Reviewing MLP charts. FUN TIMES!

[RustedFox]

I've posted on here once or twice about an interaction that I had with a PA at my GI office (I have ulcerative colitis), where the PA didn't know that I was a physician and tried to *snow* me into a lie that I knew was a lie. Shortly after I called them out on it, I saw a physician - one that I knew from the hospital.

See; these MLPs never get off of that first peak of the Dunning-Kruger curve; often because they bounce about between FM/IM/GI/Cards/Whatever.

That VERY same MLP that I called out on her lies was/is the very same one who is now doing hospitalist MLP duties at one of my job sites.

My site medical director asked me what I thought of him/her.

I told him the story of our interaction in the GI office.

Not much more needed to be said.

The reply was "Okay. They're not to be trusted. Moving on..."

---

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[67552931811]

This; for the win.

Mrs. Fox had her intake appointment at a new PMD office last week.
She came home, and this is what she had to say:

The PA introduced herself as "Doctor Jenny".
She didn't know several of the meds on my medication list; couldn't pronounce them.
She completely blew off my concerns about autoimmune disease, despite me telling her that "the pain gets better after steroids, and is in my large joints; it comes and goes without any warning".
I don't want to see her again. I really thought for an intake appointment, that I'd see a doctor.

How is it legal for them to introduce themselves as “Doctor.” I hear nps do this all day long

It’s insane

 

[RustedFox]

I have tried more than a few times to find a video clip that I could embed here, but to no avail:

You know that scene in the first few minutes of PLATOON where Sgt. Elias (Willem Dafoe) says:

"They don't know ****, Barnes - and chances are we're going to run into something out there tonight."

I feel like Elias, all day sometimes.

 

[TooMuchResearch]

I have a similar problem in the ED.
"Hi, I'm Dr. TooMuchResearch, one of the emergency doctors here."
Yes, I say doctor twice.
At least twice a week the patient asks when the other nurse is coming back. Or asks if I'm the student and one of our PAs is supervising me. After I say doctor twice and the nurse has already put my name and Dr. on the white board in the room.
Most patients just don't know the difference. Or don't care.
We have a few local primary care physicians that are probably accidental murderers, but oh so many more PAs and NPs.

You heard it:
"Hi, I'm Doctor Jenny."

My wife knew that she was a PA because she read the website before her intake appointment.

Furthermore, the patients that come to my ER seem to have no idea that they're seeing a MLP.

Me: "Who is your family care doctor?"
Them: "I see Doctor Jenny." (always first-name only)
Me: "Where does Doctor Jenny work?"
Them: "At ABCD HealthCare"
Me: "That's not a doctor. Who is their supervising physician?"
Them: "I don't know what that means."

 

[RustedFox]

I have a similar problem in the ED.
"Hi, I'm Dr. TooMuchResearch, one of the emergency doctors here."
Yes, I say doctor twice.
At least twice a week the patient asks when the other nurse is coming back. Or asks if I'm the student and one of our PAs is supervising me. After I say doctor twice and the nurse has already put my name and Dr. on the white board in the room.
Most patients just don't know the difference. Or don't care.
We have a few local primary care physicians that are probably accidental murderers, but oh so many more PAs and NPs.

I take it you're female.

I have a tangentially related problem where the geezers around here ask me what I want to do when I'm done with [medical school or residency].
I get it: I'm 38, and if it weren't for the racoon eyes, I'd look like I was in my 20s.
Mrs. Fox still gets carded for purchasing booze. she's 37, and honest-to-God looks 30.
I respond, unapologetically, with: "Nope; done with all of those. I'm Doctor RustedFox, Board Certified Emergency Medicine. Happy to take care of you."

 

[TheSingularity]

I give it about 10 yrs till full midlevel take over. Primary care (IM and Peds), urgent care, EM, anesthesia, ICU....finished. Maybe you'll have one attending overseeing 10 midlevels in EM/anesthesia/ICU. Start re-inventing yourself now.

 

[GeneralVeers]

I take it you're female.

I have a tangentially related problem where the geezers around here ask me what I want to do when I'm done with [medical school or residency].
I get it: I'm 38, and if it weren't for the racoon eyes, I'd look like I was in my 20s.
Mrs. Fox still gets carded for purchasing booze. she's 37, and honest-to-God looks 30.
I respond, unapologetically, with: "Nope; done with all of those. I'm Doctor RustedFox, Board Certified Emergency Medicine. Happy to take care of you."

I look like I'm in my 20's so get this all day long. I usually tell people "It's my first day" which guarantees a look of shock and bewilderment.

Also a side note, when the old folks bring up Doogie Howser, I tell them that I have no idea what that is, as I wasn't born when it came out.

 

[thegenius]

For any NP's or PA's or MLP's or whatever they want to be called....this is for you.

This is why most doctors are nervous and scared to sign midlevel charts and be a supervising physician, and why we cringe and get upset when they don't want to be supervised the way the doctor wants to supervise them.

Read below, directly from a lawyer. See how many people can be sued? Doesn't matter how little or much oversight there is, whether the doc is in the room or not.

A Physician Assistant's Mistakes Create Liability For The Supervising Doctor - John H. Fisher, P.C.

 

[VA Hopeful Dr]

How is a PA saying she's a doctor? And what kind of doctor calls themselves by their first name?

When I was doing DPC, I did. It's a pretty common thing to do in that area.

Heck, even now I introduce myself by first and last name - no Doctor.

 

[RustedFox]

For any NP's or PA's or MLP's or whatever they want to be called....this is for you.

This is why most doctors are nervous and scared to sign midlevel charts and be a supervising physician, and why we cringe and get upset when they don't want to be supervised the way the doctor wants to supervise them.

Read below, directly from a lawyer. See how many people can be sued? Doesn't matter how little or much oversight there is, whether the doc is in the room or not.

A Physician Assistant's Mistakes Create Liability For The Supervising Doctor - John H. Fisher, P.C.

Presently being sued for a case that I never saw, but the chart came to me for a signature.

 

[Piebaldi]

Presently being sued for a case that I never saw, but the chart came to me for a signature.

If the midlevel "supervised" had their own insurnace, they would get sued vs. you. It would be interesting to do a study - who gets sued more, physicians or midlevels? Again sometimes it's like kids - you have to let them suffer certain consequences until they realize that as a parent you love them and want the best for them - and it's not until they get a boo boo until they realize that hey i have to listen to mom and dad they know best. Letting midelvels practice independently would likely be a blessing.

 

[GeneralVeers]

If the midlevel "supervised" had their own insurnace, they would get sued vs. you. It would be interesting to do a study - who gets sued more, physicians or midlevels? Again sometimes it's like kids - you have to let them suffer certain consequences until they realize that as a parent you love them and want the best for them - and it's not until they get a boo boo until they realize that hey i have to listen to mom and dad they know best. Letting midelvels practice independently would likely be a blessing.

Actually completely wrong. Lawyers sue everyone on the chart and see what will stick. They will still sue the physician, and often the hospital in addition to the midlevel.

 

[Piebaldi]

Actually completely wrong. Lawyers sue everyone on the chart and see what will stick. They will still sue the physician, and often the hospital in addition to the midlevel.

Not if midlevels are practicing independently. That's the issue. If midlevel has a private practice or has no actually linked physician supervision they will be sued by themselves - so there is "physician" on the chart is my point.

 

[TooMuchResearch]

I am not currently not have I ever been female. Maybe I should tuck in my scrubs or shave more (or less?) often.

I take it you're female.

I have a tangentially related problem where the geezers around here ask me what I want to do when I'm done with [medical school or residency].
I get it: I'm 38, and if it weren't for the racoon eyes, I'd look like I was in my 20s.
Mrs. Fox still gets carded for purchasing booze. she's 37, and honest-to-God looks 30.
I respond, unapologetically, with: "Nope; done with all of those. I'm Doctor RustedFox, Board Certified Emergency Medicine. Happy to take care of you."

 

[TooMuchResearch]

Every time one of our PAs asks me a question and says I don't have to see the patient, I see the patient. They're going to put me on the liability hook with my name on the chart, so I'm going to get the RVU credit.

For any NP's or PA's or MLP's or whatever they want to be called....this is for you.

This is why most doctors are nervous and scared to sign midlevel charts and be a supervising physician, and why we cringe and get upset when they don't want to be supervised the way the doctor wants to supervise them.

Read below, directly from a lawyer. See how many people can be sued? Doesn't matter how little or much oversight there is, whether the doc is in the room or not.

A Physician Assistant's Mistakes Create Liability For The Supervising Doctor - John H. Fisher, P.C.

 

[southerndoc]

If the midlevel "supervised" had their own insurnace, they would get sued vs. you. It would be interesting to do a study - who gets sued more, physicians or midlevels? Again sometimes it's like kids - you have to let them suffer certain consequences until they realize that as a parent you love them and want the best for them - and it's not until they get a boo boo until they realize that hey i have to listen to mom and dad they know best. Letting midelvels practice independently would likely be a blessing.

When midlevels have their own insurance, they AND the supervising physician get sued. I've seen this numerous times in my legal work.

 

[Piebaldi]

When midlevels have their own insurance, they AND the supervising physician get sued. I've seen this numerous times in my legal work.

Again I am clearly not being clear!ha! I mean this in terms of them working ON THEIROWN with NO physician supervision. so NO physician,just midlevels on their OWN-some states have no supervision requirements.

 

[deleted951662]

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

 

[TheSingularity]

Run away

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

Sent from my Pixel 3 using SDN mobile

 

[Fox800]

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

Don't take this kind of job.

 

[Dr Mantis Toboggan]

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

They may have legal authority to practice independently. But many hospitals and healthcare systems want them to move the meat and see many patients while still being “supervised” by a physician. Essentially they want to have their cake and eat it too.

Your concern is spot on. If you hire them, and they work for you, and you profit off their labors in exchange for your oversight, that’s one thing.The type of deal you are being offered is another.

 

[MedicineZ0Z]

I give it about 10 yrs till full midlevel take over. Primary care (IM and Peds), urgent care, EM, anesthesia, ICU....finished. Maybe you'll have one attending overseeing 10 midlevels in EM/anesthesia/ICU. Start re-inventing yourself now.

15 Doctors Fired From Chicago-Area Health System

Physicians 'broadsided' by their termination

www.medpagetoday.com

 

[RustedFox]

I am not currently not have I ever been female. Maybe I should tuck in my scrubs or shave more (or less?) often.

Well don't I feel like a boob, now.

Generally, the female docs on here complain about being confused for nurses when this topic comes up.

Great response, though. Made me lol.

 

[deleted1013752]

Healthcare cost was cited as the primary driver behind that, but are cost savings actually passed on to patients? And what if national pay parity happens? My premium and copay don’t change if I see an NP, and my insurance pays the same rate for a basic visit despite living in a state without parity law.

 

[Vandalia]

15 Doctors Fired From Chicago-Area Health System

Physicians 'broadsided' by their termination

www.medpagetoday.com

In their email, hospital system CEO Mary Lou Mastro, MS, RN, and Chief Medical Officers Robert Payton, MD, and Daniel Sullivan, MD, pointed to patient cost concerns as the reason for eliminating the jobs: "Patients have made it very clear that they want less costly care and convenient access for lower-acuity issues (sore throats, rashes, earaches), which are the vast majority of cases we treat in our Immediate Cares."

If they actually reduce the amount a patient pays at one of their "immediate care" centers, I will eat my computer.

 

[thegenius]

Well don't I feel like a boob, now

I think there is a penis on your forehead.

 

[thegenius]

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

You have to get to the bottom of this and have crystal clear information, IN YOUR CONTRACT, about this.

It’s rather simple. If you are legally liable for their work, for anything they do (the PAs that is), then you must be paid to take on that risk. It’s that simple. You and only you can decide whether it’s worth it for you to take on that risk.

If the PAs are going to identify you as a supervising physician, you have to know what that means legally. You might need to hire a contract lawyer to go over your contract with them, it’s probably worth the money for that.

Now you may not easily be able to “run” from the job as others have suggested. Maybe there isn’t another one around you.

If they say “well the reimbursement you get for that is built into your salary”....thats fine, they can say that, then you have to determine if their pay is competitive.

Another way to approach this is to tell them “if im acting as the supervising physician then i plan on asking all of them to present every case to me prior to disposition and I reserve the right to see the patient prior to discharge.” See how they react. If they say “that is unacceptable as it will slow down the NPs and obviate the whole purpose of having them” ...THEN YOU RUN. That is clearly not acceptable. If they instead say “that’s ok as that is your right” then you can determine if you want to work there.

 

[Piebaldi]

This Is getting very muddy;
I am currently looking for jobs ( in a different field) in a state in which in NPs practice independently. Many of the jobs I am being offered my title is “lead physician” for a handful of NPs. The question I have, is if they are independent, then why do they need a leader? When I ask details about this, and what this means in regards to my liability, I can’t seem to get any straight answers.

Don't do it. There are numerous "collaborative" physician jobs,don't do it. In my experience midlevels have very limited understanding of medicine -even those who have been in the field for a long time. You are setting yourself up for failure.

 

[Piebaldi]

Don't do it. There are numerous "collaborative" physician jobs,don't do it. In my experience midlevels have very limited understanding of medicine -even those who have been in the field for a long time. You are setting yourself up for failure.

I think there is a penis on your forehead.

Ohio bill orders doctors to ‘reimplant ectopic pregnancy’ or face 'abortion murder' charges

Ohio introduces one of the most extreme bills to date for a procedure that does not exist in medical scienceOhio abortion law: the Ohio governor, Mike DeWine, signs the ‘heartbeat bill’, one of the nation’s toughest abortion bans, on 11 April 2019. Photograph: Fred Squillante/APA bill to ban...

www.yahoo.com

More medical idiocy coming! Ohio "legislators" want "ectopic pregnancies" to be "reimplanted" into a woman's body or else physicians face possible jail time!What is happening to the world and this field?!

 

[RustedFox]

UPDATE:

I worked Thanksgiving and Black Friday (two traditionally very busy days) at my primary job site.
Before anyone argues about Thanksgiving being "dead"; its not so at our shop, where the average patient is a 74 year old female on LOTS of meds.

We had no MLP help at all. Just me and the other afternoon doc (double-covered) against the world.
I saw just over 3.5pph both days. OtherDoc did about the same.

We had no difficulty keeping up.
Sure, some people waited 30 minutes before being seen, but whatev. 30 mins is okay.
Anyone in acute distress was seen FIRST. The "family plan" of mommy + 3 kids who are not sick... waited.

Same tag-team for both days: RustedFox and GiantGermanDoc (if I had to give him a screen name)
Its especially funny if you know me in real-life, because I'm 5'6'' and he's 6'2''.
We would make a good tag-team, as there's often the small, flighty, high-energy one paired with the big, lumbering tank.

The key was this: we both were committed to not working up level-3s and 4s that didn't need it, because we are both very comfortable with our "sick vs. not sick" assessments.
Workups talked, bull$hit walked. A lot of it was simple level-4s and uncomplicated 3s, with the odd stroke alert or sepsis alert thrown in.
Sure, we could have used an MLP to do some lac repairs and siphon off simple ortho, but pediatric fever... walked. Asymptomatic HTN... walked.
G.T.F.O.

Post-hoc analysis:

It has become very clear to us that our former MLP crew hamstrung us by doing two things:

#1) They ordered pointless tests when discharge would do. No RSV/Rapid strep/Flu swabs/Chest x-rays on simple peds fevers. No CBC/BMP/EKG/TnI/CT brain on asymptomatic HTN, or HTN that was "lightheaded" but was clearly not lightheaded. They never mastered the art of "go the hell home".

#2) They d!cked around picking up level-3 abdominal pains and level-2/3 "weakness", ordered everything under the sun, then waited until everything came back, realized that they didn't know what to do next, and dumped the case on one of us to mop it all up.

Out of our old MLP crew, there were 2 that were damn good. Both were PAs.
One was "serviceable", but needed frequent service.
The rest? Good riddance.

Someone said in a related thread that to work at a true community shop, that you need a PA to actually be an "assistant" and not try to be functioning like a PGY-1 resident.

My experience over the past 2 days has proven those words to be so very, very true.

I'm really hoping that our new PA-only crew listens to the message that we very clearly have sent them:

"You're here to see simple stuff, quickly - not to pick up big workups and then argue as to why you would do it different (sic)".

 

[TooMuchResearch]

Mt worst adventures in mis-management have all been mid-level related.
Many of our group feel this way, but we haven't had the collective balls (these are pronoun free balls, everyone and anyone can have them) to change our staffing model.
I'm writing some ideas down and will bring them to an upcoming (physician only) meeting when the mood feels right. Probably next time we are short mid-levels or we have another bad outcome directly related to mis-management and not involving a physician early enough.

UPDATE:

I worked Thanksgiving and Black Friday (two traditionally very busy days) at my primary job site.
Before anyone argues about Thanksgiving being "dead"; its not so at our shop, where the average patient is a 74 year old female on LOTS of meds.

We had no MLP help at all. Just me and the other afternoon doc (double-covered) against the world.
I saw just over 3.5pph both days. OtherDoc did about the same.

We had no difficulty keeping up.
Sure, some people waited 30 minutes before being seen, but whatev. 30 mins is okay.
Anyone in acute distress was seen FIRST. The "family plan" of mommy + 3 kids who are not sick... waited.

Same tag-team for both days: RustedFox and GiantGermanDoc (if I had to give him a screen name)
Its especially funny if you know me in real-life, because I'm 5'6'' and he's 6'2''.
We would make a good tag-team, as there's often the small, flighty, high-energy one paired with the big, lumbering tank.

The key was this: we both were committed to not working up level-3s and 4s that didn't need it, because we are both very comfortable with our "sick vs. not sick" assessments.
Workups talked, bull$hit walked. A lot of it was simple level-4s and uncomplicated 3s, with the odd stroke alert or sepsis alert thrown in.
Sure, we could have used an MLP to do some lac repairs and siphon off simple ortho, but pediatric fever... walked. Asymptomatic HTN... walked.
G.T.F.O.

Post-hoc analysis:

It has become very clear to us that our former MLP crew hamstrung us by doing two things:

#1) They ordered pointless tests when discharge would do. No RSV/Rapid strep/Flu swabs/Chest x-rays on simple peds fevers. No CBC/BMP/EKG/TnI/CT brain on asymptomatic HTN, or HTN that was "lightheaded" but was clearly not lightheaded. They never mastered the art of "go the hell home".

#2) They d!cked around picking up level-3 abdominal pains and level-2/3 "weakness", ordered everything under the sun, then waited until everything came back, realized that they didn't know what to do next, and dumped the case on one of us to mop it all up.

Out of our old MLP crew, there were 2 that were damn good. Both were PAs.
One was "serviceable", but needed frequent service.
The rest? Good riddance.

Someone said in a related thread that to work at a true community shop, that you need a PA to actually be an "assistant" and not try to be functioning like a PGY-1 resident.

My experience over the past 2 days has proven those words to be so very, very true.

I'm really hoping that our new PA-only crew listens to the message that we very clearly have sent them:

"You're here to see simple stuff, quickly - not to pick up big workups and then argue as to why you would do it different (sic)".

 

[Listen2Savage]

I've been especially pissy about midlevels since two occurrences.

1. A coordinator at an away was a PA who walked around with a chip on her shoulder, pretty much told me to eff off when the program couldn't even fill out a SLOE for me, completely took out all of her insecurities on the students.

2. When a resident gave a central line to a PA over me. Are PAs doing CVLs on the reg? Seems like not in their purvue like at all.

 

[Fox800]

I've been especially pissy about midlevels since two occurrences.

1. A coordinator at an away was a PA who walked around with a chip on her shoulder, pretty much told me to eff off when the program couldn't even fill out a SLOE for me, completely took out all of her insecurities on the students.

2. When a resident gave a central line to a PA over me. Are PAs doing CVLs on the reg? Seems like not in their purvue like at all.

I can understand not letting a medical student do a CVL. But no, PAs should not be doing these if there are EM residents around. Ever.

 

[jw3600]

UPDATE:

I worked Thanksgiving and Black Friday (two traditionally very busy days) at my primary job site.
Before anyone argues about Thanksgiving being "dead"; its not so at our shop, where the average patient is a 74 year old female on LOTS of meds.

We had no MLP help at all. Just me and the other afternoon doc (double-covered) against the world.
I saw just over 3.5pph both days. OtherDoc did about the same.

We had no difficulty keeping up.
Sure, some people waited 30 minutes before being seen, but whatev. 30 mins is okay.
Anyone in acute distress was seen FIRST. The "family plan" of mommy + 3 kids who are not sick... waited.

Same tag-team for both days: RustedFox and GiantGermanDoc (if I had to give him a screen name)
Its especially funny if you know me in real-life, because I'm 5'6'' and he's 6'2''.
We would make a good tag-team, as there's often the small, flighty, high-energy one paired with the big, lumbering tank.

The key was this: we both were committed to not working up level-3s and 4s that didn't need it, because we are both very comfortable with our "sick vs. not sick" assessments.
Workups talked, bull$hit walked. A lot of it was simple level-4s and uncomplicated 3s, with the odd stroke alert or sepsis alert thrown in.
Sure, we could have used an MLP to do some lac repairs and siphon off simple ortho, but pediatric fever... walked. Asymptomatic HTN... walked.
G.T.F.O.

Post-hoc analysis:

It has become very clear to us that our former MLP crew hamstrung us by doing two things:

#1) They ordered pointless tests when discharge would do. No RSV/Rapid strep/Flu swabs/Chest x-rays on simple peds fevers. No CBC/BMP/EKG/TnI/CT brain on asymptomatic HTN, or HTN that was "lightheaded" but was clearly not lightheaded. They never mastered the art of "go the hell home".

#2) They d!cked around picking up level-3 abdominal pains and level-2/3 "weakness", ordered everything under the sun, then waited until everything came back, realized that they didn't know what to do next, and dumped the case on one of us to mop it all up.

Out of our old MLP crew, there were 2 that were damn good. Both were PAs.
One was "serviceable", but needed frequent service.
The rest? Good riddance.

Someone said in a related thread that to work at a true community shop, that you need a PA to actually be an "assistant" and not try to be functioning like a PGY-1 resident.

My experience over the past 2 days has proven those words to be so very, very true.

I'm really hoping that our new PA-only crew listens to the message that we very clearly have sent them:

"You're here to see simple stuff, quickly - not to pick up big workups and then argue as to why you would do it different (sic)".

Love it. Imagine having a late PGY1 or early early PGY2 as an assistant that you give tasks to. “Hey see this patient.” “Hey do this lac.” “Hey deal with this social nightmare.” But there’s no teaching or asking “what do think/what do you want to do?” How much time do you save. Sounds incredible. And that’s entirely the point of what midlevels were supposed to be. Competent assistants. NOT an apprentice or a collaborator. If someone wants to learn a complex craft or be a colleague, they can go to med school.

 

[boomshaketheroom]

I've been especially pissy about midlevels since two occurrences.

1. A coordinator at an away was a PA who walked around with a chip on her shoulder, pretty much told me to eff off when the program couldn't even fill out a SLOE for me, completely took out all of her insecurities on the students.

2. When a resident gave a central line to a PA over me. Are PAs doing CVLs on the reg? Seems like not in their purvue like at all.

Midlevels do CVLs all the time. Less often in places with residents, but critical care midlevels especially do tons of them. I assume delegating meant the resident was already busy and wanted to save time. In that instance having you do it would be the opposite of what they want as they would have to stop and supervise you no matter how many you've done or how good you are.

 

[Listen2Savage]

Midlevels do CVLs all the time. Less often in places with residents, but critical care midlevels especially do tons of them. I assume delegating meant the resident was already busy and wanted to save time. In that instance having you do it would be the opposite of what they want as they would have to stop and supervise you no matter how many you've done or how good you are.

the PA had never done a CVL

 

[KeikoTanaka]

If the midlevel "supervised" had their own insurnace, they would get sued vs. you. It would be interesting to do a study - who gets sued more, physicians or midlevels? Again sometimes it's like kids - you have to let them suffer certain consequences until they realize that as a parent you love them and want the best for them - and it's not until they get a boo boo until they realize that hey i have to listen to mom and dad they know best. Letting midelvels practice independently would likely be a blessing.

I'd be willing to bet they wouldn't be sued too often regardless. Physicians take on difficult/hard cases and therefore the propensity of error is high, EVEN IF YOU DO EVERYTHING RIGHT. The patient was just too sick to take to treatment.
The MLP knows to just dump their problems on a specialist. So, if anything, I can imagine MLPs being sued for delaying important diagnoses, but, considering most work independently in outpatient PC, missing a chronic diagnosis may not be the end of the world for a couple years, until they become the hero by "incidentally" finding it years later, but now the patient is happy and didn't know any better. It's a perfect storm of patient and provider ignorance.

 

[Alvarez13]

Out of our old MLP crew, there were 2 that were damn good. Both were PAs.
One was "serviceable", but needed frequent service.
The rest? Good riddance.

Someone said in a related thread that to work at a true community shop, that you need a PA to actually be an "assistant" and not try to be functioning like a PGY-1 resident.

My experience over the past 2 days has proven those words to be so very, very true.

I'm really hoping that our new PA-only crew listens to the message that we very clearly have sent them:

"You're here to see simple stuff, quickly - not to pick up big workups and then argue as to why you would do it different (sic)".

Love it. Imagine having a late PGY1 or early early PGY2 as an assistant that you give tasks to. “Hey see this patient.” “Hey do this lac.” “Hey deal with this social nightmare.” But there’s no teaching or asking “what do think/what do you want to do?” How much time do you save. Sounds incredible. And that’s entirely the point of what midlevels were supposed to be. Competent assistants. NOT an apprentice or a collaborator. If someone wants to learn a complex craft or be a colleague, they can go to med school.

Did you just call a PA an assistant?

 

[jw3600]

Did you just call a PA an assistant?

View attachment 288071

Lol. Whoever wrote this is delusional. This is like the midlevel equivalent to Breitbart. Crazy propaganda ramblings disguised as official policy.

 

[Dr Mantis Toboggan]

Assistant (to the) Regional Manager

Lol. Whoever wrote this is delusional. This is like the midlevel equivalent to Breitbart. Crazy propaganda ramblings disguised as official policy.

 

[TheSingularity]

I just reviewed one for a kiddo with flu who actually had INCREASING tachycardia throughout their stay and then discharged.

Likely nothing will come of it but

god f*****g dammit

 

[RustedFox]

The ****ing smile on my face. Make sure all of your partners bust their ass for a couple months. Make it obvious this system works lol.

UPDATE:

We had a few days without an MLP last week, because of the transition period.
The physicians had minimal difficulty "keeping up".
I said this already.

This has been the first week for our "new" two PAs.
I use "PA" because they're both PAs, not NPs.

The volume has been low, which was an unintended blessing - it allowed us to "train" the PAs on CERNER with limited interruptions.
They took to it like ducks to water.

They're both "ex"-employees of local HCA shops.
I will take credit for pretty much "directly hiring" one of them.
I worked with her at the HCA shop for years.
I said to my director: "Dude. THIS one is the strongest one in the group. Period."

They both can't say enough about NOT working for HCA/Envision anymore.
That [last] statement can be dissected into so many small parts.
I feel like repeating the things that they said on here.
Maybe I will.

My shop is getting better and better and better.

 

[Fox800]

UPDATE:

We had a few days without an MLP last week, because of the transition period.
The physicians had minimal difficulty "keeping up".
I said this already.

This has been the first week for our "new" two PAs.
I use "PA" because they're both PAs, not NPs.

The volume has been low, which was an unintended blessing - it allowed us to "train" the PAs on CERNER with limited interruptions.
They took to it like ducks to water.

They're both "ex"-employees of local HCA shops.
I will take credit for pretty much "directly hiring" one of them.
I worked with her at the HCA shop for years.
I said to my director: "Dude. THIS one is the strongest one in the group. Period."

They both can't say enough about NOT working for HCA/Envision anymore.
That [last] statement can be dissected into so many small parts.
I feel like repeating the things that they said on here.
Maybe I will.

My shop is getting better and better and better.

Be sure to call them "physician...assistants" not "PAs". APPA wants you to blur the term so much that they are bascially slurred into "physician ass.....asdjaidjaosd". AKA "physician". F' em.

Remember - "PAs" aren't here to make your life easier - they're here to make your CMG overlords more money, and to replace you!

Optimal Team Practice (OTP)

Learn more about Optimal Team Practice, AAPA's policy intended to enhance the ability of PAs to meet the needs of patients and provide quality care.

www.aapa.org

AKA screw you, physicians! You're just keeping us PAs down. But don't dare call us "physician assistants", just call us "PAs", to confuse the public! Everyone gets a white coat...

 

[RustedFox]

Be sure to call them "physician...assistants" not "PAs". APPA wants you to blur the term so much that they are bascially slurred into "physician ass.....asdjaidjaosd". AKA "physician". F' em.

Remember - "PAs" aren't here to make your life easier - they're here to make your CMG overlords more money, and to replace you!

Optimal Team Practice (OTP)

Learn more about Optimal Team Practice, AAPA's policy intended to enhance the ability of PAs to meet the needs of patients and provide quality care.

www.aapa.org

I understand your concern.
I get it. Totally.

But you know what? I have a situation where I can train two PAs from the ground-up to help my group.
I don't want to do simple lac repairs.
I don't want to discharge asymptomatic HTN.
I don't want to manage "asthma exacerbation" with an SaO2 of 97%

We can train our PAs to be true 'physician assistants' here.
We're going to take full advantage of this.
The message has been sent. From Day 1. To these two.
....
They seem to be getting it.
They seem to dig it.
They seeem to like to be a true "Physician Assistant"
When I give an order to them, like: "Hey; I picked up this MVC. I ordered head/c-spine CT. Close the lac over their forehead.
The answer is: "Sure; no problem. Can you look at this belly pain that I picked up?"
"Sure, homeboy."

 

[Fox800]

I understand your concern.
I get it. Totally.

But you know what? I have a situation where I can train two PAs from the ground-up to help my group.
I don't want to do simple lac repairs.
I don't want to discharge asymptomatic HTN.
I don't want to manage "asthma exacerbation" with an SaO2 of 97%

We can train our PAs to be true 'physician assistants' here.
We're going to take full advantage of this.
The message has been sent. From Day 1. To these two.
....
They seem to be getting it.
They seem to dig it.
They seeem to like to be a true "Physician Assistant"
When I give an order to them, like: "Hey; I picked up this MVC. I ordered head/c-spine CT. Close the lac over their forehead.
The answer is: "Sure; no problem. Can you look at this belly pain that I picked up?"
"Sure, homeboy."

Just remember who answers to who...because they don't answer to you, its to your CMG overloads.

American healthcare. Keeping the suits rich, and the doctors beaten down.

 

[GeneralVeers]

The PAs make me more money too....at least in a system that's well-managed and physician friendly. I've literally seen my salary double in my local market since we have had PAs take over seeing the low-acuity BS. Before PAs I was at 9-10 RVUs per hour, and now that's in the range of 15-20.

 

[TheSingularity]

The amount of mid-level mismanagement I've seen this week makes me want to cry.

Sent from my Pixel 3 using SDN mobile

 

[jw3600]

The PAs make me more money too....at least in a system that's well-managed and physician friendly. I've literally seen my salary double in my local market since we have had PAs take over seeing the low-acuity BS. Before PAs I was at 9-10 RVUs per hour, and now that's in the range of 15-20.

Right. And I feel that’s ok. Just make sure you’re being honest with yourself. Eyeballing their exams. The lacs they’re going to repair. The CXRs they read as no acute disease. Sounds like they’re doing what a competent assistant should be doing. But there’s a blurry line between just making RVUs off their pseudoindependent practice.

 

[RustedFox]

Just remember who answers to who...because they don't answer to you, its to your CMG overloads.

Actually, they answer directly to us now with our new CMG.
We have 100% direct local control over our shift map and hiring/firing.
We canned all of our old MLPs, re-wrote the shift map, and hired two PAs at 15 shifts/month.
No NPs.
No.

 

[jw3600]

Actually, they answer directly to us now with our new CMG.
We have 100% direct local control over our shift map and hiring/firing.
We canned all of our old MLPs, re-wrote the shift map, and hired two PAs at 15 shifts/month.
No NPs.
No.

Not that the latest PA decree (posted earlier) wasn't ridiculous, I would much rather work with them than NPs. NP schools are literally a joke and proliferating like a disease taking inexperienced 23 year old nurses (some of which are frankly dumb) and advocating for them to be practicing on their own with a couple of online nursing theory classes. At least PAs come from a world with some modicum of standardization. And frankly they seem more aligned with the care team model.