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I recently started a housecall position with a small company, and so far it's been going ok. The usual grievances apply, but that's not the issue. I was so desperate to leave my ER position when I started feeling overstressed/undervalued that I kind of jumped into this position without too much thought.

Some concerns I'm having now: 1) I started without completing the credentialing process... Is this a liability? 2) I was told I could be full time if I saw 48-60 patients a week, and would make 100k, and that's by working m-thurs. I recently requested a pay stub that took days to get and it has no hourly rate, or other info, except for the amount I get paid weekly after taxes - which seems to come up to 92k pretaxed. Admittedly I don't always see 48 patients because of how far some patients are scheduled, cancellations, etc, but I still think the pay stub is shady and it's strange no one discussed this with me.

I would like to bring everything up with the office  manager but I'm not sure how to approach it. Im afraid there isn't much job security and they'll just fire me if I bring up too many qs. I'm loving my schedule otherwise. Should I just suck it up??

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1. if they fire you for asking questions, it's shady.

2. if you don't understand how you are getting paid, ask questions. 

3. if there is an incident, and you are not credentialed, guess who gets thrown under the bus?  Not the agency.

4. if you are scared of the management, not a good fit.

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So many issues.  I looked into a job like this in Texas once and I honestly don't have enough time to list all the issues, but here are a few....

1.  Pay:  You are being paid on patients seen?  Who is marketing?  You?  That seems like a colossal financial risk you are taking.

2.  Taxes:  I worked for a shady doc that did the same thing.  VERY hard to get a pay stub.  At the end of the year I found out why...he had paid none...ZERO taxes on me to the feds even though I was a regular non contractor employee.  It was a nightmare.

3.  Mobile care center:  The one I looked into was "mobile urgent care".  They had a little van to drive around and see patients that had expired medicines, NO BIOHAZARD TRASH BAGS and no place to clean/properly wash lacerations.  I could not even begin to imagine the OSHA violations.  

4.  Malpractice insurance:  They were new and had an umbrella policy that, if they went under, must have a tail paid to cover me...something they would not do because you know bankruptcy and all.  Hence, it would have been left to me.

5.  DEA license.  At least in Texas it needs to be tied to a practice location, and can NOT BE YOUR HOUSE...I found this out the hard way.  We had no practice location so it was very sketchy, and if I were to get tagged by the Nazi Texas Medical board no one knows how they would have dealt with it.

6.  Documentation.  They were using a free EMR and there was no easy way for a patient to get their records.  No defined path.

 

The whole thing sounded like a dream job for me, but it was so poorly implemented that it would have been a nightmare.  I backed out before ever seeing a patient and am very glad I did.

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I want to know how you can do 48 to 60 house calls a week and a 4 days week at that. At a minimum that is 12 a day. With travel and the general time consuming nature of house calls that seems impossible. My limited experience with house calls was primarily with people who were old, frail. and very ill so they had trouble coming to the office but weren't currently in need of hospitalization. If I could get 6 done well in a day I was smoking.

I'd also add housecalls reimburse very well and you may be getting underpaid. Lastly the advice I give everyone if they ask me. Get EVERYTHING in writing before you start work. I have a couple of horror stories I could share about what happens when you don't.

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I assume there is an SP involved in this mess. Maybe round with them one day and pick up some info from them. This sounds shady to me as well. you need everything in writing asap. 

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10 hours ago, Cideous said:

 

2.  Taxes:  I worked for a shady doc that did the same thing.  VERY hard to get a pay stub.  At the end of the year I found out why...he had paid none...ZERO taxes on me to the feds even though I was a regular non contractor employee.  It was a nightmare.

 

Omg I wonder if this doc is doing the same thing 😟 it was so fishy to me that they took so long to give me a PICTURE of my pay stub, and even then it had practically no information on it other than the amount I get paid biweekly!

 

9 hours ago, sas5814 said:

I want to know how you can do 48 to 60 house calls a week and a 4 days week at that. At a minimum that is 12 a day. With travel and the general time consuming nature of house calls that seems impossible. My limited experience with house calls was primarily with people who were old, frail. and very ill so they had trouble coming to the office but weren't currently in need of hospitalization. If I could get 6 done well in a day I was smoking.

I'd also add housecalls reimburse very well and you may be getting underpaid. Lastly the advice I give everyone if they ask me. Get EVERYTHING in writing before you start work. I have a couple of horror stories I could share about what happens when you don't.

I live in a large urban city and on the days that my patient list consists of patients living close together/confirmed via the office, I can easily see 15 patients (charting however, is a nightmare...). But other days they are ~20 mins away from each other and I can only see 8-12, and sometimes they are not properly confirmed by the office. We are also given a driver so we don't have to worry about parking and I can do charts in the car which is helpful. The only thing I have in writing is a copy of my vacation time. I was promised health benefits, 401k, malpractice, but have yet to see any information about that stuff as of yet... thanks for the eyeopener, I definitely need to have this stuff in writing somewhere 😓

 

6 hours ago, EMEDPA said:

I assume there is an SP involved in this mess. Maybe round with them one day and pick up some info from them. This sounds shady to me as well. you need everything in writing asap. 

Should I just ask for a contract? I feel a little awkward saying can I have everything in writing since I've already started with the company, as if I don't trust them (though I really don't, heh).

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10 hours ago, thinkertdm said:

1. if they fire you for asking questions, it's shady.

2. if you don't understand how you are getting paid, ask questions. 

3. if there is an incident, and you are not credentialed, guess who gets thrown under the bus?  Not the agency.

4. if you are scared of the management, not a good fit.

Isn't it the agency that would get in trouble for letting me work without credentialing? I agree though, I think I'm just going to have to suck it up and ask the tough questions.

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Wow. 

In a sense, I understand a little bit, early in my career I was really shy and was so glad to just have a job that I was almost afraid to ask for my rights. I don't know if that's your situation, but certainly I was once much more intimidatable and far more desperate, and was afraid to risk the one job I could scrounge.

On the pay stub thing, oddly, some states actually don't mandate or require employers to provide them: https://primepay.com/blog/state-state-pay-stub-requirements. Of course, still shady, but not necessarily illegal.

As far as credentialing, it really depends what you mean by that. For most small places I've worked, credentialing literally involved ten minutes of work...signing up for malpractice, quick web check of my license information, and Bam! You're credentialed.  Other places required two months and fifty pages of applications, a record of every breath I've taken in the last 5 years, and private investigator level of inquiry.  I think for smaller places it's not a big deal. Of course, you better be damn sure you are under insurance. Beyond that, not sure how much is mission critical, besides any mediacare/caid enrollment and state supervisory agreements if mandated.

overall though, you shouldn't be somewhere where you feel scared at just to ask for what you have a right to as an employee, and you shouldn't be intimidated into not making sure you are legally covered... After all, it is your license, which is more important than any individual job.  a truly good company will understand that you are a professional who cares about his or her reputation and license, and should have no problem providing you with what you need.  As I mentioned, I don't know if it was part of the problem, but part of the journey is accepting this and demanding what is legally your right at the outset, and let the chips fall where they may if a place is too shady to give you what you ethically should be seeing.

 

 

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