Approaching providers for precepting

[RandomD]

Due to some unfortunate politics, some rotations that were initially set up by our program fell through and we need to be active in the hunt for preceptors. I'd be interested in hearing from some folks who had to set up their own rotations and how you initially contacted the provider and worked it out. Thanks!

[Timon]

I've had luck just cold calling them. My strategy is to start with a hospital that I know has a contract with my school or that accepts students from multiple schools to rotate there. I'll look at the list of providers from that hospitals website and then search it by specialty accordingly.

 

I'll call in and after introducing myself I'll ask if they take students at their clinic and if they say yes I'll ask for the office manager or the person who is charge of clinical rotations. Once I get a hold of the person in charge of setting up rotations I'll explain what our rotations entail (requirements / timing / commitment / etc) and ask if they have anything available at a future date (I try to set them up a few months in advance). I often have my CV ready which includes my previous work history, anything of note from my program, the rotations I've already completed which includes a list of types of cases I worked with, patient populations, healthcare setting (hospital vs clinic vs SNF etc), procedures and duties I held at each clinical rotation.

 

Once I get someone to accept me as a student and I'm rotating at that site I'll typically ask the preceptor somewhere down the road if they know of anyone else who accepts students in X specialty. If there are other students with me, I'll ask them about their preceptors.

 

So far this method has yielded rotations in CT surgery, GI, IM, ICU, Urgent Care, Gen Surgery, Family Med and pediatrics.

 

My main struggle has been trying to find a psych and OB/GYN rotation in my area (especially being a male for a women's health rotation). My other struggle has been as you mention, the politics behind the scenes. After completing my CT Surgery and GI rotation, the hospital decided to pull their contracts with all programs with the exception of 1 local DO program citing "due to a lack of resources." But I haven't had much problems finding people to say yes, mostly issues with hospitals and contracts. I'll find someone and find out later that I can't rotate there due to the program not being able to work out a contract agreement with the hospital. This is why it's important to focus on hospitals your school is already has an agreement with. If it's someone's own private practice then that shouldn't be a big deal either.

[RandomD]

Thanks, Timon. That sounds like pretty good advice. The only hiccup I would have is that our program is new and this is the programs first clinical year, thus, the program doesn't have much of any agreements right now. The program put all their eggs in one basket and when that hospital fel through at the last minute we didn't have any back-ups ready. I like your approach, though. I'll give it a shot over the next few days and see what happens.

[Timon]

Then maybe focus on non-hospital rotations like family med, pediatrics, psych (try the VA), women's health (you can always try planned parenthood), or internal med (usually it'll be in their own office or they'll be setup with SNFs with looser restrictions).

 

I know sometimes programs will let you do urgent care to count for family med and some urgent cares can sometimes count as ER depending on their capabilities and acuity levels.

 

Just food for thought as to what to focus on first while you try to get harder rotations figured out. Get some easy ones going first to buy yourself time and then work on getting some of the harder ones for the future.

[LESH]

Due to some unfortunate politics, some rotations that were initially set up by our program fell through and we need to be active in the hunt for preceptors. I'd be interested in hearing from some folks who had to set up their own rotations and how you initially contacted the provider and worked it out. Thanks!

You might contact an Area Health Education Center (AHEC) or your state Primary Care Office (PCO) If your state has a NHSC state loan repayment program there is a good chance there is a listing of eligble primary care clinics. You might be able to find an women's health provider at a Community Health Center or Federally Qualified Health Center that way. Hope this helps. Feel free to pm me.

[RandomD]

Thanks for the advice. I'll start making some calls today. The rotations that I have yet to work out are psych, ER, women's health, and my two elective rotations (probably oncology and ortho). I'm thinking psych and ER are going to be the tougher two to work out. The women's health ideas are good. I'll give that a shot. I appreciate the help.

[FfIghter23]

Wow, that is absolutely disgusting that a program will take your tuition money AND make you actively find your own rotations because they are a "new" program.  I would understand if it was an elective, but for a core rotation like ER and OB/GYN... that is on them and that is what you are paying the big bucks for. Are you on a rotation currently? If you don't find a rotation in the next few months will you graduate on time? This is the kind of stuff that sickens me about the direction of the PA profession. The ARC-PA should yank accreditations for this garbage. 

[RandomD]

In their defense, they did have things worked out but the MDs at the university hospital revolted against the hospital administrators. The program has worked out some rotations for EM and psych, but I would have to go to another city and I'm not convinced it will be a quality experience. It will work out, but if I want solid rotations I'll have to hunt them down.

[gbrothers98]

Wow, that is absolutely disgusting that a program will take your tuition money AND make you actively find your own rotations because they are a "new" program.  I would understand if it was an elective, but for a core rotation like ER and OB/GYN... that is on them and that is what you are paying the big bucks for. Are you on a rotation currently? If you don't find a rotation in the next few months will you graduate on time? This is the kind of stuff that sickens me about the direction of the PA profession. The ARC-PA should yank accreditations for this garbage. 

I would agree on this point.

Programs and their sponsoring institutions should not do this to students. As if there was not enough pressure.

It is clearly stated in the ARC PA standards that the parent institution has a responsibility to provide clinical rotation sites.

As a class, you all could write a letter stating your concern about having to do this. It should be directed to your school's provost. But this has to occur as a class. 

As a class, can also write a letter to the ARC-PA too.

But have to act as a class, have to write a letter that focuses not on damning the program or the institution but on the detrimental effect this could have on your education. Be as objective as possible. 

Dont put your class officers up to this task alone. You may only get worthwhile action but have to act with united front.

There is a high likelihood that this is not 'political'. It is more likely that it has to do with money. Either someone bought out the intended site or the site itself said it wanted money and the program said no.

I ended up setting up over half of my rotations since I was over 2000 miles from my program. I set them up at the following:

1. Air Force Base I had been assigned to, still knew providers there. Did FP, Peds, OB/Gyn there.

2. Critical access hospital in the middle of nowhere, cold called a PA I served with.

3. For profit UCC, again a PA I knew from the service.

4. Cold called a FQ community health center, spoke to the director whom cut me a break. He had turned down the state PA program because the clinical coordinator there was such a witch to him. 

5. VA psych clinic in remote western town.

My constant themes here are contact people you know, be polite, search where no one else is or where no one else wants to go.

Good luck, I feel for you.

G Brothers PA-C

[FfIghter23]

In their defense, they did have things worked out but the MDs at the university hospital revolted against the hospital administrators. The program has worked out some rotations for EM and psych, but I would have to go to another city and I'm not convinced it will be a quality experience. It will work out, but if I want solid rotations I'll have to hunt them down.

Don't get it. The MDs revolted against having all medical students? Just PA students? Sounds fishy.

 

So now you drive out of town everyday for a month for rotations? Who is paying for gas? Say you have a two hour drive and you have to start at 6AM. Then you drive home and get home late and leave again at 4AM the next day? The quality of rotation better be pretty exceptional for me to keep a schedule like that.

[gbrothers98]

Don't get it. The MDs revolted against having all medical students? Just PA students? Sounds fishy.

 

So now you drive out of town everyday for a month for rotations? Who is paying for gas? Say you have a two hour drive and you have to start at 6AM. Then you drive home and get home late and leave again at 4AM the next day? The quality of rotation better be pretty exceptional for me to keep a schedule like that.

Yeah this is about money and if at an academic place, about protected time. So likely they put more teaching on their schedule without a commensurate decrease in direct patient care contact. They also likely did not offer any incentive to take on more students. But very likely that the hospital was going to get $$ from the PA program. There are also plenty of academic places that really only want to teach physicians and no other providers. 

BTW you dont need a doctor to teach PA students on rotation. Likely there are plenty of PAs at this academic hospital whom never see a student. They were hired to move the meat so the academic physicians get their protected time.

GB PA-C

[RandomD]

Gbrothers- you are pretty much spot on. The admins wanted the MDs to work more hours and the MDs countered with less teaching. That is the story we got, but I'm sure there was more to it than that. Money was most likely part of it. We have taken it to the Chancellor, but it didn't go anywhere. He just authorized the program some additional funds to sweeten the deal, but it hasnt helped as far as I can tell. I have rotations worked out for the next two months, but for anything after that I'll need to find someone myself or take one of the options in another city about 100 miles away. They offered us free lodging if we go there, but still not ideal for me. It's a mess, but it's what I've come to expect, lol.

[RandomD]

Ok, Guys. I feel like things have gotten out of hand and wanted to get some input from you guys. 

 

As I mentioned above, my program pretty much dropped the ball on our clinical year for the city I am living in. They were able to piecemeal a couple of clinical rotations together in my city, but have been unable to secure the rest of the clinical rotations. At this point, I am lacking Inpatient IM, EM, OBGYN, and Psych. My classmates (that were assigned to the same city) and I received an email from the program this weekend stating that we would have to return to the program's main city in 2 weeks and complete those rotations there. 

 

So basically, the program has given me 2 weeks notice to move 750 miles within the time frame of 2 days so that I can start the next rotation. There is also no additional funds or accommodations being provided at this time, though they say they are working on getting us something to offset the cost (most likely will not cover the full cost). These funds are not guaranteed at this time. Keep in mind, that the program initially sold us on staying in the same city for the clinical year, so we were not prepared for this. I now have to leave my family and the house I own (still paying mortgage) to trek across the state and spend more money on living expenses and travel. I will also have to return to my home city after these 4 rotations are complete to do my elective rotations, and then return to the school's city again for the final month of the program.

 

We are in the process of writing the chancellor and I was wondering what you all thought would be fair renumeration or recompense? Thanks! 

[whoRyou]

Can I ask what school this is?

[SoCalPA]

Remuneration is the correct spelling. Not trying to demean ya just want you to get it right when you write the letter. Renumeration is something different.

[RandomD]

whoRyou- I am reluctant to say, just in case the do (by some miracle) make amends. It would be easy to find out from my past posts, though ;)

[RandomD]

SoCalPA- Thanks for the correction. I am typing in fury, so my mental spell check is turned off.

[gbrothers98]

My own story years ago was an affiliation agreement not signed, pulled off rotation, waited 3 weeks for it to be done as legal departments wrangled with each other over the wording. Had to scramble to set something else up. In retrospect, there was plenty of blame to spread around, myself included. But if I failed to find a sub, I would have had to return to the program, thousands of miles away.

Very frustrating to live through but an eye opening experience into the inner workings of reality and a maturing point in my education.

While writing the chancellor or provost may be a short term expression of anger towards the situation, educational institutions face angry students, parents, alumni all the time. Those individuals get paid to manage your complaint but it may not lead to full satisfaction. 

I would strive for subsidized or free housing if you do return to the main campus. If not, at least try to focus on the endpoint. There is a lot in medical education that can serve as obstacles.....and at times very little assistance in getting over them other than your own resources. 

Try pursuing rotations at other practices locally? Existing classmates or didactic students that you can crash with back at program? Short term rental of your own home during this time? None of this is perfect or optimal but it will lead to the final goal. Focus energy on that. I empathize, the rugs been pulled out and that sinking feeling in the gut compounds the stressors in your life. 

It sucks but hang in there, you will come out the other side.

GB PA-C

[RandomD]

Thanks, gbrothers98. I agree that I need to focus on the most basic things I need to complete the program. Just not sure what all of those things are at this point. 2 weeks is not a lot of time to get things in order and come up with a game plan.

[SERENITY NOW]

To the OP, I found several possible preceptors/rotation sites by volunteering at the free medical clinics around my area.  It is a great way to work closely with a bunch of different providers, form relationships/networks, and ask if they'd be willing to let you rotate with them.  Luckily, the people who volunteer their time tend to be genuinely nice people, so all of the people I asked said yes.  I only had 1 elective rotation so I could only go with one, but it was a great rotation and I am very glad I did it.  Consider giving this a try and I bet you'll have success.