[NPInfo] Physician blogs maligning NP s and PAs another issue

Mon Mar 10 05:43:09 PDT 2008

At the retail clinic, if a patient deosn't have a PCP, we have a list of PCPs taking new patients that we give them. Many older patients still say they don't want a DO as their PCP. But they are happy to see me at the retail clinic. Go figure...

Sue D in MI

 --- On Sun 03/09, David Mittman < dmittman at advancedprac.com > wrote:
From: David Mittman [mailto: dmittman at advancedprac.com]
To: npinfo at nurse.net
Date: Sun, 9 Mar 2008 22:08:37 -0400
Subject: Re: [NPInfo] Physician blogs maligning NP s and PAs another issue

Carla: You are a pioneer. Most physicians don't want you to have, see, refer, or be the medical home for any of "their" patients. Some will have you do that all if you work for them, some wish you (and PAs also) never happened. Talk to an old D.O. The same exact thing happened to them. Their patients were taken at every turn. MDs told the patients DOs were quacks. A few still do. So, what do we do? Do we turn the other cheek? Sometimes, but let them know you are watching with both eyes. I would lunch with the "opinion leaders" in the community and ask them to help. They might say no, but I bet most will think it over or say you are right. Also a letter to the medical board asking what to do would be of interest. Not giving names, etc; just the situation and if they feel it's ethical. As for joining the ACC, please do. We are still a struggling group of committed people. We will be doing much over the next year. 
Clinician Reviews will be working with us and has agreed to help us with getting some advertising going. There are a number of ACC BOD members now on NPInfo. Dave On Mar 9, 2008, at 5:32 PM, Carla Anderson wrote: > I also wish to join the ACC. I mentioned it before, and am working > at my second job today, but will get back to it right away. I have > a question for the list. I did not see the original blog, of > malignment, but along those lines..I have my own practice. I do > not know if it has anything to do with me being an NP PCP rather > than an MD but here is what is happening. > > > I have noticed over and over again, that I refer to Ortho, or > General Surgery, or wherever, and rather than them writing me a > nice letter of Consult and sending the paient back to me, they > either continue seeing the patient for weeks or months (if they > have good insurance) and they are doing 
primary care visits, not > needed for their specialty services, (billing the patients > insurance at their specialty rates) , or they are referring > patients to another specialist. They are breaking the rules. They > upset the patient and confuse them. I do not know if they tell the > patient negative things about NPs, and they do not really know me > personally, this is not a personal thing. But one patient had > severe swelling, pain, feeling cold, and numbness to her left > wrist with positve phalens and tinels, and does a lot of repetitive > computer work...so I sent her for an u/s to r/o dvt, then emg/nct, > to eval for Carpal tunnel synrome. Initial labs including ana, rf > were negative, > but sed rate was slightly elevated. I put her on a steroid taper, > ice (after dvt was ruled out), splinting, off work, and sent her to > ortho. After I referred her to one ortho, the patient called me, 
 > and said she called another one on her own, and got in sooner, so > now could I send all thepaper work there. So I had to send another > letter to the first ortho doc, apologizing, and cancelling the > referral, and then sent another referral letter to the ortho doc > that the patient wished to see now. > > Anyway, this ortho doc did not write me any type of letter > thanking me for the consult, or did not write me any letter > regarding his exam or findings. He just referred the patient on > his own to rheumatologist to r/o lupus... and then tells the > patient to come back to him.. I had to find this out, by calling > the patient. This has happened several times, and then the > specialist gets a letter from the next specialist, as they were the > referring doc, and I get pushed out of the loop. > > UNLESS OF COURSE, INSURANCE REQUIRES I AS PCP DO THE PAPERWORK. > Then the specialist office 
will call me and tell me to play > secretary and do all the paperwork for them.. I really feel that > maligning is going on behind the scenes. I thought about having > lunch with these docs, which I will, but there are so many, > especially when the patient later tells you, of a certain doc she > has seen since childhood.. > > I have the American Academy of Family Physicians website Consult > Form, including the rules.. They are clearly breaking the rules, > and it is clearly disrespectful.. The problem is the patient is put > in the middle.. and I do feel that being an NP in private practice > is part of this passive agressive move that is occuring.. I will > continue to remain positive. I think I am going to answer part of > my own question right now... PRIOR to any referral, I will call > the doctor's office and ask to speak to the doctor directly. This > is when i have the most power. At that 
time BEFORE THE REFERRAL, > I will let the doc know that I need to be in charge of all > referrals as PCP, kept in the loop, and referred back to with > findings if specialty care is not needed. I ALSO am going to tell > the patient BEFORE the referral they are NOT TO CALL on their own > and set up with a different provider as it causes a lot of > confusion and fragmentation...The patient clearly can be in charge, > and tell > the specialist what needs to be done, as if they have good > insurance they are very powerful. And the patietns that have gone > to private NP practices know, and are very loyal, but the brand new > ones are easily influenced if no bond has developed. But these docs > MUST REALIZE I AM A GREAT REFERRAL SOURCE and I will not use them > again if they abuse this. > > Just for this one patient I had to fill out several work excuses, > medication rxs, the referral letters, the 
different imaging > studies, and the 6 pages of Family Medical leave act that had to be > faxed to both her employer and he employers insurance company. The > primary care provider (whether doc or NP or PA, needs to be the hub > of the wheel, and the specalists are the spokes). They are not the > one that coordinates the annual exams, all of the meds, the > testings, and making sure that all providers associated with the > patient are on the same page. Carla Anderson, FNP-Healing Presence > Family Practice, Oregon > > jlambertrn at comcast.net wrote: > Karen, > I echo your thanks to Stephen and David. I agree whole heartedly > with you and your thoughts and the fact that much of our knowledge/ > training is similar to the apprentice concept that has been working > for centuries. (Sorry about the run-on sentence; my high school > english teacher is probably rolling over in her grave!) As you, I > too 
remain humbled by the amazing amount of knowledge that is out > there that we (including docs) need to be on top of. I treat people > with respect, and expect the same in return, docs included. For the > most part, I enjoy a very collegial relationship with the other > docs in the ED where I work. Occasionally, I have to call a > specialist for a consult. Most are receptive to me as a NP, however > you still run across the arrogant jerk every now and then. I always > remember who they are when I am moonlighting in primary care as I > frequently do. Does a doc really think I am ever going to refer a > patient to him/her after being disrespectful or unprofession! > al towa > rds me? If the offender treats a colleague in that manner, how will > he treat my patient? Nope, no referrals for you! > As far as Panda Bear is concerned, I feel he has way too much time > on his hands. His post was long, rambling and most of 
all B-O-R-I-N- > G. One of the AMA's beefs with us has always been "they take > patients away from us, and it will affect my ability to earn a > living". Does Panda Bear have any clue to the difficulty a patient > encounters when he/she calls their PCP on a day when they truly ill > and are told that the next available appt. is in two weeks? We see > these patients in the ED every day, so there goes the theory of > "us" stealing "their" patients. Paaaaallleeeeeze! There are plenty > of patients to go around and that is an unfounded, tired, mundane > talking point put forth by the AMA and other groups. That argument > impacts patients in a very negative manner. Yep, reading that blog, > made me get the same feeling in my gut that I get when I have to > call that arrogant ENT or surgeon, or whatever. The positive point > in all of this is that I LOVE WHAT I DO, and like Peg Fitzgera! > ld alwa > ys says 
"Being a NP is the BEST job on the planet". So what next? > We all go on doing what we always do- providing quality, evidence- > based care to our patients who put their faith and trust in us > every day. One patient at a time. I think it's time to join the > ACC- Dave Mittman, are you listening? I have my credit card in > hand. LOL. > Julie Lambert, FNP > Ocean County NJ > -------------- Original message -------------- > From: karenfnp at comcast.net > >> Stephen and David, >> >> Thanks for your comments and the sample blog. As a champion, >> especially for >> NPs, I like to hear what others say about us in order to facilitate >> bridgebuilding. One aspect of health care provider training I like >> to stress >> with docs and advanced practice clinician students is that so much >> of what we >> learn in the medical aspect of what we do is apprentice based. We >> all have to >> learn the same new 
info when new diagnoses, treatments and meds >> emerge on the >> health care scene via CME and OJT to maintain quality evidence >> based practices. >> ( To have more residency programs for PAs and NPs in speciality >> areas would give >> us more credibility in specific content areas.) I like to maintain >> a posture >> of humility in terms of all that we need to know these days and >> respect docs who >> do the same. It looks like this "panda bear physician", per the >> content in this >> blog blurb, chooses to spend energy putting NPs PAs down and >> reminds me how we >> have to choose where to spend our energy in ! >> buildin >> g our allies in the physician community and not waste it a la >> "casting pearls >> to swine" as Jesus said once. >> >> Karen Riesinger FNP >> Portland, OR >> >> _______________________________________________ >> NPInfo mailing list >> NPInfo at nurse.net >> 
http://lists.nurse.net/mailman/listinfo/npinfo >> ***************************** > _______________________________________________ > NPInfo mailing list > NPInfo at nurse.net > http://lists.nurse.net/mailman/listinfo/npinfo > ***************************** > > > > Carla R. Anderson, FNP-C > Healing Presence Family Practice, PC > carla_rayne at yahoo.com > 503 819 9726 > _______________________________________________ > NPInfo mailing list > NPInfo at nurse.net > http://lists.nurse.net/mailman/listinfo/npinfo > ***************************** _______________________________________________ NPInfo mailing list NPInfo at nurse.net http://lists.nurse.net/mailman/listinfo/npinfo *****************************

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