private practice, matching issues, midlevels, and more

[LoudBark]

has anyone ever heard of a hospital that will allow a licensed non-BE doc to work there?

No, however there are probably some rural areas of the country desperate for any help they can get that would privilege you to work there.

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[docu]

i was in residency before and didnt finish. in reapplying, i very rarely get interviews compared to what i used to get before i was in residency. what is going on? are PDs badmouthing me or is it a general red flag? am i blacklisted somehow? should i get a lawyer involved?

 

[Khaos]

It is a huge red flag. I remember helping with interviews during residency and would consider it a red flag if you quit a residency to go to EM. It doesn't sound like you quit but something happened just by the way you put that up there. It is going to be very difficult for you to get past that even if your PD was saying the greatest things about you or the worst things about you.

 

[chrisisinnocent]

It's a huge red flag. Also you used up a lot of your Medicare funding so your residency will not be funded fully (if at all).

 

[shopsteward]

Once you have left a program there is almost no point at all in getting a lawyer involved. If you had a clear-cut case against the program, it would have been clear already, and if you don't you would just be making the situation worse.

The time for a resident to get a lawyer involved is the first moment they realise your future at a program may be in jeopardy and they aren't being given a way to make things right and stay on. Even then, the best the lawyer can probably do is negotiate the best possible exit terms, which might mean completion of a year, time credited, good/acceptable letters of recommendation which are acceptable, and possibly help in finding what the program thinks is a more suitable program.

The reason for negotiating these things while you still have some status at a program is that once you are out of the door no-one there will have any interest in helping you out - you are part of their past, not their future, and any help they do give will be unrenumerated, frowned upon by everyone who wanted you gone, and laying the program open to further contact - which in their mind just means further trouble.

If you have left a program other than in good standing and are having trouble finding another, the best thing might be to find work in clinical medicine for a couple of years, make a success of it so that you have letters of recommendation from Board Certified doctors that you work with and contacts with the local medical community, and then try again for a residency related to the work you have been doing in the location/state you have been working in. I remember a thread from someone who spent a couple of years working as a GP in the prison service and got back into residency after that.

 

[docu]

thank you all for the insight into this situation. most people think they are being badmouthed but maybe that is not the case. this is sad news though. i have been working as a GP in house calls for the past year and a half, hoping that might help. i applied to only about 50 programs this year in mostly fp and some in im just to see what happens.

 

[PhysiatristDoc]

I can think of five physicians off the top of my head that I know of that don't have board certification with very different reasons. When you ask what can you do ully licensed without boards...

1. General practitioner in an inner city employed position - all outpatient. Completed med school 20-30 years ago, did a year of internship then went into practice because he did not come from money and had to pay back loans and make a living.

2. "Internal Medicine" inpatient/outpatient/nursing home/home care doctor/entrepreneur son of wealth doctor who just didn't pass his certifying exam after us MD and accredited residency and moved on with life to become a very wealthy man in his own right.

3. Foreign trained MD + internal med residency US citizen, not off shore, did fellowship at a top name US place, not eligible for us boards. Works for sallary in a very strict system doing hospital work. I was surprised the system her only 3 years ago, I thought she would have a hard time moving jobs.

4. Foreign trained MD critical care doc, never trained in US but was hired about 15-20 yrs ago as full faculty. When the hospital system was bought out about 10 yrs ago, rules changed and they asked him to do retrining in the us, he refused and sued them and lost, now does home care.

5. Offshore MD with US medicine residency, either never certified or not recertified, works for IPC doing nursing homes.

 

[BolderNewfy]

will medicare or medicaid reimburse non BE BC physicians?

 

[PhysiatristDoc]

yes.

as long as they have an active state license, active dea and are enrolled with medicare, medicaid, and all of the companies that are the 'advantage' carriers in the state they wish to practice.

 

[BolderNewfy]

yes.

as long as they have an active state license, active dea and are enrolled with medicare, medicaid, and all of the companies that are the 'advantage' carriers in the state they wish to practice.

So you are saying that as a licensed physician I could open a clinic that caters to medicaid/medicare patients and self payers only? why dont more people do this. Can anyone else clarify or elaborate on this please, becuase as a person who intends on only doing outpatient medicine, why not just bail on residency now, and just open a private practice?

 

[docu]

Hospitals arent comparing MDs against NPs, they want everybody to have a piece of paper behind their name and title that says "certified" regardless if the certification is trash or not.

Hospitals get sued frequently if someone on their staff ****s up and it turns out they arent "board certified." It also invites media and public pressure on their facility and credentialing process.

If we made up a new job called "magic witch doctor" and started putting them in hospitals, it's only a matter of time before hospitals start demanding that all "magic witch doctors" are "board certified" by some sham "accreditation" organization, even if it's completely dubious and an obvious sham. They do the same bull**** with naturopaths, chiropractors, acupuncturists, and the rest of the charlatans. Its a stupid exercise at putting up a front to stave off inquiries by malpractice lawyers, media, and government organizations.

You can imagine (RIP) Mike Wallace on 60 minutes doing a sensational show and getting outraged that none of Podunk Hospitals' 30 doctors are board certified. Thats the kind of BS the hospitals are responding to. Even if the certification is an absolute joke, it's the necessary golden ticket to get admission.

i fully wholeheartedly agree with you LOL. so true!

 

[docu]

The real blasphemy is that there are bridge programs for PA to MD, but yet there is no reciprocal bridge for non-BE/non-licensed/non-BC MD to PA.

the PAs on these forums make all kinds of ridiculous excuses as to why there's a double standard at work here, but it is obvious that its the same kind of of protectionist racket dribble that they accuse us of using to limit their scope of practice.

maybe someone should be bold enough to make an MD to PA bridge program. it could seriously work. then there will be in existence the smartest PA's ever.

 

[docu]

These are the places where you can work:

1. Most rural places -- they're so desperate to find people they cant be picky.

2. Indian Health Services

3. Some VA locations, depending on how "desirable" the location is (e.g. Los Angeles, forget about it)

4. Urgent care clinics

Thank you socrates. you are wise like ur screen name. i have seen recruiters recruiting for some. it has been hard but maybe in time one of these opportunities will one day hopefully be in the only state im licensed in.

 

[docu]

First, blasphemous doesn't mean what you seem to think it means.
Second, the real issue is lability. Under the law, you get held to a higher standard with a higher degree. Meaning as an MD, you are going to be held to the same standard of care of the typical physician working in whatever field you work in. So if you moonlight in an ED, as a licensed physician, you are going to expected to meet the level of the average ED physician, not someone who is a GP with one year of experience. An NP or PA gets held to the standard of care expected of someone with that lesser level of education, so it's a much lower standard, even if the task is the same. So the risk to that individual, the hospital and the medmal carrier is lower. That's why non BE physicians are a problem -- they simply don't have the training commensurate to the level of liability and legal expectations they incur. So it's simply better to have someone with average training and knowledge for an NP working at a hospital than it is to have a doctor with below average training, even if their training is better than an NP.

spoken like a true lawyer. but i did find a hospital that might pull some strings for me and let me work there. thank God. at least someone in this world trusts me.

 

[docu]

I can think of five physicians off the top of my head that I know of that don't have board certification with very different reasons. When you ask what can you do ully licensed without boards...

1. General practitioner in an inner city employed position - all outpatient. Completed med school 20-30 years ago, did a year of internship then went into practice because he did not come from money and had to pay back loans and make a living.

2. "Internal Medicine" inpatient/outpatient/nursing home/home care doctor/entrepreneur son of wealth doctor who just didn't pass his certifying exam after us MD and accredited residency and moved on with life to become a very wealthy man in his own right.

3. Foreign trained MD + internal med residency US citizen, not off shore, did fellowship at a top name US place, not eligible for us boards. Works for sallary in a very strict system doing hospital work. I was surprised the system her only 3 years ago, I thought she would have a hard time moving jobs.

4. Foreign trained MD critical care doc, never trained in US but was hired about 15-20 yrs ago as full faculty. When the hospital system was bought out about 10 yrs ago, rules changed and they asked him to do retrining in the us, he refused and sued them and lost, now does home care.

5. Offshore MD with US medicine residency, either never certified or not recertified, works for IPC doing nursing homes.

Thank you so much. That is so amazing. I shall try to see if i can follow in someone's footsteps.

 

[docu]

will medicare or medicaid reimburse non BE BC physicians?

yes they will. at least right now they do. i take medicare, Medicaid (only in clinic), and Blue cross blue shield.

 

[docu]

So you are saying that as a licensed physician I could open a clinic that caters to medicaid/medicare patients and self payers only? why dont more people do this. Can anyone else clarify or elaborate on this please, becuase as a person who intends on only doing outpatient medicine, why not just bail on residency now, and just open a private practice?

Yes they sure can. I dont know why more people don't do this. u could even open up ur own clinc. if ur business savvy u could make a killing. i am not so great at advertising so i have small patient base in my home care company, but i make enough money to survive. i could even work for a visiting physician company, but i'd rather make all the money rather than a percentage. i think it is the overhead costs that scare most doctors off so they work for companies that take a chunk of the money they make. most of my patients come from home care companies that need referrals. it is legit according to medicare standards. don't bail out just yet because its just better to have BE/BC status, just in case things dont' work out with ur own business and u can jump onto another career. but just remember, these companies that hire you are making a ton of money you could be making by yourself..just get a biller and go on with your bad self.

 

[Makati2008]

maybe someone should be bold enough to make an MD to PA bridge program. it could seriously work. then there will be in existence the smartest PA's ever.

Highly doubtful this will occur. Also it has been tried before(FL if I remember correctly) and failed.

Furthermore the smartest PA's know their limits, which would be the problem with trying to have a non BC/BE doc trying to become a PA(He or she would hate to be collared down to the level of a MLP and I could see some practicing outside of his or her scope and causing some major problems....)

I am in favor of the ACGME/NBOME coming up with a solution for Physician's(AMGs) that couldn't pass their boards to recieve more training and to be tested until they reached an acceptable level of skill to take care of patient's safely with that specialities governing body implementing things such as more frequent recertification cycles,more CME training(that was approved by that speciality for those individuals in this situation), among other things to make sure that this person remained competent.

I wish this problem on no one and I hope you guys get the appopriate solutions that you need.

 

[DrAwsome]

Yes they sure can. I dont know why more people don't do this. u could even open up ur own clinc. if ur business savvy u could make a killing. i am not so great at advertising so i have small patient base in my home care company, but i make enough money to survive. i could even work for a visiting physician company, but i'd rather make all the money rather than a percentage. i think it is the overhead costs that scare most doctors off so they work for companies that take a chunk of the money they make. most of my patients come from home care companies that need referrals. it is legit according to medicare standards. don't bail out just yet because its just better to have BE/BC status, just in case things dont' work out with ur own business and u can jump onto another career. but just remember, these companies that hire you are making a ton of money you could be making by yourself..just get a biller and go on with your bad self.

I'm curious, what is your situation exactly? You have an MD, did residency but did not pass boards?

You can also work for medicare doing risk assessments. Pay is pretty good-about 4500-5000k/week or so.

You can open up a clinic and hire people, supervise I guess too legally. You can make a good amount of money.

You can work for the VA as well as others have pointed out, you can also work in pharma or epic.

 

[docu]

I did nearly 2 years of training in total and got licensed. I am an img so there is a longer time requirement to licensure than an Amg (unfair to say the least). I'm not board eligible because I didn't complete residency and can't take the boards because of not finishing.

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[bluewillark]

Check out EMCare and Correct Care. Two staffing firms which sometimes list rural ER opportunities in mid-south which don't require BE/BC. Most rural hospitals in places like Oklahoma, Kansas, and Arkansas will hire docs who aren't BE/BC as long as they have a clean background and aren't dangerous.

 

[ShyRem]

Docu, was that two years in the same residency program? I wonder why you couldn't transfer to complete your third year. It isn't that uncommon.....

 

[fantasty]

If you try to pick up ER positions, you might need PALS and ATLS. I'm finding the same problem. I'm IM trained, doing a research post-doc, but still need to complete the final year of residency before I'm BE/BC. My program thought "Oh, once you get your license, you'll find plenty of moonlighting opportunities". That, however, has not been the case. There were only two places (in the whole state, as far as I can tell) that had a history of hiring current residents to moonlight on overnight inpatient units, but both of these have changed their policies recently (as they've gone to higher fulltime hospitalists). There are ER positions, but a lot of our ER residents moonlight so there's rarely any advertised openings.

 

[fantasty]

Docu, was that two years in the same residency program? I wonder why you couldn't transfer to complete your third year. It isn't that uncommon.....

I do not know this as a fact (just hear-say), but I was told that most programs will want you to complete two years minimum at their institution. I realize it's only 1 more year, but that's still a significant opportunity cost.

 

[fantasty]

Yes they sure can. I dont know why more people don't do this. u could even open up ur own clinc. if ur business savvy u could make a killing.

Although I think this is a legit option, I think that malpractice insurance would be the big hurdle.

 

[gutonc]

I do not know this as a fact (just hear-say), but I was told that most programs will want you to complete two years minimum at their institution. I realize it's only 1 more year, but that's still a significant opportunity cost.

ABFM requires that the last two years of your training be in the same program. ABIM and ABP (to the best of my knowledge) do not have these requirements. That said, if you want to complete your training, you will need to submit to whatever requirements a PD throws your way. It is not uncommon (and by that I mean, it should be totally expected) for IM PDs to require transferring residents to function at their prior training level for 6-12 months before promoting them. This means that if you've completed two concurrent years of an IM residency and transfer somewhere else, expect to function as an R2 for up to a year before you get promoted to R3. You are more than welcome to resist these rules...and they are more than welcome to tell you to go **** yourself. I worked with some stellar residents who transferred in to my program as R2s and who ended up taking 4 full years to complete IM residency. I also worked with some useless wastes of oxygen who transferred in as R2s and left, 1 or 2 years later as R2s.

FWIW, IIRC, IANAL, LMFAO, WTFBBQ, etc...docu did not complete two consecutive years of residency in the same program so this discussion is irrelevant to the OP.

 

[Makati2008]

I did nearly 2 years of training in total and got licensed. I am an img so there is a longer time requirement to licensure than an Amg (unfair to say the least). I'm not board eligible because I didn't complete residency and can't take the boards because of not finishing.

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I have to disagree with you here sir. The reason I would hope that IMGs take longer to meet the min. requirement of licensure is because we don't know the caliber of all of the medical schools in the world (for example look up Oceania University of Medicine) and with AMG's you know that each one of them has met the min. amount of training deemed appopriate by their society.

 

[docu]

How do you advertise to get patients?

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[BolderNewfy]

I have to disagree with you here sir. The reason I would hope that IMGs take longer to meet the min. requirement of licensure is because we don't know the caliber of all of the medical schools in the world (for example look up Oceania University of Medicine) and with AMG's you know that each one of them has met the min. amount of training deemed appopriate by their society.

not to change the point but I went to a foreign medical school which has been assessed by the california state medical board and deemed an equivalent education, which is why graduating from the school i attended you can practice in all 50 states. Wouldnt the fact that it is deemed euivalent by the CA state medical board (which is the standard nearly every state uses), and the fact that I passed (with flying colors) the numerous United States Medical Licensing Exams suggest that I am "equivalent" in my training to a US grad. Im a US citizen and went abroad and I find the fact that I have to go through 2 more years of training before Im even eligible for licensure almost discriminatory. There is no difference between me and the other AMG residents in my program (except that I had to work twice as hard to get where i am right now).

 

[Doctor Bob]

How do you advertise to get patients?

Email them, call their house, go door to door in the community, rent a billboard, buy ad space on the side of a bus, hang fliers on telephone poles, put your name on the side of a blimp, pay for radio/TV ads, buy space in the phone book, train parrots to fly around the city and squawk your name... the options are endless.

 

[docu]

not to change the point but I went to a foreign medical school which has been assessed by the california state medical board and deemed an equivalent education, which is why graduating from the school i attended you can practice in all 50 states. Wouldnt the fact that it is deemed euivalent by the CA state medical board (which is the standard nearly every state uses), and the fact that I passed (with flying colors) the numerous United States Medical Licensing Exams suggest that I am "equivalent" in my training to a US grad. Im a US citizen and went abroad and I find the fact that I have to go through 2 more years of training before Im even eligible for licensure almost discriminatory. There is no difference between me and the other AMG residents in my program (except that I had to work twice as hard to get where i am right now).

i completely agree. after you complete all USMLEs and do the exact same residency as an AMG you should be considered as equivalent. i wonder how to file that as discrimination. not to mention the entire military requires an IMG or FMG to have 1 year of residency (12 consecutive months in one program) before they can be in a military resident but not an AMG. could it be a class action lawsuit? or file with the EEOC as unequal pay (http://www.eeoc.gov/laws/types/equalcompensation.cfm and http://www.eeoc.gov/eeoc/publications/fs-epa.cfm ) just curious.

 

[Law2Doc]

i completely agree. after you complete all USMLEs and do the exact same residency as an AMG you should be considered as equivalent. i wonder how to file that as discrimination. not to mention the entire military requires an IMG or FMG to have 1 year of residency (12 consecutive months in one program) before they can be in a military resident but not an AMG. could it be a class action lawsuit? or file with the EEOC as unequal pay (http://www.eeoc.gov/laws/types/equalcompensation.cfm and http://www.eeoc.gov/eeoc/publications/fs-epa.cfm ) just curious.

You have no case. First, The USMLE has long been described as a mere test of minimum competency, not one from which one could infer equivalency. If you are trying to suggest you proved something by doing well on that test, you are going astray from the point of that test. . Second, if the AAMC/LCME doesn't oversee your foreign medical school, then the place hasn't been accredited as equivalent by the only body that matters for medcal education in the US. Sorry, but unless this governing body provides its oversight and guarantees the standard of education that schools under its uthority must provide, by all rights your education can be marginalized. Sure, California can give credence to your foreign education but that really doesn't follow that any other state must or that the place be deemed equivalent on a national basis. It isn't. California as a state has been known to do a lot of things that don't jibe with the governing bodies of other states. I have no clue how you are being discriminated against, given that you in fact didn't go to an accredited US institution. More importantly, no court will get it either.

 

[captaincrunch]

not to change the point but I went to a foreign medical school which has been assessed by the california state medical board and deemed an equivalent education, which is why graduating from the school i attended you can practice in all 50 states. Wouldnt the fact that it is deemed euivalent by the CA state medical board (which is the standard nearly every state uses), and the fact that I passed (with flying colors) the numerous United States Medical Licensing Exams suggest that I am "equivalent" in my training to a US grad. Im a US citizen and went abroad and I find the fact that I have to go through 2 more years of training before Im even eligible for licensure almost discriminatory. There is no difference between me and the other AMG residents in my program (except that I had to work twice as hard to get where i am right now).

I'm not sure I see the point. The fact that California recognizes your school doesn't mean they consider your education to be equivalent to an American allopathic MD. After all, even California requires two years of post-graduate training for IMGs, whereas AMGs only need one. California also does things a little differently (as L2D points out), in that there are no "institutional" or "training" licenses in Cali. In fact, an individual license is required to become an R3.

L2D, I had a quick question for you. In an earlier response, you made it sound like non-boarded doctors would be held to the legal standard of their field. My understanding was that we're actually held to the "community standard," so that a practice in one community (e.g., family practice physician covering an ICU) might be acceptable in a rural setting, but harder to defend in an urban setting where specialists are readily available. I'm not sure if this distinction is relevant to the OP, but is this right?

 

[Winged Scapula]

Almost all word of mouth referrals - from prior patients, primary care physicians, specialists, radiologists, radiology techs, co-workers (ie, nurses).

Patients also find me from Google searches, articles in the paper, lectures around town, health fairs, etc.

I'm too cheap to put in ads but one of the local hospitals put me on a billboard once.

 

[Law2Doc]

...

L2D, I had a quick question for you. In an earlier response, you made it sound like non-boarded doctors would be held to the legal standard of their field. My understanding was that we're actually held to the "community standard," so that a practice in one community (e.g., family practice physician covering an ICU) might be acceptable in a rural setting, but harder to defend in an urban setting where specialists are readily available. I'm not sure if this distinction is relevant to the OP, but is this right?

courts differ on the community standard approach, but the more widely followed rule is that you end up held to the reasonableness standard of the physician who normally does the function you are doing. So if you work in an ED/urgent care setting, the standard is going to be that of an ED physician, or if you work in the ICU you are going to be held to the standard of the intensivist and if you look at your own imaging you have to meet the reasonable standard of a radiologist and so on. So no, you won't be held to a lower standard by virtue of not being boarded. As to whether what's reasonable in a rural setting is different than in an urban setting, the answer is "maybe", but that's going to be decided by expert testimony of your peers who probably have their own reason for keeping the bar high enough to keep interlopers out. But sure, if the job function in your region is always performed by non-boarded people and the standard of care is thus based on that group, you have a stronger argument. But don't be surprised if the other side in litigation decides to expand the definition of community to include specialists in a neighboring city.

 

[docu]

today i knew what a hemorrhoid looked like and got this lady some surgical intervention. lol..the nurse practitioner misdiagnosed it , didn't refer the patient to a surgeon, and treated her for UTI just cuz there was blood in her urine. which subsequently caused her a sinus infection. this is why the gov needs to make 15,000 residency spots to fill the doctor shortage instead of replace them with NP's and PAs.



We need more doctors!!! say no to the NP/PA take over.

 

[smq123]

today i knew what a hemorrhoid looked like and got this lady some surgical intervention. lol..the nurse practitioner misdiagnosed it , didn't refer the patient to a surgeon, and treated her for UTI just cuz there was blood in her urine. which subsequently caused her a sinus infection. this is why the gov needs to make 15,000 residency spots to fill the doctor shortage instead of replace them with NP's and PAs.

...how does treatment for a UTI cause a sinus infection?

 

[Boogie Man]

today i knew what a hemorrhoid looked like and got this lady some surgical intervention. lol..the nurse practitioner misdiagnosed it , didn't refer the patient to a surgeon, and treated her for UTI just cuz there was blood in her urine. which subsequently caused her a sinus infection. this is why the gov needs to make 15,000 residency spots to fill the doctor shortage instead of replace them with NP's and PAs.

I am a huge fan of logic.

Consequently, I am not a fan of this paragraph.

 

[DrAwsome]

today i knew what a hemorrhoid looked like and got this lady some surgical intervention. lol..the nurse practitioner misdiagnosed it , didn't refer the patient to a surgeon, and treated her for UTI just cuz there was blood in her urine. which subsequently caused her a sinus infection. this is why the gov needs to make 15,000 residency spots to fill the doctor shortage instead of replace them with NP's and PAs.



We need more doctors!!! say no to the NP/PA take over.

That seems weird, but I had a friend of mine who went to one of those clinics and was treated with antibiotics for strep when she actually had mono. :\ She got ampicillin, and the awful subsequent rash ensued. She freaked out, went to the ER, which cost her insurance a nice chunk of change, and her doctor laughed about it. Meh, the gov is its own worst enemy sometimes. Not sure I agree with 15,000 more spots but noctors is definitely not the way to go.

 

[docu]

That seems weird, but I had a friend of mine who went to one of those clinics and was treated with antibiotics for strep when she actually had mono. :\ She got ampicillin, and the awful subsequent rash ensued. She freaked out, went to the ER, which cost her insurance a nice chunk of change, and her doctor laughed about it. Meh, the gov is its own worst enemy sometimes. Not sure I agree with 15,000 more spots but noctors is definitely not the way to go.

No offense, but to use that as an argument doesn't make sense. it is known that if you get a rash with ampicillin, its mono, but usually a doc doesn't check for mono when it seems so simple, that is understandable, it is even in usmle world questions as commonly seen in medical practice. all u really can do is laugh, you won't get in trouble for it. its nothing serious, not even an allergy.

noctors are the replacements for the doctor shortage if we don't fill it with doctors.

the lady was on cipro for 7 days for the UTI, which caused immunity to bacteria, which in turn possibly caused the sinus infection (OR it could have hapened on its own but it happened while she was on cipro). it is a valid argument, since when you give flagyl for BV you can in turn get a yeast infection. its an infection tradeoff when it comes to high doses of ABX for prolonged periods of time. additionally, the first line treatment for UTI is TMP-SMX or nitrofurantoin. the NP gave her second line as cipro. and giving it for bloody urine doesn't seem right. don't you have to work that up? i dont think it was.

 

[docu]

BTW, im working in a rural area, so I'm starting to see how my patients have been treated by other NPs and PAs. It just seems like they don't know what they're doing. They were so desperate for a doc that they called me to work for them and im not even board eligible. This proves there is a doctor shortage that is getting desperate.

 

[DrAwsome]

No offense, but to use that as an argument doesn't make sense. it is known that if you get a rash with ampicillin, its mono, but usually a doc doesn't check for mono when it seems so simple, that is understandable, it is even in usmle world questions as commonly seen in medical practice. all u really can do is laugh, you won't get in trouble for it. its nothing serious, not even an allergy.

noctors are the replacements for the doctor shortage if we don't fill it with doctors.

the lady was on cipro for 7 days for the UTI, which caused immunity to bacteria, which in turn possibly caused the sinus infection (OR it could have hapened on its own but it happened while she was on cipro). it is a valid argument, since when you give flagyl for BV you can in turn get a yeast infection. its an infection tradeoff when it comes to high doses of ABX for prolonged periods of time. additionally, the first line treatment for UTI is TMP-SMX or nitrofurantoin. the NP gave her second line as cipro. and giving it for bloody urine doesn't seem right. don't you have to work that up? i dont think it was.

My illustration shows the lack of knowledge midlevels have, even for simple things, and that ultimately it's more costly to have midlevels than doctors. Had my friend gone to see her regular PCP vs this place, it would have cost the insurance a minimal amount to pay the PCP vs. a full blown ER visit.

 

[smq123]

the lady was on cipro for 7 days for the UTI, which caused immunity to bacteria, which in turn possibly caused the infection. it is a valid argument, since when you give flagyl for BV you can in turn get a yeast infection. its an infection tradeoff when it comes to high doses of ABX for prolonged periods of time.

No, it's not. It is not a valid argument at all. It barely even makes sense.

Do you even understand that pathogenesis of bacterial sinus infections?

 

[docu]

No, it's not. It is not a valid argument at all. It barely even makes sense.

Do you even understand that pathogenesis of bacterial sinus infections?

how do you get a yeast infection from taking antibiotics, even abx for sinus infections like ampicillin? same difference.

 

[gutonc]

how do you get a yeast infection from taking antibiotics, even abx for sinus infections like ampicillin? same difference.

Do you know the difference between yeast and bacteria?

it is known that if you get a rash with ampicillin, its mono

Always? Really? It couldn't possibly be an allergic reaction? Ever? I'm not saying that the mono/amp connection doesn't exist (although I've never personally seen it), but are you arguing that there is no such thing as an allergic reaction to PCNs that manifest as a rash? Because I've seen a metric f***ton of those (and experienced it myself).

the lady was on cipro for 7 days for the UTI, which caused immunity to bacteria, which in turn possibly caused the sinus infection (OR it could have hapened on its own but it happened while she was on cipro). it is a valid argument, since when you give flagyl for BV you can in turn get a yeast infection.

You are so far off the reservation here I don't even know where to start. In fact, I probably shouldn't. And yet...like the proverbial trainwreck, here I go.

Did she have culture-proven, cipro-resistant bacterial sinusitis? If so, then yes, your evaluation is absolutely correct? If she didn't (which I'm going to go out on a limb and assume is the case), she probably had a viral sinusitis (as the vast majority of sinus infections are viral). Even if it was a bacterial sinusitis (again, less likely), it was likely "true, true and unrelated" rather than being due to the rise of a virulent, cipro-resistant bacterium in the sinuses. Also...immunity and resistance are two different things.

its an infection tradeoff when it comes to high doses of ABX for prolonged periods of time. additionally, the first line treatment for UTI is TMP-SMX or nitrofurantoin. the NP gave her second line as cipro. and giving it for bloody urine doesn't seem right. don't you have to work that up? i dont think it was.

Please don't ever give Macrobid for anything. While Bactrim is considered 1st-line empiric therapy for UTI, Cipro is indicated anywhere that there is a reasonable level of resistance to Bactrim (like where I work...do you know your regional abx-resistance patterns? You should), Cipro should be first line. While Macrobid kind of works (and is safe in pregnant patients), it's kind of a joke.

And yes, hematuria deserves more of a workup, but what else was in the UA?

I'm all for keeping patients safe from incompetent noctors but I'd also like to keep them safe from incompetent doctors.

 

[docu]

Do you know the difference between yeast and bacteria?



Always? Really? It couldn't possibly be an allergic reaction? Ever? I'm not saying that the mono/amp connection doesn't exist (although I've never personally seen it), but are you arguing that there is no such thing as an allergic reaction to PCNs that manifest as a rash? Because I've seen a metric f***ton of those (and experienced it myself).



You are so far off the reservation here I don't even know where to start. In fact, I probably shouldn't. And yet...like the proverbial trainwreck, here I go.

Did she have culture-proven, cipro-resistant bacterial sinusitis? If so, then yes, your evaluation is absolutely correct? If she didn't (which I'm going to go out on a limb and assume is the case), she probably had a viral sinusitis (as the vast majority of sinus infections are viral). Even if it was a bacterial sinusitis (again, less likely), it was likely "true, true and unrelated" rather than being due to the rise of a virulent, cipro-resistant bacterium in the sinuses. Also...immunity and resistance are two different things.



Please don't ever give Macrobid for anything. While Bactrim is considered 1st-line empiric therapy for UTI, Cipro is indicated anywhere that there is a reasonable level of resistance to Bactrim (like where I work...do you know your regional abx-resistance patterns? You should), Cipro should be first line. While Macrobid kind of works (and is safe in pregnant patients), it's kind of a joke.

And yes, hematuria deserves more of a workup, but what else was in the UA?

I'm all for keeping patients safe from incompetent noctors but I'd also like to keep them safe from incompetent doctors.

im nowhere near incompetent for your info.
calling people trainwrecks that aren't trainwrecks from a person who is trying to be a trainwreck toward other people is pretty disrespectful.

when you say do you know the dfference between yeast and bacteria, the answer is yes I do.
so if flagyl is for bacterial vaginosis, why do some of my patients get a yeast infection if it kills bacteria? it kills the good bacteria and affects the balance...so cipro can kill good bacteria and affect the balance in the sinuses too, it works all over not just in one area. if im so wrong and if youre so smart then tell me the answer. i bet you don't know yourself.

i never said ampicillin reaction is not an allergic reaction, it could be. it is in the differential, but it causes rash in mono. no one knows a person has mono unless they do a monospot, but how many doctors think of mono when they see a typical cold? it is a common mistake among doctors. that's all im saying.

check your medscape mobile, look up uncomplicated cystitis in nonpregant women...it says tmp smx and nitrofurantoin are first line and cipro is second line. so you're saying medscape is wrong and you are absolutely right? says who? i didn't give TMP smx cuz she was allergic to sulfa and she was on cipro which after taking she got sinusitis. since when does anyone have to do a test to check if they have sinustitis? since never. you just ask if they have pain in sinus areas and go by their complaints of runny/stuffy nose. i ended up giving her ampicillin for her sinusitis. sometimes that can help UTI so it has a dual role. she probably did have a UTI because she complained of burning.she had some bacteria on UA. but really she didn't need more UTI meds because she already finished the cipro. ur not a family doctor, its not ur specialty, so you would NEVER know something like that. dont even tell me u know. ur so focused on the gut why would you know about common ailments that GP's take care of?

but just tell me this. why didn't the NP refer to general surgery for the hemorrhoid, which was the most painful thing she was experiencing? the hemorrhoid was external, not internal like the NP said. NP also scared the patient by telling her she needed a colonoscopy, but really she needed a small signmoidoscopy (if it were internal, but it isn't!!) why wasn't the bloody urine worked up further by the NP? I guess it could be just UTI but it could be other stuff too. I didn't get to work it up though, since she was in such a rush, but I am going to when she gets back from her trip if it hasn't cleared up.

for your info, i posted this on facebook and got likes and nice comments. when i post here, i get derogatory remarks. i know what's real and whats fake.

 

[docu]

HA! read it and weep!


Antibiotics Causing Sinus Infections

• There are two types of bacteria: good bacteria, which lives in the intestines helping to digest food and strengthening the body's immune system, and bad bacteria, which causes illness and infection. Antibiotics can't tell the difference between the two, so taking them before a bacterial infection has been determined causes more harm than good. According to the Annapolis Chronic Fatigue and Fibromyalgia Research Center, short-term sinus infections can be turned into chronic infections by the use of antibiotics. Yeast infections, long associated with antibiotic use in women, can travel to the sinuses. According to Dr. Marjorie Greenfield of the Case School of Medicine and University Hospitals of Cleveland, studies have shown that between 25 and 70 percent of female patients develop yeast infections following antibiotic treatments.
  
  

Read more: Can Antibiotics Cause Sinus Infections? | eHow.com http://www.ehow.com/about_6612708_can-antibiotics-cause-sinus-infections_.html#ixzz28wVdM4Nh
​

 

[docu]

i prob shoudln't have given her ampicillin for sinusitis and just waited 5 days to see if it cleared up, but she was also complaining of burning on urination despite the cipro...and said last time it felt better with ampicillin so i gave it to her. lol.

that's how i operate. love it or weep.

 

[Law2Doc]

After reading this thread it's clear that we don't need more doctors who push the antibiotics like candy, just a few that are better versed in microbiology and pharmacology, and perhaps more public education on the limitations of NPs.

 

[docu]

whatever. u dont know how to be a good GP law2doc. you try it, no one will like you. my patients love me. and i know all kinds of doctors that push oxycodone and opana and other narcotics and think they're all that for doing so, but i refuse to do that. at least i refuse to push narcotics like that and give it out like candy. antibiotics are totally another story and i know what i did was right.