Agreement vs Contract and Legal Implications

[charlotte]

deleting

[Boatswain2PA]

Few ideas.

If they are demanding you stay for 90 days...then fine, stay for the 90 days. That being said, no need to be employee of the year for those 90 days.  Take GOOD care of your patients, but in UC that means the patient in front of you, not the 100 in the waiting room.  

Even more reason to work at a very safe (ie: slow) pace if you are still being paid a training salary but seeing patients by yourself.  Nothing wrong with looking.....everything......up!  And you might need to     look     everything      up       in       more      than       one       resource       because,         you            know,       I'm         still          being           paid          training         wages!  (in case my nuance is getting lost here, I'm inferring you can work really, really, really slow).

You are also likely to come down with some vague, ill-defined illness that may require you to call into work once a week or so.  Luckily for you those days will be the same days you are working hard to find other jobs, or have interviews for other jobs.

Nobody can manipulate you unless you let them.    No one.   So don't let them manipulate you.

[Boatswain2PA]

You've been thrown to the wolves.  Just survive till you can leave.  Most important thing is your next job MUST have appropriate supervision.

Tips to surviving urgent care:  #1)  If you have any doubt, think of something terrible it might be and send them to the ED to rule it out.  Don't feel bad if you're sending 20% of your patients to the ED.

#2) Look EVERYTHING UP. Use uptodate, wikem, etc.  If you can't rule out badness, send to the ED.  Look up every prescription you write.  


On a tangental note - those of you who are pushing for independent practice might want to reflect on this poster.  (Not an insult to the OP, just an obvious example of how today's PA programs are NOT producing new grads who are anywhere NEAR ready to practice without CLOSE supervision).

[mgriffiths]

I work in family practice, but we take walk-ins so end up seeing some patients that should have gone to at least UC if not ED - if an MA said we don't have nitro when we do she would never work with me again...end of story.  That should be reported and made clear that this is not only poor job performance, but is also a breach of your trust in her to help in a worrying situation.

[Boatswain2PA]

Uncontrolled DM with SOB, P118 = full workup you can't do in UC.  Good call.  Probably not STEMI, but lots of badness to be found. I have worked with several LIS EMS systems and have never been impressed.  They see so many not-sick people that they get biased, thinking that nobody is sick. You did your job, if the patient wants to listen to EMS instead of you, then let Darwinism work itself out, just make sure your note is COMPLETE so you're not liable.

Ok, no more on-line trained NP to keep you down.  YOU practice MEDICINE the way you were TAUGHT.  You're new, so you're gonna have to go slow. That's okay, cause your COO is still making bank off of your work.

Regarding nitro, again, write the order in the EMR for the nitro.  If the MA doesn't get it and the pt has a poor outcome while waiting for EMS, then it reduces your liability.

Start looking for a better job, yours sucks. 

[Boatswain2PA]

12 hours ago, mgriffiths said:

if an MA said we don't have nitro when we do she would never work with me again...end of story. 

That means you have effective organizational management and you are a valuable part of the team.  The OP's management structure is all about making $$$ for the shareholders with obvious disregard for patients, and due to their location they have a steady stream of new grad PA/NPs to abuse.  It may be more difficult for this organization to hire a new MA than a PA/NP.

Doing locums I have worked at some reallllllly crappy places, almost always due to organizational management/leadership (or lack thereof).

[thinkertdm]

1 hour ago, charlotte said:

but I absolutely cannot stay for my mental health. Any advice?

The one contract I have ever signed was pretty clear it was a contract and it was made clear what the penalty was.  If you absolutely can not stay, then don't.  They can want you to give 15 months notice, but if you didn't sign a contract, I don't think they can take you to court for it.

I'm not a lawyer.

[mgriffiths]

14 hours ago, Boatswain2PA said:

That means you have effective organizational management and you are a valuable part of the team.  The OP's management structure is all about making $$$ for the shareholders with obvious disregard for patients, and due to their location they have a steady stream of new grad PA/NPs to abuse.  It may be more difficult for this organization to hire a new MA than a PA/NP.

Doing locums I have worked at some reallllllly crappy places, almost always due to organizational management/leadership (or lack thereof).

True, true...my job isn't perfect, but from reading a lot of nightmare threads on here I am thankful that I am spoiled...

[sas5814]

On 3/15/2018 at 2:36 PM, Boatswain2PA said:

You've been thrown to the wolves.  Just survive till you can leave.  Most important thing is your next job MUST have appropriate supervision.

Tips to surviving urgent care:  #1)  If you have any doubt, think of something terrible it might be and send them to the ED to rule it out.  Don't feel bad if you're sending 20% of your patients to the ED.

#2) Look EVERYTHING UP. Use uptodate, wikem, etc.  If you can't rule out badness, send to the ED.  Look up every prescription you write.  


On a tangental note - those of you who are pushing for independent practice might want to reflect on this poster.  (Not an insult to the OP, just an obvious example of how today's PA programs are NOT producing new grads who are anywhere NEAR ready to practice without CLOSE supervision).

I have been doing this for almost 30 years and I just had a miss. Retrospectively I can see where the mistake was but in the moment... nope.

Guy came in and said he started Augmentin for an ear infection and threw up every time he took it. That was the reason for his visit. he mentioned not feeling good and having a headache but those were secondary concerns. No fever, normal vitals, really a normal exam including a complete neuro check. Stopped the antibiotics because his ears looked fine. Told his to see his PCP if he still felt bad the next day. Guess who had mastoiditis and developed meningitis? Guess who, for the first time in recorded history forgot to document ER follow up instructions? This guy.

I told him to go to the ER if he worsened and I even have an automatic phrase that I plug into the instructions on every chart but, in this case, I neglected to include it.

Many people pawing through the case with perfect 20-20 rear looking vision find this to be the only, and certainly critical, error.

So a new grad in a solo situation sounds like a bad idea.