Love2BePAC Posted July 2, 2013 Share Posted July 2, 2013 For those out there working with new grads in family practice (or for those who have been new grads in family practice), what is the expectation of time to get up to speed? My first job was a terrible fit for me -- thoracic surgery. It was bad from the get-go. I was there 6 months and then, thankfully, had found a job in family practice. I was really excited. I started this new job at the beginning of June. I kept telling my SP that I am new to family practice, having had only one 2-month rotation. He kept saying, "You're smart, you'll catch on quickly." So, he gave me my own schedule off the bat and when I'm not busy, I am with him or other physicians. Generally I'm there with at least one other doc or sometimes the PA who's been there 7 years. This month has been very trying. Some days are good days where I pretty much know what to do for patients. Then other days are not good days...like today. He called me tonight and said that he's going to back off my schedule because it's obvious that I'm uncomfortable and have a lot to learn, but that I'm motivated and intelligent and he's not worried about me learning it. Most of the time, I will be with other physicians acting in the role of a student for the most part. It was a relief, but at the same time, I feel so dumb. Having it happen this ways makes me feel completely inept. I am overwhelmed. I knew that I wasn't ready to see my own patients, especially when they book them every 15 minutes. I tried to communicate that. I'm not sure what to do. I'm really down on myself and my confidence is shaken. So, I want to know: What is an appropriate time frame to build up your skills and knowledge to successfully treat patients on your own? Or at least 90% of patients? I study at night and write important stuff down. Not sure how else to get better other than seeing patients and discussing them with the docs/PA. Thanks, Sheryl Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 2, 2013 Moderator Share Posted July 2, 2013 4/hr is too many for a new grad, especially if you are also having to learn a new emr. 2-3 /hr if low complexity is ok or 2/hr if high complexity or doing procedures. read "primary care secrets" cover to cover and this will get you up to speed on most issues seen in an fp office. good luck. Link to comment Share on other sites More sharing options...
Love2BePAC Posted July 2, 2013 Author Share Posted July 2, 2013 4/hr is too many for a new grad, especially if you are also having to learn a new emr.2-3 /hr if low complexity is ok or 2/hr if high complexity or doing procedures. read "primary care secrets" cover to cover and this will get you up to speed on most issues seen in an fp office. good luck. Thank you for your recommendation. I looked on Amazon and I see one from 2003. Do you know of any new versions or do you think that's okay? Link to comment Share on other sites More sharing options...
Love2BePAC Posted July 2, 2013 Author Share Posted July 2, 2013 And I agree about the complexity issue. My biggest issue is that these patients are complex! Today alone (scheduled every 15 minutes), I saw man who was hit on his bicycle by a car, a lady with new onset LE edema and headaches (with 15 PMH), an uncontrolled newly diagnosed diabetic (who just got out of the hospital from a DKA coma), and new patient with uncontrolled HTN, gout, DM, hyperlipidemia, back pain, GERD, and hypothyroidism. He was the easiest! I can do a cough/cold, sinusitis, wheezing, pap, headache, allergies, abdominal pain, and so on in about 10-15 minutes. But I keep getting these other ones because the docs have no room on their schedule. But with these difficult ones, I'm not really having too much difficulty with the diagnosis. Part of my issue is the treatment and the workup. I'm not having a great time with the antibiotics this practice prefers. And all the docs are completely different. In this clinic, almost all coughs get a cxr. All that wheezes gets PFTs. Tympanogram for a URI/otalgia. It's just that I wasn't trained this way. So, I have to learn the practice's way of making more money. Good or bad, not sure. Anyway, I know I will get better. I don't think my SP would keep me around if he didn't see potential. I just wish he listened when I told him I need to start more slowly and be mentored more closely. Then I don't think I'd feel so dumb. And I'm harder on myself than he could ever be. So I will buck up and read and read. And see as many patients as I can to practice my skills. Link to comment Share on other sites More sharing options...
Joelseff Posted July 2, 2013 Share Posted July 2, 2013 It's funny how FP is sometimes looked down as easy compared to specialty but the spectrum of pts combined with the complexity of these pts make FP/PC/IM a VERY tough field. You really learn a lot your first couple of years. I for one LOVE it. I have the multi-morbidity but stable pts and then there are those who keep you on your toes. It is such a rewarding job though often thankless...this said with me coming off a call weekend covering 6 "close-to-retirement" docs whose pts are from the same generation. There were 12 admissions (2 were mine) 10 or so SNF calls and one hospital discharge that had meds but no sigs or strengths so the RN had to run through meds (TNTC meds Btw) with me while we tried to page the discharging Doc....who never answered. I was able to get him straightened out and he is doing ok and his doc saw him today. Most importantly (this is really a "duh statement"), As a PA in FP (i suppose in any specialty), I feel that if you have a great SP who takes the time to teach you and goes over pts with you, and one who sees your value and treats you accordingly, you will fair much better than if you have a slave driving douche-bag as one. Sent from my myTouch_4G_Slide using Tapatalk 2 Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 2, 2013 Moderator Share Posted July 2, 2013 Thank you for your recommendation. I looked on Amazon and I see one from 2003. Do you know of any new versions or do you think that's okay? I think there is a newer version but that one should be ok too. Link to comment Share on other sites More sharing options...
cbrsmurf Posted July 2, 2013 Share Posted July 2, 2013 One thing that may help is to triage the complex patient if you don't have enough time. The high cholesterol, a1c's <10s, systolic BP <180s, chronic HA's workup/treatment can wait until next week. Manage the abd pains, cellulitis, UTI's, chest pains first. And yes, many FP practices are trying to make money on ancillary testing. Choose your battles. I, for one, find it borderline unethical to CXR every cough. Go in on one of your off days and shadow one of the other PA's/docs. One day with another provider gives you a lot of tips/insights in my opinion. Link to comment Share on other sites More sharing options...
Acebecker Posted July 2, 2013 Share Posted July 2, 2013 I started in urgent care within a family practice after 4 months in internal/family medicine seeing 10-14 patients a day. In your situation, I would simply have to take longer with the ones who needed it and bounce back & forth between the really sick ones and the ones I was actually supposed to see. I continued this in urgent care, too - I see >25 pts/day on average and during the really long w/us bounce in and out. But as mentioned - I try to triage the ones away who can wait. It will come with time. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 2, 2013 Moderator Share Posted July 2, 2013 don't get discouraged, this is normal. He did overbook you by doing for patients in our. Honestly 1-2 patients an hour if you are brand-new in the patients are complex he likely should just utilize you as a urgent care add-on initially so you get the office systems figured out, EMR figured out, workflow issues figured out. Keep the thing simple. Learn the office. Once you get comfortable, start doing more routine care, for the 1st 6 months. I would not see any more than 15 a day. After that adjust as needed. Link to comment Share on other sites More sharing options...
Joelseff Posted July 2, 2013 Share Posted July 2, 2013 don't get discouraged, this is normal. He did overbook you by doing for patients in our. Honestly 1-2 patients an hour if you are brand-new in the patients are complex he likely should just utilize you as a urgent care add-on initially so you get the office systems figured out, EMR figured out, workflow issues figured out. Keep the thing simple. Learn the office. Once you get comfortable, start doing more routine care, for the 1st 6 months. I would not see any more than 15 a day. After that adjust as needed. From my experience, I started out with more pts/day (about 15) and as I started to see more routine (but very complex) pts, I started trimming my schedule back. I now see about 10-12 per day and these are mostly 99214's. I think, for me and where I am as a clinician, this is challenging yet not overwhelming. YMMV. Sent from my myTouch_4G_Slide using Tapatalk 2 Link to comment Share on other sites More sharing options...
Love2BePAC Posted July 3, 2013 Author Share Posted July 3, 2013 don't get discouraged, this is normal. He did overbook you by doing for patients in our. Honestly 1-2 patients an hour if you are brand-new in the patients are complex he likely should just utilize you as a urgent care add-on initially so you get the office systems figured out, EMR figured out, workflow issues figured out. Keep the thing simple. Learn the office. Once you get comfortable, start doing more routine care, for the 1st 6 months. I would not see any more than 15 a day. After that adjust as needed. This is exactly it! A lot of the issue is the paperwork! The practice has not converted to EMR yet (coming in September) and the paper charts are ridiculous. I cannot find anything in them. I don't know how to bill/code. My SP is "teaching" me how he codes the exams, but I worry about it. Technically, he does everything "by the book" on paper to be able to bill as many 99214 as possible. Ethics seem questionable. But he knows how to CYA. I thought initially I was being used as the urgent care add-on, but then they started scheduling me my own patients. I didn't realize my SP didn't have my scheduled blocked off. Initially, I was supposed to see 1 patient per hour in June and then 2 per hour in July. Then it all went haywire and my schedule wasn't blocked. Today, the NP I work with said that her father (a FP doc) just hired a new grad PA who will receive 6-12 months of training. The NP said that her dad really liked this person and felt that she was worth the time and money to invest in her training. I think that's the best approach. I don't know why my SP thought the "sink or swim" approach would be preferred. As an aside, I felt mighty cool today when I was comfortable with a feeding tube issue and he wasn't. Working in thoracic, I dealt with them all the time. I told him what antibiotic to use and he claims he didn't hear me; he called a GI doc and the GI doc told him the same thing. ;) It felt good to actually know something more complex. When I think about it, my SP's only experience hiring a PA was one who was in his office as a student for 4 months (2 month FP rotation and 2 month preceptorship). So I don't think he had realistic expectations at all with me coming in fresh. He keeps saying, "You just come across as knowing so much, I guess I assumed you'd be ready to go." But I'm not and now I feel so dumb. I'll learn. Thanks for all the input everyone! It's much appreciated. Link to comment Share on other sites More sharing options...
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