Received a rather odd letter request from a patient today. We are all used to writing letters such as the patient needs time off, they are safe to do their jobs while taking their prescription meds, etc. This one threw me for a loop, though.
This pt has ADHD and decided to stop taking their ADHD med. Their work wanted a letter from me stating the pt can do their job fine w/o their ADHD med. I'm not sure I want to do this because:
1. I do not personally supervise the pt's work and have no idea if they would be OK doing their job w/o their ADHD med
2. It is the job of the pt's work supervisor to determine their work competence
3. This seems like a potential liability issue. As an extreme example, let's say this pt is an Air Traffic Controller and has ADHD. Clearly, if the pt goes off their ADHD med, and an accident occurs, the results can be disastrous, with many lives lost. If I certified their fitness for work w/o their ADHD med, then I could be sued.
Anyone run into a similar situation or have thoughts on this?
Any time spent working outside business hours is money lost unless actively seeing patients. No additional work or tasks performed past the allotted time is accounted for or made up. If you own the business, then maybe you are doing well to ensure patient satisfaction and maintaining them as a solid source of income, but that's in your interest and extra efforts are expected as that business owner. But nobody's paying for that ancillary staff to stay late or for that nurse practitioner to continue to write extra letters.
Suggesting nurse practitioners "do more" do make up for the pay shortfalls fails to account that they are by and large doing the same amount and billing for the same complexity as their colleagues work more "advanced" training. Doing more will simply equate to lower quality care while giving clinics a means to squeeze more from already overworked clinicians.
A PA I used to work with came in an hour early every day and stayed an hour late every day so she could get more patient access in and accommodate their schedules. She was praised up and down for all that she was doing for her patients and the money that she was bringing into the clinic. She did make a not more in bonuses. But during that time, I watched her literally burn out because she tried so hard to maintain a high accessibility to her patients at times that took away from her own personal life. And for all that extra effort, she still didn't make anywhere near with the lowest paid Dr was paid at that clinic system.
Specializes in Psychiatric and Mental Health NP (PMHNP).
djmatte said:
Any time spent working outside business hours is money lost unless actively seeing patients. No additional work or tasks performed past the allotted time is accounted for or made up. If you own the business, then maybe you are doing well to ensure patient satisfaction and maintaining them as a solid source of income, but that's in your interest and extra efforts are expected as that business owner. But nobody's paying for that ancillary staff to stay late or for that nurse practitioner to continue to write extra letters.
Suggesting nurse practitioners "do more" do make up for the pay shortfalls fails to account that they are by and large doing the same amount and billing for the same complexity as their colleagues work more "advanced" training. Doing more will simply equate to lower quality care while giving clinics a means to squeeze more from already overworked clinicians.
A PA I used to work with came in an hour early every day and stayed an hour late every day so she could get more patient access in and accommodate their schedules. She was praised up and down for all that she was doing for her patients and the money that she was bringing into the clinic. She did make a not more in bonuses. But during that time, I watched her literally burn out because she tried so hard to maintain a high accessibility to her patients at times that took away from her own personal life. And for all that extra effort, she still didn't make anywhere near with the lowest paid Dr was paid at that clinic system.
I am not suggesting NPs work 1-2 hrs OT every day. My first job was in a rural primary care clinic where the providers had to write their own letters for pts, fill out disability forms, etc. At that job, once I got up to speed, I probably worked 1-2 hours OT PER WEEK. And if one of my pts had to go to the hospital for serious illness, I would go visit them on my own time because I cared. The doctors did that, too.
At my present job, we have a document services team, but I still have to review and edit letters, disability stuff, etc. I probably work 15-20 minutes extra every day.
NPs can't have it both ways. If we want more respect, IPA, and higher pay, to be more like doctors, then we have to act more like doctors.
Also, I have never seen a group of people so afraid of competition as many NPs on this forum. In a competitive job market, the BEST will be the ones with jobs. So one way to squash those crappy NP schools is some competition. In my previous profession, I had to compete for jobs. Internally w/in the organization, I had to compete for the best assignments. Competition is good. That is the whole point of a free market for goods, services, labor.
Just want to add that many NPs on this forum have complained they want to be paid more. It seems unfair that their appts are reimbursed at almost the same rate as MDs, but NPs make a lot less.
MDs work their behinds off. All the MDs I know put in a lot of extra time. If NPs want to be paid at a higher rate compared to MDs, then they must demonstrate a commitment that goes beyond "9 to 5." Most NPs do this, so I am not criticizing NPs in general.
NPs can't have it both ways. If they want to be viewed as providers that just work their 8 hours and no more, then they deserve to be viewed as "less" than MDs in terms of quality of care.
The "going the extra mile" has nothing to do with reimbursement equity. Altruism has noting to do with compensation. Reimbursement is entirely a product of decision complexity and procedure. If someone wants to pay me extra to fill out a form, great. If not, then I'm not going to volunteer anything. I'm okay with checking some blanks on a DOT form for the examiners and using the Adobe signature. I'm not okay with disability papers, tenant pet "emotional support animal" memos and letters for lawyers, etc. My business niche grows increasingly narrow, and I'm okay with that. Ten years ago, I was more amenable to doing what you suggest, but here and now I'm not.
You mentioned lawyers and accountants not working 9-5. I haven't suggested anything about discrete hours. Rather, I suggested getting my work done and being done. Accountants aren't doing S-corp reports and income tax reporting for free after 5pm, and lawyers are traditionally billing for six minute increments of labor, communication, and thought.
Let's agree to disagree. You do you. I'll do me, and our clientele can see whomever they want.
djmatte, ADN, MSN, RN, NP
1,248 Posts
Any time spent working outside business hours is money lost unless actively seeing patients. No additional work or tasks performed past the allotted time is accounted for or made up. If you own the business, then maybe you are doing well to ensure patient satisfaction and maintaining them as a solid source of income, but that's in your interest and extra efforts are expected as that business owner. But nobody's paying for that ancillary staff to stay late or for that nurse practitioner to continue to write extra letters.
Suggesting nurse practitioners "do more" do make up for the pay shortfalls fails to account that they are by and large doing the same amount and billing for the same complexity as their colleagues work more "advanced" training. Doing more will simply equate to lower quality care while giving clinics a means to squeeze more from already overworked clinicians.
A PA I used to work with came in an hour early every day and stayed an hour late every day so she could get more patient access in and accommodate their schedules. She was praised up and down for all that she was doing for her patients and the money that she was bringing into the clinic. She did make a not more in bonuses. But during that time, I watched her literally burn out because she tried so hard to maintain a high accessibility to her patients at times that took away from her own personal life. And for all that extra effort, she still didn't make anywhere near with the lowest paid Dr was paid at that clinic system.