YourAveragePA Posted November 3, 2023 Share Posted November 3, 2023 Bit of a rant.... I work for the feds, and I'm not sure if if it's just my facility or area, but it has become downright frustrating to practice medicine. I'm in a surgical subspecialty and the overwhelming majority of my patients have chronic, debilitating pain from severe OA or other mechanical issues and have failed conservative measures. They need surgery, but for the past 2-3 years, we have to tell them 1 of 3 things...... #1) Ok well, we're booked out 7-9 months for elective cases so, we'll see you next year sometime #2) We can send you out into the community and have it covered by us, but it will take the community care office 3+months before they even process your paperwork (true numbers, had this conversation today with the dept head at my facility). Then you get scheduled and see someone probably a few months after that, who will then schedule you for surgery probably a month or two after that. or #3) Sorry, live with it. The administrative burden is what it is, that's never going to change and I've gotten used to it to be honest. But the most disheartening/frustrating things I deal with 10x a day is the look on someone's face when you tell them there are no other choices and they're just going to have to deal with it for 8 more months. I don't know if I'm alone in my experiences, but it's taking a toll. I've been with the gov't for 8 years and just got a scholarship to get my DMSc. After that I owe them 3 years of service, so I'm stuck for a minimum of 4 more years. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 3, 2023 Moderator Share Posted November 3, 2023 Hang in there, it’s pretty much stinks everywhere right now. Our broken system is close to imploding. I wish I had better words of advice. on a sidenote, how did you get a scholarship for your doctorate? Do you work for the VA? Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted November 4, 2023 Share Posted November 4, 2023 I work in orthopedics for a large health system in a smallish metro area and almost all of our total joint surgeons are booked out minimum 3 months with the most sought after 6+ months. The exception is one surgeon who was just hired and is fresh out of fellowship...but he's actually getting booked up faster than expected. He's been with us for just over 1 month and is already booked out a month, but he also doesn't have tons of OR time yet as that is all being reworked to start 2024. In other words...it's not just the feds who are backed up, and I feel your pain. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 4, 2023 Moderator Share Posted November 4, 2023 11 hours ago, YourAveragePA said: Bit of a rant.... I work for the feds, and I'm not sure if if it's just my facility or area, but it has become downright frustrating to practice medicine. I'm in a surgical subspecialty and the overwhelming majority of my patients have chronic, debilitating pain from severe OA or other mechanical issues and have failed conservative measures. They need surgery, but for the past 2-3 years, we have to tell them 1 of 3 things...... #1) Ok well, we're booked out 7-9 months for elective cases so, we'll see you next year sometime #2) We can send you out into the community and have it covered by us, but it will take the community care office 3+months before they even process your paperwork (true numbers, had this conversation today with the dept head at my facility). Then you get scheduled and see someone probably a few months after that, who will then schedule you for surgery probably a month or two after that. or #3) Sorry, live with it. option #4. They show up at my little rural critical access hospital and expect me to get them into ortho/surgery/ent/random specialty today. That almost never happens and leaves everyone frustrated. Quote Link to comment Share on other sites More sharing options...
SedRate Posted November 4, 2023 Share Posted November 4, 2023 (edited) Perhaps it's location dependent and private practice vs public/university/health care system... Have you tried referring the pt to a lesser known academic facility? In my very brief experience, the total joint docs aren't booked out very far and if it's a "yes" clinic the pts can almost always book see a PA or surgeon same-day or within a week. Edited November 4, 2023 by SedRate Quote Link to comment Share on other sites More sharing options...
kettle Posted November 5, 2023 Share Posted November 5, 2023 21 hours ago, EMEDPA said: option #4. They show up at my little rural critical access hospital and expect me to get them into ortho/surgery/ent/random specialty today. That almost never happens and leaves everyone frustrated. The expectations of rural hospitals can be high. Especially when people travel from major cities. I've had numerous patients who have chronic conditions not solved in major tertiary care centers, show up in the little ER thinking we can solve everything 1 Quote Link to comment Share on other sites More sharing options...
Mayamom Posted November 5, 2023 Share Posted November 5, 2023 And am betting your not allowed to offer opiates to ease their pain to cover until surgery? We could not in the prison system. Quote Link to comment Share on other sites More sharing options...
sas5814 Posted November 6, 2023 Share Posted November 6, 2023 It is not uncommon. I work at the VA and ortho is the single most challenging service for us. The demand is very high and they are always short staffed. This has led to a contentious adversarial referral process. It probably won't make you feel any better but its not just you or your location. 1 Quote Link to comment Share on other sites More sharing options...
LKPAC Posted November 7, 2023 Share Posted November 7, 2023 Just wait until we get "free" universal health care! You'll be backed up twice as long! 1 2 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 7, 2023 Moderator Share Posted November 7, 2023 Just give the private practitioner the same “facility fee” that hospital get to bill and see the mass exodus of providers from hospital employment. private practice = motivation to do more. Employ status for health system = talking. 1 Quote Link to comment Share on other sites More sharing options...
YourAveragePA Posted November 11, 2023 Author Share Posted November 11, 2023 It’s not just Ortho in my facility. If I order an EMG….4 months. PT…3-4 weeks for them to be scheduled. Any form of brace other than your standard cock up splint…4-6 weeks. I can’t and won’t prescribe opioids for chronic pain, I’d rather leave that up to the PCP or pain mgmt. I guess it’s just the way things are and there isn’t a way to fix it. Quote Link to comment Share on other sites More sharing options...
iconic Posted November 11, 2023 Share Posted November 11, 2023 (edited) The pain management in my area (as well as PCPs) have all dumped their opioid patients on suboxone/methadone clinics after getting them addicted and throwing up their hands Edited November 11, 2023 by iconic Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted November 15, 2023 Share Posted November 15, 2023 On 11/10/2023 at 9:51 PM, YourAveragePA said: I can’t and won’t prescribe opioids for chronic pain As one of my preceptors stated many years ago, never start opioids without an end in mind. On 11/7/2023 at 6:36 PM, ventana said: Just give the private practitioner the same “facility fee” that hospital get to bill and see the mass exodus of providers from hospital employment. Absolute racket that this is reality. The fact that hospitals can bill more for the same services as compared to a private practice is just some underhanded bull poop that I'm sure was the result of hospital lobbyists. Quote Link to comment Share on other sites More sharing options...
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