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  • Avatar StateOfMyHead 
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    They will take over primary care at least for majority of people on Medicare/medicaid. People with private insurance will be able to see docs.

    I would be very leery about going into primary care now.

    Above statements are predictions, not what I consider ideal. Docs are foolish, unable to organize and thusly allow this crap to proliferate. Being replaced by online degrees, it’s pretty pathetic tbh.

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    This is happening in my area in many specialties including neuro, gyn and derm. The wait list for a physician is 4-6 months or longer but there are plenty of PA/NP openings…thank you but I will wait. I’m hanging on to my sweet spot age physicians, 45-55yo range with a death grip. It has become an interesting lesson in adherence to recommended treatment as I am now more diligent about staying connected and attending the routine checks for fear of losing my “spot” with a physician.

    Avatar StateOfMyHead 
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    My first house 1995 paid $52,500 renovations $45,000 I resold in 1999 for $159,000 it last sold for $335,000 in 2008.

    in reply to: My house History #238776 Reply
    Avatar StateOfMyHead 
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    It will be interesting to watch the number of MVAs in states with legalized cannabis.

    in reply to: What's with this CBD oil fad? #238123 Reply
    Liked by hatton1, Lordosis
    Avatar StateOfMyHead 
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    OP I would bet when it all settles $350,000 will be the new $250,000. A key factor in the housing issues ten+ years ago was predatory lending. Many felt entitled to the home of their dreams and an interest only loan would make that happen….I can barely type that without snorting. Although prices in my area are high this time around I don’t see the frenzied sheep who drove the previous housing bubble into a predictable disaster. My guess for this area…it will correct likely 10-15%, which would not be enough to stop me from buying a home I will live in.

    in reply to: Housing prices #237827 Reply
    Liked by AZPT
    Avatar StateOfMyHead 
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    Since I’m 10 years out from retirement and have seen the ups and downs the thought of a significant and lasting decline when I am ready to retire remains in the back of my mind but hasn’t changed my strategy. For you young whippersnappers I wouldn’t be overly concerned at this point because most here are making and saving a considerable amount of money so even if reduced it would be sufficient to have a comfortable retirement starting in your 60s.

    In addition to adequate planning/saving I think it comes down to the luck of the draw depending on when you were born and when you will retire. Am I hoping the market continues to go up into my retirement? Heck yes but if it doesn’t I’ll manage. That said I continue to carry a significant portion of my portfolio in residential real estate which I consider to be my bond fund but with a likely better return so my stock market holdings remain aggressive at my advanced age.

    in reply to: Wippersnappers #236817 Reply
    Avatar StateOfMyHead 
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    Outpatient psychiatrist with outpatient no show rate of about 10-15 percent. It’s higher at the VA. Our clinic tried charging for no shows but it just pissed people off. Reminder calls the day before made a difference. We can discharge a patient after 3 no shows but I’ve never actually done that.

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    My old practice (FM) tried the same thing, but since it also pissed patients off they stopped charging. I always thought that it was funny that a patient would schedule an appointment, no-show, and waste between 15-30 minutes of my time that another patient could have used, and then be mad when they’re charged for it.

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    Sad that the practice would cave because people who were wasting precious resources got pissed off.

    The practice where I work not only charges the no show fee to those they can, I think medicaid and medicare won’t allow?, but they also discharge patients who have 2 no shows without extenuating circumstances. Appointment reminders are helpful but I think the discharge component is the key. This is a low to middle income, rural area. The majority of patients respect these policies, take this minimal level of ownership in their care and there is almost always a waiting list.

    in reply to: No-shows and cancellations #235417 Reply
    Avatar StateOfMyHead 
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    I am not against NPs or PAs but against the online diploma mills, unregulated standards of education, low barriers of entry.

     

    as a physician, we all know that most of what we learn in medical school gets outdated pretty soon. Its a life long learning.

     

    a well educated NP can do descent job on par with any physicians if he/she continues to learn and hone the skills. However, they should first have substantial nursing experience before getting into NP role. Be a nurse first and then a practitioner.

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    I wish I could “like” this multiple times.

    Avatar StateOfMyHead 
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    I would be very concerned if I am a medical student or a new attending.

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    Or a PA or NP. The climate, supply-demand, insurance requirements, patient satisfaction, outcome expectations, work:life balance thing etc all multiplying at warp speed. It will be interesting to see how it plays out.

    Avatar StateOfMyHead 
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    Sounds like someone should start a movement…

    It would not go over well with the general public.  Physicians are difficult to herd towards a cause. Nurses lobby way stronger. Physicians have already given up the reins to admin who mostly have nursing background.

    maybe not…

     

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    You are correct and actually the lack of push back to admin, CMS etc has been and will continue to have the potential to be far more detrimental to patients and physicians than NP issues. Unfortunately the momentum for all the above has been established and to counteract it would require an organized, respectul, time consuming effort among respected physicians which is not likely to happen.

    Avatar StateOfMyHead 
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    Why do NP students shadow doctors instead of NPs?

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    Because the smart ones realize they will have access to far more knowledge.

    Avatar StateOfMyHead 
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    My sister is in NP school. She’s trying to do it the “right way.” She attends part time in person at one of the more regarded programs in our metro and has 6 years of med surg/ICU nurse experience at the two major academic hospitals in the city.

    She’s actually pretty frustrated by the experience and has expressed she isn’t sure it is all worth it. Even at a “good” program she hasn’t been impressed with most of the classes and instructors. She’s frustrated that the market is being saturated, especially with online degrees and those with little or no prior nursing experience. She is about to start her clinicals and is on the fence about whether or not it will be enough. She’s mulled doing a critical care internship (a few hospitals offer these) after she graduates before she pursues a full time position, if only to make her more marketable.

    She actually hasn’t had an issue getting preceptors, which surprised her because she was stressing about it for years in advance. It turned out her nursing connections were enough to get more options than she though she would have, including a few docs. However, I believe at least one of them is a mid level and I believe it will all be happening in the hospital she currently works at, and if isn’t an employee her rotations are at risk. Apparently in our state something was recently passed to require schools to help with placement. She looked into it and it was relatively worthless. Basically, “try own your own and come back if you don’t get anywhere.”

    What I find more interesting is with 4 -5 years of ICU experience, she is one of the most experienced nurses in her unit in a major teaching hospital. They can’t keep them…they all go to NP school or better paying jobs in the suburbs!

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    Few hospitals seem to keep RNs because there is virtually no shut off valve on NP admissions. If she does an internship it won’t necessarily make her more marketable as the hospitals don’t seem to care who they hire but it will provide her with a more comprehensive education. She should consider it very seriously.

    Avatar StateOfMyHead 
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    Terrible situation with plenty of blame to go around.

    This problem seems pervasive in NP education and frankly the fact that whoever accredits NP schools hasn’t strongly addressed it does untold damage to their quest for legitimacy.

    I have been involved in many iterations of this problem. As I said at one point I offered to literally set up a site and be the site coordinator for a well-regarded NP school if they could buy some of my time from the uni. I would have done it for 4-5% of my salary. No interest whatsoever. Not only did they not have resources to help students find sites they didn’t have any funds to develop an established training site.

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    What a shame they didn’t take advantage of your offer. It is more likely they didn’t want to spend the funds as opposed to not having the resources.

    Avatar StateOfMyHead 
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    Splash Refinancing Bonus

    Unfortunately NP2Bs are a dime a dozen and the time investment it can take to bring them up to speed is considerable. Since she is young and obviously doesn’t have any professional contacts established who are willing to provide training it is also likely she has minimal if any RN experience. The years of RN experience were originally the cornerstone supporting the brief NP educational tract and has been bastardized as the universities strive to drive up revenue. Most even previously reputable brick and mortar universities are encouraging undergraduates to stay enrolled through their doctorate without taking any time to work as a RN thereby reducing the chance they won’t return with the aforementioned tuition money. I know this sounds harsh but it is something she should have arranged in advance or considered in her university selection as there are schools who provide preceptor experiences.

    Avatar StateOfMyHead 
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    I would be fine letting them use Dr if they equally share the liability.

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    The problem for me is the difference in education and therefore knowledge.

    I was chief of staff at our hospital a few years ago and the whole “DNP” thing raised its head here.  The NP programs in our area now require all NPs to have a doctorate, or DNP.  Hence, they wanted to be called Dr. and were referring to themselves as “Dr.”.  This caused confusion for the patients.  We enacted a hospital policy that DNPs could not use the Dr. salutation in the hospital.  This is something thats going to hit everyone at some point.  After this policy passed, with unanimous physician support, I had a few unhappy DNPs.  One of them argued with me that they were as good as a physician in treating patients and should be allowed to use “Dr.” if they had a doctorate degree.  Lots of fun.

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    Thinking that we need to work on a policy like this, before it comes up. Can you share your policy?

     

    Just today, I received a thank you card from a husband of a patient I delivered. I had to do forceps, a skill not many Ob docs even have anymore. It was super sweet of him to write me a thank you card…. to bad he address me as:

    Dear Mrs. Last Name

    Really?????

    My male partners were shocked…. unfortunately, it has happened so many times (Patients saying things like “what happens if you are on call and I need a c-section? Do one of the guys come in? etc.) that I wasn’t totally shocked, like they were.  However, it was still disappointing.

     

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    It is a shame a layperson’s oversight in such a sweet gesture made you feel that disappointed. I totally get the frustration with the Old Boys Club that I know still exists today but would guarantee this was an unintentional faux pas. He would probably be mortified that you felt slighted by his attempt to show gratitude for the wonderful gift you helped bring into their lives.

    in reply to: How to address NPs and PAs in letters #233969 Reply
    Liked by hatton1
    Avatar StateOfMyHead 
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    If he didn’t have the management fee I would be inclined to think this is a fair diversification strategy. Closing costs on the front end are paid and they are avoiding the closing costs on the back end for now. The properties in Rockville, although like anywhere are dependent on market trends at any given time, should continue to increase in value. In that price range they  should attract decent tenants who are able pay the rent. This might work out ok in the long run especially if they can increase the rent and ditch the management company. Whether to keep it past the time where they can sell without capital gains is a different topic and one that can be considered a few years down the road. In the meantime they are also continuing to build equity. It is difficult finding properties in nice neighborhoods that will net significantly more money than the mortgage but I believe they are a better long term bet than buying a cheaper property in less desirable area with more impressive numbers on paper. Good luck OP, I applaud your initiative.

    in reply to: New Rental Property #233882 Reply
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