casias12

My favorite video. I close all the time, primarily using interrupted buried sutures, or simple interupted sutures. Sometimes a mattress suture if the patient is kind of big. No class can teach you what you need. Just get in and do it.

This is not correct. Incident-to billing allows for billing under the physician NPI at a higher rate as long as the NP/PA is following the alread-established diagnosis. Adding something new requires billing under your own number. Here is an article listing the rules for incident-to: Incident-to billing: Clearing up the confusion | Medical Economics Fortunately, you won't go to jail for doing this, and many practices do it. Usually, an audit, warning and fine come first. Some practices get away with it for years before being caught. You can, however, lose your NP license depending on the scope of practice in your state.

I guess it depends on a few "professional" factors. 1) How confident are you that you can handle situations appropriately. If you can handle most things until sun-up, and avoid bothering the on-call surgeon, you are worth more. 2) How long have you been with the group, and are you respected by them. They should be willing to pay you near what the surgeon makes if they know you can confidently do the job. If they think of you as a glorified answering service, you aren't worth as much to them. 3) Would you be willing to walk if you want a particular pay and they won't consider it...and would they let you walk? It sounds like you are not quite in the driver's seat, or you wouldn't be here asking. You don't seem to know your own worth to them. Start with that.

What a ridiculous thing to say. OP. If you are in a clinic and provide your own insurance, of course they need to verify this. It is their right to know that you are covering the patients you see with malpractice insurance. . In most states, you also have to provide it to the state, which is public information.

I do all caps. ARNP.

Someone once said a cardiologist could be replaced with an app, a primary could be replaced with a Wal-mart greeter. I took that to mean that PCP's just refer patients out, loosely, by the body system, and specialists get so used to seeing the same thing, they can write orders in their sleep.

"I have visited some of the best and the worst prisons and have never seen signs of coddling, but I have seen the terrible results of the boredom and frustration of empty hours and pointless existence." Warren Burger was a man with many statements, but no solutions. A quack and embarrassment for the Supreme Court.

Welcome to the real world. Most provider groups are small, and can't afford the luxury of extended training for someone who has been trained to a Master's degree level. I imagine he is putting you under a "stress test" to see if you will sink or swim. A new tactic a few of my colleagues are using during interviewing is scheduling the interview at the end of office hours, and having a prospective NP do an exam with a real patient during the interview. You may try looking for a job in a large institution, or maybe try looking to see if one of the many Medicare Advantage plans (United, Humana) are hiring for their clinics or home visits. Unless this is a very understanding physician, you days are probably numbered.

As Flipper points out, they are going through "structural changes", but they are usually in a state of confusion. Most of their "programs" come and go because they are all pilot programs. I worked with a section of United Health Group doing home visits for 1 1/2 years, then was given the opportunity to find another job within the company, or leave. Right now. Today. There were scant few opportunities available for me to transfer to on such short notice, so I had to leave with 2 weeks pay. I was making 100k base with bonus, so about $110k per year. They started out giving me .57 per mile, but about 3 months in, they changed the mileage to a "per diem" which was a whopping $430 a month. It wasn't a healthy working environment either. Lots of failed communication, finger-pointing, laying blame, hostility. I just tried to stay in my car and out of the office. The only way I could survive the time I worked there. Hope this helps.

Any NP practicing independently in an indepent state. I know several. Is that enough?

You are entitled to your opinion, but you are wrong on a few key points. How do they say it? You don't know what you don't know?”. Anyway. Training is only a tiny portion of becoming an advanced clinician. PA's are presumed to hit the ground running”, because their schooling is more focused. I agree that a lot of NP education is garbage nursing stuff. I used to find LPN's to be better nurses early on, and some became better than RN's overall because they were very task-oriented. But they had limits in their scope of practice that required an RN to do some of their work, and ultimately pushed them out of almost every hospital I know of. Why choose a degree that has more limits than the alternate choice? PA's are having the same job issues as NP's, although they have still managed to hang on to a small pay advantage in most areas. In Florida, there is a shortage of jobs for both. Many postings are for NP/PA, but a wise physician will tell you they prefer an NP because of the autonomy. As for changing specialties, NP's can work wherever their scope allows. Primarily, adult (now adult-gerontology), or FNP (all ages). I happen to be an adult ARNP, and have found absolutely zero limit as far as changing or considering changing specialties. The only limit I have is not treating under 18, which is fine by me. But I could add a post-master's certificate for family NP if I wanted it. In the real world, I just trained with a PA, and interviewed another PA who will be making exactly the same as the NP's in our company. I know many NP's who are functioning in roles that a PA could not do. But I don't know any PA's functioning in a role that an NP couldn't do.

You are much better off going from RN to NP. A nurse practitioner will always be a better degree. PA's will never operate independent of physicians in any state.... ever. NP's, on the other hand, have independent practice in many states now, and will gain ground in others. NP's can do everything a PA can do, but with more autonomy.

Ummm.Ok.No. It doesn't pass through the right atrium into the PA. It goes from RA to RV then to PA. ECG waveforms don't change when it passes through. You read the pressure from the tip of the catheter to see determine when you pass from RA, to RV, to PA, to wedge. It's usually not hard to get a wedge, but you may have to move the catheter in and out a little bit. It migrates, so getting a wedge once doesn't mean it will wedge agin a couple of hours later. Unless you manipulate the catheter a little. Pro tip - Don't wedge and then inflate the balloon. That would be bad. As far as invasive, I guess it depends on your definition. PA catheters are done in cardiothoracic surgery and cardiac cath lab all the time. The only "unpleasant" electrical activity is a little v-tach when you are in the RV. Just let the catheter settle and wait for the v-tach to stop. Don't grab for the paddles, the patient won't like that.

I feel the same way. I was a nurse for 15 years, and worked closely with physicians to gain trust and write "verbal" orders for things that made sense. As time went on, I think autonomy and involvement dwindled. Making the jump to nurse practitioner was, for me, a necessity. When I walk into hospitals today, never see the same nurse twice, and see them all sitting at the desk doodling on their i-things, I get a little annoyed. Ask a question of a nurse, the common answer is, "I don't know if he went to surgery yesterday, I've only had him for 4 hours". But any nurse who is planning to move up to NP should already be at a point in their career where they are thinking "I know what I would order/do for this patient. Man I wish I could just write the orders". That is someone who has enough experience to make the transition and be successful.

It wasn't a surprise to me. I just wanted to present it that way to see what comments would be generated. This was a fictitious patient, but it did present several legitimate scenarios. 1) Trading drugs for something else. 2) Over-using prescribed drug and running out way too soon. 3) False readings on UDS. 4) Hoarding old medications and using them in times of need. 5) Household that has red flags for prescribing controlled substances. 6) Use of opioids for chronic pain without adjunct therapies. 7) Use of opioids for neuropathic pain. 8) Need to educate patient about the mechanism of her pain, and help develop an appopriate plan for treatment. Anyway. Some good comments. Have a great New Year!