TheDermPAC Posted April 3, 2022 Share Posted April 3, 2022 I’ve been at my current position as a new grad for just a few mos. They want me to start practicing as sole provider in office. Do I have any legal rights to say no? That I’m not comfortable given my level of experience? I have a contract and it doesn’t specifically state anything regarding this. I’m not sure what to do in this situation. Any advice would be helpful. Quote Link to comment Share on other sites More sharing options...
UGoLong Posted April 3, 2022 Share Posted April 3, 2022 There comes a time... The real question is if you have a backup who you can reliably call on. 1 Quote Link to comment Share on other sites More sharing options...
Mayamom Posted April 3, 2022 Share Posted April 3, 2022 Is it dermatology? Quote Link to comment Share on other sites More sharing options...
TheDermPAC Posted April 3, 2022 Author Share Posted April 3, 2022 Yes Quote Link to comment Share on other sites More sharing options...
Mayamom Posted April 3, 2022 Share Posted April 3, 2022 You have a right to say no but be prepared to have your reasons. What are their reasons for asking for this only having been there a few months? What are your concerns? Quote Link to comment Share on other sites More sharing options...
Cideous Posted April 4, 2022 Share Posted April 4, 2022 1 hour ago, Mayamom said: You have a right to say no but be prepared to have your reasons. What are their reasons for asking for this only having been there a few months? What are your concerns? Yeah, say no and be prepared to find another job... 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted April 4, 2022 Administrator Share Posted April 4, 2022 Basically the above. If you wanted to work with a doc in the office all the time as you... you're in the wrong profession. Or, at least, in the wrong specialty. The reason you're hired is to make money so the doc can go do other things. Most of those 'other things' are going to be not in the office. In surgery, you're hired to replace a surgeon assist and do all the preop and rounding so the surgeon can go do other stuff. Regardless, you exist to be a cheaper replacement for a physician, and I sure hope you didn't get all this way without realizing that. 1 4 Quote Link to comment Share on other sites More sharing options...
jmj11 Posted April 4, 2022 Share Posted April 4, 2022 You might be under estimating yourself. I took a job once in rheumatology, coming out of ED and FP prior to that. The rheumatologist was the only one in town. I was cramming day and night. Back in those days there was no electronic help but big PCs and limited sources, so I had a pocket full of home-made flash cards to learn the meds and labs. Then as the end of my first month came, she tried to commit suicide. Not my fault. An in-office romance gone sour. There were IM docs in the group but no rheumatology and they asked me to say on and run her practice until she "gets well." She didn't come back for about six months. I did refer my most complex patients to another rheumatology group 100 miles away. But I was able to keep the ship afloat until she stumbled back on-board. My point is that sometimes we can grow into challenging situations better than we thought. 3 1 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted April 4, 2022 Share Posted April 4, 2022 Outline a “day in your life” at work and the things you see. How many do you go to the doc about? Why? Are any of them repeat of previous questions? Why repeat? Will the daily patient load be the same when you are alone? What is the WORST thing you think could happen? What are the resources? Do you have Hi Def derm photography for weird lesions? Are you confident in your surgical/procedure skills? What kind of support staff is in the clinic? Not being crass but being honest - life threatening in the office things are highly UNlikely with dermatology. Take charge of the situation and maybe not jump to a legal issue - figure out how to make it rock for you and set it up to succeed. Otherwise, all of the above is correct - if you don’t ever want to work alone - find another job. 1 1 2 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted April 4, 2022 Administrator Share Posted April 4, 2022 2 hours ago, jmj11 said: My point is that sometimes we can grow into challenging situations better than we thought. This is great advice. I had a similar, though not as dramatic nor high stakes, experience that got me into occupational medicine. Quote Link to comment Share on other sites More sharing options...
MediMike Posted April 4, 2022 Share Posted April 4, 2022 10 hours ago, Reality Check 2 said: Not being crass but being honest - life threatening in the office things are highly UNlikely with dermatology I imagine the concern may be missing a possible malignant lesion? I dunno. Nearest exposure I've had to derm is ignoring the referral I got 3 years ago. Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted April 4, 2022 Share Posted April 4, 2022 @MediMike That is why I mentioned hi def photography for Derm. We use it at the VA for records, telederm eval by dermatologists and teaching. The photographs are amazing and detailed and can use a dermatoscope - all measured and documented from many angles. That would only delay more intense scrutiny by 24 hrs perhaps. Not sure what the standard is in Derm these days. And, honestly - you can't fail much with a biopsy. Just my thoughts 1 2 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted April 4, 2022 Share Posted April 4, 2022 Meh, just put some steroid cream on it. 2 1 1 Quote Link to comment Share on other sites More sharing options...
Ty2PA Posted April 4, 2022 Share Posted April 4, 2022 Ugggg derm. Barely on the wrong side of 40 and the last 3 years I've hit the trifecta: melanoma, basal cell carcinoma, and atypical fibroxanthoma (that looks a lot like squamous cell carcinoma). Even when the doc was certain it was melanoma, he still biopsied it and took a week on labs, and then scheduled the Mohs procedure "with a rush on it", which meant 3 weeks later instead of 3 months later. My AFX Mohs was scheduled for about 6 weeks out, because it was "moderately urgent". With some HD photos, or even a really nice smart phone, you could probably double-check tough cases the next day with the doc and hardly go wrong, and get some great feedback on those cases. Sounds fun! 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 5, 2022 Moderator Share Posted April 5, 2022 have faith! no real life threats in derm that will not sit for 1day or even 1 week take good notes take lots of photos so you can review with the doc jump my friend, you will find you can fly - just don't oversell yourself - be honest with patients "I am going to have the doc take a look at this" type statements We all have those moments in our careers when we think "how on gods earth can I possibly do this job"....... (for me it is the first day back after every vacation...) You Can Do THIS!!! 1 Quote Link to comment Share on other sites More sharing options...
doubledose Posted April 5, 2022 Share Posted April 5, 2022 I think learning to fly alone was pretty intimidating to me at first. First time they told me doc was taking vacation, I was like "F***!" but after few single weeks alone I kind of liked it, staff adjusted to my skill set and nurses morphed into gap fillers while Doc was away. Don't ever discount staff experience. Some of the best psych meds I have ever prescribed came from MA/nurse recommendation on what worked for them or other patients. Always remember medicine is a team sport. Eventually, I was able to muddle along with out supervision, and now can run my clinic and cover psych (med refills mostly) while everyone had COVID. Now I can run alone, and will get another person on the phone in a tight spot (ask your nurse to get someone on phone while you continue seeing patients and do a resident style turnover, this will let them know where you stand on information and they will feel more comfortable guiding you; and you will likely get positive remarks for admitting your limitations/weaknesses). It's always embarrassing at first as you have to admit your faults/weaknesses but you will become comfortable with them. Never practice outside your scope and if you're uncomfortable... it's likely because you care. Remember, even your SP was placed in the position of being uncomfortable multiple times before they were released without supervision. Last, you will never get to a point where you won't look something up. Even the most experienced people on this site say they frequently look info up, and are continually learning with >30 years practicing. Stay sharp, work smarter not harder, listen when others talk (two ears - one mouth for a reason). 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 5, 2022 Moderator Share Posted April 5, 2022 17 hours ago, doubledose said: Last, you will never get to a point where you won't look something up. Even the most experienced people on this site say they frequently look info up, and are continually learning with >30 years practicing. 200 plus credits a year on UpToDate with reading every year - commonly know more about the correct way to manage things then the doc's This week topic - anal pap with MSM (with and with out HIV Dx) Interesting read. Working on seeing if a system wide change in care is needed. Today paused in my busy day to talk to patient whom was exceptionally educated in his lifestyle and disease process. Learned more from him in 10 min then 30 min of reading. Will of course verify his suggestions but you can learn from anyone! 1 2 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted April 5, 2022 Share Posted April 5, 2022 8 minutes ago, ventana said: Will of course verify his suggestions but you can learn from anyone! One of my many old sayings..... everyone I meet knows something about medicine I don't. 32 years of practice and I look things up every day. 3 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 6, 2022 Moderator Share Posted April 6, 2022 On 4/4/2022 at 10:29 AM, Reality Check 2 said: Not sure what the standard is in Derm these days. probably about 3 months for an appointment Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 6, 2022 Moderator Share Posted April 6, 2022 If someone has an emergent life threatening rash they likely died during the wait to see derm or it was already treated by someone else. mid they made it through the waiting period, they will survive another few weeks at minimum. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted April 6, 2022 Administrator Share Posted April 6, 2022 2 hours ago, LT_Oneal_PAC said: If someone has an emergent life threatening rash they likely died during the wait to see derm or it was already treated by someone else. In all fairness, the one time I had a patient with possible SJS, they were seen that day. The one time I suspected a subungual melanoma, the patient was seen the next day. Derm is crazy busy, but in my experience has made room for the can't wait stuff. Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted April 7, 2022 Share Posted April 7, 2022 9 hours ago, rev ronin said: In all fairness, the one time I had a patient with possible SJS, they were seen that day. The one time I suspected a subungual melanoma, the patient was seen the next day. Derm is crazy busy, but in my experience has made room for the can't wait stuff. agreed...when I worked FM had a handful of similar cases. Working in ortho have had one suspected melanoma (almost exactly one year ago) that I noticed during a knee exam. All it took was a phone call to the dermatologist requesting immediately follow up or what they would recommend as next step for work up (ortho was just a phone call requesting they fit the patient in...unfortunately never did find out if I was right). Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 7, 2022 Moderator Share Posted April 7, 2022 Sublingal melanoma. my shame point thought I had one (yes I did scrub the crap out of the nail to make sure not just dirty). Got into derm asap (don’t remember how quick but less then a few weeks) note came back “dirty nails” they scraped and trimmed with scapel and got to normal nail. lesson learned dig dig dig. Scrub scrub scrub. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 7, 2022 Moderator Share Posted April 7, 2022 My better lucky than good referral: maybe 20 years ago guy comes into the ED with complaint of lesion on penis x 2 weeks. Looks like an abrasion. Referred to derm. Dx squamous cell ca/Bowen's dz. Another penis saved. 2 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted April 7, 2022 Share Posted April 7, 2022 17 hours ago, EMEDPA said: Another penis saved Doing the real work there! Quote Link to comment Share on other sites More sharing options...
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