Moderator True Anomaly Posted January 24, 2017 Moderator Share Posted January 24, 2017 As an aside, I believe one of the biggest barriers to provide adequate care for an individual patient is an undiagnosed or undertreated psychiatric issue- however great or small. Link to comment Share on other sites More sharing options...
Joelseff Posted January 24, 2017 Share Posted January 24, 2017 I for one LOVE primary care. I also make a good salary (don't want to give specifics but I make as much as some specialist PAs) and I only work 40 hour weeks, 15-18 pts per day and no call or weekends. I also have great bennies... Oh and we are hiring for Urgent Care type Primary Care (after hours PC) if you are interested, pm me. Sent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
mackjacks Posted January 26, 2017 Share Posted January 26, 2017 I really like FP too - only 3 years in but (knock on wood) nowhere near burned out. I like the long-term thinking and keeping up on when their last mammogram/colonoscopy/etc was, and teaching people that if they can get their A1c even 1% better their chance of ending up with -insert scary complication- drops. I like seeing moms, dads, aunts, kids, and knowing who is related to who in a neighborhood clinic. There are some really horrible entitled people, but luckily our corporate is ok about us telling patients to be respectful and laying down the law - if the patient doesn't like it they can go somewhere else. For me, helping get a 20 year old DM1's a1c from 13 to 8% is worth it. If you go into family medicine, remember that some people truly don't know how to best treat a viral URI/may just want to hear from someone in a white coat that they are going to be ok and abx aren't the right choice. Teach them to target their specific symptoms with flonase/sudafed/mucinex/tessalon/robitussin/tylenol/USE A HUMIDIFIER/whatever. I tell them if they start getting any worse or get a fever call me and I'll call in abx - 90% don't call. If you do any chronic pain, know your comfort level and make the patients aware ahead of time that if their pain requires more than a certain strength/number of opiates you will have to refer them out. I do a TON of I&Ds of abcesses - this is great fun if you like popping pimples/can smell horrible :) I HATE being sick with URIs myself all the time. I hate manipulative, lying patients and that I often can't prescribe the best medication for a condition due to insurance. Oh, and HATE coumadin management. Medicaid in my state is terrible and it's borderline impossible to get a medicaid patient on a novel anticoagulant. Link to comment Share on other sites More sharing options...
SoCal_PA Posted January 26, 2017 Share Posted January 26, 2017 Primary Care for me right now: Too much to do. 10 min sick visits (hear chest pain) 26 a day expected in 8 hrs Patients who don't want to participate - just give me a pill, I don't want responsibility Would you like fries with that Happy Meal? Developing health prevention is a farce with 10 min appts, few resources and no support NO RNs EHR and meaningless use sucking up all your visit time Preauthorizations to fart, breath and provide basic medical care ZERO time to teach diabetic patients much less manage them Again, no support - bare bones staff and no RNs BAD mgmt at private solo level Oppressive admins in corporate Lots of IM in FP but no time to handle everything Polypharmacy Fibromyalgia Chronic Pain Deductibles, copays and unrealistic expectations from patients - wants to come in once a year with an A1c of 9.... Currently killing me and my desire to continue in FP much less medicine Until or unless FP/IM is seen as the complex SPECIALTY it is - run And the current administration in govt isn't going to help us...... Why are you in such a bad environment after working for 25 years? Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 26, 2017 Share Posted January 26, 2017 Why are you in such a bad environment after working for 25 years? I don't do corporate medicine - I can't live in a Press Ganey environment. I chose this little family practice as a doc retired and I took on his 30+ year panel of patients. Almost 2 years in, I have fully determined that the doc who owns the practice has no idea what he is doing business wise. Being a physician doesn't mean you know how to run a business. The doc is also a happy candy man. Happy patients mean no complaints and repeat appointments. Too many benzos, narcotics, ambien, soma and mixtures of unfathomable consequence. He has made it clear that he doesn't want to change anything and expects "HIS" PAs to do his bidding, sign the scripts when he isn't there and keep people "HAPPY". Not real medicine a lot of times - just happy. Yes, people should get antibiotics if they paid a copay. The doc also doesn't know business - bad office manager, no knowledge of what he doesn't know. He won't listen to me. At all. As long as his little world rotates happily for him - nothing needs to be done. Never mind state regs, staff licenses, sending the biller to classes or getting outside audits of finance and billing. His little world is happy and he sees too many patients per day and he isn't going to do anything differently. He doesn't see that there is a problem with seeing 28+ patients a day in 8 hours and doing 3 hours of work after hours. He doesn't get that we aren't in compliance with a bunch of state regs and could easily be cited. He doesn't have a clue that the office manager has no idea how to run a medical clinic soundly. So, I have self limited my options based on my ethics, my limits and my desires to not be an ass kissing corporate drone. Our town is controlled by two corporate monsters who control most clinics and jobs for PAs, MDs and NPs. Yep, it sucks right now. I am weighing my options and considering the future. Part of that consideration is out of medicine altogether. Moving isn't realistic or actually going to change anything. Every town in America is going corporate medicine and autonomy and real medicine are going by the wayside. I have to stay employed and support my family. So, find a job while you have a job. Question is - is there anything better out there that isn't controlled by the corporate monsters. Corporate has too many chiefs and not enough indians and too many people counting metrics instead of caring for patients. It is what it is for now - going to change when it can. Link to comment Share on other sites More sharing options...
newton9686 Posted January 26, 2017 Share Posted January 26, 2017 Because people don't look for sick people in primary care. I had an obese, tachycardiac 28y/o PT on medication for fertility with sharp pleuritic chest pain x 12 hours and I couldn't convince the MD to order a CT to rule out pulmonary embolism. This is after she tells me that the person we should of admitted, but didn't 2 days before had a BNP of 2000 with symptoms and EKG consistent with heart failure with ischemia. But what do I know, I'm just a student trying to find sick people. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 26, 2017 Share Posted January 26, 2017 I also made the mistake thinking this doctor wanted a colleague and partner when the old docs retired. I took over a whole panel of sick overmedicated patients and tried to detox them and stay on target with current medical guidelines. He doesn't want a colleague, he wants someone to not buck his system or think independently. It wouldn't matter if this was a widget factory - thinking independently and ethically is basic to me and not negotiable. It shouldn't be negotiable for any professional. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 30, 2017 Share Posted January 30, 2017 Today's Monday Menu for Disaster 10 min appts - 21 scheduled for the day by 10 am. A full physical gets 20 minutes. 10 minutes to see febrile female abdominal pain. Diffuse lower quadrant pain with some leuk's in the urine. Not buying that this is 'just a UTI'. Patient doesn't want to follow my recommendations and "just wants an antibiotic" while I think she could have an appy or bowel issue. Bargaining with me so she can leave town for a 14 day trip this week. Sorry, need more info to make a final decision. Oh and she wants this to count as a med check for her thyroid so she doesn't have to come back. Umm, NO. You are sick and we are only dealing with that right now. 10 minutes to see diplopia and dizziness after a colonoscopy 3 days ago. Patient doesn't tell us prior to arrival that she has already been in the ER - no CT - and NEVER called the GI doc. Doesn't look like Horner's Syndrome. Doesn't look like anything. No stroke symptoms or findings. Worried about optic arteries and nerves. Has an old carotid ultrasound showing small plaque at the left bifurcation. Normotensive. Has to keep one eye shut to see singular items.Binocular vision is diplopia. Dizzy but not vertigo. What can I do with that in 10 minutes??? With no data. 10 minutes to see a COPD patient who never brings her inhalers with her despite us asking umpteen times. She has no idea what she takes when and doesn't remember despite copious education what a long acting and short acting inhaler are. Can't tell me how she judges her symptoms. Overly concerned with a 4 mm pulm nodule of less than 1% chance of malignancy. So, an hour behind, working into lunch. Charts to do. Stat items brewing. Confusing cases. So, take home point. 10 minute appointments are worthless and futile and contribute to burn out and overwhelming feelings. If you want to do primary care - insist on better formats for appts. I have tried and been shot down and told not to ask again. Interview later this week......................................... Link to comment Share on other sites More sharing options...
BruceBanner Posted January 30, 2017 Share Posted January 30, 2017 Yep I can relate. Not every day is that bad but boy when it's bad I'm ready to go mow lawns for a living. I'm just hangin' in there until I find another vine to swing to. Bless those souls who enjoy it. Link to comment Share on other sites More sharing options...
camoman1234 Posted January 31, 2017 Share Posted January 31, 2017 Today's Monday Menu for Disaster 10 min appts - 21 scheduled for the day by 10 am. A full physical gets 20 minutes. 10 minutes to see febrile female abdominal pain. Diffuse lower quadrant pain with some leuk's in the urine. Not buying that this is 'just a UTI'. Patient doesn't want to follow my recommendations and "just wants an antibiotic" while I think she could have an appy or bowel issue. Bargaining with me so she can leave town for a 14 day trip this week. Sorry, need more info to make a final decision. Oh and she wants this to count as a med check for her thyroid so she doesn't have to come back. Umm, NO. You are sick and we are only dealing with that right now. 10 minutes to see diplopia and dizziness after a colonoscopy 3 days ago. Patient doesn't tell us prior to arrival that she has already been in the ER - no CT - and NEVER called the GI doc. Doesn't look like Horner's Syndrome. Doesn't look like anything. No stroke symptoms or findings. Worried about optic arteries and nerves. Has an old carotid ultrasound showing small plaque at the left bifurcation. Normotensive. Has to keep one eye shut to see singular items.Binocular vision is diplopia. Dizzy but not vertigo. What can I do with that in 10 minutes??? With no data. 10 minutes to see a COPD patient who never brings her inhalers with her despite us asking umpteen times. She has no idea what she takes when and doesn't remember despite copious education what a long acting and short acting inhaler are. Can't tell me how she judges her symptoms. Overly concerned with a 4 mm pulm nodule of less than 1% chance of malignancy. So, an hour behind, working into lunch. Charts to do. Stat items brewing. Confusing cases. So, take home point. 10 minute appointments are worthless and futile and contribute to burn out and overwhelming feelings. If you want to do primary care - insist on better formats for appts. I have tried and been shot down and told not to ask again. Interview later this week......................................... I hear you on the busy day. 27 today (double booked 3 times) and sent a 14 yr female to the ER for unexplained 104.9 f temp, oral. Did UA/strep/chest xray with negative brudzinski and kernig signs while she is a poor historian (pt has MR). We are in talks about buying the practice and I need to really think about seeing 24-27 on average everyDAY!!! I love family medicine, but some days I am burning myself out of medicine completely. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 31, 2017 Share Posted January 31, 2017 I think it is a sad state of affairs when we HAVE to see XXX number of patients per day to keep the lights on. Quality cannot be sacrificed for quantity. And, to add insult to misery - the abdominal pain lady canceled her CT scan one hour before and disappeared off our radar and didn't get her labs done. Prob went somewhere and just said UTI sx and got abx and will leave the country. Hope she doesn't perf an appy in some foreign place with interesting hospitals......... Can only lead the horse to water. Link to comment Share on other sites More sharing options...
mmiller3 Posted February 2, 2017 Share Posted February 2, 2017 Primary Care for me right now: Too much to do. 10 min sick visits (hear chest pain) 26 a day expected in 8 hrs Patients who don't want to participate - just give me a pill, I don't want responsibility Would you like fries with that Happy Meal? Developing health prevention is a farce with 10 min appts, few resources and no support NO RNs EHR and meaningless use sucking up all your visit time Preauthorizations to fart, breath and provide basic medical care ZERO time to teach diabetic patients much less manage them Again, no support - bare bones staff and no RNs BAD mgmt at private solo level Oppressive admins in corporate Lots of IM in FP but no time to handle everything Polypharmacy Fibromyalgia Chronic Pain Deductibles, copays and unrealistic expectations from patients - wants to come in once a year with an A1c of 9.... Currently killing me and my desire to continue in FP much less medicine Until or unless FP/IM is seen as the complex SPECIALTY it is - run And the current administration in govt isn't going to help us...... I have to ask--why do you remain in this position? Everything you describe sounds like a nightmare. Are you locked in to this place? Link to comment Share on other sites More sharing options...
mmiller3 Posted February 2, 2017 Share Posted February 2, 2017 I don't do corporate medicine - I can't live in a Press Ganey environment. ... I am weighing my options and considering the future. Part of that consideration is out of medicine altogether. Moving isn't realistic or actually going to change anything. Every town in America is going corporate medicine and autonomy and real medicine are going by the wayside. I have to stay employed and support my family. So, find a job while you have a job. Question is - is there anything better out there that isn't controlled by the corporate monsters. Corporate has too many chiefs and not enough indians and too many people counting metrics instead of caring for patients. It is what it is for now - going to change when it can. Press-Ganey is an idiotic system designed by people who either have never practiced, or have forgotten what actual medicine is. That said, it is not the end of the world. We have Press-Ganey scores essentially advertised under our pictures for new patients choosing providers. The administration typically only bothers you if you have all negative scores, or an extremely egregious claim in one of the replies. I work for one of the corporations you despise, and it is run better than the small community hospital I used to work for. There is strength in numbers, and what applies to the physicians almost always applies to the APPs in our system. I get paid about the national average for PAs in Family Medicine, and I work 32 hours a week. We can achieve a decent bonus via RVUs, which is an incentive to see more (but not always possible when you work in a large office). Link to comment Share on other sites More sharing options...
Reality Check 2 Posted February 2, 2017 Share Posted February 2, 2017 I have to ask--why do you remain in this position? Everything you describe sounds like a nightmare. Are you locked in to this place? See my post above about this particular job. Two interviews this week....................... Link to comment Share on other sites More sharing options...
mmiller3 Posted February 2, 2017 Share Posted February 2, 2017 See my post above about this particular job. Two interviews this week....................... Outstanding. Good luck. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted February 2, 2017 Share Posted February 2, 2017 Outstanding. Good luck. My town is corporate controlled. The two majors have more than 85% of the jobs. So, sometimes you just have to have a job and work. I am looking outside of family practice with a focus that keeps me off call, not taking work home and not trying to fix everything under the son with a paper clip and a rubber band................ We will see what the world has to offer. Link to comment Share on other sites More sharing options...
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