tunafish Posted August 26, 2014 Share Posted August 26, 2014 Was in clinic today and saw this "phenomenon". It was a blow to my aspiring student mind. The PA I talked to (well experienced years wise) says "this is just this doc", but nevertheless it was a very strange dynamics there. They were behind on time, lots of routine follow-ups in their patient list yet MD wanted to see EVERY case and essentially started H and almost P for every patient after PA was done with them. What a waste of resources and underutilization of PAs. How often do you guys see this? How to avoid this when looking for job/site? Link to comment Share on other sites More sharing options...
Guest Paula Posted August 26, 2014 Share Posted August 26, 2014 That set up is counter productive to a PA practice and pointless to even work in that type of practice. That is not a good way to learn the PA career either. Please tell me you are not in a rotation with that practice. When you interview for a job ask questions about how the practice is run and how the physician utilizes PAs. Do not take a job with the type of PA/physician relationship you experienced today. Blows my mind too. Link to comment Share on other sites More sharing options...
UGoLong Posted August 26, 2014 Share Posted August 26, 2014 I saw that in my ortho rotation. Our office doesn't run that way; we just keep seeing whoever the next patient is (unless they specifically want to see the doc) and then they're out the door. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 26, 2014 Moderator Share Posted August 26, 2014 Agreed- for an experienced PA, this is a complete waste of time for both the PA and the doc. Honestly, why even hire a PA? You lose money by paying the PA and you lose productivity time from freeing yourself up to see other patients. I've only seen it with new grads, which is understandable. Link to comment Share on other sites More sharing options...
gbrothers98 Posted August 26, 2014 Share Posted August 26, 2014 Might be a reimbursement issue especially if patient new to practice. Better reimbursement if the doc sees the patient. Could also be that this SP is a bit on the compulsive and anxous side. I have met SPs that wanted to do this even with very experienced PAs. They eventually go through several PAs and no one will work with them due to this stringent oversight. They will also be the ones to covertly and overtly work to remove PAs from the practice or department. Had a similar SP whom eventually was removed from his position where I work in part due to this. His level of anxiety over our practice became overbearing and detrimental to general morale. In a nutshell, the place was at risk of having all 6 PAs who worked there seek employment elsewhere. During the years he was our SP he would review cases and instead of feedback, provide negative and at times demeaning comments. His involvement in cases usually caused more confusion and poor outcomes. It sounds like the original poster is doing some shadowing. I hope that this is also not a clinical rotation site. Likely not, that type of behavior with an experienced PA is indicative of an intolerance of the MD/PA concept and a PA student would not be a welcome presence in the clinic. Good luck in your future endeavors. G Brothers PA-C Link to comment Share on other sites More sharing options...
tunafish Posted August 26, 2014 Author Share Posted August 26, 2014 That set up is counter productive to a PA practice and pointless to even work in that type of practice. That is not a good way to learn the PA career either. Please tell me you are not in a rotation with that practice. When you interview for a job ask questions about how the practice is run and how the physician utilizes PAs. Do not take a job with the type of PA/physician relationship you experienced today. Blows my mind too. Not a rotation, thanks goodness! I will sure ask about the dynamics before accepting a job. It was not a private practice, so I guess money for PA salary was not an issue for this doc. I could see why doc needed a PA: that PA was a scribe to doc. Write that script, look up that dose, calculate BSA, lookup labs. Glorified personal assistant...maybe he doesn't know PA does not stand for personal assistant. Link to comment Share on other sites More sharing options...
fireguy Posted August 26, 2014 Share Posted August 26, 2014 probably a reimbursement issue, especially of the practice does not know how to bill incident to billing Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 26, 2014 Moderator Share Posted August 26, 2014 money is the answer. what's the question? Link to comment Share on other sites More sharing options...
Guest Paula Posted August 26, 2014 Share Posted August 26, 2014 Not a rotation, thanks goodness! I will sure ask about the dynamics before accepting a job. It was not a private practice, so I guess money for PA salary was not an issue for this doc. I could see why doc needed a PA: that PA was a scribe to doc. Write that script, look up that dose, calculate BSA, lookup labs. Glorified personal assistant...maybe he doesn't know PA does not stand for personal assistant. PAs are not to work as scribes. I would last less than a day at a practice like that. It hurts all of us when PAs believe this is all they're capable of. Link to comment Share on other sites More sharing options...
FBIDoc Posted August 26, 2014 Share Posted August 26, 2014 We are constrained to some of this by an evil and anachronistic set of medical staff bylaws at the hospital...slowly chipping away at the rot however =P Link to comment Share on other sites More sharing options...
cinntsp Posted August 27, 2014 Share Posted August 27, 2014 We are constrained to some of this by an evil and anachronistic set of medical staff bylaws at the hospital...slowly chipping away at the rot however =P I think the best way for us to chip away at the rot is not to work at places like that. When they find they can't hire anyone then they'll start to wonder why. Link to comment Share on other sites More sharing options...
andersenpa Posted August 27, 2014 Share Posted August 27, 2014 money is the answer. what's the question? It still doesn't work if the doc and PA are reasonably productive. If the doc is replicating the PAs work, that is time out of his schedule to see more of his own pts An additional 15% vs 100% of a different pt doesnt add up (I know you know this but it is frustrating and needs to be said!) Link to comment Share on other sites More sharing options...
quarternote Posted August 27, 2014 Share Posted August 27, 2014 Emed is right. All about the $$. My last job was like that. I was a Hospitalist. Even after the 100% sign behind was lifted. The docs saw everyone. It was all about the RVU's. Their bonus was based on RVUs. The docs knew we were competent. Some were really smart. They would see the patient put in a few orders. Fly through their census so that if it was a slow admission they could go home and then send us the names of the ones they didn't write notes on. A few tried to stand up for us but there was no fighting admin. Needless to say I didn't stay there. Link to comment Share on other sites More sharing options...
quarternote Posted August 27, 2014 Share Posted August 27, 2014 At my first job for the first 6-12 months the doc saw everyone I did. My independence was a gradual thing. It was in General surgery. There was a lot to learn. It was fine, he was very kind and taught me a ton. New grads need to understand that it takes a while to build a relationship and take advantage of the learning. Both the PA and DR's license are on the line. At the end of 5 years in that job I was his right hand. He trusted me. If you are a new grad reading this and have a nice teaching boss take advantage of the learning. Sometimes I wish I still had that... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 28, 2014 Moderator Share Posted August 28, 2014 It still doesn't work if the doc and PA are reasonably productive. If the doc is replicating the PAs work, that is time out of his schedule to see more of his own pts An additional 15% vs 100% of a different pt doesnt add up (I know you know this but it is frustrating and needs to be said!) sometimes docs spend less than a minute in the room to say hi, discuss the dx and tx and leave, then bill at 100%. common scam. seen it many times. they then document "I personally was involved with this pts care and oversaw pa smith, and agree with his dx and plan. " cha ching. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 28, 2014 Share Posted August 28, 2014 ^^^ Link to comment Share on other sites More sharing options...
physasst Posted August 28, 2014 Share Posted August 28, 2014 This is not as uncommon as you might think. My first job was this way (one of the reasons I left)...but I also know of many, many PAs with similar workplace environments, where the PA captures the H&P, presents to the physician, and then the physician goes in, verifies the H&P, formulates a treatment plan, and then asks the PA to do the orders and scheduling.... Basically a glorified secretary. It sucks, but I would caution people against thinking that this is rare...it is more common than many believe. FWIW, many PAs are okay with this. Many PAs look at being a PA as a job.....not a career or a passion, and they don't mind the comfort and security that this arrangement provides. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 29, 2014 Share Posted August 29, 2014 This is not as uncommon as you might think. My first job was this way (one of the reasons I left)...but I also know of many, many PAs with similar workplace environments, where the PA captures the H&P, presents to the physician, and then the physician goes in, verifies the H&P, formulates a treatment plan, and then asks the PA to do the orders and scheduling.... Basically a glorified secretary. It sucks, but I would caution people against thinking that this is rare...it is more common than many believe. FWIW, many PAs are okay with this. Many PAs look at being a PA as a job.....not a career or a passion, and they don't mind the comfort and security that this arrangement provides. I just realized the neurologist we send patients to uses his PA in this way. I read a note from the PA and it was very thorough and explained the treatment plan, the diagnosis, the medications and the last paragraph said: "I performed the HPI, H&P, made a presumptive diagnosis, discussed a possible treatment plan and Dr. X then saw the patient who verified the H&P, and formulated a treatment plan. " I was shocked and now saddened to hear this may be common. It is pointless to be a PA if you are used (abused) in this manner. Link to comment Share on other sites More sharing options...
FBIDoc Posted September 2, 2014 Share Posted September 2, 2014 I think the best way for us to chip away at the rot is not to work at places like that. When they find they can't hire anyone then they'll start to wonder why. Agreed, but in this case I have a great group that is very supportive and this entire valley is 10 years behind everywhere else...I am comfortable wiping out the rot for the profession's sake here... =P Link to comment Share on other sites More sharing options...
FBIDoc Posted September 2, 2014 Share Posted September 2, 2014 sometimes docs spend less than a minute in the room to say hi, discuss the dx and tx and leave, then bill at 100%. common scam. seen it many times. they then document "I personally was involved with this pts care and oversaw pa smith, and agree with his dx and plan. " cha ching. Problem is that it's not a scam and as long as MC/insurers continue to discount our work, practices are going to take advantage of us performing the lion's share of the work, but having the docs follow along...it only makes good business sense. Link to comment Share on other sites More sharing options...
Febrifuge Posted September 2, 2014 Share Posted September 2, 2014 This is not as uncommon as you might think. My first job was this way (one of the reasons I left)...but I also know of many, many PAs with similar workplace environments, where the PA captures the H&P, presents to the physician, and then the physician goes in, verifies the H&P, formulates a treatment plan, and then asks the PA to do the orders and scheduling.... Basically a glorified secretary. It sucks, but I would caution people against thinking that this is rare...it is more common than many believe. FWIW, many PAs are okay with this. Many PAs look at being a PA as a job.....not a career or a passion, and they don't mind the comfort and security that this arrangement provides. Well, I'm someone who sees medicine as a passion and a calling, but at the same time a job and not something that I wanted to completely subsume and dominate my life. That's one of the reasons I chose the PA path instead of the MD path. (That, plus my age, plus our desire to start a family, plus lots of strong opinions about how much time I want to spend at work, no matter what I do.) I do agree that a PA who is employed much the same way a clinic might put a bright MS4 to "work" is not being afforded their due respect, and not practicing at the top of their game. I agree it's kind of insulting. But let's not be too quick to look down on anyone who sees medicine as a job, because news flash, it is. I've spoken with lots of disillusioned MDs who romanticized being a doctor so much, the reality of managed care and insurance paperwork just weigh on their souls. Sure, it might be a calling, and it's a privilege and an honor (to me, anyway), but it is a job first and last. Considering it "just" a job doesn't excuse people from needing to care about doing it well, of course. Whatever else it may (or may not) be for an individual is, and I say should be, up to that person. Link to comment Share on other sites More sharing options...
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