New grad to PA: what support did you need at first job?

[joanna.nola]

I'm doing my last rotation at a Family Medicine clinic I hope will hire me. I believe they are about to extend me an offer.

My question: what did you ask for in terms of support at your first place of employment? Did you have a month of orientation where you saw patients with your SP? Did you slowly build up your panel of patients and consult your SP as needed? What was the timeline for you?

Like a lot of clinics, this clinics' goal is a patient every 15 minutes (I will have my own panel). I know they won't expect this of me as a new grad, but I'm wondering what I should ask for, both for me and for my SP. It seems he will need a reduced load while I'm transitioning so he can spend more time answering my questions etc.

 

In summary: How did you make the transition from student to clinic-based PA? What do you wish you'd asked for in terms of support in becoming a provider at your clinic?

[Doc Savage]

I will be going through this same transition really soon too. I am in the last month of my family practice rotation. I can not really give you advice from my perspective, but I can give you advice from the perspective of another. I worked with an NP at my family practice site who was a student who rotated through there and then got offered a job. She ended up taking it and now she has been practicing for a little over 2 years now. She still asks the docs and other more seasoned providers (PA's and other NP's) quite a few questions and they support her well when she has questions about a case or needs another pair of eyes. Her first year she said she saw about 10-12 a day and stayed 2-3 hours after the office closed to catch up on her notes. She is now a little more comfortable but feels well supported by all if she needs it and sees about 15 or more a day and only spends an hour or so doing notes. I guess I think the gist of it is that she feels like she can handle anything now because she has such great support.

 

Now I am not sure if you will be expected to "grind" one day. By that I mean that your panel has so many medicaid patients that you have to see 25-30 a day to equal enough worthy of keeping the doors open. I know one PA that sees 25-35 patients a day... he is a "grinder" because over 50% of his patients are medicaid. I know one provider that only sees 8 or so patients a day and does really well... but they all have private insurance and they all require many labs and workups for the type of integrative medicine they are seeking. It is a strange dynamic!

 

So in terms of support I would just ask that your preceptors and SP's give you the same backup that you have now with them but it will be with your discretion instead of theirs and not being afraid to ask questions or ask for reassurance. I think that is the biggest factor.

[Contrarian]

^^ Great answer...!!!^^

 

One method I've used has been to see the patients that were being transfered to my panel with the provider transfering the patient. This was not with all patients but surely with the complicated ones.

 

The transfering provider would introduce me into the encounter and sort of "show me off" to the patient. Due to the positive transferance between the patient and the provider.... the patient would be trustful and accepting of the change.

 

During this "introductory" encounter... the transferring provider would basically brief me on the important details/particulars about that individual patient. This would be done in front of the patient and in such a way that the patient would feel confident that I was competent because of the way the transferring provider communicated with me as a equal/collegue that knows as much or more about medicne than they do.

 

In one of my current jobs... I'm taking on a bunch of patients from a provider who was fired. In the interim, they were trans ferred to one of the physicians. Now a couple days a week, I sit in on a couple encounters where the physicians introduce me to these patients and they often make comments to the patients about my "expertise" in addiction medicine, and extensive experience in cardiology/internal medicine/pain management. They usually do it in a deprecating way that engenders awe and confidence from the transferring patients. Its actually kinda funny and humbling (and refreshing) listening to physicians (psychiatrist) place my general and specialty medical experience above their own.

 

If your patients are going to be transfered from a Physician... if at all possible, the physician should introduce you to the patient and convey upon the patient that they (the physician) has the utmost confidence in your knowledge, ability, and skillz and that they (the patient) is in good hands. The physician should also state that the both of you will be working together to care for them and that you will be consulting them (supervision) regularly to ensure the best care.

 

Also... in the beginning, I requested a 3:1.... PA-C:Physician visit schedule. Basically, for every three times the patient sees the PA... the patient is schedualed with the Physician (Patient sees Pysician every 4th visit to the clinic).

 

This sort of builds supervision and quality into the schedule and promotes oversite and feedback.

 

Just my initial thoughts...

 

Congrats ...

Welcome to the profession... :wink:

[EMEDPA]

My first job was at a place with a residency program. my sp was the residency director. he told me at the interview that he considered me a resident and he was there for as much or as little help as I needed. I saw what I was comfortable by myself from day 1 and ran stauff by him and the senior residents that I was unsure of. after a yr there he had the new interns do a 1 month em procedures rotation with me as the preceptor of record. it was a great first job but really not in a place I wanted to live so after 2.5 years I moved on both to get a better scope of practice and a better zip code.

[joanna.nola]

Thank you everyone for your replies! I will be at a FQHC, so the majority of the patients are medicaid patients. So I guess, as redonems said, I'll be expected "grind" some day. The doctor I work with is just a few years out of residency and there is an NP I've only talked to a little as a student, but she is very experienced and has been warm toward me. So I think I will have two providers I can turn to in this process. I want to make sure I ask for enough during negotiations in terms of support as a new provider. Unfortunately, I did not even write prescriptions on my rotations, even though I always discussed the plan with my preceptor (and this varied depending on how good the preceptor was). So I'm just nervous about the transition, even though I think I have the knowledge base. I know I'll be on uptodate after every patient encounter. And probably spending those two hours in the evening doing charts. I know my doc I work with spends time doing charts in the evening, which freaks me out, cause I figure I'll have to multiple that time several times over for me. But I knew it wouldn't be easy!

[TWR]

also put on your laptop www.fpnotes.com

[Doc Savage]

I know my doc I work with spends time doing charts in the evening, which freaks me out, cause I figure I'll have to multiple that time several times over for me. But I knew it wouldn't be easy!

 

If you are using electronic health records some providers (mostly the grinders) have templates and notes saved in the system. They apply the template and edit it accordingly and do all the notes on the laptop while in the room with the patient. Does this site have EHR's yet? That will make it somewhat easier with well childs, physicals, and other things like that that can be time consuming. Also do not be afraid to ask for some "Administrative" time that can be integrated into your work schedule. Lots of providers will take a day or half day off every now and then during normal clinic hours to either fill out paperwork or catch up on notes. Otherwise they are stuck at the office during "off" hours and their 50 hour work week turns into 60+

[Contrarian]

Did you mean "fpnotebook.com"..??

[jsfelder0417]

Charting by Exception!

[joanna.nola]

They do have EHR, although watching the doc use it seems like it isn't very intuitive. He's constantly moving between a bunch of screens. As a student I don't have access to it, but since he knows I might work there, he tries to tell me what he's doing while he's typing. It probably won't make sense until I use it, though (I hope!) He mostly seems to get the HPI and PE in the room, but not much else; he still has charts at the end of the day. He doesn't seem to use the templates that you refer to, redonems. I've seen those in other clinics. So I will certainly have to get those in place. Providers get Friday afternoons for administrative time (that's why I'm out early today). They are done before 3 on Fridays (last appointment about 2), but have appointments through lunch. So at least only Monday-Thursday will be long days and even if I have to chart for a couple hours, I'll be done by 5 on Fridays for a weekend break. That seems manageable. Thanks everyone for your replies I'll check out fpnotebook, too! As you can tell I'm sort of freaking out that in a few months I will actually be a PA. The forum is of great comfort to me because all of you remind me that it can be done!! :)

[joanna.nola]

And I meant to say thank you, Contrarian, for the suggestion of having the doc introduce patients he's transferring to me to gain the patient's confidence and trust in me. I know that none of these patients know what a PA is; PA's almost exclusively work in hospitals in New Orleans (and even there no one knows what a PA is). Most patients refer to the NP in the clinic as a doctor. So I know they think white coat=doctor.

Contrarian, did you share the patients with the doc or have your own panel? I like the 3:1 suggestion, but at this clinic, providers don't see each others patients. I'm wondering if that is because the only midlevel currently on staff is an NP, so there is a less of an SP role performed by the doctors (she's also been an NP for like 20 something years). I'm wondering if I should suggest this to my SP or if it won't make sense because I'm expected to have my own panel.