jd1111 Posted April 5, 2018 Share Posted April 5, 2018 So I work for a small privately owned ER group of 7 MD partners and 5 full time PAs. We recently started staffing a small ER with solo PA coverage and there have been talks about PA partnership in the group. Everything was sounding amazing. Suddenly we have a new ED director, young and fairly new ER MD. He is not known to be the most PA friendly, and has just found an archaic policy from 17 years ago stating every level 3 patient, every admitted patient, and every patient for whom we are consulting a specialist needs to be run by the attending. I find this humiliating and degrading after 10 years of practice. I like this hospital and this group otherwise and do not want to leave, but feel I may have to. Any thoughts? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 5, 2018 Moderator Share Posted April 5, 2018 faced with a similar situation a few years ago I left.... Link to comment Share on other sites More sharing options...
quietmedic Posted April 5, 2018 Share Posted April 5, 2018 In many NYC ERs this is 100% standard. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 5, 2018 Moderator Share Posted April 5, 2018 1 minute ago, quietmedic said: In many NYC ERs this is 100% standard. that is ok for a new grad, but not someone with years of experience and/or a CAQ Link to comment Share on other sites More sharing options...
lkth487 Posted April 5, 2018 Share Posted April 5, 2018 Honestly, before I came on this forum, I didn't realize solo coverage existed anyway. The young guy just may not know about outcomes and how common it is in rural areas. I'm in a small metro and, granted all ERs are academic, but there is definitely no solo coverage here. There wasn't any at or near my med school either as far as I know. So it might just be a new thing for this guy. How do the other docs feel about this? I'm sure they're not happy having to do this when they were used to not having to? Link to comment Share on other sites More sharing options...
quietmedic Posted April 5, 2018 Share Posted April 5, 2018 47 minutes ago, EMEDPA said: that is ok for a new grad, but not someone with years of experience and/or a CAQ I'm talking everyone...New grad through senior citizen PA. Agreed, it's silly. Sometimes I think it's about double billing... Link to comment Share on other sites More sharing options...
jd1111 Posted April 5, 2018 Author Share Posted April 5, 2018 As far as I'm aware, there will be no increase in billing from this as the attending will not be evaluating the patient, and no statement will be made in the chart by the attending, only a statement by the PA that the case was discussed. Maybe its ego, it just seems humiliating with 10 years of practice to be running straightforward cases past and attending. At the moment I'm hostile, and if they have anything to say about the way I cared for the patient, they can feel free to take over the case themselves.. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 5, 2018 Moderator Share Posted April 5, 2018 I agree it may be hubris for me as well, but I’d consider leaving also Link to comment Share on other sites More sharing options...
Miaow Posted April 5, 2018 Share Posted April 5, 2018 There was recently an email sent at my organization talking about physicians needing to sign off on all inpatient notes, admissions and discharge orders because they claim that they are not getting paid and are in fact losing money in many cases. Is this politically motivated or is just bottom line $$$ stuff? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 5, 2018 Moderator Share Posted April 5, 2018 1 hour ago, Miaow said: There was recently an email sent at my organization talking about physicians needing to sign off on all inpatient notes, admissions and discharge orders because they claim that they are not getting paid and are in fact losing money in many cases. Is this politically motivated or is just bottom line $$$ stuff? Money is the answer...what's the question :) Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted April 6, 2018 Share Posted April 6, 2018 It's usually about the reimbursement not your ability. I handle it by saying, "I'm admitting this patient, feel free to say hi so the group can bill an extra 15%" Sent from my SM-N950U using Tapatalk Link to comment Share on other sites More sharing options...
Will352ns Posted April 6, 2018 Share Posted April 6, 2018 7 hours ago, Marinejiujitsu said: It's usually about the reimbursement not your ability. I handle it by saying, "I'm admitting this patient, feel free to say hi so the group can bill an extra 15%" Sent from my SM-N950U using Tapatalk Haha, I sometimes say pretty much the same type of thing. The ED I work in has always had a policy on briefing the Docs on level 3 and above; I believe all the local hospitals here have the same policy. It doesn't bother me. It's usually is a casual conversation with who I'm working with, "hey pt in 3 came in with X, workup is Y, I'm gonna Z". To which I usually get something like, "cool, thanks". Done. Link to comment Share on other sites More sharing options...
narcan Posted April 6, 2018 Share Posted April 6, 2018 The problem I run into with this, or at least what frustrates me most about it, is that medicine is inherently stylistic, and when you have to run 50% of your patients by the doc, you're going to be subject to that doc's stylism with regard to how extensive a work up you do, what treatment options are available, etc. It grinds my gears when I'm trying to go one direction and the doc takes it in another. We defer to their judgment for a reason, but it doesn't mean that my way wasn't going to yield the same result and the same outcome. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted April 7, 2018 Share Posted April 7, 2018 On 4/5/2018 at 0:57 PM, EMEDPA said: Money is the answer...what's the question :) Money is always the answer if you look deep enough into all PA MD policies! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 7, 2018 Moderator Share Posted April 7, 2018 3 hours ago, narcan said: The problem I run into with this, or at least what frustrates me most about it, is that medicine is inherently stylistic, and when you have to run 50% of your patients by the doc, you're going to be subject to that doc's stylism with regard to how extensive a work up you do, what treatment options are available, etc. It grinds my gears when I'm trying to go one direction and the doc takes it in another. We defer to their judgment for a reason, but it doesn't mean that my way wasn't going to yield the same result and the same outcome. And the other issue is a delay waiting for the doc to be available to present the easy admission, dispo, etc if they are busy...the policy was present before calling for the admit or talking to the specialist or sending them out the door...means I can't see another pt and the pt can't go to the floor, go home, etc. Did I mention I was working on production and spent an easy 30-45 min/shift waiting to present pts that didn't need presenting.... I did not tolerate that BS for long. literally they would stick their head in, say I've reviewed the workup, looks good, and then sign an attestation "pt comanaged with me" and bill an extra 15%. of course they couched this all as a pt safety issue. made me so angry I left that job hating my choice to become a pa every shift. Link to comment Share on other sites More sharing options...
quietmedic Posted April 8, 2018 Share Posted April 8, 2018 On 4/6/2018 at 6:57 PM, narcan said: The problem I run into with this, or at least what frustrates me most about it, is that medicine is inherently stylistic, and when you have to run 50% of your patients by the doc, you're going to be subject to that doc's stylism with regard to how extensive a work up you do, what treatment options are available, etc. It grinds my gears when I'm trying to go one direction and the doc takes it in another. We defer to their judgment for a reason, but it doesn't mean that my way wasn't going to yield the same result and the same outcome. Yup! Absolutely true. One reason I hate ERs that do this...slows you down, then the MD is pissed that you (1) didn't do it HER way and (2) that you are slowing HER down due to MD overread policy...and then they take it out on you. So in the end, the PA is ALWAYS screwed. Link to comment Share on other sites More sharing options...
cinntsp Posted April 9, 2018 Share Posted April 9, 2018 On 4/6/2018 at 4:57 PM, narcan said: The problem I run into with this, or at least what frustrates me most about it, is that medicine is inherently stylistic, and when you have to run 50% of your patients by the doc, you're going to be subject to that doc's stylism with regard to how extensive a work up you do, what treatment options are available, etc. It grinds my gears when I'm trying to go one direction and the doc takes it in another. We defer to their judgment for a reason, but it doesn't mean that my way wasn't going to yield the same result and the same outcome. Ding ding ding! "Did you do XYZ?" No...because I'm not practicing medicine in 2005. It drives me nuts. I'm leaving a job because of the level of oversight they feel is appropriate. The nonsense is more common with newer attendings. Link to comment Share on other sites More sharing options...
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