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Discussion

Time to move on?

I am a FNP working in primary care. Graduated May 2013 and have been at the current job for 1 year. It is a good job with good doctors who are willing to answer questions and give me as much autonomy as I wish to have (I realize that this is sometimes more important than salary, so I want to point it out). I was hired to replace an MD who was retiring. Our practice consists of 3 MDs, a PA and me.

Since the beginning of Obamacare in January, we have seen a marked decrease in the number of patients that we have been seeing. Many of our patients simply dont come in because they cannot afford their deductibles or their insurance is not accepted anywhere so they have to be seen as a "self pay" which can become expensive, as well. The PA and I are both salaried employees and have a bonus structure based on the number of patients that we see (The bonus structure was recently changed which reduced our bonuses by about 50% beginning in June of this year which has made a substantial difference in our incomes).

With the lower numbers, the schedulers have been giving more patients to the PA than they have been giving to me. In a sense, I understand this as the PA has been here for nearly 4 years and has a client base already built. Completely understand when "her patients" return to see her. No issue with that. My problem comes when the majority of new patients and patients that are "overflow" from the doctors who have full schedules, are also placed with her. I am literally seeing 5-8 patients a day at this point. I understand that they are trying to help her by giving her more patients but it isnt doing me any favors by a) leaving me completely bored all day and b) seriously affecting my income. I have had only 1 patient complaint since I started (no additional refills of pain meds for a patient that had narcotic prescriptions from multiple providers per pharmacist) and, according to the schedulers, they have not had patients request not to see me.

I have discussed this with the MDs and the practice manager several times and it will improve for a few days but then I go right back to

Thoughts or advice?

Thanks

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    • Featured Replies

    Move to a state that has expanded Medicare.

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    • Experts

    I read to the point where I sensed that you are being treated unfairly, and that leads me to advise you to move on.

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    One year experience is good enough to move on.

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    Move on.... There really is no loyalty when it comes to money. I am a new practitioner who came to a practice that services majority low income patients. The numbers are low, but were also low before the practice was taken over by the MD who hired me. Apparently he is already talking about closing the clinic or dropping us down to two days a week because he is losing money. Everyday I come in I'm afraid that I'll be told that the clinic is shutting down and it has me stressed to the max. There's a lack of communication between the MD's company and our office staff purposefully on his company's part. I've been warned by my supervising physician ( she was the one who sold the practice) that he does not want to keep it. At the end, the medical profession is a business as well. If your numbers continue to remain low and they are losing money, they'll let you go anyway. Best to leave on your own terms and in good standing rather than letting it get ugly.

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    • Author

    Thanks all... I pretty much have the same opinion but feel bad because everyone here is so great. I hate to let them down by leaving but, ultimately, it is a business and I have to do what is best for me and my family. Its unfortunate that the numbers are so low now and I know no one has control over that. Im certain that it will pick up October-January but I cant continue to work at a low pay rate strictly banking on 4 months of the year to be busy. Flu season didnt even last thru February this year so 8 of 12 months being this slow is not going to work.

    I applied for the other position yesterday. Will keep my fingers crossed.

    Thanks again.

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