Is it typical to have preceptors in M3 and M4 who are NPs and PAs at your school?

[Matthew9Thirtyfive]

Tell you what, why don't you lose 2 jobs in the space of 4 years due to patient satisfaction scores directly related to antibiotic prescribing then come back and see how you feel about it.

No, I’m not judging you. I’m saying wow like it sucks that medicine in this country has gotten to the point where you feel bullied into that cause I’m sure you wouldn’t do it if you had the choice.

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[Lawpy]

No, I’m not judging you. I’m saying wow like it sucks that medicine in this country has gotten to the point where you feel bullied into that cause I’m sure you wouldn’t do it if you had the choice.

Well that's another thing to add to my jaded list now

 

[VA Hopeful Dr]

No, I’m not judging you. I’m saying wow like it sucks that medicine in this country has gotten to the point where you feel bullied into that cause I’m sure you wouldn’t do it if you had the choice.

Fair enough, tone is hard to read at times. My apologies, I'll edit that to be a touch less defensive.

Weird thing is, it doesn't have to be. I was still pretty strict about it in my practice and in 2 years only had 2 patients leave over it. But it was a very different patient population than anywhere else I've worked.

 

[Lawpy]

Can we get rid of patient satisfaction scores completely? Or at least not tie them to job performance?

 

[Matthew9Thirtyfive]

Fair enough, tone is hard to read at times. My apologies, I'll edit that to be a touch less defensive.

Weird thing is, it doesn't have to be. I was still pretty strict about it in my practice and in 2 years only had 2 patients leave over it. But it was a very different patient population than anywhere else I've worked.

Yeah my bad. I was responding during a thing for school and had to just post it quick. Didn’t think it would come across that way but I totally see why it did haha.

 

[sloh]

Fair enough, tone is hard to read at times. My apologies, I'll edit that to be a touch less defensive.

Weird thing is, it doesn't have to be. I was still pretty strict about it in my practice and in 2 years only had 2 patients leave over it. But it was a very different patient population than anywhere else I've worked.

Are there many FM employers where patient satisfaction scores aren’t seriously what they care about the most as long as patients aren’t acutely losing life or limb?

 

[VA Hopeful Dr]

Are there many FM employers where patient satisfaction scores aren’t seriously what they care about the most as long as patients aren’t acutely losing life or limb?

There can be. When I did DPC, I didn't want unhappy patients but I wasn't going to cater to them either.

If you take insurance, patient satisfaction is a quality measure that will affect reimbursement.

 

[armytrainingsir]

Rookie mistake: the average URI lasts 7-10 days. If you give a 5 day antibiotic, you're getting lots of calls about either a) this antibiotic didn't work I need a different one or b) needing a 2nd zpack since the first one didn't do the job.

Give them a refill on the zpak, and sell it because their infection is 'so bad' you expect it will need TWO rounds of the once a day wonder drug.

 

[VA Hopeful Dr]

Give them a refill on the zpak, and sell it because their infection is 'so bad' you expect it will need TWO rounds of the once a day wonder drug.

I'd thought about that earlier on but then you do run into the occasional person (5% or so) that actually has a bacterial URI then you end up doing a 3rd course of antibiotics.

 

[Ho0v-man]

I mean it sucks, but most people don’t want to pay $40 to get patted on the head and told “...I don’t think you need any treatment as it’s likely viral. But if it persists or gets worse, come back and pay another copay.”

I remember in undergrad my microbiology teacher said that she knows their just doing their jobs but “I don’t have the time or money to keep dealing with this.” She also said “No one better try to prescribe me amoxicillin either. That’s basically just bubblegum!”

If we can’t expect people that educated to trust what we’re doing, can we really expect more from the general public?

 

[Lawpy]

I mean it sucks, but most people don’t want to pay $40 to get patted on the head and told “...I don’t think you need any treatment as it’s likely viral. But if it persists or gets worse, come back and pay another copay.”

I remember in undergrad my microbiology teacher said that she knows their just doing their jobs but “I don’t have the time or money to keep dealing with this.” She also said “No one better try to prescribe me amoxicillin either. That’s basically just bubblegum!”

If we can’t expect people that educated to trust what we’re doing, can we really expect more from the general public?

The midlevels are doing something right to easily win that trust since the general public worships them while also criticizing doctors...

 

[Matthew9Thirtyfive]

The midlevels are doing something right to easily win that trust since the general public worships them while also criticizing doctors...

That’s because we live in a McDonald’s culture where we want it our way. Midlevels are great because they just give you what you want, whether you need it or not while the doctor does nothing for you.

 

[Chads2]

The teaching service doesn't guarantee good teachers.

I am well aware. This is largely the reason why I focus on being a good teacher. Hopefully I don’t get replaced by a midlevel.

 

[sylvanthus]

Concerned that my future medical school uses NPs and PAs to precept OB rotation and wanted to see if it was the norm amongst all MD schools. Thanks!

I had a RN for surgery......



On the plus side, the hours were cake and I had no intention of doing surgery.

 

[sylvanthus]

No, I’m not judging you. I’m saying wow like it sucks that medicine in this country has gotten to the point where you feel bullied into that cause I’m sure you wouldn’t do it if you had the choice.

Try working in the ED. I started doing unnecessary xrays, unnecessary labs, etc, after having patients complain that “he did nothing for me.”

All that info you learn during medical school and residency about appropriate medical care goes right out the window when the “customer” wants stuff.

Centor criteria, Ottawa ankle rules, avoid narcotics ? Doesnt mean jack in the real world.

Least now most of my patients are unconscious.

 

[Redpancreas]

I had a RN for surgery......



On the plus side, the hours were cake and I had no intention of doing surgery.

Curious for these people saying they have non-MD/DOs precepting their rotation, could you elaborate more about your experience and tell us what exactly they did. If they are precepting your rotations this is incredibly inappropriate and we can probably use our collective braintrust to figure out how to deal with it.

@sylvanthus NVM he/she is an attending. To anyone else though, if you've been precepted by a non MD/DO please state the 1) Duration 2) Scope 3) Rotation 4) School - optional for confidentiality (but you're welcome to message me it and I could cross-verify and post it).