Purrsx2

I started working in the end of February for an outpatient ENT clinic of a large teaching facility. It is mid-May and I am still waiting to be credentialed... I am seeing patients, diagnosing, prescribing and referring, but I pend all prescriptions to be signed by MD and he puts attestation on every SOAP note of mine and all services are billed under his name. I was explained that I cannot see patients and bill until the credentialing process is completed. I am not sure if it means credentialed by that large teaching facility or by Medicare, Medicaid and every major and minor insurance company out there, but I am still patiently waiting. While the surgeon was on vacations, I was not allowed to see patients since those visits could not have been billed under his name. So I just sat in the office for 2 days and read ENT books and did some research for a couple of complicated medical cases he told me to figure out (did a good job on that, so when he came back we changed their Tx plan based on my recommendations). I still got paid for those 2 days, which was nice, but it was kind of weird just sitting there in an empty office full of support stuff (2 LPNs, receptionist, surgical scheduler and office manager).

Question for all working NPs: if Glassdor gives NP salary range for a particular employer as 41 to 45 per hour, and the offer states 41.02 for a new graduate NP (38400 for 18 hours), is it worth to try and negotiate, or is it really non-negotiable because this corporation is using pay grade rates (grade 1 through 30)? Is it possible to renegotiate the rate after you get 1 year of experience? As a side note, this employer is a non-profit organization and a great name to have on the resume for the future. I graduated back in May 2016 and could not land a job, no one wants a new grad with no relevant experience, so am absolutely taking this offer. However, is it too late to try and negotiate after I said yes, but before I sign the contract? I am making this much as an operating room nurse (6 years of experience) currently. Any advice is greatly appreciated.

BCgradnurse, Thanks for the response. I am expected to start allergy testing program in the office. They have 2 LPNs there, I don't know if the surgeons (they have 3 of them there) expect me to do the testing and then analyze the results, talk to the patient and come up with the treatment plan, or LPN will be doing the technical part of it (would need to be trained to do it, I guess) and I will be doing the rest. I will get more info on that.

Thanks, BostonFNP and BCgradnurse! Since I work in OR, I have seen my fair share of intubations with glidescope (it has a monitor that shows the trachea and vocal cords to assist with difficult airway), EGDs, Bronchs and FESS, so I have a very good idea of normal versus abnormal looking structures. The surgeon also mentioned that he will provide me with a book that he uses for his ENT residents. As for allergy testing - I am totally new to that, so I don't even know where to start...

Thanks for advice, BostonFNP! How difficult was it to learn how to do fiber-optic endoscopy?

Anyone with ANY experience in the above procedures? I am a new grad and I am offered a part-time position in ENT office. I was wondering if these procedures are something that a new grad can be trained to do in the office setting by the hiring MD (surgeon) or I will need some kind of official training. I am also expected to do allergy testing and the only provider who knew how to do it left a while ago, so "on-the-job" training is not even an option for that one... Any advice is greatly appreciated!

You can also contact your local Labor Department. If you are not being paid your earned wages, Labor Department will get involved and you will receive all your back pay pretty quickly.

When applying for DEA license the form requires to state the address of the practice where you are prescribing. What do you put there if you are not working/prescribing yet?

Is there anyone who currently works or worked as Nurse Practitioner in an ENT office? Have you done the following procedures: 1) Nasal bleed cauterization; 2) Scoping with flexible fiber-optic scope (visualizing throat and vocal cords); 3) Salivary stone removal; 4) FNA for neck mass; 5) Peritonsillar abscess aspiration; 6) Myringotomy / ear tubes placement; 7) Allergy testing (in-office) and allergy shots. Thanks!

It is a known fact that Andrew Wakefield, a British former gastroenterologist and medical researcher, published a fraudulent 1998 research paper in the world-known peer-reviewed medical journal Lancet, claiming the link between the administration of the MMR vaccine and appearance of autism/bowel disease. This claim was consequently refuted by his peers in the same journal. Shall we believe Dr. Wakefield's claim on the basis on the fact that his paper was published in Lancet and OP's personal belief that ?Shall we consequently ban MMR vaccine on the basis on the above "evidence"? Anyone can write an article with false claims, "supported" with non-existent sources or references to non-existent data from those sources, and that article will be published... until peers who know how to read research come up and refute the claim that is based on nothing but "wishful thinking". This is what happened in J. Pereira's case (the article OP keeps posting again and again) - he posted lies that suited his agenda/bias, and got publicly "whipped" in the same peer-reviewed journal by his own peers. I guess, OP somehow conveniently continues to overlook this and cite false data to prove own personal agenda. Or, perhaps, OP does not know how to read research articles and separate "wishful thinking" from scientific evidence (especially if this scientific evidence does not support OP's personal agenda/bias). That is exactly how people lose credibility in the eyes of the community.

I would really appreciate if you provide your source for this statement (reliable one).

Thank you for the provided article, written by J. Pereira . I read it and looked up the sources that were quoted in this article. Some of them were not listed, and others did not have information that he referred to. No wonder, this ERRATUM IN was posted in the same journal with regards to his article: Curr Oncol. 2012 Jun;19(3):133-8. doi: 10.3747/co.19.1063. [h=1]Pereira's attack on legalizing euthanasia or assisted suicide: smoke and mirrors.[/h]Downie J1, Chambaere K, Bernheim JL. [h=3]Author information[/h] [h=3]Erratum in[/h] Curr Oncol. 2012 Jun;19(3):e227. [h=3]Abstract[/h][h=4]OBJECTIVE:[/h]To review the empirical claims made in: Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol 2011;18:e38-45. [h=4]DESIGN:[/h]We collected all of the empirical claims made by Jose Pereira in "Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls." We then collected all reference sources provided for those claims. We compared the claims with the sources (where sources were provided) and evaluated the level of support, if any, the sources provide for the claims. We also reviewed other available literature to assess the veracity of the empirical claims made in the paper. We then wrote the present paper using examples from the review. [h=4]RESULTS:[/h]Pereira makes a number of factual statements without providing any sources. Pereira also makes a number of factual statements with sources, where the sources do not, in fact, provide support for the statements he made. Pereira also makes a number of false statements about the law and practice in jurisdictions that have legalized euthanasia or assisted suicide. [h=4]CONCLUSIONS:[/h]Pereira's conclusions are not supported by the evidence he provided. His paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world. [h=4]KEYWORDS:[/h]Belgium; Canada; Euthanasia; Netherlands; assisted suicide; evidence; slippery slopes https://www.ncbi.nlm.nih.gov/pubmed/22670091 Quite embarrassing, eh?

Thank you for the googled links. I carefully read all the information provided on those links, but still did not find any cases where "patients and children have been euthanized without their consent or knowledge". Here is the quote from the article: "Belgian parliament on Thursday agreed with the doctors who argued that in rare cases of unbearable and irreversible suffering, children should have the same right as an adult to ask to die with dignity. Under the amendments to the country's 2002 euthanasia law, a child of any age can be helped to die, but only under strict conditions. He or she must be terminally ill, close to death, and deemed to be suffering beyond any medical help. The child must be able to request euthanasia themselves and demonstrate they fully understand their choice. The request will then be assessed by teams of doctors, psychologists and other care-givers before a final decision is made with approval of the parents." Provided links did not support your statement that "patients and children have been euthanized without their consent or knowledge".

I would be very interested to see your source of this information. Thanks in advance.

Thanks to everyone who actually answered my questions. I agree that president can't change state regulations. Is he able to appoint a healthcare "Czar" who will initiate changes in Medicare/Medicaid rules, since these are federal entities? If Medicare, for example, would mandate that NPs can only work under the supervision of MDs to be able to get reimbursement, than it is only a matter of time when the rest of major insurers will follow the suit, regardless of what state scope of practice is. Can it possibly happen? Also if Medicare decides to change the reimbursement to NPs from 85% to 60% as a cost cutting matter, without affecting reimbursement to MDs, the rest of the major insurers might also follow the suit. Can this happen? Is it true that conservative states have the most restrictions on NP practice, which is reflected in reimbursements to NPs in those states being much lower that the rest of the country?