katypa Posted November 16, 2012 Share Posted November 16, 2012 Hi, and thanks in advance for any advice. I have a messy situation. I'm a fairly new grad (1.5 yr inpatient experience) who recently started a new job at a family practice in NC. In NC you can practice with your supervising MD off site, so I'm the only provider there. It's a fairly rural area, and many patients have come in with chronic pain/benzos/amphetamines. I've been uncomfortable with a lot of this, and tried to be careful in my documentation and screening of patients before writing these scripts. A few cases I did want some back up on, and had some resistance from my office manager. She discouraged me from calling my supervising MD, and instead had my call another PA from our group. I did that, and felt satisfied with his advice. The next day a patient wanting amphetamines had a wishy washy story and no past medical records. I told my office manager I wasn't writing his script, and she told me that not doing so was "failure to treat," that I had to do it, and that we could be sued if I didn't. She then made me call the owner of the practice (a builder -- nonmedical person) and justify this decision... Ultimately I told her I wasn't calling him, but our supervising MD, who agreed with me and we wound up finding out that hew as getting meds from 4 different providers. Meanwhile, however, the office manager and owner have stressed to me that they're worried about "bad PR" if I continue to not "work with people" on their meds... The office manager has also been completely unreceptive to my attempts to explain to her that she will not be able to dictate my prescription writing. I'm feeling really uncomfortable and am going to walk. But should I take any action against her? I am going to call my supervising MD and let him know what she's been doing, but I didn't know if I shoudl take any additional precautions to protect myself? I don't think I've done anything without sufficient documentation or justification, but she is a whack job and I'm just worried about my future career! I almost want something in writing showing that she has been acting inappropriately, but don't know what steps I should take. Thanks again for your advice. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted November 16, 2012 Share Posted November 16, 2012 Hi, and thanks in advance for any advice.I have a messy situation. I'm a fairly new grad (1.5 yr inpatient experience) who recently started a new job at a family practice in NC. In NC you can practice with your supervising MD off site, so I'm the only provider there. It's a fairly rural area, and many patients have come in with chronic pain/benzos/amphetamines. I've been uncomfortable with a lot of this, and tried to be careful in my documentation and screening of patients before writing these scripts. A few cases I did want some back up on, and had some resistance from my office manager. She discouraged me from calling my supervising MD, and instead had my call another PA from our group. I did that, and felt satisfied with his advice. The next day a patient wanting amphetamines had a wishy washy story and no past medical records. I told my office manager I wasn't writing his script, and she told me that not doing so was "failure to treat," that I had to do it, and that we could be sued if I didn't. She then made me call the owner of the practice (a builder -- nonmedical person) and justify this decision... Ultimately I told her I wasn't calling him, but our supervising MD, who agreed with me and we wound up finding out that hew as getting meds from 4 different providers. Meanwhile, however, the office manager and owner have stressed to me that they're worried about "bad PR" if I continue to not "work with people" on their meds... The office manager has also been completely unreceptive to my attempts to explain to her that she will not be able to dictate my prescription writing. I'm feeling really uncomfortable and am going to walk. But should I take any action against her? I am going to call my supervising MD and let him know what she's been doing, but I didn't know if I shoudl take any additional precautions to protect myself? I don't think I've done anything without sufficient documentation or justification, but she is a whack job and I'm just worried about my future career! I almost want something in writing showing that she has been acting inappropriately, but don't know what steps I should take. Thanks again for your advice. Ask the owner and office managers to call the state medical board and the DEA about their concerns and see where that gets them. Office managers are just that and have no say in how you practice medicine.BTW are you willing to lose your license and maybe go to jail to get along with people? Quit two days ago and send a letter explaining your actions to your SP and the state medical board. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 16, 2012 Moderator Share Posted November 16, 2012 get her fired or leave. those are pretty much your choices.... Link to comment Share on other sites More sharing options...
Guest JMPA Posted November 16, 2012 Share Posted November 16, 2012 Ask the owner and office managers to call the state medical board and the DEA about their concerns and see where that gets them. Office managers are just that and have no say in how you practice medicine.BTW are you willing to lose your license and maybe go to jail to get along with people? Quit two days ago and send a letter explaining your actions to your SP and the state medical board. total agreement. diversion is morally, ethically, financially, and so much other ally wrong. she needs to be made example of. Link to comment Share on other sites More sharing options...
KCMA79 Posted November 16, 2012 Share Posted November 16, 2012 RUN!! The owner and office manager should have no influence over how you practice med. This is between you and your SP. If PR is more important than practicing good med. they are headed toward running a pill mill and turning you into a Mr Feel Good. I have been a PA for 30+ yrs and can't recall ever giving anyone amphetamines. Do many of your patients have out of state tags on their cars? Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 16, 2012 Moderator Share Posted November 16, 2012 You have worked really hard to be your license and DEA DO NOT GET BULLIED by a non-clinical staff to write ANYTHING - not even a script of PCN - - If you get caught you will be penalized by the state medical board and your license will be pulled, suspended or revoked or some type of punishment for you. The next time she does this I would seriously consider pulling her in a room, close the door (no witnesses) and explain to her in no uncertain terms that you are the clinical decision maker, you hold the license, you hold the knowledge and the liability NOT HER. Do it professionally and nicely but be very firm. A Doc would NEVER allow something like this to get occur and you need to stop it ASAP. As for failure to treat with stimulants.... yeah right, the is ZERO medical justification for this commment (ADHD meds are not mandatory). It is okay to talk to a more senior PA or NP if you trust them, I have done this alot in the past on both ends I would talk to the SP about the office manager - and don't be afraid to tell it like it is - that she is bullying and demanding that you write certain controlled substance scripts for patients and you are not comfortable with it - there is not a doc out there that should not stand 100% behind you and say that is not acceptable. And if they don't I would be afraid for your job and license I would not make any reports to anyone outside the practice at this point, that is just not playing nice in the sandbox so to speak...... NEVER sign a blank script in this office.... If you want to scare yourself - go to a state medical board and read the recent administrative actions - just don't do it..... Here is MASS http://www.mass.gov/eohhs/consumer/physical-health-treatment/physicans/complaints/disciplinary-and-other-board-actions.html Link to comment Share on other sites More sharing options...
TWR Posted November 16, 2012 Share Posted November 16, 2012 I believe that "not working with patients" both controls and unnecessary abx caused me to be "let go". In retrospect it was a blessing because I worried about the pain medicine issue and leaving that practice which was driven by money was in my best interest. My advice to katypa would be to get the heck out of the practice. Your SP is either not watching what is going on or turning his head. The office manager is way out of line. The practice is owned by a builder!!!! Holy s..t! Link to comment Share on other sites More sharing options...
bradtPA Posted November 16, 2012 Share Posted November 16, 2012 Here is the kicker. In NC, a practice is required to be partially owned by a physician. If this practice is not, you could be censured for it. I know a PA that was reprimanded in NC for working at a weight loss clinic owned by a lay person, despite the PA not knowing it was an offense. Office managers are there to tell you when to come to work, not how to practice. Get the hell out of there fast. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 17, 2012 Share Posted November 17, 2012 I'd be suspecting the office manager has deals going on the side with patients and their drugs. Just sayin..... Link to comment Share on other sites More sharing options...
CAdamsPAC Posted November 17, 2012 Share Posted November 17, 2012 I'd be suspecting the office manager has deals going on the side with patients and their drugs. Just sayin..... It wouldn't be a suprise if this is the case. Two words........pill mill! Link to comment Share on other sites More sharing options...
Contrarian Posted November 17, 2012 Share Posted November 17, 2012 The next time the "office manager" tries to direct your care... you should "hand them a application" and if warranted write them a LOR... Those that have been here a while KNOW what I'm refering to... :wink: Link to comment Share on other sites More sharing options...
zepoPA Posted November 17, 2012 Share Posted November 17, 2012 ... I'm a fairly new grad (1.5 yr inpatient experience) who recently started a new job in family practice in NC. In NC you can practice with your supervising MD off site, so I'm the only provider there. It's a fairly rural area, and many patients have come in with chronic pain/benzos/amphetamines. I've been uncomfortable with a lot of this, ... Like many colleagues have suggested: Leave that job ASAP. There are many things that concern me about your current job situation. The obvious is what everyone else mentioned, of course; but additionally, I'm looking at the complete disregard of your SP about what happens in the clinic, and most importantly, HOW YOU FEEL, as a "fairly new grad" , with a new job in FP, knowing your previous experience was inpatient medicine. I would expect the SP should be communicating frequently with YOU, regarding not only specific medical cases, but also about your well being and how comfortable you are with the responsibility, staff, demographics, patient load, etc etc etc. The level of communication MD-PA in your particular scenario should be a high priority, and should not diminish until you, as a solo provider, demonstrate that you are comfortable with the every aspect of the medical practice you run. This total disregard from SP concerns me even more than the ridiculous attitude of the Manager. After all, managers never took an Oath to uphold any professional or ethical standards. Link to comment Share on other sites More sharing options...
Hemegroup Posted November 17, 2012 Share Posted November 17, 2012 Quit two days ago and send a letter explaining your actions to your SP and the state medical board. Seconded. Mills continue as such unless someone speaks up. That is obviously not the place for you. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 17, 2012 Moderator Share Posted November 17, 2012 The next time the "office manager" tries to direct your care... you should "hand them a application" and if warranted write them a LOR... Those that have been here a while KNOW what I'm refering to... :wink: ahh good old memories of C gonig off... that actually is a great solution that clearly lays out the provider role. Link to comment Share on other sites More sharing options...
Contrarian Posted November 17, 2012 Share Posted November 17, 2012 Non-Physician trying to direct your "practice of medicine": "Hey PA Such and Such... You need to order XyZ" PA-C: [First Goes to office or out to car and gets a manilla folder] Then Goes to the Non-Physician trying to direct their "practice of medicine" and says: "You know, when I decided that I wanted to practice medicine, I researched programs, completed the pre-reqs, completed the applications, secured LORs, submitted the applications and fees, flew around the country to several interviews, matriculated into and completed the required curiculum and clinicals, graduated and sat for the National Boards, THEN applied for license to practice medicine and prescribe mediciations." "It sounds like YOU want to practice medicine. So here is a few applications [hands them the folder containing applicatiions to a few PA and/or NP programs] to a few good programs that I had on hand. You should research them, and when you are ready, talk to me and I might be able to hook you up with a LOR." [smile]:wink: "IF you get accepted, and IF you complete the program and IF you pass the Boards... we can then debate medical practice styles... and even then, we will be clinical equals and you still don't/won't get to dictate/direct my practice." "For that... the process is even longer because you would need to start with taking the MCAT." Snaark-o-licious...!!!!!!! Link to comment Share on other sites More sharing options...
Febrifuge Posted November 21, 2012 Share Posted November 21, 2012 I'd be suspecting the office manager has deals going on the side with patients and their drugs. Just sayin..... That was the first thing that occurred to me, as well. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 22, 2012 Share Posted November 22, 2012 I cannot even imagine this scenario .... if my office staff told me to do anything aside from where to place the paperwork they need to file there would be an issue. You need to take control of the situation. Show them the strength of a person who practices medicine and completed PA school ... and if they dislike it walk away ... My guess is people usually walk away after a year at this place ... and i bet they find a new grad to replace you. Link to comment Share on other sites More sharing options...
emfdj Posted November 22, 2012 Share Posted November 22, 2012 The office manager, SP and builder have a good thing going (for them). They won't very happy if you try to mess it up. You're there for loan repayment so they think they can treat you however they want and you can't leave. But it's your license! Protect it. Contact whoever is paying your loan and tell them you can't work at this site and give examples of why not. So if you have to leave, or this practice decides you're more trouble than you're worth, they'll be forewarned. They may even help you get into a new site. Link to comment Share on other sites More sharing options...
Hemegroup Posted November 22, 2012 Share Posted November 22, 2012 Well played, emfdj. My first job was at a loan repayment site, where I was accepted by the NHSC and was finally to begin my wait for disbursement. Unfortunately, they allowed their on-site Pharmacist with a head bigger than NY to play superior ... he would refuse dispensing of new dx Psych meds saying that "PAs are not qualified" (one patient ended up accosting someone on the street a few days later), 'wrote me up' for writing for 90 Percs 10/325 (pt was appearing for f/u after serious damage to his hand, recovering from necrosis issues, had been on dilaudid and fentanyl in house prior to seeing me), it was ridiculous. In hindsight, glad I'm not there anymore ... it wouldn't have been worth the NHSC money. Have I had to consolidate and forebear for a while? Yup ... but 3 years of forbearance allowance is a long time to hunt for a decent place and secure a better spot. Hopefully politics will be on your side this time, OP, if you are at a NHSC site ... politics and ethics. Link to comment Share on other sites More sharing options...
emfdj Posted November 23, 2012 Share Posted November 23, 2012 I'm speaking from experience too, hemegroup. The site where I worked used the NHSC to attract out of area PAs, docs and dentists because they had such a bad reputation in the area no one local would work for them. They were users and abusers. The only "good" thing about working there was that I realized my moral and ethical standards are more important than any job and any amount of money. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 23, 2012 Share Posted November 23, 2012 Do any of the these sites get reported to the NHSC? They should, but I fear the behemoth government would take years to respond. Link to comment Share on other sites More sharing options...
Hemegroup Posted November 23, 2012 Share Posted November 23, 2012 Sadly, I had no idea I was being set up until it was too late. Be cautious and always always document document document any and all incidences of conflict even if you consider them to be insignificant at the time. Sorry to hear, emfdj, but not to hear that you got out. Sounds like we might have been at the same place! Link to comment Share on other sites More sharing options...
emfdj Posted November 23, 2012 Share Posted November 23, 2012 The site where I worked been removed from NHSC rosters years before I got there. But later someone wanted to work there because it's in an underserved area. So NHSC let them back in. After my experience there, I asked NHSC to investigate. But I don't think anything happened after that. They are still on the list of eligible sites on the NHSC jobs. Link to comment Share on other sites More sharing options...
Cideous Posted November 25, 2012 Share Posted November 25, 2012 Office managers make me LOL. Most don't have bachelors degrees in anything, and a good portion have little to no college. They started off answering the phones and now presume to tell us how to practice medicine. They are not to be trusted in any way shape or form. When I ran a facility I had an office administrator work for me that simply did the paperwork and other admin duties of an office manager, but he had no authority over the rest of the employees....I retained that totally. Most doctors are light weights, they want to be loved by everyone, but they also want to pay little and get lots in return. They will go hire some first class tool to carry out their will without looking bad. Good cop, bad cop thing. I have seen it over and over again. Dump that job and leave. ps Stay as FAR away as possible of offices that have the wife of the doctor as the office manager. /shudder Link to comment Share on other sites More sharing options...
Guest Paula Posted November 25, 2012 Share Posted November 25, 2012 @katypa: How have things turned out? Let us know what happened. Link to comment Share on other sites More sharing options...
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