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SoundofMusic

SoundofMusic

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  1. SoundofMusic

    Do not understand scheduling issue

    I actually do not have student loans to re-pay, but that whole premise is just ridiculous anyway. If I've earned the trust and repeat visits of my patients, then deserve to keep them. It's all just very odd - the practice is odd in many ways, but I took the job to get experience. It's not a bad place overall, but this has me flummoxed. I guess I just need to go back to the manager and tell her how I feel. They are very cheap and I sometimes suspect they are also doing it to save money, but I'm not sure. I'm salaried but the doctor is not. However, I'm assuming she must earn productivity points as well. I do remember that on days I'd be seeing more patients, she did seem frustrated and would complain that she was bored, "this is ridiculous ...I only have so and so number of patients today ...." etc, I just simply feel she is literally taking my patients from me. Now, on one hand, I'm glad she's taking some of them on, and I'm glad patients get to see a physician at times. But some of these folks I have worked hard with, and I have been following them and know them well now.
  2. SoundofMusic

    Do not understand scheduling issue

    So, I've been at my practice a good 18 months and seem to be doing fine -- no comments or complaints from my boss or from patients out of the ordinary. A new doctor straight out of medical school started about six months later. She's good, but also very domineering and a few of the patients found her to be very condescending and from what nurses say, a few have said they'd rather not come back because of her. I feel she's ok and a decent provider myself. I had built up a decent panel of patient myself, and for a while, it seemed I would see at least a third more to double the amount of patients that she would see on many days. All of a sudden now, I found out that the front desk has been told to route patients to her schedule first, then fill mine. I'm not sure if this applies to the other mid level providers or not. So now I sit, and when I'm with her, I see half the patients I normally do. On other days, I'm full, and when I'm working our call weekend shifts I'm full as always. A couple patients have commented that they have been trying to see me for weeks, but they are being sent to her. One was upset to the point she wanted to leave the practice as it felt to her like they were shuffling her around. When I approached our practice manager, she says that Dr. A needs to see patients "because she has bills from medical school and needs to pay them, " . I'm assuming that she wasn't happy or perhaps making her productivity bonuses or something. Is this a thing? Or does it sound like they're trying to reduce my schedule for some reason? I feel paranoid they might be trying to get rid of me, although they keep scheduling me on and on for my regular days and asking me to take call, etc. I personally would often enjoy bonuses of my own due to high productivity, but with this happening, I guess I won't be seeing that extra bonus. As she gets more of the patients on her panel, mine just seems to be dwindling. Don't even know what to think!! I have been thinking about leaving this practice for a while to be closer to home, but now I feel like leaving just to try to get to a place where I have potential to earn bonuses and will get to keep my patients!
  3. SoundofMusic

    Thoughts on doctors and management styles

    Thanks for the responses. In regard to wanting my hand held .... I'm not sure that's entirely fair. As a person who has always worked in past corporate PR and also large hospital system eonvirnments, I am used to professional annual evaluations. I'm also used to seeing leaders lead and to being advanced and developed as an employee. I'm new to the single owner medical practice environment and I just don't know what the norms are. As a military spouse having picked up a bit on leadership styles, I find it strange how this is done and thought doctors would have more to do with the development of their employees ..... but I guess this isn't how it works. It's all different from what I'm used to, so I was actually just trying to learn.
  4. So, the doctor that owns our practice and has been there for 30 years, and is essentially "my boss" has a hard and fast rule for all staff that all issues regarding the practice must be addressed first with the practice manager and not directly with him -- like, ever, at all. I can understand how this makes sense for routine matters, but as an NP in the practice, I feel this is just stifling. I don't feel like I can go to him and talk, about much. Sometimes I just want guidance, reassurance, or just to shoot the breeze in general -- or get feedback on my performance. He's a great one minute manager -- offers praise if you've handled a singular issue well, and is always thanking us for picking up extra shifts, or whatever. But in almost two years I have not received a performance eval of any kind. So, is this a normal thing or is my doc just a big wimp/jerk/avoidant type personality who doesn't want to deal with conflict or to have conversations. I just don't feel like I can knock on his door and just talk .... we have to go through the practice manager . . . who can at times also act as his attack dog as well. I also don't feel like I'm being developed much as an employee. They're all nice enough to work with, but I find this sort of management style strange and have nothing to compare it to as this is my first time working alongside md's in practice on a daily basis. Any thoughts or comments on how it is done in your practice? Sometimes I really feel he just doesn't care ....which is also sad/disturbing.
  5. SoundofMusic

    Practice manager driving me bonkers.

    Practice manager has her two grandkids come in to be seen, accompanied by their grandmother (who has authority to bring them in). Practice manager's son is the father, and he is divorced from the mother of the two girls. One is 13, one is 11. Kids come in to be seen for cold and sinus issues. I do my thing and prescribe their meds. One of the girls is a bit surly, and I realize she wasn't feeling well, but one could tell it was really just a lot of brattiness on her part, which she somewhat exhibited towards me ....don't feel it was anything personal ...she's just a 13 year old with poor manners and God knows what else going on. Grandmother pulls me in after visit is over and we initially discuss why I decided to order a CXR for the younger one (younger girl had been complaining of CP ...which I didn't feel there was much reason for ...anyway, that's beside the point. ) Grandmother then wanted to ask me an additional question about the girls behavior and confided in me that she feels they're being allowed to behave poorly at home -- routine use of F word, throwing things, getting in Grandma's and other faces, aggression, etc. and grandmother is just not sure what to do. Her concerns seemed reasonable and with the behavior I witnessed during the visit, I had to believe her that things were getting more difficult with the kids in some way. I realized I was getting into a weird area with these being the practice manager's grandkids. I basically counseled her very broadly and told her perhaps she might want to discuss these issues with the girl's mother, and that in general, it's wise to make sure the kids don't need perhaps some counseling, or whatever, to determine why they are behaving this way. Anyway, practice manager strides back after a few minutes and complains that grandmother was "taking up too much of my time," and advises me not to listen to anything she says ....that she's "crazy" and I should just have stuck to the issues they came in for. I am just flummoxed by this. Why pull me into the family issues? Practice manager says she's also listed for these kids as a POA and is privy to family issues, but I chose to keep the conversation with the grandmother confidential. I don't even know if I want to work for this practice anymore after this -- they put me into a position of seeing the family members, yet try to "advise" me on what to do as a clinician towards them. I don't even know what to think!! This just seems wrong on so many levels. I can't say I spent anymore than three minutes talking to the grandmother once she decided to confide in me about the kids.
  6. Have been working in a small mom and pop practice for about a year now -- no EMR -- all on paper. Doc is old school. Very busy and well loved practice with a large patient volume. I started there a year ago, with a few years of retail health experience, but not fully versed in primary care. The staff has all worked together for years, and we as NP's/PA's seem to march in and out of the practice, as no one ever stays too long. Have done well there and now am a fully fledged member of the provider staff, take call, and can stand on my own well - just need guidance now and then, which is appropriate, as I get any case handed to me. Still, one of the MA's there finds it in herself to be snappy and rude to me out of the blue. She's a rougher country gal, with a mouth, and I feel she gets an attitude about us as mid level providers, as many of us just get there, learn our stuff, then leave after 1-3 years. Or, it's just me ....I'm not sure. I hold off from just handing it back to her during the work day as I don't want to confront her, I'm not her boss, and I just don't have the time to duke it out with her in between my busy schedule. Also not sure what she'd do as she seems just slightly mentally unstable ....really don't want to get into a full on screaming match or worse with her in front of everyone. So, after the last episode, where she chided me for leaving the lid too loose on an FOBT sample (granted, yes, that could be a problem ....but it's also trivial and she could have just simply and kindly told me to make sure I tighten the lids before I leave them in the rooms, .....instead she ripped me over it rudely and nastily in my face) I decided to complain about her to the practice manager and have demanded a meeting between us all to address it with her. I feel wimpy, but it needs to be discussed. There are staff members in some places that often will treat the doctors with the utmost respect, yet feel they can be all out crappy to the mid levels. .... because they think they can I guess. The practice manager, though, seems to make excuses for her ...."well, that's just her" and "oh, she just does these things and thinks out loud, " etc, etc. I say BS to that ... .this gal knows exactly what she's doing and just wants to bully me around. So, hope I'm doing the right thing ....guess if it continues I'll leave ....but it makes me sick. Maybe it's my cue to leave ....
  7. SoundofMusic

    RN with public Reprimand Inspiration

    It's 2018 and I'm still reading your post. You have no idea how much this has helped me to hang on through a board complaint made against me by a former employer. I was also recently reprimanded and the entire experience was so hideously painful I cannot even describe it ..... but..... I survived it, and I'm still practicing well as an NP. I'm fearful now that the complaint may cross to the state I'm working in now .... which hopefully does not mean hiring more legal help ..... But, I know I will survive and it has made me stronger. At times the pressure seems so strong that I wish I could leave the profession all together .... and then I have days where my patients are complimenting me, or thanking me for helping them in some way and that they're so glad I'm their provider .... so, what can you do? Learn from it, I guess.... and move on. But be cautious .... every single day. But please know how this post in particular helped me on many days to just hang on and fight.
  8. Any good and relatively inexpensive courses anyone could recommend? Or conferences? I've put this off and have until next July to get it done ....will pay more if it's worth it.
  9. Just started in a primary care office in Maryland. Often, patients under 18 are coming in without parents, and without any sort of parental consent form on the charts. Coming from the Minute Clinic environment, I always thought kids had to be accompanied by the parent. I realize this is not true for teenagers seeking birth control, pregnancy testing, STD testing, etc .....but for routine medical visits, shouldn't they be accompanied by a parent? We get a lot of the school physicals also being done without the parents of the older teenagers. To me this can be fraught with issues when kids are unreliable historians, uncooperative, clueless about their family history, etc. Looking at our state consent laws, it's very confusing. I'm finding lots of trouble with parents not present during these visits ...
  10. SoundofMusic

    How much did NP school prepare you?

    Right -- I think that over time, as an NP you will catch up simply due to experience in practice, but it's very tough at first.
  11. SoundofMusic

    Favorite part of being a Nurse Practitioner?

    I don't know -- everyday I wonder if I should just hang it up ...I'm just four years into it, spent 3 in retail, and now during my first year in true primary care, I get easily overwhelmed and am often in a state of panic and/or sheer terror. However, it is pretty cool to write those orders and do that follow up, especially if your treatment helped that patient. Really nice when patients like you, want to come back to see YOU personally, and to see how much they believe in you. Also nice to have nurses to help you, especially if they know what they're doing. Nice to not have to do the grunt work anymore .... nice to get a smidgeon more respect from patients than you did back in the days of nursing. Nice to work with a great doctor, which I do work for, and to collaborate and/or discuss cases with him. Nice to have weekends off finally. I'm still balking at having to wear street clothes, however -- just wish they'd let me wear scrubs and a lab coat ....which they won't. And I guess the money is better ....but you sure work hard for it. I feel NP's should get paid far more, and I also think doctors, should also get paid far more than what THEY do. We're all so pitifully underpaid considering the work we do, and the responsibility we hold.
  12. SoundofMusic

    NP thoughts on office managers?

    Oh gosh -- I'm relatively new in the field, but still have not really seen one who seemed to have the ability to effectively really manage, and who just did not seem untrustworthy and smarmy. The one I have now does a lot to make my job easy, but also CONSTANTLY cracks the whip on us in terms of patient volume and a host of other things. She just seems to always be lurking . .... right around the corner, ready to pounce if she sees something out of line. And it is tough at times taking orders from someone you KNOW has likely half or a third the education you do and truly has no understanding of how hard your job is. That said, yes, it's their job to keep the office running at a profit so we can all get paid ... The one I have now is already driving me crazy. She seems to draw you into her conflicts with others, which is ridiculous, because she doesn't seem to have the balls to stand up to the people whose behavior she wants to correct. She wants everyone to just keep their mouths shut, keep their heads down and do their job .... but it's just so unrealistic. There will always be a little bit of gossip in any office ...will always be a few moments here and there where people who are constantly hustling will sit back and slack a little. There will always be patients who take up a huge amount of time, and there will always be times where you just fail to perform perfectly. This one seems to look at us providers as if we are cattle ....she ALWAYS comes to talk to me during my lunch hour about SOMETHING ....which makes me mad ...I NEED A BREAK ...even just 15 mins to clear my head before the next session ... but she will never leave me alone during this time .... just wish they could view us providers as people/humans who need a little leeway ....but there is none. She's always digging and always saying things like, you need to remember who you work for .....ugh. (not necessarily to me, but says that about others ....actually, I think she's just a little off.) Also tough to see her relaxing, sitting at her desk with her manicured nails and cute outfits, all the while I'm sweaty, running from room to room, with my hands in various patient orifices, and me just trying to keep myself looking like an entirely disheveled mess. My dream would be to have my own practice where I as the provider ran things .... and eliminate the NEED for this type of person. But not sure that's entirely feasible ....lol.
  13. SoundofMusic

    How much did NP school prepare you?

    I will honestly say, I strongly feel not all that much. I did 700 clinic hours, whereas my doc went to med school for 3 years, then did 3 years of solid residency ....that's what you NEED. I wish that's what I could have done. Now I'm out and expected to know and do what he does ...(well, not really), but sort of ...it puts you in a perpetual state of intellectual disarray and discomfort/risk ... even the PA's I work with were far better prepared. Now that I'm here, I wish I'd gone to PA school. A nurse turned PA is a nice combo -- you've got the nursing background, but get the medical training to prepare you more thoroughly. Just my .02.
  14. SoundofMusic

    How to deal with obnoxious staff

    Oh I know .... I absolutely cannot and will not say much if anything at this point ... just trying to formulate a coping strategy for now.
  15. SoundofMusic

    How to deal with obnoxious staff

    Yep -- grates on me even more as I have to stand in a tiny room right right next to me While I chart .... í ½í¹„
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