Collaborative Physician Issues

[nbtw]

I'm reaching out just for some guidance. I've tried to do some research on my own but have been unsuccessful. My former collaborative physician is refusing to complete credentialing paperwork related to my new job. I've never had any issues with this physician and there have never been any patient complaints against me. She doesn't have to recommend me but only speak regarding my work. I have a copy of the collaborative agreement we both signed which states that reviewing my work would be one of her duties. I don't know what my rights are here. I had a collaborative agreement because of the state practice laws but here the physician is not holding up their part of the bargain. I was wondering if any other APRNs have had to deal with a similar issue. Any guidance is appreciated.

[Oldmahubbard]

In my experience, if the physician is not directly profiting from you, they resent having to be a collaborator. I honestly can't blame them. And they don't feel like doing 15 minutes of paper work. So they put it off.

I encountered this, and so thankfully, in the nick of time, collaboration requirements were discontinued shortly thereafter in my state.

I wish I had an answer. It is unlikely it is anything personal against you.

[elkpark]

If you used to work directly with this physician, and have now taken a new position at a new organization, and no longer work with her, I can certainly see why she would be unwilling to continue as your collaborating physician. I agree it would be more appropriate to have someone you will be working with within your new organization to take that role.

[OllieW, DNP, PhD, NP]

Hmm I have never even met my collaborative physician.

[Oldmahubbard]

Hmm I have never even met my collaborative physician.

Hilarious. Well in my state there was never any requirement that we meet in person with the collaborator. Only that a certain number of charts would be reviewed quarterly. It can be done electronically.

However if you have never met your collaborator, it seems to me that the spirit of the collaborative law is being violated.

Which is no big surprise.

[Back2SchoolRN]

ntbw,

We must not be the only ones. Surely!

On my first NP job in the Midwest, I interviewed with one collaborator and found out after I started that he was being pushed out and the jerk they hired in his place would now be my collaborator. He was from another country where women are much oppressed. He clearly had no desire to work with an NP, but couldn't pass up the money.

He spent an average of 8 minutes with the patients on his unit, then went on to his private practice. (I and those other patients were side income for him). He required that I consult him over every little order, which I respected at first because I was so new. But he did not want to mentor, even a few minutes a week, and refused to be contacted by text or e-mail. He would accept only phone calls and they had to be under a minute or so.

He would interrupt my brief background basis for my plan, with an order as though I were the floor RN calling for orders, exactly. Later, when I asked him about a particular situation, again he would bark, but "Yes, yes, Suzy!" (not my real name). Sometimes he did not listen to the entire planned order. Yet when he went on vacation, he left me covering his more acute patients AND mine, without a request, report, or verifying I could care for them safely.

Even so, I did not talk him down except privately to a 2nd nurse who was at nearly the end of her NP program, and then only explaining this.

I had trouble getting him to audit the required charts, too. I started auditing the EMR to check on the number and timing. That's when I caught him falsifying a supposed visit to me, in which he wrote he'd examined a patient and consulted with me in person, none of which had actually happened! I expected that he would have me pushed out if I complained to him, maybe set me up to reported to the BON. I knew the Board of Healing Arts/medicine would not do anything, so I could (I thought) only report the situation as discreetly as possible to my direct supervisor. I did so.

After that, my job became hellish. There had been no clinical complaints, concerns about my judgment, disrespect to the MD, nothing. My nurse, that student NP, was taken away and I was given her duties. This was possibly due at least in part to saving money as they had just been taken over by a large corporation. But there was no warning and no explanation, or asking for my willingness. No orientation to her duties, either.

I began to be graded on her non-NP paperwork duties, too, and required to make myself available with my door open for patient drop-ins, and to make my patient appt schedule subordinate to everyone else's on the multidisciplinary (psych PHP) team--even if that made me idle in the middle of the day and at work long after everyone else had left.

Of course I started looking for a job after I saw this was real and permanent and escalating. I feared I would be set up to not just be fired but reported to the Board. Not to be sued, because they'd be sued, too---but disciplined by the Board for (God knows what!) I would not have done.

It was past time already that I had the required number of practice hours to apply for permission from the BON and a DEA number, both required in my state to prescribe controlled substances. For weeks he'd said he would sign it, hadn't "gotten to it yet. I the meantime, I left by mutual agreement, and he refused to sign the document or even answer my e-mails. I gave up for fear more than 2 (brief, polite) e-mails and one text could be considered harrassment.

That puts me on an equal footing with new grads without that much-desired DEA. Worse, actually, because how does that look, with less than a year on the first NP job, and a collaborator who refuses to acknowledge you worked under him for that long?

It means someone else has to prescribe those meds for at least 6 months, and a collaborator actually has to collaborate. Without that, I can and have been credentialed to work at another job, but without the DEA, Now, shortly into my new job, when they lost the collaborator at my new job, they are having trouble finding one who will work with me without my having the DEA. Wil this cost me the job? Maybe.

I negotiated a settlement for leaving that horrible job by mutual agreement, with a gag order. An employment attorney said there was nothing else I could do, and that I'd done well for myself, monetarily. Period. And so you see, physicians have another way to punish and control us or to get even for having to collaborate at all, with no consequences whatsoever.

It should be a professional duty to sign a document required for future employment, or a necessary legal process for full practice because it is not a reference or recommendation. It takes 30 seconds, being just a signature. Like the person in Human Resouces who tells potential employers only your dates of employment there, it simply states that yes, you have worked that many hours, which, to the BON, qualifies for the application.

So this is NP abuse, and yes, I think there must be others, and it needs to stop.

BTW, To those who think nbtw is asking the MD to give her a glowing reference or to continue as her collaborator, she is not. She's asking for documentation that she worked there and there was no disi[plinary or clinical concern.

I would like to know how it turned out for you, nbtw.

[Oldmahubbard]

A poor collaborator can be a nightmarish situation for an APRN. Unfortunately there are probably more bad ones than good ones.

The onus is also on the APRN to ensure that state regulations are being followed.

Have you ever tried to make a doctor do something they don't feel like doing? Good luck with that.

[Rnis, BSN, DNP, APRN, NP]

I have filled out credentialing reference for other providers.... Just have someone else fill this out. It's annoying she won't...but she has not obligation.