MEC to Physicians: "Get your PLPs under control."

[RustedFox]

Got this in the e-mail today from one of my job sites:

TL : DR - "PLPs are causing problems because they can't medicine. The MEC is watching and holding the physicians responsible. All you suckas need to get the PLPs back in line."


....


In past several months the MEC has become aware of a few instances where the clinical care for our patients have fallen below the standards we have set for ourselves and which we pride ourselves on. As you are aware several physicians/physician groups employ the services of Advanced Practice Professionals including Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) in the care of their patients. The practice needs of some physicians and physicians groups have required that their PAs and APRNs take ED call to help with the ever increasing work load of their practice. This is permitted by the Medical Staff Bylaws and Rules and Regulations provided that the APP on call is backed up by one of their supervising physicians for that call. Whereas it is recognized that there are limitations to the knowledge, skill set and experience of APPs, the intent of this arrangement is to permit the APP to help the physician on call with their call responsibilities, and does not relieve the physician of their primary call obligations and responsibility to the patient.

The expectation therefore is that the physician be involved where the clinical needs of the patient require their skills and expertise, including personally assuming care of the patient whenever necessary. This requires close communication between the APP and the physician on call to determine when such consultation and assumption of care may be necessary, particularly for critically ill, complex or deteriorating patients. Please be reminded, therefore, to establish such parameters with your covering APP staff in order to timely involve you in the care of such patients. Together, and with your help, we are confident that we can deliver the high quality care exceeding expectations for which our patients have entrusted their care to us.

If you have any questions or need additional information, please do not hesitate to reach out to me, and, as always, many thanks for your help in making a difference in the care of the patients we are privileged to serve.



Explain to me again why PLPs think they can practice independently?

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[Porfirio]

Because corporations want them to?

 

[bravotwozero]

So the pendulum has now swung in the other direction, at least at RF's hospital. I know of at least a few cases where attendings got reprimanded/fired for reigning in and supervising MLPs like they're supposed to. There was at least one case in Louisiana where an EP got fired for refusing to admit a patient to a midlevel. He took the case to the Louisiana medical board where they basically said there's nothing we can do...

 

[thegenius]

What do you mean "refusing to admit a patient to a midlevel?"

hand over a patient to a midlevel?
Or refuse to admit a patient to the hospital that was taken care of by a midlevel?

 

[ShockIndex]

I had a good one about 3 years ago while working at our small, community affiliate hospital. An 18-year old comes to the ED with an acutely painful and deformed right testicle. I look at the call list and see that, while we have urology coverage every other day (and sometimes they are only credentialed to take care of left testicle), this particular day Dr. McNutt is on-call and is full credentialed to treat both testicles. Great news as the patient would not need to be transferred to Our Lady of Neglect Regional Referral Center.

So, I have our secretary page Dr. McNutt and 10 min later his PA, Jenny, returns the page. The conversation goes like this:

Me: Hey there, Jenny. I’ve got a guy with an acutely torsed testicle. It’s going to need your boss pronto.

Jenny: Did you get an ultrasound?

Me: Nope, it’s obviously twisted and I’m about to attempted to untwist it (makes twisty motions in the air with both hands). Ultrasounds are for equivocal presentations.

Jenny: Gee, this sounds pretty bad. Perhaps you should transfer him to Our Lady of Neglect. Their urologist is probably at the hospital and could see this guy faster than Dr. McNutt could get there.

Me: Hmmm, no. Dr. McNutt is on call and this is a time-sensitive diagnosis. He needs to stop jerking off and get his waxed ass down here.

Jenny: Well, that is the problem. Dr. McNutt is out of town and I can’t take a patient to the OR without a urologist.

Me: Hmmm, your supervising attending is out of town and unavailable to fulfill his EMTALA obligations? That sounds like a personal problem. I suggest that you either perfect mass-energy transport and beam his ass here, or call one of his partners and get one of them here before Our Lady of Neglect’s ambulance. Because, if they are not here before the ambulance, I’m going to have to check THAT box on the EMTALA transfer form. You know, the box that says, “Failure of On-call Physician to Respond.”

Jenny: Are you are threatening me?

Me: You, no? Your boss, just a little.

Within 15 minutes, Dr. Shaft from the same urology practice was standing tall in the ED and prepping for the OR.

I sent that case for peer review and risk-management, but never heard a damn word about how they would prevent similar shenanigans in the future. Sometimes I think these jerk-offs pull this crap just to see if we will take the bait.

 

[MechEDoc]

I sent that case for peer review and risk-management, but never heard a damn word about how they would prevent similar shenanigans in the future. Sometimes I think these jerk-offs pull this crap just to see if we will take the bait.

Dr. Richard earns the hospital tons on money. They'll just put a target on you.

 

[RoyBasch]

Dr. Richard earns the hospital tons on money. They'll just put a target on you.

This was my first thought when ShockIndex said risk-management buried this clear cut potential EMTALA violation.

 

[NYEMMED]

My hospital started a new policy that all conversations must be attending to attending. The consulting attending can choose to send their middle of the road provider, but only after they discuss the case with me themselves...

Likewise any consult from an ED MLP has to come to me first, then I call the consult to the consulting attending.

 

[thegenius]

This was my first thought when ShockIndex said risk-management buried this clear cut potential EMTALA violation.

LOLZ

(I know what you mean)

 

[Franzd'Epinay]

Got this in the e-mail today from one of my job sites:

TL : DR - "PLPs are causing problems because they can't medicine. The MEC is watching and holding the physicians responsible. All you suckas need to get the PLPs back in line."


....


In past several months the MEC has become aware of a few instances where the clinical care for our patients have fallen below the standards we have set for ourselves and which we pride ourselves on. As you are aware several physicians/physician groups employ the services of Advanced Practice Professionals including Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) in the care of their patients. The practice needs of some physicians and physicians groups have required that their PAs and APRNs take ED call to help with the ever increasing work load of their practice. This is permitted by the Medical Staff Bylaws and Rules and Regulations provided that the APP on call is backed up by one of their supervising physicians for that call. Whereas it is recognized that there are limitations to the knowledge, skill set and experience of APPs, the intent of this arrangement is to permit the APP to help the physician on call with their call responsibilities, and does not relieve the physician of their primary call obligations and responsibility to the patient.

The expectation therefore is that the physician be involved where the clinical needs of the patient require their skills and expertise, including personally assuming care of the patient whenever necessary. This requires close communication between the APP and the physician on call to determine when such consultation and assumption of care may be necessary, particularly for critically ill, complex or deteriorating patients. Please be reminded, therefore, to establish such parameters with your covering APP staff in order to timely involve you in the care of such patients. Together, and with your help, we are confident that we can deliver the high quality care exceeding expectations for which our patients have entrusted their care to us.

If you have any questions or need additional information, please do not hesitate to reach out to me, and, as always, many thanks for your help in making a difference in the care of the patients we are privileged to serve.



Explain to me again why PLPs think they can practice independently?

That's great.

I wonder if that statement caused some blowback from hospital administrators (who often are former nurses).

 

[ShockIndex]

This was my first thought when ShockIndex said risk-management buried this clear cut potential EMTALA violation.

I can’t say for sure that it was buried since I never heard a word back from risk management, the Chief if Staff, or my director. To be fair, Dr. McNutt could have been put on probation or disciplined and I was not told. I kinda doubt it. Like you, I doubt a damn thing happened. However, read on for more hilarity from the same clowns.

Dr. Richard earns the hospital tons on money. They'll just put a target on you.

Yep. However, notice how the hospital leadership responded to this case:

Same small Bumpass hospital with qod urology coverage by the same group that also covers a couple of nearby, community hospitals that happen to be owned by a competing medical system. Making matters worse, not every urologist in that group has full privileges at every hospital. Now, how one doctor is allowed to be on-call for multiple, competing systems is beyond me. But I digress...

So, another request for a urologic consult (I don’t remember the exact case) was paged out to none other than Dr. Nutty McNutt who is listed on the call sheet. After 30 minutes, there is no reply so the secretary dutifully calls the practice after hours operator at the prescribed 30 minutes and 1 second mark:

Secretary: Hello, this is the ED at Bumpass Hospital. We are try to reach Dr. McNutt for a consult.

Operator: Oh, Dr. McNutt is not on-call tonight. He switched with his partner Dr. Jizz’em. I’ll get him to call you.

Listening I to the call I knew there was about to be a problem because nobody had ever heard of Dr. Jizz’em before that call. Twenty minutes later, Dr. Jizz’em calls back and is a total mess with a thick, gooey accent that could barely be understood. The call goes like this:

Me: Hello Dr. Jizz’em. It’s nice to meet you. I have a consult request for X.

Jizz’em: Well, I’m not sure that I can help you. I’m new to the practice and my OR credentials are not yet approved for your hospital. You will just have to transfer him up to Our Lady of Neglect Regional Medical Center.

Me: Let me get this straight. Dr. McNutt, who has privileges here at Bumpass Hospital, is listed as on-call, but he suddenly switched to someone who doesn’t have privileges and the swap not reflected on our call list?

Jizz’em: Well, we take call for many, many hospitals, and sometimes these clerical errors occur. Besides, I’m kinda busy tomorrow in clinic down the road at Clusterfrack Hospital (a competing community hospital just down the road).

Me (feeling kinda salty at this point): So, you are not privileged at my hospital, but you are privileged at Clusterfrack which is 10 minutes away. Yet, you want me send this guy to Our Lady of Neglect which is not covered by your group, is 45 min away, and never has capacity? Hmmm, no. What needs to happen is one of your partners who is credentialed to handle your EMTALA obligations here at Bumpass needs to get their ass and over here. Or, you need to accept this patient to YOUR service at Clusterfrack in transfer. If it’s the latter, I’m checking THAT box on the EMTALA transfer form with both your and McNutt’s name in the blank next to it as failing to respond. The administration can then sort out the blame tomorrow.

Sure enough, the patient went down to Clusterfrack and Holy Hell was raised the next day by hospital admin because a patient was sent out of the system for care. Funny how hospitals respond when they get hit in the wallet.

 

[namethatsmell]

Sure enough, the patient went down to Clusterfrack and Holy Hell was raised the next day by hospital admin because a patient was sent out of the system for care. Funny how hospitals respond when they get hit in the wallet.

There really are few things as delicious as transferring to a competing system after repeatedly sounding the alarm on coverage issues only to fall on deaf administrative ears.

 

[Birdstrike]

"Let's keep PAs down so we can get sued more and put cash in a CMG's pocket! Yeah, awesome!"


Like I've always said, refusing to let mid-levels practice independently, while simultaneously agreeing to "supervise" them without actually supervising them, is a poor choice and a lose/lose situation for doctors. All you're doing is letting CMG and hospital businessmen take the extra revenue from the work the mid-levels have done from you, while exposing yourself to unacceptable levels of liability. The physician loses, but gains nothing, from this type of arrangement.

I see nothing wrong with that letter, by the way. Any competent and rational supervisor could and should send that out to their doctors who are not adequately ensuring the quality of care provided by the mid-levels they've signed up to supervise.

Keeping mid-levels dependent on you does not keep your salary high. It only allows you to be blamed when a mid-level has a bad outcome, while putting money in the pocket of an administrator. Only by letting mid-levels work completely on their own, without any physician to blame when something goes tragically wrong, will underscore the importance of physician-level training. That increases your perceived value, demand for your skill level and therefore salary.

Seeing physicians fight against mid-level independence is one of the most perplexing things I see fellow physicians do. It's short sighted, seems to be based mostly on emotion and resentment, and shows a misunderstanding of what seems likely to be in their best interest.

 

[Brigade4Radiant]

"Let's keep PAs down so we can get sued more and put cash in a CMG's pocket! Yeah, awesome!"


Like I've always said, refusing to let mid-levels practice independently, while simultaneously agreeing to "supervise" them without actually supervising them, is a poor choice and a lose/lose situation for doctors. All you're doing is letting CMG and hospital businessmen take the extra revenue from the work the mid-levels have done from you, while exposing yourself to unacceptable levels of liability. The physician loses, but gains nothing, from this type of arrangement.

I see nothing wrong with that letter, by the way. Any competent and rational supervisor could and should send that out to their doctors who are not adequately ensuring the quality of care provided by the mid-levels they've signed up to supervise.

Keeping mid-levels dependent on you does not keep your salary high. It only allows you to be blamed when a mid-level has a bad outcome, while putting money in the pocket of an administrator. Only by letting mid-levels work completely on their own, without any physician to blame when something goes tragically wrong, will underscore the importance of physician-level training. That increases your perceived value, demand for your skill level and therefore salary.

Seeing physicians fight against mid-level independence is one of the most perplexing things I see fellow physicians do. It's short sighted, seems to be based mostly on emotion and resentment, and shows a misunderstanding of what seems likely to be in their best interest.

You will still be blamed see CRNAs and surgeons. They will find a doctor to blame.

 

[Birdstrike]

You will still be blamed see CRNAs and surgeons. They will find a doctor to blame.

Apples to oranges. Those docs necessarily must share mutual patient with the CRNA's during OR cases. Demand mid-levels get independence and freedom from supervision and then don't get involved in their patients at all, neither directly nor indirectly. At that point you're no more connected to their case than an optometrist in Omaha, and you're not listed anywhere in the medical record to be subpoenaed. The sure fire way to ---- this up would be to give mid-levels independence but to keep some distant, symbolic supervisory role, that doesn't advance patient safety but ties you in enough to still be liable. If you don't get ahead of this and sever all ties, that's the worst case scenario that weak physician leadership will certainly be coerced into accepting by default.

 

[SXMMD]

Apples to oranges. Those docs necessarily must share mutual patient with the CRNA's during OR cases. Demand mid-levels get independence and freedom from supervision and then don't get involved in their patients at all, neither directly nor indirectly. At that point you're no more connected to their case than an optometrist in Omaha, and you're not listed anywhere in the medical record to be subpoenaed. The sure fire way to ---- this up would be to give mid-levels independence but to keep some distant, symbolic supervisory role, that doesn't advance patient safety but ties you in enough to still be liable. If you don't get ahead of this and sever all ties, that's the worst case scenario that weak physician leadership will certainly be coerced into accepting by default.

I don't see physicians ever truly escaping liability. If the ER is on fire and your colleague needs a quick hand to help stabilize, do you help? Maybe you're not obliged to, but I have a hard time seeing a court letting you off the hook on a technicality- "Dr, your colleague came to you for help, patient was decompensating and you had 5 minutes to spare. You couldn't offer 5 minutes of help to save a dying patient?"

I could be wrong, but honestly I don't see a way you get to cut the cord when somebody has to be blamed and you're the fattest target/wallet in the room.

 

[Birdstrike]

I don't see physicians ever truly escaping liability. If the ER is on fire and your colleague needs a quick hand to help stabilize, do you help? Maybe you're not obliged to, but I have a hard time seeing a court letting you off the hook on a technicality- "Dr, your colleague came to you for help, patient was decompensating and you had 5 minutes to spare. You couldn't offer 5 minutes of help to save a dying patient?"

I could be wrong, but honestly I don't see a way you get to cut the cord when somebody has to be blamed and you're the fattest target/wallet in the room.

That’s why it’s called risk management, not “risk elimination.” Being liable for one patient every once in a great while determined by your choice is a great improvement upon being liable for every patients another provider sees, all the time.

Your response is the classic physician response.

I have never met a group of human beings who will complain so much things they’l fight just as hard to keep from changing.

 

[Brigade4Radiant]

Apples to oranges. Those docs necessarily must share mutual patient with the CRNA's during OR cases. Demand mid-levels get independence and freedom from supervision and then don't get involved in their patients at all, neither directly nor indirectly. At that point you're no more connected to their case than an optometrist in Omaha, and you're not listed anywhere in the medical record to be subpoenaed. The sure fire way to ---- this up would be to give mid-levels independence but to keep some distant, symbolic
supervisory role, that doesn't advance patient safety but ties you in enough to still be liable. If you don't get ahead of this and sever all ties, that's the worst case scenario that weak physician leadership will certainly be coerced into accepting by default.

The thing is that this happens in the ED so if you are in the ED and don’t help and you are noticed as the “captain” you will be held liable just as much as the surgeon.

 

[SXMMD]

There is internal conflict here though- if midlevels are so bad they'll expose themselves through liability, then necessarily this is not a "once in a great while event."

In the same vein, while currently one is liable for every pt the midlevel sees, how often are you sued? Once in a great while... not on every patient. So in practical terms, I don't see much a difference between liability you hold now vs when midlevels are independent. I anticipate a functionally similar outcome.

Dont get me wrong, I'm all about riding the waves of change, I just don't think this is going to go the way you think it is going to go.

 

[NYEMMED]

"Let's keep PAs down so we can get sued more and put cash in a CMG's pocket! Yeah, awesome!"


Like I've always said, refusing to let mid-levels practice independently, while simultaneously agreeing to "supervise" them without actually supervising them, is a poor choice and a lose/lose situation for doctors. All you're doing is letting CMG and hospital businessmen take the extra revenue from the work the mid-levels have done from you, while exposing yourself to unacceptable levels of liability. The physician loses, but gains nothing, from this type of arrangement.

I see nothing wrong with that letter, by the way. Any competent and rational supervisor could and should send that out to their doctors who are not adequately ensuring the quality of care provided by the mid-levels they've signed up to supervise.

Keeping mid-levels dependent on you does not keep your salary high. It only allows you to be blamed when a mid-level has a bad outcome, while putting money in the pocket of an administrator. Only by letting mid-levels work completely on their own, without any physician to blame when something goes tragically wrong, will underscore the importance of physician-level training. That increases your perceived value, demand for your skill level and therefore salary.

Seeing physicians fight against mid-level independence is one of the most perplexing things I see fellow physicians do. It's short sighted, seems to be based mostly on emotion and resentment, and shows a misunderstanding of what seems likely to be in their best interest.

I used to think exactly the way you did. Now Im on the other side. The only way to minimize risk from MLPs managing patients is to be completely aware and in control.

Even if "Independent" and we don't sign their chart, Physicians will still be sued no matter what. Why? Lawyers...
Lawyers are looking for the biggest possible payday, Physicians are the fattest cash cow for them to hit with the highest malpractice coverage, even if the malpractice coverage was equal they would want to add the physician to increase any award, and the lawyers payday.
Lawyers will just subpoena the schedule for that day, and you will be sued because you were there and as the person with "the highest education and experience level" in the emergency department "you should have known this MLP was going to hurt my client"....

 

[Mushdoc]

You would still likely be liable if they asked for help, but if they don't ask for help, then you're unaffiliated with the case. You have no responsibility if you are unaware, unaffiliated and not legally or institutionally responsible. A few lawyers might try at first but I really don't think it would work.

....Now if the hospital or staffing agency puts it into their contract.......

 

[GeneralVeers]

I don't affiliate myself with any patients that I'm not responsible for even if in the ED. If there was an NP/PA managing a patient I wouldn't do anything if not officially responsible.

 

[thegenius]

Like I've always said, refusing to let mid-levels practice independently, while simultaneously agreeing to "supervise" them without actually supervising them, is a poor choice and a lose/lose situation for doctors. All you're doing is letting CMG and hospital businessmen take the extra revenue from the work the mid-levels have done from you, while exposing yourself to unacceptable levels of liability. The physician loses, but gains nothing, from this type of arrangement.
...
Keeping mid-levels dependent on you does not keep your salary high. It only allows you to be blamed when a mid-level has a bad outcome, while putting money in the pocket of an administrator. Only by letting mid-levels work completely on their own, without any physician to blame when something goes tragically wrong, will underscore the importance of physician-level training. That increases your perceived value, demand for your skill level and therefore salary.

There are numerous examples on this forum, where I work, and others where having midlevels practice in an ER increases doc pay. It also increases CMG pay as well.

So we do get compensated for the risk. not sure why you think it does not.

 

[Birdstrike]

The thing is that this happens in the ED so if you are in the ED and don’t help and you are noticed as the “captain” you will be held liable just as much as the surgeon.

No one is talking about refusing to help when asked. That's not even a thing. The point is, you don't get sued because your partner (M.D.) has a patient you never saw, with a bad outcome. That's because he practices independently. Whether or not you join him/her to help out with a case once in a blue moon, doesn't mean you're medical-legally liable for every patient he sees. You're not signing his charts or acting as a "supervisor." As long as you agree to supervise P.A.s, you're liable for ever chart you sign. If they gain independence, you wouldn't have to sign every chart and wouldn't be liable for any chart you don't sign.

There are multiple PA's working in my group. None currently work under me, I don't supervise them and I sign none of their charts. It's impossible for me to get sued over patients they see. The docs who're supervising, on the other hand can get sued.

 

[NYEMMED]

No one is talking about refusing to help when asked. That's not even a thing. The point is, you don't get sued because your partner (M.D.) has a patient you never saw, with a bad outcome. That's because he practices independently. Whether or not you join him/her to help out with a case once in a blue moon, doesn't mean you're medical-legally liable for every patient he sees. You're not signing his charts or acting as a "supervisor." As long as you agree to supervise P.A.s, you're liable for ever chart you sign. If they gain independence, you wouldn't have to sign every chart and wouldn't be liable for any chart you don't sign.

There are multiple PA's working in my group. None currently work under me, I don't supervise them and I sign none of their charts. It's impossible for me to get sued over patients they see. The docs who're supervising, on the other hand can get sued.

How did you manage to do this? I feel like most everyone is forced to supervise.

 

[Birdstrike]

Dont get me wrong, I'm all about riding the waves of change, I just don't think this is going to go the way you think it is going to go.

I don't "think it's going to go" any other way than stay as it is. Frankly, I don't really care, because I currently have no PA's working under me and am not liable for any. So, it really doesn't matter to me much either way. My main point is that I find it amusing when docs complain about having to be liable for PAs that are dependent on them, yet simultaneously resists PAs becoming independent of them.

Other than that, I have no dog in this fight. I took made some hard and painful sacrifices to be in more control over this, and I am.

 

[Birdstrike]

I used to think exactly the way you did. Now Im on the other side. The only way to minimize risk from MLPs managing patients is to be completely aware and in control.

We're not on different sides on this. When I was forced to work with PAs that I had no role in hiring or firing, I supervised very closely. I wasn't a "sign the chart the next day" kind of guy. Although, I know some people say they are coerced to do this, either indirectly or due to impossible, patient volume loads.

Even if "Independent" and we don't sign their chart, Physicians will still be sued no matter what. Why? Lawyers...

Not true. You can't be successfully sued just "cuz lawyers." They have to have a case. Suing someone with no supervisory role doesn't work. Now, it may be possible someone has signed you up as the supervising physician (your employer or ED director) and you may not know that. They you could be held liable. But just because you're a doctor in the hospital at the same time a PA committed malpractice, doesn't mean you are liable. You really just think that if a PA has a bad outcome, they can sue ever doctor, everywhere in the hospital, who's ever been on staff, all nurses in the hospital (they have insurance policies, too) and the CEO (they have executive liability policies) and his boss and his boss, "cuz lawyers"?

No.

The reason is because they are independent of the treating provider.

 

[Birdstrike]

You have no responsibility if you are unaware, unaffiliated and not legally or institutionally responsible.

Yes. Thank you. This is a very simple concept. They're either dependent providers or independent providers. Currently ED mid-levels are dependent providers, and essentially the only group fighting to keep it this way, is doctors.

 

[Birdstrike]

I don't affiliate myself with any patients that I'm not responsible for even if in the ED.

Yes. It's so simple. It's mind boggling to me that anyone in Medicine would have trouble understanding this.

 

[Birdstrike]

There are numerous examples on this forum, where I work, and others where having midlevels practice in an ER increases doc pay.

Yes. If you own the group, you can use revenue from mid-level work to increase your pay if you choose to. That's how we do it in my physician owned group for the M.D.s that take on mid-levels. Most EPs don't work in physician owned groups.

It also increases CMG pay as well.

Oh, yes absolutely it increases CMG pay, just not CMG physician pay much, if at all.

CMGs pay you a market rate for your work, no more, no less. They don't give you revenue from mid-level work out of principle or out of the goodness of their own heart or at all. That's not how corporations work. Any excess revenue/profits, including above and beyond market rates for payroll, are going to be counted as profits and are going to go to the owners (shareholders) of the company. Profits are not and will not be randomly distributed to any certain class of non-owner employees. A rare exception would be a profit-share system for non-shareholders. If you know of examples of such programs for employed (non-owner/non-shareholder) M.D. I'd be interested in hearing about them.

Thought experiment: A CMG CEO and Board of Directors discuss some excess revenue during their last quarter. One board member makes a motion to use that money to increase physician pay. Another members makes a motion to use that money to increase CEO and Board member pay.

Which motion passes and which fails?

 

[Birdstrike]

How did you manage to do this? I feel like most everyone is forced to supervise.

When I worked in the ED I was forced to supervise. Now that I don't work in an ED (post fellowship), I have the choice.

 

[blue.jay]

No one is talking about refusing to help when asked. That's not even a thing. The point is, you don't get sued because your partner (M.D.) has a patient you never saw, with a bad outcome. That's because he practices independently. Whether or not you join him/her to help out with a case once in a blue moon, doesn't mean you're medical-legally liable for every patient he sees. You're not signing his charts or acting as a "supervisor." As long as you agree to supervise P.A.s, you're liable for ever chart you sign. If they gain independence, you wouldn't have to sign every chart and wouldn't be liable for any chart you don't sign.

There are multiple PA's working in my group. None currently work under me, I don't supervise them and I sign none of their charts. It's impossible for me to get sued over patients they see. The docs who're supervising, on the other hand can get sued.

Not having to supervise midlevels is a luxury these days

 

[NYEMMED]

When I worked in the ED I was forced to supervise. Now that I don't work in an ED (post fellowship), I have the choice.

One can hope and wish... At this point in my career, I cannot afford to do a fellowship, It would be nice...

 

[blue.jay]

When I worked in the ED I was forced to supervise. Now that I don't work in an ED (post fellowship), I have the choice.

They are now in ICUs too

 

[Birdstrike]

One can hope and wish... At this point in my career, I cannot afford to do a fellowship, It would be nice...

I had to go into debt to do mine.

 

[Birdstrike]

They are now in ICUs too

I don't work in an ICU, but maybe it's an environment more conducive to supervising, being a more controlled, closed system? I don't know.

I've worked with some great docs and some not so good. I've worked with some great mid-levels and some not so good. But there wasn't a single one whose liability I yearned to take upon myself.

 

[thegenius]

I don't "think it's going to go" any other way than stay as it is. Frankly, I don't really care, because I currently have no PA's working under me and am not liable for any. So, it really doesn't matter to me much either way. My main point is that I find it amusing when docs complain about having to be liable for PAs that are dependent on them, yet simultaneously resists PAs becoming independent of them.

I agree that. However it makes some sense...doctors just want to practice by themselves and don't even want to be a part of the whole PA thing. And they don't want PAs to "play doctor". Makes general sense to me. Docs do make money off the easy cases too and it's part of being a doctor. You get the complicated stuff, you get the easy stuff.

 

[Birdstrike]

My advice to physicians regarding mid-levels is to choose one of these. Either,

-Embrace being responsible for them and commit to close supervision, or

-If you must resent being responsible for mid-levels, work towards and support their full independence so you no longer have to.


Do not choose to:

-Fighting to keep mid-levels dependent on physicians, while resenting the fact that mid-levels are dependent on physicians.

 

[Birdstrike]

I agree that. However it makes some sense...doctors just want to practice by themselves and don't even want to be a part of the whole PA thing. And they don't want PAs to "play doctor". Makes general sense to me. Docs do make money off the easy cases too and it's part of being a doctor. You get the complicated stuff, you get the easy stuff.

That's cool. If you're happy with the way the system is, then I'm cool with that.

 

[thegenius]

No I’m not happy with the current system. I don’t want PAs to practice independently and I don’t want to sign their charts. I only have so much power though. I can’t rise up and just change the system.

I do disagree with your prior post responding to mine. Yes I agree that if a company has increased revenue they will likely want to keep it among management and not give it to their employees. But employees can also negotiate these things and do get some of that money. It’s part of the negotiation process.

so I will grant you the admission that I bet there are some ED groups out there that are not optimally designed and profits stay at the top, and you will grant me the notion that in fact there are ED groups out there where docs make more money as a result of supervising mid levels. if you don’t, then I will force you to listen to only N’Sync and Carly Rae Jepson for the next 30 days.

There are docs who have posted on here their general increases in take home pay after signing P.A. charts. I am one of them and know that we made more under TH based on the language in one of our contracts.

 

[Birdstrike]

if you don’t, then I will force you to listen to only N’Sync and Carly Rae Jepson for the next 30 days.

Is this negotiable? Can it be the Weird Al versions of said demons?