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djmatte

djmatte ADN, MSN, RN, NP

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djmatte has 7 years experience as a ADN, MSN, RN, NP.

djmatte's Latest Activity

  1. djmatte

    New grad FNP - Health Risk Assessments?

    As others have noted, Medicare wellness exams give you absolutely no clinical experience. At most you get adept at getting detailed histories. But those companies only goal is to make a quick buck while you do the leg work. They have very minimal overhead or need of facilities as technically no physical exam is necessary. It’s an annual “come to Jesus” so Medicare can better plan for the next year. Ensuring the patient knows what preventative things they *should* be getting (whether they opt to actually do them or not). These companies are not vested in the long term outcomes as their only role is to ask the questions and document the needs. Meanwhile pcps never see those outcomes and basically are already doing the same thing. I don’t recommend this as a first job and only as a supplement should you need the extra cash. It will never get you in the door.
  2. djmatte

    Prescription "cookbooks?"

    5 minute clinical consult is my standard quick reference. But occasionally go deeper with other options.
  3. djmatte

    Layoffs - FQHC and others

    We have a quest lab on site at most of our clinics. So don't technically do our own draws. What I push my MA to do is pick up the slack on what scheduling should be doing as it is only run by two schedulers who aren't really good at what they do. One method I recommend on the telehealth side is to get a system where the MA calls the patient and gets them the access to whatever system you are using. They can also validate insurance and if you are collecting a copay, they can do it over the phone. Doxy.me is my preference as it is free (or you can pay 30 bucks a month on it). But epic also has some video functionality. But it's slow and obnoxious.
  4. djmatte

    Layoffs - FQHC and others

    If you’re incorporating telehealth, I would get on the horn with as many patients you previously saw who are in for regular chronic conditions at the intervals they would normally come into the clinic and get them on the schedule. Have someone go back 3 to 6 months and start calling anyone who hasn’t been seen that probably should be. Any refill requests are put on the schedule. Any patient advice that requires any form of medical thought is put on the schedule. Our scheduler’s have done this and where before patients had to initiate this contact, our group is under the impression the clinic is allowed to get that ball rolling through this. lately some of my days have been pushing 24ppd. Granted some are still slow but getting better. We’ve incorporated a range of options including Doxy.me and now Doximity App has video capability. I’m suspecting this whole thing will be pushing clinics and clinicians to do things they never had to do before.
  5. djmatte

    COVID 19 Pay rates

    So far everything seen in Michigan only wants RNs. Kick me their info though because of my clinic starts firing with our low census, I’ll be looking into that!
  6. djmatte

    Full practice authority only bills for 85%?

    State doesn't set those up from my understanding. Federal law and insurance company policy does. Adjust your expectations and move on. Or just don't bother with insurance and go with a direct primary care model.
  7. Someone posted a suite in the past here and hell if I can find where that thread went. Looking to sort out ideas to get into a telehealth side hustle. I am actively looking for good EMR options and maybe something that has some form of ability to send prescriptions that isn't an exorbitant price. Any thoughts?
  8. First step is acknowledging your mistake. Second step is fixing your mistake. The third step Is moving on. It isn’t going on explaining why your mistake is or isn’t valid. we have some honor system on these boards for sure and you choose to or not to abide by that. there’s nobody to enforce credentials, but you can probably be banned for breaking the TOS once you publicly disclose you are. Regardless of your failure to understand those terms.
  9. djmatte

    Best schools

    Alabama all day. You’ll have a degree that people will actually respect. Phoenix is OK for someone who just needs a promotion related terminal degree. We saw this often in the military where someone needed a masters to get to their next pay grade. Past that, I wouldn’t trust a degree from there where someone needs to exhibit actual competency in a subject.
  10. djmatte

    Help Choosing FNP Program

    Frontier has its own prestige. Especially for nurse midwives. It may not be the other schools, but it’s dedication to nursing practice and family medicine is exceptional. While granted I am biased having attended there, I appreciate a school with the heritage of being founded as a nursing service with one of the first midwifery programs In the early 1900s that evolved into a school that encompasses broader programs to improve the health of those lacking access. As a school, they were setting distance learning standards when others weren’t to include secure browsers, in person requirements, and video monitored proctored exams. Those other schools are probably great. But if cost is an issue, frontier has done fine for my career.
  11. djmatte

    Scared of being successfully sued

    A few things I would have done different. Since you previously filled these meds, you now technically have a working relationship with them. Under circumstances where there’s a controlled substance I’m uncomfortable with, I heavily impress the side effects of long term use, the alternative medications available, and recommend tapering of these. Sometimes it works. If they don’t choose to, I give them one week supply With a UDS, promise to fill the rest when results are in, and encourage them too follow up with their regular provider. I wouldn’t go so far as to educate the other provider as I’m sure they more than understand the reality of addiction with these meds. Some providers just don’t care or don’t want the fight. If you felt inclined to justify to them your choice then maybe. You’re never obligated to maintain another providers therapy. But you do have some obligation to reduce the risk of withdrawal. With either a tapered dosing or arranging an alternative appointment. By all intents though, this is a patient in a shared clinic. Presuming you and the other provider are mid levels and your previous history treating this patient, you already own their outcomes. You likely won’t be sued at the end of the day though.
  12. I would argue until those boards are passed, you never use the FNP. You are an MSN only. “NP-C” or “FNP-BC” are only conferred when certified. FNP Is not a college degree type and shouldn’t be used. Similar is applied to RNs. My cousin got her BSN but never passed her boards. Took twice and never went back sadly. She will always have her BSN, but without that certification, she can never claim to be an RN or a nurse at all. You can’t claim to be an APRN either as that is for select types of advanced licensed nurses. Not all MSN or DNPs are advanced practice nurses. That title indicates advanced training with additional privileges. If you don’t meet the board certs for those, you don’t get to claim it.
  13. djmatte

    Are you supposed to check a boy's foreskin during a physical?

    Did you actually read the conclusion? “A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbehad more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.“
  14. djmatte

    Are you supposed to check a boy's foreskin during a physical?

    Well woman exams 25 and over per ACOG guidelines should have a breast exam offered every 1 to 3 years. Breast exams are pretty standard of practice in my clinic and one of my precept locations were sticklers on them. And that’s primary care. I’ll admit male exams aren’t to the same scale or consideration unless there’s a specific complaint. But I’m unaware of any recommendations for that specifically.
  15. djmatte

    FPA in Florida passed today!

    I'd call inability to write schedule 2 with full practice authority a win. In an environment where clinics and clinicians are being scrutinized for writing controlled substances, having the legal up front conversation with new patients in my own clinic to not prescribe them would be fantastic. I can prescribe them under my collaborator in Michigan and with the sheer numbers our practice (and this region) has done over decades, addressing the opioid epidemic has been a patient management nightmare. Not having to check databases for scripts, investigate patients rational for doses, or having to regularly do UDS's to ensure compliance in an area where diversion is huge would make my day.
  16. djmatte

    Are you supposed to check a boy's foreskin during a physical?

    Again, why are we resurrecting two year old threads? You're new to these forums as of a month ago. But every post you've made has been regarding gender diversity and personal issues with seeing the opposite sex.
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