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It's too bad that moron fake PA gave the MDs someone to point their finger at. They don't want the bad publicity, so they look for a scapegoat, in this case it was an unlicensed PA.

Did you see the latest cover of medical economics? Big, bold title showed $200+ million lawsuit, and in big, red letters it says, "It started with a midleves mistake". Turns out it was an unlicensed PA that was involved, but now all of us under the AMA-created title 'midlevel' are incompetent. Just another sign of the MD community trying to segregate themselves at the top to keep their thumb on everything else. The more heated their position gets, the more worried they are. We're not going anywhere....

I think it's the 24 hr ED/hosp call that breaks this camel's back. It's frustrating and sleep depriving. I have to do around 25% of the call. Doesn't sound like much, but it feels like a lot.

I could, and have a really good offer, but I'm making too much money now to change. I was having a really bad group of days and venting a bit. There are positives, like the fact that since there is no doc backup I have to learn everything and it's helping me become really good at what I do. Then again, my buddy NP is pulling down around $300K/yr in his own business niche and he wants me to join him for the same $$$.... hard to turn that down!!! We'll see...

I did the same thing. I know how you feel. Hang in there. There are good days and bad. I was getting super stressed and super tired and vented a bit. It's not that bad some days. You will always have the experience that you are going through now to look back on and compare lifes tough times to, which helps. You'll have bad times in some form in the future, and you can say, "this sucks, but not as bad as when I was in school and I worked full time and......".

Ever feel stretched so thin it makes you wish you never got into healthcare in any form? I'm about spent here.... a rural hospital with the only doc on vacation so I'm it for the ER/hospital/LTCU and clinic and literally people all around me waiting to take a piece of me all day and that's not counting any of the patients!!! Trying to juggle trauma patients/cardiacs while running back between xrays to the clinic to try to see 3 or 4 more patients while the phone is ringing needing instructions on INR results, panic values, order clarifications on the new RSV infant admission, or the ****** off inpatient that can't understand why we can't do a HIDA scan before an ultrasound, or the call me in the middle of the night every night to come in and see whatever in the ER... AAAAAAAAAAAHHHHHHHHHHHHHHHHHHHH!!! I wish I would've become an engineer...

Yep. Primary care clinic, with inpatient rounds on my admissions and 1:4 ER/LCTU/Acute call. 1:4 would be nice, but I somehow get stuck with about 40% of the call time. And I get paid the least of the 4 for the call time. I get more angry every single minute...

I work in one of the most rural places in America. Yes I know what it's like. I don't rotate there. I work there. Once again, I think it would be better to put up with the rural %$& independently than be in a urban setting without autonomy. Isn't really off topic either, as autonomy and independence has everything to do with NP to MD programs, as that would be the driving force for most NPs doing this.

Everything. The call, the pay, the lack of administration, the patients constantly bothering you for more and more, the drug seeking tax-dollar slugs on welfare and medicaid, the movement toward government run socialization of medicine, the ones who are too good to get on the phone and consult with someone that wasn't part of their fraternity in school. I'm just going to find where the best reimbursement is in medicine right now, and explode in it and make enough money to invest in other venture enough to get out of medicine altogether. I'd rather run a backhoe than do this crap.

Not so much that anyone wants to. We'd just rather live rural and independent than urban and not. Lesser of two evils. Doesn't really matter to me personally, as after 3 yrs out of school, I already hate it so much that I make a daily attempt to find another way to make six figures as far away from healthcare as I can get. Come on powerball....

Wrong again. Autonomy won't give any advantage to fam practice NPs in a place with all the goodies where all the MDs have flooded to. I would much rather practice independently in a rural area than joined at the hip with a MD in museumville.

Let's see... more autonomy, how about complete so I don't have to have an even higher overhead and startup expense to open a new clinic in a rural place that doesn't have one. Then I see around 5000 people a year who likely wouldn't have seen anyone had a provider not come to their town. Then, I can consult the physicians I refer to regularly as needed, just like I do now. Yeah, go to one of the completely autonomous states and find a NP who is independently practicing orthopedic surgery. Yeah, I want to get paid family docs wages too for the same services. How dare I... Where's the savings? How about the miles the rural folks have to drive if they don't have a clinic in their town? How about the ERs who have about 70% of their patients that belong in a clinic where the bill to us taxpayers is about 10% the cost. Instead their in the EDs because they can't get into their doctor (or more appropriately the system has led them there like sheep).

Compared to yrs ago, they most certainly are starving for students. And so are fam practice residencies. Keep thinking you are on par with God as your last sentence suggests and remember all those rural nobodies that will die without proper primary care because there are no docs to replace the retiring ones. This isn't a hypothetical situation, either. It's happening right here right now. You can try to convince God when you meet him... because you can't convince me or anyone else that isn't a traditional med student/grad. Or you could just give us NPs complete and total autonomy to open our own rural health clinics without having to pay some doc to sign off. That would be also worse for the patient although I think it would be fine in most cases. Bet you'd rather pick the first option if you were forced to pick one, further strengthening the argument that it's not about the patients benefit at all.

This is the school of thought of the general opposition to any change such as a bridge program for midlevels. It makes sense to me, however, in a growing shortage of fam docs... why not create a bridge program that includes all the essential sciences and cuts way down on all the non-primary care exposure? It COULD be condensed, it COULD work well and it COULD produce real, competent doctors for the primary care field. Hell, you could even require rural health practice for one of these "short-cut" doctors. "sure it makes sense to you because you are a np" states the med student. I personally hope to be so far away from medicine in any form by then it won't matter. I hate it. "but bridging is a short cut and that's not fair because that's not how I did it" states the med student. 4 yrs bach, min 1 yr experience, 2 yrs grad school, for a total of 7 yrs when you want to begin your likely 2 yr bridge program... hardly a shortcut. "but your 7 yrs isn't as hard as ours" Who cares? This attitude of my way or no way is costing this country a lot of lives. That's right, many people will die simply because a bridge program idea or other open minded ideas to increase the primary care doc work force will continue to be shot down because the opposition ultimately cares more for themselves than the patients. "but patient safety is what we're concerned with" No, you're not. If the number one killer is heard disease, and the way to prevent that is the simple task of lower lipids, blood pressure, controlling diabetes, and promoting heart healthy behaviors, that even us lowly midlevels can do with our eyes closed then it's easy to see that even a MD that was bridged would satisfy the laws to open their own clinic and receive the meager reimbursements to make a practice work. This would result in more patients seen, and therefore more risk factors treated, resulting in lower mortality and morbidity in this country. At least now you can admit that you'd rather more people die than be open minded to an alternative method of becoming a primary care MD.

Bullseye. You could attempt to find a career field that is loaded with more ambiguous and meaningless material, but you will not succeed. Nursing education makes me nauseous. The nursing educators will argue that you need to write papers about what color of aura Martha Rogers was feeling on Tuesdays, but you'll never convince me this can make you a better NP. If there ever comes a day that a NP can get a MD online with clinical rounds at your home town or nearby city, I'll be saying goodbye to the N in FNP forever.

or you could just anonymously run a bead of polyurethane glue along the door of her office, then close it. once it dries within a few seconds, they'll have to saw around it to get it open. :angryfire

Kansas (rural). Salary $108,000, with full paid benefits and 5 wks PTO/CME leave, $1500/yr CME allowance, plus $25k/yr for loan repayemnt. This sounds like a lot, but in my opinion, for what I do, it should be minimum $200K salary. 356 more days till the end of my loan repayment contract, then it's bye bye. I do clinic (high seventies/year) and inpatient/ED call/rounds. Call is 1:4, and divided out for the extra $30k/yr is around $13/hr. ED averages around 4-5 patients per day. Kicker is the docs do exactly the same thing for almost 3 times as much money. That's one of the biggest reasons I'm leaving. And, the productivity bonus plan is rediculous (5% up to $200K, then 10%). I think 33% is fair. I'll be joining a friend NP soon who is on pace to make $300K/yr this year. How? self employed in a genius niche...

The answer to your question is a NP can absolutely own a practice. Even in states that suck for NPs (like Missouri) you have every right to own a practice regardless of whether or not you work there. If a layperson can own a practice, NPs can too. You have to have the books right (policies/procedures/documented consults, etc) to please the state gov't laws, but this is merely a formality made by the state medical association to protect their sacred ground.

If all providers would do this there'd be enough money in the system for everyone to have free medicine no matter what. Medicare part D is a joke, and a slap in the face to our seniors, all of whom were in some way affected by a war 100 times more horrific than we are bitching about today. This will happen, but unfortunately, it will be made by politicians instead of healthcare savvy people so it will come with many more negatives forcing a great many of us out of healthcare altogether and costing many people their lives (ie wait-listed for a heart cath).

You need to laugh at those offers so hospitals/doctors start learning that those are rediculous. Tell them you want a percentage of your billing. I'm learning to play the gov't reimbursement game and I'll be in the $300K/yr ballpark soon. You just have to find where the money is and exploit it, unless you did this strictly to practice in a field you enjoy. The way I see it if they're going to take a bigger chunk of my paycheck in taxes, then I'm going to get back at them 10 fold (in a legal way, of course). I just want to make as much as I can in as little time as possible so I can enjoy my family and the things I like to do (golf, fish, hunt, travel, ......)

I hate their expensive brochures, and I don't believe a word any of them say, because they are trained to sell you something and they manipulate facts and studies and I see right through it. I act interested at times, but they can see what I prescribe. That's the one reason I would like to see socialized medicine, as all that would go away. I just tell them I'm an exclusive generic user, as the cost of medicines that are non-generic are rediculous, and I've been very successful with 99% of my patients on all generics. And they love me because not only is their BP and HA1C better, their meds went from $600/month to $30/month because their doctor gave them the last reps meds they saw and has no idea the cost or insurance situation of the patient. Here's a good example: you find dyslipidemia, and diet/exercies fails, and it's time for a statin. Why the hell would anyone not give Lovastatin? It's cheap, it works for most to get them where they need to be, and even the higher doses can be combined at Wal Mart $4/month (20mg highest dose) and they'd have to pay a max of $16/month for the highest dose of Lovastatin.

I wouldn't do it. You'll be bored out of your mind. It takes me 30 seconds to do one. I don't care what anyone says about checking their whatever. You can look at their history in a few seconds, and if you check for hernias, tendon reflexes, and DRE, you're wasting your time. They just want their license so they can make a living. If they have high bp, just get them on the meds and shorten the license. I'm telling you, it's easy enough you'll do two weeks of them and be ready to quit medicine altogether. I'd do it all day, every day... for $500,000 a year. And you think I'm doing something awful... the docs I work with didn't even know what monocular vision meant before I came. Can't get around that one... but otherwise give them their license and tell them to see their regular doctor if you see anything out of the ordinary.

You should know what you are producing in every way. Number patients, averages, billing, and collecting. Then you can negotiate what you want. You should be able to get about 1/3 of what you bring in over your salary and benefits. If you like salaries and don't want productivity based pay, then ask for a figure that makes sense to you that you can answer the question, "Why should I pay you XXXX?" If you don't get what you want, start looking for another job that will give you a fair deal like this. They are out there, and unless we all start leaving the rediculously low paying places, they'll never learn. The only difference in my opinion between a NP and a MD pay in family practice should be the base salary should be higher for the MD due to the higher liability and training. But in all fairness we should all be on the same level as far as productivity since we bill out the same in most cases. If you work hard, and get someone to listen to a fair productivity based system, there isn't any reason in the world you shouldn't make $120K+. Good luck.

I get an extra 20K/yr but this is for on call for hospital inpatients, long term care and ED. This is getting ready to go to 30K/yr, but this is rediculous in my opinion so I'll be leaving when my contract is up as the docs are getting four times that for the SAME THING. Yes, they know more (very generally speaking) and get trained more and have more liability. But out here in rural America when we NP/PAs are expected to know more, take on more liability and perform more independently they have to learn we're not going to take peanuts for this. If you are a NP/PA and get screwed like this DON'T TAKE IT!!! Leave and force them to pay fairly. There are plenty of jobs out there.

You can make your own check off sheet for the most common complaints then make a general SOAP based sheet for the rest. That's the premise of T-Systems anyway.