medicolegal reasons (understandably). When this issue for APPs (both PAs and NPs in my new practice) came up, our group was told that it is system-wide policy that APPs can't do or can't be credentialed to do bedside ultrasound. I'm wondering what resources are available to help PAs/APPs develop a credentialing process for bedside ultrasounds within their organization. I see there is a Society of PAs in Clinical Ultrasound, however not many resources regarding this professional practice issue. Can anyone help point me in a direction or offer up their professional experience?
  3. I'm currently a PA working in EP (electrophysiology). I am in the process of obtaining privileges for elective DCCV (direct current cardioversion) and was wondering if any of my fellow PA's had similar privileges. These would be scheduled elective procedures (typically for atrial arrhythmias), and would be completed under conscious sedation by anesthesia. I am hoping to touch base with someone about how they went about obtaining privileges, and their hospital's protocal for midlevels and cardioversion. Thank you very much.
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