Dealing with disrespectful NP

[Iamnew2]

Wanted to get others' opinions on this.
I work as a med director in a rehab hospital. Overall things have gone very well since I started the position. We have a Medicine group that also covers, their old NP left and they hired a new NP. The new NP is very reluctant to be taught, despite not being very good, makes errors, and is kinda snippy. I understand that she is a hire and is paid by the Medicine group but at the end of the day, I am the medical director. She does this really stupid thing where she writes notes under a PM&R heading, and despite me telling her not to do so, she continues doing so, telling me that she has been told by the Medicine group, etc. that that's how it's supposed to be. This of course is beyond nonsensical as the Medicine group is supposed to do the Medicine part of things and I do the PM&R.

I spoke with the CEO and he's arranging a meeting with the other group. I am not sure how to go about this. This really frustrates me that she is so inappropriate.

It's also odd that the hospital has Medicine medical directors at other hospitals. In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance.

Thoughts?

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[lejeunesage]

"In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance."

Correct. Usually, a non PM&R medical director is hired when a facility has a hard time recruiting a physiatrist.


She sounds completely out of line to me.
The question is how much clout do you have?
Does the Medicine team serve at your pleasure? If you decided tomorrow to go with a different medicine team, could you do it? If you have that kind of discretion, then whoever runs the medicine team is going to do their utmost to keep you pleased, including getting rid of a recalcitrant NP if that's what it takes. If on the other hand you're a "medical director" who is nothing more than a signature on hire, you'll need to approach things more delicately.

Either way, a conversation with the head hospitalist/IM person is a good place to start.

 

[deleted941485]

"In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance."

Correct. Usually, a non PM&R medical director is hired when a facility has a hard time recruiting a physiatrist.


She sounds completely out of line to me.
The question is how much clout do you have?
Does the Medicine team serve at your pleasure? If you decided tomorrow to go with a different medicine team, could you do it? If you have that kind of discretion, then whoever runs the medicine team is going to do their utmost to keep you pleased, including getting rid of a recalcitrant NP if that's what it takes. If on the other hand you're a "medical director" who is nothing more than a signature on hire, you'll need to approach things more delicately.

Either way, a conversation with the head hospitalist/IM person is a good place to start.

Idk if your in a position to hire and fire but you do know that they are pumping these MLPs idiots out by the truck load. I don’t think you’ll have trouble finding another inexperienced yet malleable NP.

 

[Iamnew2]

"In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance."

Correct. Usually, a non PM&R medical director is hired when a facility has a hard time recruiting a physiatrist.


She sounds completely out of line to me.
The question is how much clout do you have?
Does the Medicine team serve at your pleasure? If you decided tomorrow to go with a different medicine team, could you do it? If you have that kind of discretion, then whoever runs the medicine team is going to do their utmost to keep you pleased, including getting rid of a recalcitrant NP if that's what it takes. If on the other hand you're a "medical director" who is nothing more than a signature on hire, you'll need to approach things more delicately.

Either way, a conversation with the head hospitalist/IM person is a good place to start.

Well the CEO has arranged a meeting already. I have essentially doubled the census, and the hospital is doing very well, not to mention that they had a hard time finding someone in terms of a med director. The hospital wasn't doing that great prior to me. I am pretty reasonable and agreeable and most of the staff tends to like me. Patient outcomes have also skyrocketed in terms of positive values, PEM, compliance so I think in general administration wants to keep me happy. I think the Medicine team tends to be chill and reasonable.

What confuses me is that they have been told in the past (when no PM&R director was here) to write notes under PM&R in order to capture function. I have explained repeatedly that this it not how it works - a Medicine doctor is not a PM&R doctor and cannot do PM&R notes as if they were rehab doctors. When the notes are written under PM&R they also erase my notes! which is double work for me.

I want to be polite and reasonable but don't appreciate the complete out of line behavior of this NP.

*Frustrating*

 

[Iamnew2]

"In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance."

Correct. Usually, a non PM&R medical director is hired when a facility has a hard time recruiting a physiatrist.


She sounds completely out of line to me.
The question is how much clout do you have?
Does the Medicine team serve at your pleasure? If you decided tomorrow to go with a different medicine team, could you do it? If you have that kind of discretion, then whoever runs the medicine team is going to do their utmost to keep you pleased, including getting rid of a recalcitrant NP if that's what it takes. If on the other hand you're a "medical director" who is nothing more than a signature on hire, you'll need to approach things more delicately.

Either way, a conversation with the head hospitalist/IM person is a good place to start.

"In my understanding a rehab unit has to have a PM&R medical director in order to be in compliance."

Correct. Usually, a non PM&R medical director is hired when a facility has a hard time recruiting a physiatrist.

You know it's interesting because I was also under the impression that that was the case, re: a facility hiring a non-PM&R doc when they are having a hard time, however in my neck of a woods, there was a med director who was a PM&R doc, who was replaced by a non-PM&R/Medicine doctor who saw patients in a Medicine capacity in the same capacity. I couldn't make out what the deal was with that.

 

[j4pac]

Isn’t what they are promoting fraudulent? That’s a problem and can eventually also put you in hot water as medical director.

If the NP makes errors regarding patient care and refuses to learn…I’m getting them fired. There is too much at stake and our patients deserve better.

 

[Iamnew2]

Isn’t what they are promoting fraudulent? That’s a problem and can eventually also put you in hot water as medical director.

If the NP makes errors regarding patient care and refuses to learn…I’m getting them fired. There is too much at stake and our patients deserve better.

Yes that's whatI told the CEO. I said a medicine team cannot write under PM&R notes and for the midlevel for snippily tell me to "talk to administration" is so incredibly disrespectfulthatI will have to address it tomorrow in front of the CEO and the medicine team. I liked the previous NP, she sometimes disagreed but at the end of the day she was sufficiently humble and had enough of an understanding that she had to learn to do what the physician ultimately decided. This NP I am not ok with.

 

[RangerBob]

If you’re the medical director of the rehab unit then patient care in the rehab unit stops with you. It’s that simple.

I agree with the others—a practitioner with performance issues who isn’t willing to hear their errors/address needs fast remediation or replacement. I think as medical director it’s within your right to request the medicine group “fix it,” however they see fit. Their job (if they’re consultants) is to provide consulting internal medicine services for the rehab patients-they get to determine how to do that in large part (how often to see patients, whether to use an NP, etc), but ultimately you’re the director.

We have issues with our group here and there but when we’ve requested a physician not be allowed to care for our patients they’ve listened.

Also—I believe technically any physician can be a medical director. If I recall you used to have to be PM&R, done a rehab fellowship, or had one year rehab experience (SNF counts) to qualify as a medical director. There was a big push (by AAPM&R I think?) to define the rehab medical director as a PM&R physician (similar to how a psych hospital director has to be psych board certified) but I think that measure failed and Medicare decided to let each individual hospital decide how to define a rehab physician for purposes of being a medical director.

If I am mixed up hopefully someone can correct me

 

[PMR2008]

Also—I believe technically any physician can be a medical director. If I recall you used to have to be PM&R, done a rehab fellowship, or had one year rehab experience (SNF counts) to qualify as a medical director. There was a big push (by AAPM&R I think?) to define the rehab medical director as a PM&R physician (similar to how a psych hospital director has to be psych board certified) but I think that measure failed and Medicare decided to let each individual hospital decide how to define a rehab physician for purposes of being a medical director.

Absolutely right. Anyone can be a inpatient rehab med director.

 

[D P356]

That sounds frustrating. It’s always a good idea to know where your bread gets buttered.
Humble pie gets served to everyone, even the very best.

 

[The kitchen sink]

Let us know the outcome of the meeting

 

[Iamnew2]

Let us know the outcome of the meeting

Meeting went well. CEO agreed with me and we ultimately did what I asked.

 

[The kitchen sink]

Meeting went well. CEO agreed with me and we ultimately did what I asked.

Good to hear