Fired because they "can't afford me"...now what?

[AngelfireRN]

I think I'm cursed, I really do.

I left a perfectly good cardiology job to work for my primary care doc, whom I'd known for 26 years, after he called and nearly begged me to come work for him. Historically, the man hated NPs, so I was flattered, to say the least.

Never having done primary care to speak of (with the exception of the infamous "All is not Well" incident), I had a lot to learn, and we both knew it.

In the course of three months, I was seeing upwards of 20 patients on some days (not all), had passed my 2nd set of boards (meaning I was double certified), and had been farmed out to a satellite clinic that doc had gone in with, where they needed an NP to cover some days. This did not sit well with either me or doc's wife, as we found out about it on the same day, but I went and made the best of it.

Today, fresh off a weekend that doc was away, where we saw upwards of 50 patients, worked down 2 nurses, and treated doc's wife for food poisoning, I figured I'd at least get an "Atta girl".

Wrong.

I went in after clinic to ask if I had made any major oopsies that we needed to discuss, and he had 4 charts on his desk out of the 50+ that I had seen (not too bad for 3 months in, if I do say so), but he said we had bigger problems.

He shuts the door, and proceeds to tell me that the business is not picking up like he had hoped it would, and that I am not seeing enough people to cover mine and my assistant's salary. It went on, with him saying that I WAS improving, majorly so in the past two weeks, so that he felt that he didn't have to follow me so closely, but that the practice was taking a hit.

So I asked him, "Are you firing me?"

He said "We can't afford to keep you".

So, in a nutshell, I'm improving, but I cost too much. Kinda like telling someone that they have cancer and have 3 months to live, but GREAT NEWS!, their cholesterol levels are fabulous!

I don't know what to do. He made mention of possibly having me back as hourly PRN, but I don't even know if I can stand the thought of seeing him again as my doc, let alone working there anymore. His wife (also the OM) was just sobbing when I left, she apparently had no idea, we've been talking on Facebook all evening, with her thinking that I'm mad, and once I get past the numb, I probably will be, but not at her.

This wasn't what I signed up for. Any advice would be great. Thank you.

[AngelfireRN, MSN, RN, APRN]

OK, now, please don't accuse me of trying to find a reason not to accept this job, I went in looking to start that day. However, the interview, from the start, gave me a funny feeling, what I call and "utz" in my belly. Had the same feeling before the Florida trip when I nearly died, and again before I accepted the clinic job, and both times I ignored them. No more.

The doc seemed nice enough, from the start, but I took issue with several things.

First, he offered me a rate that was about $20,000 less than entry-level NP salary.

Secondly, as he was explaining the job, he continuously referred to other physicians as idiots for not taking pain management patients, because "that's where the money is". He requires the patients to come in every month for their scripts (which is a good system, for control purposes, I'll admit). He also was quite proud of the fact that he ran scads of diagnostic tests (carotid Dopplers, US, Holters, etc.) himself, instead of referring the patients out. That, I was OK with, as well, until he coached me to "be vague in your notes here, just make sure that you list a diagnosis that will pay for the test". I must have looked at him weird, because his next statement was "It's not ILLEGAL, we don't do anything illegal here."

Lastly, when I asked about how we would manage the pain/benzo patients, as in Alabama I can not write controlled substances, he said "Are you sure you can't?" ( Pretty darn, sir) "OK, no problem, I'll sign them, and if I'm not here, we'll keep them locked up, so you can get them if you need them." So, in other words, blank, signed script pads, and me responsible for writing the controls.

It just didn't wash with me. And anytime someone has to make it a point to assure me that nothing is illegal when nothing about legality has been broached raises a flag, to be honest. I refuse to put my license in jeopardy just to get a job in less than a week.

Thoughts about whether I'm paranoid, wise, or indifferent would be appreciated.

And my old job has been dissolved. I will get up with the hospital that the clinic merged with and see if I can sell myself back in, by offering to sign a contract, if need be. I spoke to the headhunter that hooked me up with the job, and he can't help, since it's not posted. However, when I told him what happened, he said that, if I told them the circumstances, I should have a shot, since, per his reports from the clinic, my work was impeccable, and also given the reasons I elected to leave.

Thanks again, all. It's a comfort knowing you're here.

[erroridiot]

I am so sorry you had to endure this "doctor" and what he had to say to you for any length of time whatsoever. Are you sure the FBI or other enforcement agencies aren't already keeping an eye on this dude? I would not be sure enough to risk my license on that.

Do you live in a small community? Are there other jobs available within driving distance?

What about some community or public health type of position?

Most of the government agencies seem to be hiring NP and PA from time to time and they for sure aren't doing the "Illegal" with the narcotics.

It was only the first interview. It usually takes a few to find a good fit and I wish you well.

[leslie :-D]

definitely trust your instincts.

how many times have we ignored them, only to discover we should've listened to them in the first place?

you're a hard-working, impassioned person and professional.

show yourself enough respect to wait for the environment you're worthy of.

leslie

[nursel56]

I'm having the unmistakable feeling that Angelfire + Doc "it's not ILLEGAL!" is what we call "not a good fit" LOL!!

Facebook, to me has this characteristic of having things morph into not so good things as info is churned through it -- even innocuous or totally professional sounding networky things -- well honestly I don't trust it with all it's likes, not likes, pokes, suggestions, games, badges, dumb tests and the final clincher, creating your group of "Facebook BFFs". (doesn't best imply one of something anymore?) Also, I'm pretty sure it suggested I be friends with someone I was only thinking about the other day. . . hmmmmmmm

Angelfire, hang in there! If I could make it happen you'd get a grant of a couple hundred thou and open your own practice - as it's always best to do it your way. It will take longer to get something close to the ideal and if you jump to soon you'll probably have to go through all this ^$%$^% again! No good!

[tyvin, BSN, RN]

Well I guess I might be the only one who thinks that what you wrote about what that doc said to you wasn't suspicious. Even as an RN I've had the same circumstances with regards to "writing scripts etc.." and I didn't find anything wrong with it. As for his suggestions of charting he is absolutely right. If nurses don't document the Dx in relation to and connect it all succinctly about what the patient received the insurance companies play the "we aren't paying you" game and believe me I've seen the books on some places where insurance companies had the right to refuse because the correct documentation wasn't even close to being correct for payment.

In the past I have been hired to teach nurses how to chart because hospitals and the like are loosing big money due to the nurses not charting correctly. As for you being suspicious of him not knowing you; as an NP, can or cannot write schedule whatever; the fact is that in many states NP's can write all except schedule II's. And wanting a thriving business; tell me what's wrong with that. He is right, pain management is big business resulting in big bucks not to mention being able to help many people live comfortable lives while managing their pain.

Sounds like a position with autonomy IMO. It may not be for you but please don't cast suspicion on what are already common practices. He probably expects and is looking for an NP who will not be afraid to take the reins and run.

[Ruby Vee, BSN]

i say "go with your gut."

whether or not there was anything actually illegal in what the doc was suggesting, it didn't sound ethical to you. and if these are the practices he describes to you in an interview, what other practices will he require once you have the job? if it doesn't feel right, it probably isn't right. take your license and run!

[Tina, RN]

Go with your gut feeling. For sure...

[AngelfireRN, MSN, RN, APRN]

OK, for an update, I have an interview with MY cardio guy this week. He's been after me to help him on weekends for a while now, but after I told him what happened, he said "OK, well, we need to sit down and talk", and that was it. Here's hoping, yet again.

As for the other doc, not even a week after the infamous "It's not ILLEGAL" interview, I get a phone call (they WOULD call in the middle of Zumba), and a message that I can barely understand (English was a second language, at least). I returned the call, only to find that it was a recruiter, of sorts, who wanted me to come in for an interview. As I was writing the info down, I noticed that it looked familiar, and nearly fell over when the man said that it was with the same doc! I explained that I had already interviewed with the doc, and apparently just flummoxed this poor guy. He didn't know what to say.

"You are SURE you have interviewed with the doctor X, Angelfire Lastname?"

"Yes sir, last week"

"Because the Doctor X he is not telling me this, Angelfire Lastname."

You're right, sir, I made it up. Silly me.

I am SO glad I steered clear of that place, even more so now!

Thanks again guys, I'll keep you posted.