dmdpac Posted March 3, 2018 Share Posted March 3, 2018 Here's a link to the thread for easy reference. I'll echo what other's have said. Run and run fast. What is being described is dangerous. Link to comment Share on other sites More sharing options...
LonguylandPA Posted March 3, 2018 Author Share Posted March 3, 2018 So if I go into work and renegotiate patient load... how many patients per 10 hr day would be responsible for a new grad? 30-40? If they accommodate that, should I stay? or is it already too sketchy to begin with? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 3, 2018 Moderator Share Posted March 3, 2018 no more than 25, but they likely would want you to ramp up at some point. just leave. it isn't safe there for you, the other clinicians, and certainly not the patients. Link to comment Share on other sites More sharing options...
LonguylandPA Posted March 3, 2018 Author Share Posted March 3, 2018 6 minutes ago, EMEDPA said: no more than 25, but they likely would want you to ramp up at some point. just leave. it isn't safe there for you, the other clinicians, and certainly not the patients. Okay. Going to have the talk today Link to comment Share on other sites More sharing options...
lkth487 Posted March 3, 2018 Share Posted March 3, 2018 I'm in peds so a little more tuned into peds problems but you WILL miss something like DKA or leukemia if you have to see that many patients. in our peds ed thankfully we have time and as a resident or PA, you are generally not expected to see more than 2-3/hr, even for experienced providers. I've seen kids who were discharged from UC weeks or months ago and end up having leukemia. You better believe those people got sued. And the kid might die because of the missed diagnoses. Don't be that guy. It's not because they were incompetent - it's because if you work in an environment like the one you describe, you WILL miss things because it's just not possible to provide good patient care with that volume. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted March 3, 2018 Share Posted March 3, 2018 Leave these jobs for the nurse practitioners, go find a real job in medicine. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2018 Moderator Share Posted March 4, 2018 4 hours ago, Boatswain2PA said: Leave these jobs for the nurse practitioners, go find a real job in medicine. yup. I don't want to be known as the quickie mart provider of choice. Let someone else have the job. I feel that way about the entire "retail medicine clinic in a drugstore" concept. Link to comment Share on other sites More sharing options...
LonguylandPA Posted March 4, 2018 Author Share Posted March 4, 2018 So I had a discussion today with the head pa the conclusion of the discussion was: the office has been seeing 80-90 pts a day because of the flu season now that thats ending, we expect to see 50-60 a day in 10 hours. On sat nights there are typically two providers that split about 65 patients in 6 hours I told my concerns and the PA said that I would not be expected to be on my own until I feel ready.. So this is at least another 3 months which im sure would be extended further. any patient that I have even the slightest question about, I can get the head PA to come take a look. I also met and spoke behind the scenes with one of the newer PAs today (1.3 years out of school, has been here for 7 months). her take on the high volume load issue was that "this demographic population (uneducated Orthodox Jewish population more often than the avg US population come in for almost frivulous complaints and that she hasn't ever felt unprepared. She agrees that the practice is a little nonchalant when it comes to some things but she isn't scared or anything. she works full time at an ER and does this urgent care 2x a month. Here is my take on this: I feel comfortable knowing that I will be seeing 30-40 a day with the head PA on shift with me for the next 3 months At the same time, I will be actively looking for some sort of ER position or perhaps a primary care job with the plan of transitioning only working in this urgent care once a week or so. I think this is a responsible choice. what do you guys think? Link to comment Share on other sites More sharing options...
LonguylandPA Posted March 5, 2018 Author Share Posted March 5, 2018 @EMEDPA I am assuming your like on my recent post of this thread is approving in nature? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 5, 2018 Moderator Share Posted March 5, 2018 30 minutes ago, LonguylandPA said: @EMEDPA I am assuming your like on my recent post of this thread is approving in nature? yup. if you are going to stay in any capacity, slow down and concentrate on each patient, not the 65 others in the waiting room....:) Link to comment Share on other sites More sharing options...
Guest ral Posted March 5, 2018 Share Posted March 5, 2018 On 3/4/2018 at 0:48 AM, LonguylandPA said: ...the conclusion of the discussion was: the office has been seeing 80-90 pts a day because of the flu season now that thats ending, we expect to see 50-60 a day in 10 hours.... My interpretation of the above: "We realize that we are making you eat a lot of shit sandwiches right now but, in a few months, we will start sprinkling sugar on them." I will never be that hungry. Link to comment Share on other sites More sharing options...
LonguylandPA Posted March 5, 2018 Author Share Posted March 5, 2018 12 hours ago, EMEDPA said: yup. if you are going to stay in any capacity, slow down and concentrate on each patient, not the 65 others in the waiting room....:) awesome. that makes me feel better. Also... Would a Full time primary care job be a nice base ground to a part time UC position, or would you feel that an ER position is far far far more superior? asking because I have interviews for both coming up I know that the ER would get me exposed to more complexities, but most ERs in my 20m radius only offer "residencies" (Lowball pay) and would not be great nor the hours, however, if its truly worth it, I would greatly consider it. Thank you EMEDPA Link to comment Share on other sites More sharing options...
sas5814 Posted March 5, 2018 Share Posted March 5, 2018 i think it depends on what you think you want to do with your career. If you want to do ER work...work in an ER. ER is also good training for UC because the magic of UC is not missing the bad problem among all the trivial things. However slogging through a low pay ER pseudo-residency probably isn't worth the trouble if UC is your goal. Family medicine gets you exposed to a broad variety of things all of which have some value no matter where you land. Link to comment Share on other sites More sharing options...
camoman1234 Posted March 5, 2018 Share Posted March 5, 2018 50-60 patients per 10 hours is no better. That's like saying a BigMac (550 calories and 29 grams of fat) is good for you when you compare it to a Whooper (630 calories and 35 grams of fat). They are just making your crappy situation look "a little better" by throwing out crazy numbers. 50 patients per 10 hours does "look and sound better" than 70-100 per 10 hours, but sit down and do the math on how busy you will be. 1 patient every 12 minutes the entire 10 hours. When do you get to slow down and breath, use the restroom, eat....? If you take 2 bathroom breaks at 4 mins a piece then 1 patient only has 4 minutes with you...How about if you throw something crazy in there like LUNCH...I was very good at eating in less than 10 mins which was not enjoyable, but you have to think if you bring something to heat up in the microwave then that is another 5 mins (at least). That is 23 minutes away from seeing patients, so that totals just under 2 patients you have to lost/not seen so you gotta find that time somewhere. Then how about that depressed patient or suicidal patient or that I&D/laceration/dislocated shoulder/ankle fracture...plus you have to review all imaging and don't forget you have to chart on ALL these patients...I do would RUN far from this job as you will regret it later from burn out, taking charts home, or standing in front of a judge telling him/her why you missed a leukemia in a 6 year old.... Link to comment Share on other sites More sharing options...
sk732 Posted March 5, 2018 Share Posted March 5, 2018 54 minutes ago, camoman1234 said: 50-60 patients per 10 hours is no better. That's like saying a BigMac (550 calories and 29 grams of fat) is good for you when you compare it to a Whooper (630 calories and 35 grams of fat). They are just making your crappy situation look "a little better" by throwing out crazy numbers. 50 patients per 10 hours does "look and sound better" than 70-100 per 10 hours, but sit down and do the math on how busy you will be. 1 patient every 12 minutes the entire 10 hours. When do you get to slow down and breath, use the restroom, eat....? If you take 2 bathroom breaks at 4 mins a piece then 1 patient only has 4 minutes with you...How about if you throw something crazy in there like LUNCH...I was very good at eating in less than 10 mins which was not enjoyable, but you have to think if you bring something to heat up in the microwave then that is another 5 mins (at least). That is 23 minutes away from seeing patients, so that totals just under 2 patients you have to lost/not seen so you gotta find that time somewhere. Then how about that depressed patient or suicidal patient or that I&D/laceration/dislocated shoulder/ankle fracture...plus you have to review all imaging and don't forget you have to chart on ALL these patients...I do would RUN far from this job as you will regret it later from burn out, taking charts home, or standing in front of a judge telling him/her why you missed a leukemia in a 6 year old.... I was feeling hypomanic just trying to read that... When I did family med, I was expected (solo, out of the gate) to see 3-4 pt's an hour for the first 4 months, then 4-5/hr in an 8 hour day...flu season I'd see up to 35 in a day. I also had to round on my care home residents - I booked a 30 min slot for nursing concerns daily for that. I would fit in minor injuries/eye FB's/suturing between easy stuff that took longer to chart than to see. If someone told me that I'd be seeing upwards of double that with only an extra two hours to do it, they'd have been hearing two words - one starting with an F and other ending with 2 of them. I work 12's in ER and I'm expected, especially with the new EMR we just put in, to see 2-3/hour...and we've been hammered with people lately, so keeping up without screwing up is difficult at best. Words to live by "Keep up but don't screw up" - it's hard to do sometimes. $0.02 Cdn SK Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 5, 2018 Moderator Share Posted March 5, 2018 AGREE WITH THE ABOVE POSTER WHO SAID YOU NEED TO THINK ABOUT YOUR LONG TERM GOALS. This particular job is not sustainable in the long term for the reasons stated above. You need to figure out if primary care, UC, or EM (or something else) is really what interests you and start making moves in that direction. Link to comment Share on other sites More sharing options...
camoman1234 Posted March 5, 2018 Share Posted March 5, 2018 3 hours ago, sk732 said: I was feeling hypomanic just trying to read that... When I did family med, I was expected (solo, out of the gate) to see 3-4 pt's an hour for the first 4 months, then 4-5/hr in an 8 hour day...flu season I'd see up to 35 in a day. I also had to round on my care home residents - I booked a 30 min slot for nursing concerns daily for that. I would fit in minor injuries/eye FB's/suturing between easy stuff that took longer to chart than to see. If someone told me that I'd be seeing upwards of double that with only an extra two hours to do it, they'd have been hearing two words - one starting with an F and other ending with 2 of them. I work 12's in ER and I'm expected, especially with the new EMR we just put in, to see 2-3/hour...and we've been hammered with people lately, so keeping up without screwing up is difficult at best. Words to live by "Keep up but don't screw up" - it's hard to do sometimes. $0.02 Cdn SK That is how my brain works, sometimes I look back and wonder how I made it through undergrad and grad school is my scattered thoughts! :) I call is squirrel brain, "oh look squirrel!" I guess I should of put in there "You are getting screwed, leave that crappy job." At least you followed some of it. Link to comment Share on other sites More sharing options...
PallParker Posted March 5, 2018 Share Posted March 5, 2018 This is really a big load. So you just can't stand it such a rhythm of work for a long time! Link to comment Share on other sites More sharing options...
skyblu Posted March 5, 2018 Share Posted March 5, 2018 I’m the chief PA of an UC similar to what you describe as far as acuity, and there is NO WAY a single provider in my practice would be expected to see 70-100 patients a day (12 hr shifts.) Once we hit 50 due to flu season, I went to management and demanded double coverage for my staff. The owner wanted to pay us more, but the providers all agreed: no amount of money can compensate us for practicing unsafely. We are also in the process of training scribes, because let me tell you, nothing is more soul crushing than sitting down to do 40 notes at the end of the day! Especially when so many were for similar complaints. This is not safe, you will not be practicing good medicine, and you will not be doing quality charting. You’ll be a machine stamping scripts and churning out half-assed diagnoses, because that’s literally all you will have time for. If you were on of my students or my mentees, I would advice you to run far far away from any place that treats patients as numbers and medicine as a production line in a factory. PS: I have 10 years of ER experience before moving to UC, and have seen first hand how catastrophically wrong a “simple” visit can go. Don’t do it! Link to comment Share on other sites More sharing options...
AlteredBeast Posted March 7, 2018 Share Posted March 7, 2018 Way too many patients a day, every patient encounter no matter how simple or complicated carries a risk of liability for yourself. That place sounds like a cattle call. Hell no. Link to comment Share on other sites More sharing options...
kargiver Posted March 10, 2018 Share Posted March 10, 2018 You should be learning how to practice medicine, not hired to move meat. I'll echo everyone else's sentiments - don't walk, RUN from this place. It's just that simple. G Link to comment Share on other sites More sharing options...
Guest ERCat Posted March 10, 2018 Share Posted March 10, 2018 Just have to chime in here. Obviously this job is a freaking joke. How does seeing 50-100 patients per day allow you any time to take a thorough history, actually examine patients, think carefully and document? You’re in the business for taking care of patients. Efficiency is great but clearly whoever is running this urgent care doesn’t give two sh*ts about practicing good medicine. I also am concerned that as a new grad you would even think this is okay. This is the time for you to be unsure of yourself and gaining knowledge and skills. You’re really not supposed to be super confident or super fast - you’re supposed to be focusing on NOT KILLING PEOPLE. Link to comment Share on other sites More sharing options...
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