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Supervising physician demands I present every urgent care patient to him...do I refuse?


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As I've posted elsewhere here, I'm at a crappy medical organization where I was hired for Urgent Care and then was told that for a while I'm going to be seeing mostly Primary Care until they build up enough Urgent Care patients. Fine. And I was told that I'm going to have to cover call every 8 weeks for the primary care patients, which was not on the contract, but they said there shouldn't be any phone calls, so fine.  And, we are required to go over every chart to make sure they are coded right for the billers, which involves about 15 minutes per chart of ICD-10 research, CPT coding, reassigning procedures to their proper ICD codes, improving the charts so that they can be upgraded a notch for EM coding ,and the like.  In addition, theres about an hour a day of chart review where they nitpick my charts critiquing my primary care documentation(which I was not trained in or hired for), but fine. I can live with that.

Yesterday, my supervising physician just informed me that I am going to have to present all Urgent Care patients to him, to review my plan, before I treat and  discharge (our patient load for the time being is low). Now that would be appropriate for a student or fresh outa school practitioner, but I'm a PA with almost a decade of experience, and years of experience in Urgent Care. It was all I could do to not walk out of the place when I was told this yesterday, and now I'm considering going in and saying that "no, I will not be doing that". What do you all think?

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24 minutes ago, quietmedic said:

As I've posted elsewhere here, I'm at a crappy medical organization where I was hired for Urgent Care and then was told that for a while I'm going to be seeing mostly Primary Care until they build up enough Urgent Care patients. Fine. And I was told that I'm going to have to cover call every 8 weeks for the primary care patients, which was not on the contract, but they said there shouldn't be any phone calls, so fine.  And, we are required to go over every chart to make sure they are coded right for the billers, which involves about 15 minutes per chart of ICD-10 research, CPT coding, reassigning procedures to their proper ICD codes, improving the charts so that they can be upgraded a notch for EM coding ,and the like.  In addition, theres about an hour a day of chart review where they nitpick my charts critiquing my primary care documentation(which I was not trained in or hired for), but fine. I can live with that.

Yesterday, my supervising physician just informed me that I am going to have to present all Urgent Care patients to him, to review my plan, before I treat and  discharge (our patient load for the time being is low). Now that would be appropriate for a student or fresh outa school practitioner, but I'm a PA with almost a decade of experience, and years of experience in Urgent Care. It was all I could do to not walk out of the place when I was told this yesterday, and now I'm considering going in and saying that "no, I will not be doing that". What do you all think?

I think that you are "being punked" by this organization. If it doesn't feel good to you, you probably should not be doing it.

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I'd be looking for my next gig, pronto. I'd probably grit my teeth and bear it out until I had my next gig lined up, although I have a healthy f-u pile built up so I'm not sure how long my mentality would last in the shop you're describing.

 

For the meantime, I agree with your current plan. Flat out stating "I'm not going to do that. If this is the way things are going to be here, I'll have no choice but to find a team that will utilize me to my full potential".

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I guess it depends on the situation.

 

If you have a SP who isn't used to supervising PA's, it might be reasonable as long as it's not affecting your pay, hours, ability to get bonuses, etc.

 

On the other hand, if you are salaried and there's a huge line of patients waiting in the waiting room, you need to have a discussion.

 

I do not know your work situation, but my first instinct would be have a discussion with the SP and/or higher ups about the situation.

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Thanks all for the input and letting me vent here (I'll try to limit that....).

Yeah, it's so belittling...I mean, I have the time, but do I really need to ask him for approval for giving a little zofran to a nauseous person (he actually is against that because it's an "ER medication", but that's a different story...)

I wonder if it's because he isn't used to PAs, but state law or not, that's what he demands.  I guess I can tolerate it a bit while it's slow, but if I stay, and things get busy, Hell no.  I was wondering in part if anyone else has to put up with this sort of thing, or if it's totally uncalled for (seems it to me).

Anyhow thanks all.

 

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So this is the newest *new* trend......Family practice/Urgent Care hybrids.

I avoid these like the plague.   

Firstly, I just don't like primary care.  God bless those in Family practice, I did it for awhile but it was just not for me.

Secondly, it's very hard to do a proper Family Practice/Urgent Care clinic.  The billing codes are different, the follow-up is different.  The appointment vs no appointment is different.  The lab reviews....the lack of X-Ray in FP which EVERY UC needs.  On and on.  FP docs are trying to cash in on walk-in clinic visits without dong any of the things that make Urgent Care...Urgent Care. The one exception in Texas is CareNow.  They have the resources to do FP and UC together, but working there I have been told is a nightmare.  They close at 10:00 but dont leave until 1am most of the winter.  Everyone I've met who has worked there only last 1-2 years and had that "just returned from war" look on their face.  Talk about PTSD....

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17 hours ago, UGoLong said:

I think he may be doing it so the case can be billed under him.

Time to go.


Sent from my iPad using Tapatalk

This.  The patients charges will get paid at a higher rate if the physician can dictate that he was consulted on the case and laid eyes on the patient, concurring with the PAs POC.  In a struggling practice, it makes sense to do.  So, to whom is your commitment?  The patient, the practice, or your career?  Good luck.

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For the past 15 months, I am working in a 'virtual' sort of environment, NOT seeing any patients virtually however, and NOT working anywhere near the top of my license.  An MA cold be doing most of what I'm doing- with 24 yrs experience.

But, they are trying to get more programs online- I will probably be doing some 'telehospitalist' role at some point.  It's no stress, and pays at a decent PA rate! 

I have been looking to change departments, and I have interviews coming up soon.  However, in my career I have left for what I thought  would be greener pastures, only to find out it was a poor choice, job ended, etc.

I would ask why, and how long this is planned for.  That may help.

Good luck

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On 4/10/2018 at 2:56 PM, quietmedic said:

I'm going to be seeing mostly Primary Care

"Okay....so I'm not your primary care provider, so we will make a little change in your blood pressure medicine and then I want you to follow up with your primary care provider next week."

On 4/10/2018 at 2:56 PM, quietmedic said:

go over every chart to make sure they are coded right for the billers, which involves about 15 minutes per chart

I think that should take about an hour every chart.  I mean....you want to go to the primary source documents for coding and make sure you squeeze every single penny out, right?  You talked to them about tobacco cessation for the 5 minutes?  Hmmm....not sure if the requirement is for 5 minutes or 6 minutes, I better look that one up to.....what page is that on again?  I better walk over to the coders office and sit down with him to check.  I think I'm going to get a cup of coffee on my way.  Oh, and I gotta go to the bathroom on the way as well.  Where was I going again?  Oh yeah, to the coders office.  Next patient's ready?  Sorry, I gotta go to the coders office....after I go to the bathroom (again), and after I get (another) cup of coffee.  

On 4/10/2018 at 2:56 PM, quietmedic said:

theres about an hour a day of chart review where they nitpick my charts

I totally think this should be stretched out to 3-4 hours, with frequent coffee and bathroom breaks.  

On 4/10/2018 at 2:56 PM, quietmedic said:

I am going to have to present all Urgent Care patients to him

Sounds like a GREAT idea boss.  The runny nose in room 2 is ready to be discharged so I gotta talk to you.  But first, I'm going to go down to the coders office to see if this is a level 2 charge or a level 3.  We might also want to double check the records to make sure this kid has EVER been seen before for a runny nose as I think that may change something on billing too....right?  I'll be back in about 45 minutes to present this patient to you.  Oh, there's 4 more patient's waiting?  Well, I gotta go to the bathroom, and get a cup of coffee.....

Meanwhile apply for real jobs, cause this ain't one of them.

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Guest UVAPAC

Just a thought...

If this is truly a new job that you started within the last several weeks... maybe the doctor just wants to get to know you and your style.  Maybe they want to ensure that they are signing off or overseeing someone who is competent.  I just worked with an APRN who has been in practice WAY longer than I have, who I felt was borderline completely incompetent.  

Maybe you can inquire if this is short term or permanent.  I am always open to constructive criticism/feedback and learning opportunities.  

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On 4/12/2018 at 0:54 AM, Boatswain2PA said:

"Okay....so I'm not your primary care provider, so we will make a little change in your blood pressure medicine and then I want you to follow up with your primary care provider next week."

I think that should take about an hour every chart.  I mean....you want to go to the primary source documents for coding and make sure you squeeze every single penny out, right?  You talked to them about tobacco cessation for the 5 minutes?  Hmmm....not sure if the requirement is for 5 minutes or 6 minutes, I better look that one up to.....what page is that on again?  I better walk over to the coders office and sit down with him to check.  I think I'm going to get a cup of coffee on my way.  Oh, and I gotta go to the bathroom on the way as well.  Where was I going again?  Oh yeah, to the coders office.  Next patient's ready?  Sorry, I gotta go to the coders office....after I go to the bathroom (again), and after I get (another) cup of coffee.  

I totally think this should be stretched out to 3-4 hours, with frequent coffee and bathroom breaks.  

Sounds like a GREAT idea boss.  The runny nose in room 2 is ready to be discharged so I gotta talk to you.  But first, I'm going to go down to the coders office to see if this is a level 2 charge or a level 3.  We might also want to double check the records to make sure this kid has EVER been seen before for a runny nose as I think that may change something on billing too....right?  I'll be back in about 45 minutes to present this patient to you.  Oh, there's 4 more patient's waiting?  Well, I gotta go to the bathroom, and get a cup of coffee.....

Meanwhile apply for real jobs, cause this ain't one of them.

Haha yeah, pretty much sums up my experience so far.

In any case got over my anger, still at this job until something better pops up...at very least, a lesson in humility even in the face of absurdity, I guess.  The paycheck is OK, so, whatever, I guess.  

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On 4/12/2018 at 11:04 AM, UVAPAC said:

Just a thought...

If this is truly a new job that you started within the last several weeks... maybe the doctor just wants to get to know you and your style.  Maybe they want to ensure that they are signing off or overseeing someone who is competent.  I just worked with an APRN who has been in practice WAY longer than I have, who I felt was borderline completely incompetent.  

Maybe you can inquire if this is short term or permanent.  I am always open to constructive criticism/feedback and learning opportunities.  

Yeah...when I diplomatically asked, I was told "it's not forever, but for the foreseeable future"...not the best answer...so it is what it is.

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I apologize in advance for using the "S" word, but apparently that is the law....

As several stated, depends on your state laws--and it must be looked at from both the physician side and the PA (passive aggressive) side, but think through the possibilities I don't see in this chain

1:  Is the SP setting you up to leave so that a NP can be hired?

2:  Do  you workup, and refer every patient to the SP.  Let him/her get behind.  As a PA (Passive-Aggressive), that is your inherent right, and puts the malpractice burden on the SP 100%

3:  Is your SP also the medical director?  If not, perhaps a three way meeting to discuss what the policy is.

4:  Are their other PAs in the department?  If so, are they treated the same way.  Does the SP have other PAs?  Are THEY treated the same way?  If not, why are YOU being discrimated against?

 

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Haha yeah, pretty much sums up my experience so far.
In any case got over my anger, still at this job until something better pops up...at very least, a lesson in humility even in the face of absurdity, I guess.  The paycheck is OK, so, whatever, I guess.  


I would like to welcome you to the specialty of mercenary medicine (at least for the time being).
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You have to ultimately decide if this is something that you personally can put up with, because the answer on this forum with all of us militant PAs will always be to get out of there and find a "real" job.  Your situation is unfortunately the reality for a large number of PAs.  I started a new hospitalist gig last year with a higher patient census, less pay, worse benefits, and more administrative hassle because the location was much better for me.  I quickly found out how the docs at this new site felt about PAs/NPs and how much oversight was felt to be necessary.  After about 6 months I realized it won't ever be a good place for an experienced PA and told them adios.  I don't have the time or care to try and drive change at a particular job.  There are bigger problems in life.  It's not hard to find a job as a PA especially if you have the flexibility to move.

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