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So I am a new grad who case been practicing only a few months. I am at a busy fqhc where I work in primary care. A lot of my patients are very sick/complicated, and I have 15 minute appts. So today I was approached by the CMO and told that the pain management guy we had working with us will be leaving soon. He asked me if I felt comfortable continuing to prescribe the pain meds "my patients" have been receiving. When I said I wasn't comfortable he asked me if my license or my patients were more important to me. Long story short he was pressuring me and while I didn't say yes I didn't say a hard no either. I feel like I want to send him an email with a more definitive no but I'm worried about repercussions. Any advice?

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5 minutes ago, deltawave said:

Start looking for a new gig. 

Agreed.  Good gawd that's awful.

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He was flat out bullying you.  Tell this POS cmo you’re out.  He literally is making money off of you, with zero- zilch, none, nada-risk to him.  
One slip up, you are gone, and he’ll still be there.  You are the money making fall guy.

Has any one, ever, said “hey, the cardiologist is leaving, you want to take over cardiology for a wee bit”?  No.  And pain management is a specialty in its own right.

He’ll say no repercussions but there will be.  The second the tiniest thing happens, he will be all over you.   
 

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I have actually had similar expereince

 

I think saying up front that you in general do not beleive in chronic opiates, benzos and controlled substances and that you will likely be taking almost everyone off their meds in a slow tapering fashion.  See what the response is (BTW this is a NIGHTMARE situation and one that ABSOLUTELY should not be done by a new grad)

 

You need to reach out to your SP and medical director and just calmly, professionally, state that you are not getting the mentoring you need and that you are not comfortable in your skin.  In no way would I consider taking those patients on as a new grad, they are some of the hardest patients ever to deal with, they will eat you alive

 

 

BTW NEVER take medical advice from a bean counter - never, ever..... they are not licensed medical professionals period (I am still waiting for the first lawsuit that the bean counter admin folks for setting office policy that actually effects negatively the quality of care in a medical malpractice suit....)

 

 

 

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The CMO will not have your back when the medical board wants to take your license away after a patient dies from an overdose.  These chronic pain patients that require opioid therapy should be seen by pain management.  I would mention in your email that your patients would be best served in that way to assure they receive appropriate, SAFE care.

Edited by cinntsp
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I think I will just need to talk to him again tomorrow and say no. If he fires me for that what can I do? When he was twisting my arm he suggested that I try to wean people off and I am aware that this will be an absolute nightmare. I just feel like if I suddenly start writing for a bunch of controlled substances 2 months into practice even with the intention of tapering it is going to look bad. Unfortunately the whole role of SP is frankly ridiculous at this place, I have nobody I can really talk to. I took the job because I am a a NHSC scholar and it was the only thing going anywhere near where I lived. 

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Suggestion: Give the patients a choice:

1) "I wish to taper my medications..."
2) "I wish to be referred to another pain management practice, and my current dosing will be continued for up to 90 days, and thereafter no further controlled substances will be prescribed"
3) "I neither wish to taper nor be referred out to a pain management practice, and instead I opt to terminate the patient/provider relationship with this practice effective immediately.  I understand that failure to select either option 1 or option 2 mandates this option by default.  I understand that no further controlled substances will be prescribed to me by this practice, and specifically absolve (providername) of any charges of patient abandonment or undertreatment by my choice of this option"

Not really, but if I got a pain management panel and 15 minute appointments, that's how I'd approach it.

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5 hours ago, RainOnNeptune said:

I am at a busy fqhc where I work in primary care... today I was approached by the CMO ....asked me if I felt comfortable .....he asked me if my license or my patients were more important to me. Long story short he was pressuring me....but I'm worried about repercussions.

Anyone who wants to stretch their student loans out for 10 years in exchange for working at one specific place should take note of this.  You can make the minimum payments for 9 years, and just be one year away from that big pay-back of your student loans disappearing, when some asshat CEO like this takes over and you are put in this situation.  Say no and you're fired in 6 months.  Suddenly, 9.5 years after graduation you have paid off zero in student loans.

3 hours ago, ventana said:

(I am still waiting for the first lawsuit that the bean counter admin folks for setting office policy that actually effects negatively the quality of care in a medical malpractice suit....)

I wish the medmal attorneys would do us all a favor and delve into this.  There's GOTTA be a lot of money there for them.

 

1 hour ago, RainOnNeptune said:

When he was twisting my arm he suggested that I try to wean people off and I am aware that this will be an absolute nightmare. I just feel like if I suddenly start writing for a bunch of controlled substances 2 months into practice even with the intention of tapering it is going to look bad.

I'm going to be a little devil's advocate here.  

What's wrong with accepting these patients and starting weaning them off.  Do your research and become the expert on pain management.  Document well that you discussed with each patient the new data that chronic opioids result in decreased in quality of life so you are going to decrease their MME while working with them to find the best possible methods to manage their pain.  

Consider the money in this. Have your chronic migrainers scheduled weekly for a trigger point injection.  Your tech can have the room set up, the 10cc of lidocaine prepped, and patient gowned before you walk in.  You walk in, glove up, ask the patient a few questions as you wipe down the site, make the injections, and walk out within 4 minutes.  Might keep them out of the ED (thank you!!!!!), makes you money, extremely low risk for the patient, and no more opioids for the chronic migrainer!  Everyone is happy!  And if that doesn't work, refer them.

Diclofenac, lidoderm patches, yoga, trigger point injections, referrals for nerve ablations, ketamine....all things you can be a relative expert on in just a few days reading.  

I doubt you would look bad to anyone if you "suddenly started writing for a bunch of controlled substances 2 months into practice" if you showed a gradual decrease in MMEs.

Go for it, you can do it!

Edited by Boatswain2PA
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I think some of us forget what it feels like to be a new grad. Doing something you’re uncertain about — without backup — can be recipe for disaster.

 

Listen to your gut, newbie! There are other, better jobs out there and answering the question about why you left should be straightforward.

 

 

Sent from my iPad using Tapatalk

 

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12 hours ago, RainOnNeptune said:

he asked me if my license or my patients were more important to me

That sounds like a threat to me.  This MUST be reported.  But bottom line, if you don't have a license it doesn't matter how important your patients are.  Stand your ground and look for a new job...NOW.  But, I would also look into reporting this (as already mentioned), because that would maybe give you whistleblower protection if poop hit the fan.

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Your license is more important to protect so you have a long career ahead of year.  You don't want your license suspended because you messed up with a chronic pain patient. 

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On 10/31/2019 at 11:46 PM, cinntsp said:

The CMO will not have your back when the medical board wants to take your license away after a patient dies from an overdose.  These chronic pain patients that require opioid therapy should be seen by pain management.  I would mention in your email that your patients would be best served in that way to assure they receive appropriate, SAFE care.

oh man no

Pain Management is for complex pain patients, not for dumping all narcotics patients on

This practice created this mess at the physician level and it should NOT be handed off to a new grad.  I think that they should have a meeting of some type with the practice providers and bring up a plan, make decisions as a team, and solve it together.

If not then the chronic controlled meds patients should be put on the physician or experienced providers schedule/panel.

The new grad might be able to do some of these with strong support, but it will be unreasonable to expect them to do it any other way.

 

As well the new gov't guidelines stating tapers need to be slow and individualized means it might be  multi year process, not quick and some will fail the taper and need to be maintained.  Others will leave practice, some will likely try street drugs and OD and others will simply give up and die

 

Overall not the place for a new grad unless a LOT of supports 

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without my license I can't take care of my patients... so yeah... I need to take care of my license first 

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On 10/31/2019 at 11:44 PM, Boatswain2PA said:

(I am still waiting for the first lawsuit that the bean counter admin folks for setting office policy that actually effects negatively the quality of care in a medical malpractice suit....)

Stay tuned. PAFT is working on the final lnaguage for Shared Responsibility and Liability which was an idea I came up with after working in UC and listening to these kinds of horror stories. We had some bumps in the road getting it organized but we will formalize it soon and then start spreading the word and trying to get other organizations to embrace the concept.

Edited by sas5814
fat fingered spelling
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4 hours ago, sas5814 said:

Stay tuned. PAFT is working on the final lnaguage for Shared Responsibility and Liability which was an idea I came up with after working in UC and listening to these kinds of horror stories. We had some bumps in the road getting it organizaed but we will formalixe it soon and then start spreading the word and trying to get other organizations to embrace the concept.

^^^. I love this.

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