Collaborating physician problems

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I'm new here..this is my first post. I really don't know where else to turn, so I found all nurses and thought I'd give it a try.

I have been working as an FNP in a rural clinic. From day one I was on my own. If I ask a question, he will say, "If you don't know you shouldn't have ordered the test" or "give me a medical reason you're concerned about this" in a condescending way. He has laughed at me for things I've said or questions I've asked, and trust me, I don't ask him things often.

Is this even remotely usual? I'm terrified to look for another job, thinking ALL collaborators will be like this!

He is the only physician in the office and I'm the only NP, but he will tell me "all the physicians I've talked to agree you give steroids too frequently". I'm pretty conservative on steroid use, so I'm just left wondering what is going on?

Any advice?

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I'd start looking elsewhere. That isn't a supportive environment.

I'm not an NP, but I read these boards frequently and many people share their work stories. From what I've seen, you're arrangement is actually NOT common. Most physicians, when they take on an NP, realize that they need to train them so that they can trust them to take care of their patients. A good physician knows a capable NP is worth his/her weight in gold, as the physician can feel comfortable in leaving them to work autonomously when they must be away. For a new grad, this competency only comes through a mentorship with the collaborating physician, since NPs lack formal residency (which needs to change).

From what I've seen, many physicians give a few weeks of working WITH them so you can learn how they tend to prescribe and treat in their office. From there, you go alone, but the physician is usually happy to be a resource. You should never feel afraid to ask questions, and I feel the environment you're in is VERY bad for you. You won't learn as much as you should, which could jeopardize your license and career if you mess up one day and the physician doesn't have your back (which it sounds like he won't.)

Start sending out applications to other positions is my advice!!

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Thank you slyfoxrn! I have been internalizing his every criticism and I've even had to see a psychiatrist over it! I feel I've allowed him to make me feel so low and so inept. I appreciate you taking the time to answer me, as I no longer trust my own thoughts. I'm putting in for a transfer!

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Thank you slyfoxrn! I have been internalizing his every criticism and I've even had to see a psychiatrist over it! I feel I've allowed him to make me feel so low and so inept. I appreciate you taking the time to answer me, as I no longer trust my own thoughts. I'm putting in for a transfer!

You're welcome. Don't let him bother you like that! His opinion doesn't matter. Think of this way: you're a new NP eager to learn and give high quality care to her patients. He's a physician who hired you yet won't give proper training. Which one of those people is inept? I'll give you a hint - it isn't you!

A physician taking on a new grad NP has a big responsibility to train that NP. NP programs lack enough clinical hours for an NP proficient upon graduation, and any physician that wants the revenue increase that comes along with having an NP has to be willing to train them. I'm sure you're a great NP, but just like a new grad medical student NEEDS residency, you NEED a physician, NP, or PA willing to take you under their wing for a while and help you blossom into a capable provider. You will get there, do NOT doubt yourself - you just have to find a supportive teacher to help make that happen.

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Specializes in Adult Internal Medicine.
A physician taking on a new grad NP has a big responsibility to train that NP. NP programs lack enough clinical hours for an NP proficient upon graduation and any physician that wants the revenue increase that comes along with having an NP has to be willing to train them. [/quote']

Sorry, are you an NP?

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Sorry, are you an NP?

I think I've made it quite clear that I am not an NP, so I will thank you for finding a different venue for trying to attack me for my views as you so often do. You're obsession with stalking me from one post to the next is starting to become amusing. I do not have to be an NP to see how few clinical hours are required for NP programs - some as low as 500, with the average being around 600 or so. Assuming a 40 hour work week, that is FIFTEEN weeks of full-time work to go from RN to someone in charge of diagnosing and treating patients. Meanwhile, PAs have over 2,000 hours of clinical time, and physicians, with residency, have tens of thousands. So no, no matter how much you want to protest otherwise, no nurse practitioner is ready to be an independent provider fresh out of school after spending only 600 hours in the role. Can NPs be wonderful, competent providers? Of course - but only after many, many more hours of practice.

To argue otherwise would be ignorant. I'm a huge proponent of NPs, but I would never let one come near me fresh out of school with no physician oversight.

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Specializes in Adult Internal Medicine.
I think I've made it quite clear that I am not an NP so I will thank you for finding a different venue for trying to attack me for my views as you so often do. You're obsession with stalking me from one post to the next is starting to become amusing. I do not have to be an NP to see how few clinical hours are required for NP programs - some as low as 500, with the average being around 600 or so. Assuming a 40 hour work week, that is FIFTEEN weeks of full-time work to go from RN to someone in charge of diagnosing and treating patients. Meanwhile, PAs have over 2,000 hours of clinical time, and physicians, with residency, have tens of thousands. So no, no matter how much you want to protest otherwise, no nurse practitioner is ready to be an independent provider fresh out of school after spending only 600 hours in the role. Can NPs be wonderful, competent providers? Of course - but only after many, many more hours of practice. To argue otherwise would be ignorant. I'm a huge proponent of NPs, but I would never let one come near me fresh out of school with no physician oversight.[/quote'] There is nothing personal in challenging the statement you made. Several times you have made statement about NP education and NP competency without any evidence to support your position nor any personal experience with advanced practice nursing or APN education. I am questioning your statement not you personally. If you have no personal NP experience than please cite some sources to support your claim, I would love to read them. It is curious to me that you state NPs are not competent providers after passing the national certifying exam for competence for entry to practice because of a lack of experience, yet you seem to think yourself competent to make that judgement without any experience. Collaboration in practice is a wonderful thing regardless of being an MD a DO a PA or a APN. More than 17 states have deemed NPs competent to practice independently. NPs are held to the same standards as their physician counterparts. I have learned much from my experienced colleagues which include NPs and PAs as well as physicians, but I was competent on my first day. I believe the OP was also competent on his/her first day. In my experience it is not unusual for another provider to question why a test was ordered or a drug prescribed. On the other hand, as a provider you should make sure you feel like you have support in your practice and can ask questions when you don't know the answer. I still have things pop up on a weekly basis that I don't know, however, I know who to call to get the answer. This is true of any provider, especially new ones, regardless of title. My collaborating physician has 30 years of experience and he still makes calls and asks advice because that's what good providers do. If it were me OP, I would find a better working environment.
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I'm a she. Anyway, I feel some type of residency would be preferable. I was always in the top of my class, but there are situations we just couldn't cover. For example, I recently found a urachal remnant on a guy. A what!? Was my first thought. I was looking for kidney stones. So, should I not have ordered the test because I didn't know what that finding meant? Well, that was my answer from the good doc. So I called a urologist who kindly filled me in. Good thing, because this guy had a malignant tumor.

Its not that I won't do my research or make my calls. I just thought a collaborator was someone to guide you with those oddities.

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Hi Miriam,

More training and experience is never a bad thing and increased hours in clinicals could not hurt, however I think you really validated your concerns AND established your own competency when you related that story about your collaborating's reaction to the test you ordered. Your action was to contact a urologist, his was to say "don't order the test unless you understand the results" - he didn't help you to provide high quality care but he did help you in motivating you to find a better situation with a competent collaborating MD or DO.

By the way, your response was awesome and is one of the reasons that NP provided care has far lower rates of malpractice claims than MD provided care.....nobody can be expected to know everything - which is why we specialize. You are specializing in primary care, you ordered the right tests, you collaborated appropriately with a specialist and I bet you provide outstanding care!

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TheOldGuy..thank you!! I'm so glad I found this site. I've been afraid to even discuss this with NPs in my local group, thinking everyone would just assume I must be doing poorly or I wouldn't encounter so much criticism. I need a place where I can feel more comfortable and can sometimes learn things without feeling like I should already know it all. I really appreciate all of this support!

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Specializes in ICU & LTAC as RN. FNP.

Start looking for a different position. I have had really good experiences with physicians so far. There are some, apparently like the one you work with, who think they are superior and like to belittle others. The doc I work for treats me with respect, and answers any question I have, without any attitude. Do yourself a favor, find another doc.

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Specializes in ER.

I graduated with my FNP last December. While I felt competent, I did not really feel confident. Having a physician beat you up like this is no way to build confidence! Obviously, he is not a good collaborating doc for you.

I am very fortunate, I work in primary and urgent care, and I have several terrific supporting docs to turn to when I have a question. They are very supportive. However, your approach when asking advice is important. Never say, "I don't know what this is or what I should do". Always approach the situation with "this is my working diagnosis/clinical impression, and this is my treatment plan and the diagnostic studies I have ordered. Do have any ideas/advice on anything else?" This way, you do not look clueless.

Can you ask for a different collaborator? Can you work in another part of the hospital/clinic? I hope they can find you someone more supportive as you develop your skills. This doc seems like a hater!

Good luck,

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