ILPA Posted June 12, 2014 Share Posted June 12, 2014 Hello all, Just wanted to take a poll of how many of you actually get "supervised" by your supervising physician? How many of you practice without physician in the office? Do your supervising physician signs of everything you do? My employer just hired a new MD from out of country and had a heated debate about role of PAs ( obviously he has no clue about what we do or can do). I work very independently and my supervising physician is sometimes at a different clinic. He maybe signs off 5% of my work. He is very confident in me, unlike this new M.D. Trying to educate him, but its so frustrating.... He thinks we need to be babysat and have all of our work signed by our supervising physician... Arrggghhhh!!!!! Thanks Link to comment Share on other sites More sharing options...
cinntsp Posted June 12, 2014 Share Posted June 12, 2014 You already know the answers to your questions. You should have a talk with your collaborating doc and ask him to speak to the new hire about your role and capabilities. Link to comment Share on other sites More sharing options...
ILPA Posted June 12, 2014 Author Share Posted June 12, 2014 Thanks wutthechris... Yes, I know, but wanted to take a poll to show this new doc that we are not idiots and don't need anyone breathing down our necks! Taking a poll would prove my point :) Link to comment Share on other sites More sharing options...
gleannfia Posted June 12, 2014 Share Posted June 12, 2014 Hello all, Just wanted to take a poll of how many of you actually get "supervised" by your supervising physician? How many of you practice without physician in the office? Do your supervising physician signs of everything you do? My sympathies. I had this happen with a foreign doc, and I had 20+ years experience at the time. Boy, did we butt heads. Thankfully, I go out of there, for other reasons as well. Sometimes I think FMGs see us as competition. Not all are like that, but like you said, many do not have a clue what we do. My employer just hired a new MD from out of country and had a heated debate about role of PAs ( obviously he has no clue about what we do or can do). I work very independently and my supervising physician is sometimes at a different clinic. He maybe signs off 5% of my work. He is very confident in me, unlike this new M.D. Trying to educate him, but its so frustrating.... He thinks we need to be babysat and have all of our work signed by our supervising physician... Arrggghhhh!!!!! Thanks Link to comment Share on other sites More sharing options...
andersenpa Posted June 12, 2014 Share Posted June 12, 2014 What does you state require for -chart cosignature -on site presence -definition of remote site supervision Get this from AAPA or your state chapter present it to him If he chooses to disagree with the law then that is an argument with his physician partners who already depend on your current scope of practice Link to comment Share on other sites More sharing options...
cinntsp Posted June 12, 2014 Share Posted June 12, 2014 Thanks wutthechris... Yes, I know, but wanted to take a poll to show this new doc that we are not idiots and don't need anyone breathing down our necks! Taking a poll would prove my point :) I don't think an informal thread from an online forum where folks are often militant about the capabilities of PAs(and rightfully so - this is our place to vent) is the best data to use to prove your point. You should gather information from the AAPA site, maybe even snag the patient education brochure from PAFT, and speak with your collaborating doc about the two of you having a collegial sitdown with the new guy. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 12, 2014 Moderator Share Posted June 12, 2014 I work solo at 2 of 3 jobs and alternate charts with a doc at the other. have not seen my sp at one of them in over 2 years. my state does not require chart review , but my hospitals do so all charts are signed within 1 month. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted June 12, 2014 Moderator Share Posted June 12, 2014 Agree with wutthechris and andersen....if you're a proven commodity to your practice, and this new foreign MD is going to gum up the works enough to cause a slowdown in volume and therefore revenue....well, money talks ultimately, so the partners in the practice will try to re-educate him quickly or his stay at your clinic would be short-lived Link to comment Share on other sites More sharing options...
delco714 Posted June 12, 2014 Share Posted June 12, 2014 In a surgical subspeciality, it's a little A, little B. Some is acknowledge after the fact Steve PA-C, Maine, urologic surgery Link to comment Share on other sites More sharing options...
rcdavis Posted June 12, 2014 Share Posted June 12, 2014 you are getting good advise here. check state laws (what is minimum required). check hospital bylaws (as empa said, they are usually more restrictive), and see what the staff requires. then go to the senior partner. if the new guy doesn't want to play ball, drop him as a supervisor, and exclujde him from partaking in any profit sharing of monies you generate. my suspicion, however, is that he has the same reaction as many of our patients: "what's this? a PA? what is a PA? can they practice without a doctor? I'll see a doctor, right? " and he is a little sketchy about co-signing charts of patients he has not seen ("hey, in residency, as a pgy 3 I still had to present patients to my attending") la good compromise would be for him to not cosign any charts (and not get paid for those patients), until he sees the quality of work you all do..and gets a chance to review 'from a distance' what you see, how you think, etc. this happens a lot with docs either from overseas or from training institutions that do not use PAs. trust me, his attitude will pass. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 12, 2014 Moderator Share Posted June 12, 2014 we had a new doc a few years ago who didn't want to sign pa charts. the senior doc pulled him aside and explained he got 1/2 the rvus of each pa chart he signed so working with 2 PAs on a shift he doubled his bonus (100% of his own + 2 PAs @ 50% each). he is all about us seeing as many pts as possible now....should be, we buy each doc in our group the equivalent of a high end BMW each year with the bonuses they get from us. Link to comment Share on other sites More sharing options...
Guest Paula Posted June 12, 2014 Share Posted June 12, 2014 ^^^^ Do you ever get a ride in the BMW as a thanks for the money you made for them? My state does not require chart or prescription co-signature. Chart review is determined at the practice level. I must have a delegation of prescription authority for DEA on file and it is signed every year. I speak to my collaborating physician about any patients I think is necessary and dictate that the physician was consulted in my note. (I review one patient a month or so. Not many anyway). I am the sole provider at the clinic every Friday, when the physician is off or sick, or is in California trying to sell his company to the highest bidder. He's gone a lot. Link to comment Share on other sites More sharing options...
gbrothers98 Posted June 15, 2014 Share Posted June 15, 2014 Hello all, Just wanted to take a poll of how many of you actually get "supervised" by your supervising physician? How many of you practice without physician in the office? Do your supervising physician signs of everything you do? My employer just hired a new MD from out of country and had a heated debate about role of PAs ( obviously he has no clue about what we do or can do). I work very independently and my supervising physician is sometimes at a different clinic. He maybe signs off 5% of my work. He is very confident in me, unlike this new M.D. Trying to educate him, but its so frustrating.... He thinks we need to be babysat and have all of our work signed by our supervising physician... Arrggghhhh!!!!! Thanks I think this can be viewed in several different ways. First, if this supervision is detrimental to productivity, this needs to be brought to the forefront immediately. I am always aghast with the supervising physician that will use supervision as an obstacle to getting things done and view this as a personality deficit (unmanaged anxiety) and an insight into the perception they have of their role in supervision ( I am here to tell you what to do because I know what is right, you dont). I wont go into this further except to state that this type of negative relationship causes much employment dissatisfaction on the part of the one being supervised. It wont likely get better and could in fact get worse. Contrary to this, if there has not been exposure to supervision of a PA in the past, then this is an excellent opportunity to develop a colleague and ally. A sit down to determine if this is just an attempt to get to know practice patterns and develop a comfort level is a consideration. I really dont find anything wrong with this especially in light that many states and facilities do set supervision guidelines with minimums but no limits on maximums. While my state sets no overt percentage, my SP reviews 100%. Through my career, I have had varying degrees of supervision, ranging from the bare minimum of telephone contact and cosignage to a very detailed review of nearly all the patients I had cared for. I have always looked at this as the individual SP responsibility to determine the level they were comfortable with. Then it is their workload to bear. As for feedback and direction, I always welcome comments to improve my practice and collegial insight from SPs to make me better. On the other hand, being told to do something because of a preference without supporting evidence or a concern that has little to no basis, makes me feel like an errand boy and I will professionally challenge that with an evidence based explanation of why I do what I do. Then it comes down to working well with others. My anecdotal experience is that those who dont work well with others eventually meet the door regardless of their positions, whether they are old time experienced PA or new doc on the block. Good luck G Brothers PA-C Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 17, 2014 Moderator Share Posted June 17, 2014 I own my own practice my SP owns 1% and signs anything that needs a physician signature I function just like a MD or DO - I run the show..... and deal with all aspects of practice management..... show him the web site and let him figure out that we can see patients the same as he does.... Link to comment Share on other sites More sharing options...
Febrifuge Posted June 17, 2014 Share Posted June 17, 2014 State law says my SP needs to *review* 10% of my charts, and sign some unknown portion of those. I literally see her twice a year, because we schedule meetings and I drive down to the administrative office. I can email her any time I need to. We have a great working relationship. Link to comment Share on other sites More sharing options...
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