New Graduate Trouble- please help!

[CAdamsPAC]

On 5/9/2020 at 3:07 PM, EMEDPA said:

what does your actual supervisor, a physician, have to say about the matter?

Supervision by a physician is required and must be continuous, but doesn’t necessarily require the physical presence of the physician where services are performed. N.Y. Education Law §6542(2)

 

10 CRR-NY 94.2

10 CRR-NY 94.2

94.2 Supervision and scope of duties.

(a) A licensed physician assistant or a registered specialist assistant may perform medical services but only when under the supervision of a physician. Such supervision shall be continuous but shall not necessarily require the physical presence of the supervising physician at the time and place where the services are performed. The licensed physician assistant or registered specialist assistant shall retain records documenting the continuous supervision by the physician who is responsible for such supervision.

(b) Medical acts, duties and responsibilities performed by a licensed physician assistant or registered specialist assistant must:

(1) be assigned to him or her by the supervising physician;

(2) be within the scope of practice of the supervising physician; and

(3) be appropriate to the education, training and experience of the licensed physician assistant or registered specialist assistant.

[CAdamsPAC]

On 5/9/2020 at 4:23 PM, PhysicAsstinNY said:

My attending told me to do one thing and the nurse practioner told me to do another. I couldn’t do what they both asked at the same time and make both of them happy, so I did what the attending asked me to and in doing so was considered to be “insubordinate” to the lead APP. 

Tell her to report your "insubordination" to the  State of New York Health Department, see where that gets her.

[CAdamsPAC]

On 5/9/2020 at 4:16 PM, PhysicAsstinNY said:

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

Bovine scatology!

[SedRate]

21 hours ago, rev ronin said:

Does it matter?  They're just an employee too, have a massive ton of debt to manage, and will be told to toe the line or be terminated.

Perhaps, sadly. But ya gotta think that they still care about their license and potential for malpractice claim, especially if the patient received a different medical treatment than the one they prescribed.

I know you and Cideous don't work in hospitals, so it's probably different than corporate outpatient medicine which may have more cog-in-wheel setup, but I doubt the CMO (physician) of a hospital would tell a fellow physician to fall in line or be terminated if they don't let the NP change their orders and medical treatment plan on a chart the physician is signing. Hospitals still require a physician to oversee pt care, at least the several that I have privileges at in my state. 

[CAdamsPAC]

36 minutes ago, SedRate said:

Perhaps, sadly. But ya gotta think that they still care about their license and potential for malpractice claim, especially if the patient received a different medical treatment than the one they prescribed.

I know you and Cideous don't work in hospitals, so it's probably different than corporate outpatient medicine which may have more cog-in-wheel setup, but I doubt the CMO (physician) of a hospital would tell a fellow physician to fall in line or be terminated if they don't let the NP change their orders and medical treatment plan on a chart the physician is signing. Hospitals still require a physician to oversee pt care, at least the several that I have privileges at in my state. 

There are several cases of physicians being disciplined for " failure to properly supervise PAs" in the NYS Medical Board report of punitive actions. I don't think the OP or their S/P want to be added to the list.

[dream2pa]

Another PA eaten alive by a NP.

I thought I was the only victim  ... ;(

[CAdamsPAC]

1 hour ago, dream2pa said:

Another PA eaten alive by a NP.

I thought I was the only victim  ... ;(

 

1 hour ago, dream2pa said:

Another PA eaten alive by a NP.

I thought I was the only victim  ... ;(

 

1 hour ago, dream2pa said:

Another PA eaten alive by a NP.

I thought I was the only victim  ... ;(

"We" need to make them choke on the feast!!!

[SedRate]

3 hours ago, CAdamsPAC said:

There are several cases of physicians being disciplined for " failure to properly supervise PAs" in the NYS Medical Board report of punitive actions. I don't think the OP or their S/P want to be added to the list.

Ouch, yeah, probably not. And that's perhaps why the hospital and CMO may want to protect PA and Physician by disciplining the "team boss" for attempting subversion. I wonder who gave them the power to perform said subversion. And, who is this team boss anyway? Still haven't heard from OP if this person is of administrative or nursing background. Or worse off, both. 

[CAdamsPAC]

On 5/10/2020 at 12:35 AM, Cideous said:

Welcome to the future....supervised by NP's......

You are projecting your bias. The New York State law is quite clear, the NP has ZERO  legal authority over the OP. The true problem is the S/P needs to stand up and call  the NP out formally within the organization and the State Medical Board!  The OP must rear up and use the law to crush this NP!!!

[Cideous]

3 hours ago, CAdamsPAC said:

You are projecting your bias. The New York State law is quite clear, the NP has ZERO  legal authority over the OP. The true problem is the S/P needs to stand up and call  the NP out formally within the organization and the State Medical Board!  The OP must rear up and use the law to crush this NP!!!

Without the definitive backing of his supervising doc, your advice is a one way ticket to the unemployment line.

[CAdamsPAC]

3 hours ago, Cideous said:

Without the definitive backing of his supervising doc, your advice is a one way ticket to the unemployment line.

Maybe, but letting the S/P know that a letter to the NYS Health Department on the issue will bring the attention back where it should be. The law is quite clear the S/P is responsible for any patient care rendered by the OP so following the NP's direction will splash back onto the S/P. It seems to me that  the OP is headed to the chopping block if they don't come out swinging with both fists! 

Edited May 16, 2020 by CAdamsPAC

[PhysicAsstinNY]

On 5/15/2020 at 4:05 PM, SedRate said:

Ouch, yeah, probably not. And that's perhaps why the hospital and CMO may want to protect PA and Physician by disciplining the "team boss" for attempting subversion. I wonder who gave them the power to perform said subversion. And, who is this team boss anyway? Still haven't heard from OP if this person is of administrative or nursing background. Or worse off, both. 

This person is a nurse practioner. She is the team leader. 

[CAdamsPAC]

12 minutes ago, PhysicAsstinNY said:

This person is a nurse practioner. She is the team leader. 

Who by NY law has ZERO clinical authority over you. The law is quite clear that your SP has sole clinical authority over your activities, whether on or off site!

[Cideous]

1 hour ago, CAdamsPAC said:

Who by NY law has ZERO clinical authority over you. The law is quite clear that your SP has sole clinical authority over your activities, whether on or off site!

Clinically maybe, but administratively she absolutely could make his life a living hell.  Up to and including firing him.  Depending on the state he works in, his admin could fire him for *any* reason.  I'm referring to states like Texas.

[CAdamsPAC]

15 minutes ago, Cideous said:

Clinically maybe, but administratively she absolutely could make his life a living hell.  Up to and including firing him.  Depending on the state he works in, his admin could fire him for *any* reason.  I'm referring to states like Texas.

Someone with intestinal fortitude would be in Human Resources asking,  no demanded an explanation of the policy on retribution and harassment in the organization!! This PA profession is full of far too many people who will roll over and play dead when being screwed over!!

[Cideous]

24 minutes ago, CAdamsPAC said:

Someone with intestinal fortitude would be in Human Resources asking,  no demanded an explanation of the policy on retribution and harassment in the organization!! This PA profession is full of far too many people who will roll over and play dead when being screwed over!!

What else can an "assistant" do?

[CAdamsPAC]

10 minutes ago, Cideous said:

What else can an "assistant" do?

That's a Bovine Scatlogy reply and you know it! This person needs to "man up" and hold those who are placing his license and career at risk accountable under the PA Practice laws of NY state along with the HR and Medical Staff Office. Running scared like a rabbit from a fox isn't the answer to this circumstance. Standing up and fighting isn't the hallmark of far too many of the invertebrates that populate the PA profession!!! Whine and snivel about your freaking job title while you allow NPs to screw over you while breaking the freaking law.

Edited June 4, 2020 by CAdamsPAC

[Pac30]

I agree with you about him standing up for himself, but all of us know once you lose the nurses your life is a living hell. This is gonna end one of two ways. Go down fighting and get canned, or quit before they get you. 

[CAdamsPAC]

13 hours ago, Pac30 said:

I agree with you about him standing up for himself, but all of us know once you lose the nurses your life is a living hell. This is gonna end one of two ways. Go down fighting and get canned, or quit before they get you. 

A constructive discharge was behind (meaning forced out because of a hostile workplace) his resignation along with a formal complaint to the NY State Medical Board for the organization's non-compliance with NY State PA Practice Law and cite the NP for her dismissal of the SP treatment orders ie; practicing medicine without a Medical License. We collectively are just punching dummies for far too many practices and it's well past the time to hit back as a profession!!

Edited June 4, 2020 by CAdamsPAC

[CAdamsPAC]

13 hours ago, Pac30 said:

I agree with you about him standing up for himself, but all of us know once you lose the nurses your life is a living hell. This is gonna end one of two ways. Go down fighting and get canned, or quit before they get you. 

P.S. we know that animals avoid screwing with The Honey Badger they have learned that it would not be a good move! We as a profession need to be more like The Honey Badger!

[GetMeOuttaThisMess]

Tyrann Mathieu (aka "Honey Badger")?   

Edited June 4, 2020 by GetMeOuttaThisMess

[narcan]

Another option to consider is transferring to another department within the hospital. I would document all of the conversations you've had about this and thoroughly document your recollection of the incident in question. 

It can be really hard to navigate office politics, especially when an NP has their big girl pants on. Since you're a new grad, I assume you're still in orientation and perhaps that's why this person feels they have such direct control over you.

The most sinister part of this story is how presumably this lead NP got all of her friends to file complaints against you. This situation is not going to get better unless you fall in line and win this person over or switch departments/leave. At the end of the day, big hospitals and organizations are just minefields and you're in the middle of a big one.

Perhaps most importantly, don't listen to a bunch of randos on the internet who aren't in your shoes and aren't going to suffer the consequences. You're in the room, trust your gut, and proceed accordingly. Have your CV ready and start getting a parachute packed in case you need to jump ship, but if you can avoid that outcome for your first job, that's probably preferable.

[CAdamsPAC]

2 hours ago, narcan said:

Another option to consider is transferring to another department within the hospital. I would document all of the conversations you've had about this and thoroughly document your recollection of the incident in question. 

It can be really hard to navigate office politics, especially when an NP has their big girl pants on. Since you're a new grad, I assume you're still in orientation and perhaps that's why this person feels they have such direct control over you.

The most sinister part of this story is how presumably this lead NP got all of her friends to file complaints against you. This situation is not going to get better unless you fall in line and win this person over or switch departments/leave. At the end of the day, big hospitals and organizations are just minefields and you're in the middle of a big one.

Perhaps most importantly, don't listen to a bunch of randos on the internet who aren't in your shoes and aren't going to suffer the consequences. You're in the room, trust your gut, and proceed accordingly. Have your CV ready and start getting a parachute packed in case you need to jump ship, but if you can avoid that outcome for your first job, that's probably preferable.

All acceptable advice until another episode of his SP orders not being followed leading up to an unacceptable outcome for the patient. I'm sure the SP, CMO , NY State Medical Board and Plaintif Attorney will all accept that he was just following the "Team Leaders" orders. It will all work out in the National Practitioner Data Bank. It's all in the OP's hands and will fall onto  his back.  BTW  the idea of play nice during BOHICA   or run away without  a fight is just what I've witnessed from most PAs .

Edited June 7, 2020 by CAdamsPAC

[sas5814]

I like "randos on the internet". I don't think we went looking for OP...they came to us.

That said you are correct. It is easy to give big advice like "move" or "quit" when it isn't your ability to pay your bills is on the line. It isn't an easy discussion with easy answers.

It is going to take some bold people to stop this from happening to someone else because it is wrong. It is wrong medically. It is wrong legally.

Roll over or run away is no better advice. Just safer.

[iconic]

Too often the advice given on these boards is to look for a new job, but how many bad practice arrangements there are? We need to stand up for ourselves, and our practice rights, because no one else will.