Katya000

You could always pop into medical school classes, it's my understanding that a public university cannot tell you to leave if you are there for education, and you don't have to pay if you aren't looking for a degree--however you won't necessarily have access to everything you need and may or may not get some flak for being on medical student's "turf" if you tell them who you are. It would be awfully time consuming though haha. Good bye full time job, hello 4 hours of lecture 5 days a week!

I can't remember where I heard this/read this, may have been on this forum, but there was an NP who lived in FL but refused to work there and did locums out of state just because practice laws were not ideal--but loved FL too much not to live there. I don't have any personal experience myself with FL practice laws but know certain states can be EXCEPTIONALLY difficult and time consuming to get licensed--apparently CA can take six months for it to go through Hopefully someone here can give you some better guidance.

I'm looking for a good book on procedures for primary care if anyone has any suggestions? I would also like to find a good book on thorough documentation to help CYA--I never felt that I was taught how to document well and I find that it takes me a very long time to chart. I found these two books, anyone have any experience with them? Essential Clinical Procedures: Expert Consult - Online and Print, 3e (Dehn, Essential Clinical Procedures): Richard W. Dehn MPA PA-C, David P. Asprey PhD PA-C: 9781455707812: Amazon.com: Books Pfenninger and Fowler's Procedures for Primary Care, 3e (Pfenninger, Pfenniger and Fowler's Procedures for Primary Care, Expert Consult): 9780323052672: Medicine & Health Science Books @ Amazon.com

I would just make sure to keep your hours up and your experience current to keep you competitive for a NP job in the future, if you find you need one FT. Based on what you are telling me I wouldn't work FT as an NP while working your business, I would do PT, per diem, locums, something just to keep your resume current in terms of clinical experience. Depending on your state laws you could explore having your own private practice some day--you obviously already have business experience which is what a lot of us lack, sadly. And having your own practice doesn't need to be super complicated--telemedicine is starting to take off, which I think would be great for something like mental health (not so sure how I feel about primary care unless someone is calling in from another office and has already taken vitals, assessed the patient etc). In the future I plan on hanging out my own shingle and doing a very no frills community clinic with low overhead.

I put in my notice and left my job. I was the 4th provider to leave in a six month period. You would think this would give them some impetus to change but apparently this clinic has been a revolving door for providers and CMO almost as long as it has existed. I'm going to do locums work now, travel the country, possibly do locums to permanent eventually. I got a lot of primary care experience from this job from Hell, but more importantly I know what to look for in my next permanent job. And I'm going to be picky

They'll probably be willing to wait for you as rural areas are often desperate for help and the work they do get tends to be transient as people decide either they don't like how isolated it is or (honestly) the job sucks but there isn't much competition to be a better clinic/hospital so they just keep going through people. I would just contact a few in the rural area you are interested in, let them know your situation, they might interview you beforehand and get a lot of stuff out of the way so that when you do get your certification it won't take as long to on-board you. I don't know your personal situation but finances were tough when I graduated and I was eager to get some money to pay my bills.

Don't forget to add B12 to that mixed injection cocktail Honestly I love my patients (most of them) but they can be SO insistent about things they DO NOT NEED. The best ones for me are when they tell me they know all the tests came back negative for X (multiple sclerosis for a true example) but they know they have it because they can "feel it inside". And want me to 1- put in a referral to neuro for them or 2- just start prescribing the specialty drugs without any obvious necessity. I also get lots of weird requests for specialized "letters". A letter to the landlord to say the boyfriend needs to move in, a letter to the group home manager to tell her that the living arrangements are exacerbating her heart disease (current 2ppd smoker with personality disorder most likely causing daily fighting among residents), a letter to get a patient out of jury duty without medical cause, a letter after never being seen in-office for an excuse for missing work the past three days "I was sick". Or the return of the letter that didn't work for its supposed purpose "this needs to be changed because they won't accept it". All these requests get back to me as somehow urgent, but the guy with the wildly abnormal labs told by his specialist to get into his PCP asap to discuss them, well he's scheduled THREE MONTHS AWAY and I only find this message by looking in the chart for something else as it was never routed to me.

Eek, I guess I'll add that to my list of questions to ask the recruiter.

I'm seriously considering one of these jobs while I'm looking for something more permanent, or I may start doing locums for awhile to travel the country with this as my first placement. They are offering $140 in OR with a sign on bonus of $1000 for the company I'm considering, I have seen as low as $50 per hour. I'm at a crossroads in my life, I have about one year of experience at a community health center that ended up being a disastrous place to work, and I am currently going through a major break-up (3 year relationship, we were engaged but the longer we were together the less it seemed to work). We're still living together (amicably but it's awkward) so you can imagine how I would be desperate to grab something quick :)

Sounds exactly like my position. Zero control over my schedule, multiple times I say "no double books unless I approve" (rarely happens), double books placed on my schedule without even a head's up they are there (I have to find them on my schedule--and then they'll say "per RN or per another provider" as if that makes it all okay), lunch for 15 mins is a very lucky and slow day indeed, and I leave at 6 at the earliest with my last slot being 420 or 440, plus I spend hours of my "personal" time charting as they don't believe in granting admin time. We hire medical assistants without any experience and nobody knows how to do anything, and you're lucky if you can find someone to do that UA for you as a lot of the time people are either hiding from work or off busy with something else. We have one of the slowest RNs in the world, she takes (I AM NOT JOKING) 2 hours to do a UTI appt. She sees 2 ppl a day and still ends up with tons of overtime (they pay her hourly). Absences by MAs/RNs are so common and ignored it's a joke. And the same day acute visits I get are almost always about controlled substances. My advice? Get your experience and get out! There are great FQHCs out there, they are difficult to find, but look hard while getting experience. Unless of course you signed up for loan forgiveness, then you're stuck with 2 years. I applied, was accepted and turned it down because I could never work at this place for another 6 months, let alone 2 years!

Not weird requests but outright lies about reason being seen for pain seeking patients. Stuff they know would never be turned away like chest pain; or an acute complaint like UTI and you get them in the room and they actually just want their oxycodone Rx renewed for vague back pain complaints. Ask them directly about said reason for appt and they deny ever wanting to be seen for UTI or chest pain, etc. Even our staff will lie to get someone out of the waiting room into another provider's exam room--eg day before yesterday patient showed up to establish, 1 hour late for appt, told them I wouldn't see her and she started banging her head against the wall wailing she was going to kill herself if she didn't get her pain meds. They told a different provider she'd walked in off the street with acute suicidal thoughts, never mentioned she was actually scheduled and arrived late, so he saw her. It was a giant spectacle that ended with her spewing profanities and threats at the check-out lady after her pain pills were denied for obvious pain-seeking behavior (multiple prescriptions and ED visits in the last few months, not to mention the behavior she exhibited at the visit). Oy vey, I'm burnt out too.

oof. I think I'd keep looking for something in-between. If you want easy, I'd move to be closer as I hate commuting and an hour would be the max I would ever commit to for commute. And that would probably last 6 months lol The difficult job with the right support would be what I would choose personally; if the risk is all on your shoulders and you don't have the experience to manage this responsibility, skip it. I'm basically in this position right now, I work independently after graduating in May 2014 with VERY LITTLE support and looking for something new. The temptation for something easy is definitely there, and some days I wish I just worked in a Minute Clinic, but I know I'd get bored so quickly it wouldn't last.. If you absolutely need to work right now, pick the easy one with 3 hour commute, see if you can live closer or keep looking in the meantime.

I think law would be great to study, and I'd probably want to work malpractice for anything that seemed like it needed an advocate but meh, I've known about the glut of law graduates, poor paying jobs and miserable hours for at least a decade which is why it doesn't appeal to me. Being an NP may not be the best possible job in the world, but I'd still rather do this than be a MD because of the loan debt. And there really is a lot of flexibility in types of jobs for NPs and I'm currently looking for a new job and haven't had an issue with finding something despite the over-saturation of NPs in the market. Harder for new grads, but I have over a year experience now so it's been much easier. Plus I like to work in rural areas so that helps. Suffice it to say, I'd skip law school and pick up some books, check youtube for "classes" (youtube has everything!) and live vicariously :)

In a pinch I have prescribed for my fiance but NEVER felt comfortable with it, and never prescribed anything controlled (even though he asked once when he had a killer headache). I made him establish with someone at the clinic where I work. I honestly think it puts us in a really difficult situation where you may want to help someone but you have a pressure/bias because of the relationship. So personally I think it's a bad idea. I've never prescribed for myself and never would unless I was dying or something extreme. I worked my way out of being a PCP for those who work with me at a lower or higher level. I am a PCP for a FNP colleague and it's never been uncomfortable, he's always been willing to work within my area of comfort for prescribing. I will prescribe for other members of the staff for acute things after being assessed, UTIs/sinus infections etc. Still do not feel comfortable doing controlled stuff for people I work with because of the pressure (cause honestly I like to take care of people and I'm sensitive to their pain and I feel I would probably be less biased than with someone I didn't have a personal/working relationship). Truthfully I can be a bit of a hard ass about controlled meds but I work/live in an area with unbelievable drug addiction/abuse/diversion.

My clinic pressures us to see psych patients and I don't feel comfortable with it because of lack of education and training. Legally in my state according to BON I cannot manage these patients' care, but that doesn't seem to bother the higher ups in my clinic. I have been collaborating with our mental health NP when I see these patients or suggesting they be seen at a psych clinic. I cannot do actual referrals for external psych because the clinic "forbids" it, so I refer via a conversation with the patient. Our mental health NP is leaving at the end of July though so the patients are starting to freak out about what is going to happen to them.