Moderator EMEDPA Posted July 11, 2012 Moderator Share Posted July 11, 2012 I recently spoke with a new grad who has an urgent care job at which they do no invasive procedures other than suturing minor lacs and I+d only of paronychia. no large abscesses, no fb removal of any kind, etc. the place is a referral factory: metallic fb in the eye? ophtho abscess? surgery headache not responding to tylenol? neurology all kids under 6 mo? peds all chest pain and abd pain? er for eval all sprains, dislocations, and fxs to ortho ingrown toenail to podiatry hemorrhoid? surgery or GI vag d/c? gyn etc, etc apparently the practice owner is very risk averse...I couldn't stand a job like that....in my mind this practice is doing less than an fp office. they basically have become a retail med clinic while calling themselves an urgent care....shameless....after 2 years of this the guy will have lost all his procedural skills.... Link to comment Share on other sites More sharing options...
d2305 Posted July 11, 2012 Share Posted July 11, 2012 If he's a new grad, he has none to loose. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2012 Author Moderator Share Posted July 11, 2012 if he's a new grad, he has none to loose. hopefully he learned some on rotations but if he doesn't use them, poof! Link to comment Share on other sites More sharing options...
d2305 Posted July 11, 2012 Share Posted July 11, 2012 We had to fight with medical students, interns, and residents to do procedures, and I don't remember doing very many. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 11, 2012 Share Posted July 11, 2012 Boring..... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2012 Author Moderator Share Posted July 11, 2012 We had to fight with medical students, interns, and residents to do procedures, and I don't remember doing very many. bummer. that's certainly a change from my experience. I did tons of procedures as a student. at most of my sites I was the only pa student there and at only a few were there residents or medstudents. for example on my trauma surg rotation there were a few residents but all upper level so they were happy to let the new guy try a chest tube, central line, etc on my 3 em rotations( em, peds em, elective) I did tons of suturing, I+D's, etc over the 22 weeks I spent in the ER. On my IM/hospitalist rotation I actually taught my intern how to suture, do abg's, start IV's and draw blood as he had never done any of those things before(it was his first week of internship and further along in my clinical yr). Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted July 11, 2012 Share Posted July 11, 2012 If he's a new grad, he has none to loose. Totally contingent on the program you attended and what clinical sites you went to. I only recall one rotation where I had to fight with residents for surgeries or procedures. Other than that, it was all me! In Gen. Surgery, I closed every single case alone while my preceptor went to the swing rooms to start on the next case. In the ED I did all my own lacs, abscesses, pelvic exams, etc. In my rural family practice rotation in Alaska, I did my own skin tag removals, cryotherapy treatments for warts, pelvics, immunization/travel shots, etc. What's the point of going on the rotation if you can't learn/do anything?? I'd be leery of taking an UC job with no procedure work. If you don't use it, you will lose it. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2012 Author Moderator Share Posted July 11, 2012 yup. I have noticed over the last 20 years or so that students who attend more established/older programs tendd to have better rotation sites because those schools had first pick of the area rotations and preceptors and got rid of the bad ones(which were then picked up by newer programs.) for example at my trauma surg rotation they only took pa students from my program even though there were 2 pa programs in the area of that rotation. it was set up > 20 yrs earlier and they had a lock on 1 pa student slot/mo year round. there were not even local med students there, just foreign med students on special international electives. Link to comment Share on other sites More sharing options...
Acebecker Posted July 11, 2012 Share Posted July 11, 2012 I work UC and would die without procedures and the freedom to take care of occasionally very sick people. Handling only sniffly noses, while easy, is mind numbing. My load is fair/moderate, so I do try to avoid complex cases that would need CT/MRI imaging and I will refer some of those or send to ER. But when I get a patient who has more than a strained muscle, I still follow the case through until it exceeds my resources. Just yesterday I managed a facet jt fracture in the c-spine (will be seeing a spine surgeon for f/u); 2 weeks ago I had an L2 compression fracture (stable). I sew someone daily, sometimes multiple people. EMED - are you saying that all these types of patients would be sent elsewhere in the clinic you mentioned initially? How is it providing good URGENT care to refer everyone out for everything? I would think the compromise to quality of care and patient safety would be a horrendous risk. Link to comment Share on other sites More sharing options...
Cideous Posted July 11, 2012 Share Posted July 11, 2012 It takes all types. What you hate someone else might love. Why judge what others do? Just accept that it's not for you and move on....Not everyone needs to shock v-fib on a daily basis to feel fulfilled. /shrug Link to comment Share on other sites More sharing options...
Just Steve Posted July 11, 2012 Share Posted July 11, 2012 I wonder if the UC is purely hourly wage or if they are missing a chance to increase their income by billing a higher RVU code. I am just a student but have been trying to figure out how this whole income thing works for PAs and it seems that procedures are easy money... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2012 Author Moderator Share Posted July 12, 2012 it takes all types. What you hate someone else might love. Why judge what others do? Just accept that it's not for you and move on....not everyone needs to shock v-fib on a daily basis to feel fulfilled. /shrug my point was that it is an inefficient practice if all they do is refer pts. The pts would get the same care from calling a nurse hotline and asking what specialist they should consult. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2012 Author Moderator Share Posted July 12, 2012 i wonder if the uc is purely hourly wage or if they are missing a chance to increase their income by billing a higher rvu code. I am just a student but have been trying to figure out how this whole income thing works for pas and it seems that procedures are easy money... this pa makes an hourly wage regardless of # of pts seen and procedures done(or not done) and is pushed to "move the meat". When you don't do any procedures you need to see a lot of pts to make the practice $. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 12, 2012 Moderator Share Posted July 12, 2012 Did he say what his typical daily load will be, patient-wise? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2012 Author Moderator Share Posted July 12, 2012 Did he say what his typical daily load will be, patient-wise? 30 pts in 8 hrs with a 1 hr lunch. that's 4.25 pts/hr. doable if every pt is "please refill my atenolol". not doable if you have a few cases for which you actually have to do an exam and develop a ddx. I can do "move the meat pace" at 6 /hr including charting with all no brainers, about 2.5/hr if I am doing procedures or workups. at my prior job we ran a flu clinic during the height of the season. to get to the flu clinic provider you needed minor sx and nl vs with no serious comorbidities. we had a single page paper chart with check off sx written in by the triage nurse, check off exam by the pa/doc and check off script. any inappropriate pt could be turfed without hassle. I once saw 60 pts in 12 hrs and had a lunch break. I don't want to do that every day. Link to comment Share on other sites More sharing options...
ToppDog Posted July 12, 2012 Share Posted July 12, 2012 That's too bad. That would be boring. Although, I have seen the opposite of that & it's not too smart either. I've seen some docs treat UC as an ER, holding up rooms for hours while monitoring a pt's status, & when you only have 3 exam rooms & one procedure room, it's a complete waste. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2012 Author Moderator Share Posted July 12, 2012 agree with above. at an urgent care the options are : dx and dispo home tune up and send home( iv fluids in gastroenteritis for example) stabilize and transfer there is really no place there for a big workup. one of the docs I work with got into a bit of trouble when he ordered send out labs, waited a few hrs and they came back + requiring a transfer and delaying care. one was a + trop, the other a + d-dimer. my philosophy when working uc is that if they need a lab I can't get in 10 minutes they need to be transferred. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.