Working in a rural health clinic as a Pediatric Nurse Practitioner is no joke. While the surrounding desert, littered with majestic Joshua Trees, may be beautiful, the challenges are significant. Lack of specialty-trained providers, scarce resources, and, of course, little or no access to mental health services are just some of the daily concerns that I faced.

Residents in Rural Areas Have Higher Health Risks

There are approximately 61 million Americans who live in rural areas, which include Tribal, frontier, and regions that are geographically isolated areas. In the past, most people who lived in rural areas were older and in a lower socioeconomic bracket. A 2020 Gallup poll study found that 31% of Americans prefer to live in a rural area versus an urban city. During the COVID pandemic and the ability for many people to work remotely, several families moved from big cities into rural, small-town communities like Joshua Tree, California.

According to the Centers for Disease (CDC), people who live in rural areas experience higher rates of cigarette smoking, high blood pressure, and obesity. The five most common leading causes of death in rural areas include:

–              Heart Disease

–              Stroke

–              Cancer

–              Chronic Lower Respiratory Disease

–              Unintentional Injury

Maternal and Infant Health Concerns

Approximately 18 million women of reproductive age live in rural areas in the U.S. Closures of maternal health units and hospitals, as well as a decrease in the number of maternal health providers in rural areas; all contribute to increasing maternal and infant health disparities. Premature births, low infant birth weight, postpartum depression, increased maternal mortality, and severe maternal morbidity are crucial circumstances that contribute to the health and well-being of both newborn infants and their mothers.

An extensive 30-year background in pediatrics and maternal child health came in handy working in a rural clinic. My most significant focus with newborns and new moms was breastfeeding and newborn care. I would spend at least an hour with new moms and newborns. I would also assess the postpartum mom’s mental health and make sure she had enough support at home, and often gave the new mom’s my personal phone number as a resource in case they had any questions.

Mental Health: The Number One Health Disparity in Rural Healthcare

Access to mental health services is the number one health disparity facing rural communities in the United States. Suicide rates in rural areas are higher, partly due to lower public funding and limited access to mental health services. Some of the contributing factors include:

–              Isolation

–              Loneliness

–              Decreased access to transportation.

–              Access to firearms

–              Lack of specialty services

–              Cultural competency to aid diverse populations.

Elevated Cannabis Use in Adolescents

Cannabinoid hyperemesis syndrome in adolescents and young adult patients was a common diagnosis seen in my rural pediatric clinic in Joshua Tree. It often involved adolescents who complained of abdominal pain, nausea, and vomiting due to excessive marijuana use. All too often, the parents of these teens were in denial of the teens smoking “too much marijuana” and would find it challenging to have the teens stop smoking due to their friend groups.

The rural pediatric population has multiple risk factors that increase their vulnerability to adverse consequences as cannabis legalization expands across the United States.

Some concerns include:

–              Increased Access and Use

–              Greater Mental Health Risk

–              Cognitive and Academic Impact

Rural areas tend to have decreased resources for intervention and education to alleviate these risks. I personally spent lots of time educating teens and their parents regarding marijuana addiction. Handouts with online and community resources were given to patients and their families, which emphasized the mental health risks and cognitive impairments of long-term marijuana use and abuse.

High Risk of Opioid Use Disorders

Drug overdoses are the leading cause of injury-related deaths in the United States. According to the CDC, in 2021, there were 106,699 drug overdose deaths in the country. The number of drug overdose deaths is rising in rural areas, where they now occur more frequently than in urban areas. The book and movie ‘DopeSick’ highlighted the detrimental effects of excessive opiate use in rural areas like the Appalachian Mountains.

Increased Need for Psychiatrists and Psychiatric NPs

The need for psychiatric mental health providers has been growing in rural areas. It is estimated that up to 65% of nonmetropolitan counties lack psychiatrists and psychiatric NPs. Over 60% of rural Americans live in areas designated as having a shortage of mental health providers. Some of the reasons include:

–  Escalating mental health care needs: suicide, alcohol and substance abuse, opiate addiction, depression, and domestic violence are on the rise in rural areas.

–  Role of Psychiatric Mental Health Care Nurse Practitioners (PMHNP): PMHNP can help bridge this gap by providing comprehensive mental health care, including diagnosis, treatment, and medication management. Their ability to practice independently is crucial in areas with limited healthcare providers.

– Telepsychiatry: PMHNPs play a big role in telepsychiatry enabling them to provide patient care and mental health services in remote locations.

-Policy Support: There’s increasing support for PMHNPs to address the various issues that exist in rural areas and work in the fullest capacity of their education and training.

Working in a rural health clinic has been a challenging and gratifying experience. I was able to spend unlimited time with my patients, ensuring they received the patient education and care that they needed. However, at times, I felt helpless due to the lack of mental health and substance abuse facilities in Joshua Tree, CA.

Are You Interested in Rural Healthcare?

Are you a healthcare provider interested in working in a rural area in the U.S.? Contact a MedCare staffing recruiter today and get started on your locum tenen adventure.

The post Innovative Care: How Nurse Practitioners are Revitalizing Rural Health Clinics appeared first on Medcare Staffing.

If you’re a hustler and a go-getter who loves to travel, working for a Locum Tenens agency may be the right career choice for you fresh out of medical school.

The Place Holder

Locum Tenens in Latin means’ placeholder.’ Many facilities all over the United States need temporary physicians and healthcare providers to cover for providers who may be on maternity leave, taking a leave of absence, or due to physician scarcity. A locum tenens physician temporarily fills the space of another. Organizations like hospitals, Federally Qualified Clinics (FQHC), Dental clinics, and Urgent Care centers employ locum tenens healthcare providers.

Movie Star Status

Working with a locum tenens agency is like being a movie star. Once you sign up with a locum’s agency, you are set up with a locum’s recruiter who works for you like a Hollywood agent works with an actor. You now have a representative who will start looking for your next locum assignment and negotiate your pay and work assignment on your behalf.

Your locum’s recruiter will ask you questions like:

• Where would you like to work?
• Are you looking for an assignment close to where you live?
• Are you willing to travel?
• What states are you willing to travel to?
• What pay range are you looking for?
• What type of jobs are you willing to consider?
• Are you looking for a locum position that will become your permanent job?

Tailor Made for You

What specialty do you want to work in? Do you only want to work nine to five? No weekends, no night shifts, or holiday shifts? Get specific on what you want. Your locum’s recruiter’s primary goal is to ensure you and the client are a perfect fit.

Once you get an assignment, your locum’s recruiter will also be your point of contact. Your recruiter is accountable for you and is there to be your representative to help you resolve any issues like pay discrepancies, scheduling, and various miscellaneous issues that may pop up during your assignment.

Work Through Your Down Time

Some new physicians who attended a medical school overseas or in the Caribbean may face credentialing and licensing challenges in certain states like California or Texas that will not allow you to be eligible to take your medical board exams. For a new physician experiencing these circumstances, you may still be able to work in various other states through a locum agency instead of experiencing downtime. At the same time, you wait for board eligibility requirements.

Make More with Locums

Many new doctors start working with a locum tenens agency because they can make more money quickly. According to the Physician Side Gigs website, across the locum tenens compensation database, the average hourly locum rate was approximately $215/ hour, which varies based on the physician’s specialty. Whether you’re working in internal medicine, outpatient, or critical care, on average, physicians working with a locum tenens agency earn a higher hourly rate compared to their full-time colleagues in permanent positions.

Specific locum assignments may pay more due to physician needs and extenuating circumstances like:

• Increased census load
• Increased time on call
• Rural Areas

Groovy Scheduling Autonomy

Jumping into a new job after residency can be tough. Strict work schedules created six months in advance, with seven days on and seven days off in a hospital, are now your new normal. This can be stressful. It’s a major lifestyle change, leaving you with limited time for family life and personal vacations.

Locum tenens can offer you greater autonomy over your personal work schedule, giving you more flexibility and control over your life. Locum’s work gives you the opportunity to work with a recruiter who will help you create an epic work-life balance to fit your personal needs, leaving you with ample time for family, self-care, and world travel.

Taxes and Write Off’s

If you’re working on a locum’s assignment, you’ll probably be working on a 1099 tax status and have to keep track of your taxes. On the positive, you can write off lots of expenses like gas, lab coats, uniforms, shoes, medical equipment, and many other miscellaneous on-the-job items. You can also create your own LLC.

More Pro’s

Today, physicians and healthcare providers have more freedom to change jobs due to the Federal Trade Commission issuing a final rule banning noncompete nationwide. In the past, a physician may have not  been able to start a new job, work an extra job, or moonlight through a locum’s agency that posed competition for their current employer and or corporation due to contractual conditions that prevented workers from taking a new job.

With Every Pro, There Are Also Con’s

Travel, flexibility, and making more money are excellent pros to working locum tenens. Some cons may include:

• Licensing: Some locum agencies may pay for your licensing in various states, depending on provider need and agency policy. However, you may have to pay out of pocket to get licensed in multiple states.

• Credentialing Is verifying a physician’s or healthcare provider’s qualifications. The locum’s agency will evaluate education, certification, work experience, and license to practice in each state. Be aware that some credentialing may take up to ninety days to complete with some agencies.

• Electronic Medical Records (EMR’sEMRs): If you pick up locum assignments in different facilities and states, you may have to learn different EMR’sEMRs every time you pick up a new assignment. Learning a new EMR system can be stressful for some. Learning a new EMR may take time and slow you down when seeing patients. It’s essential to consider this and be patient during the learning process.

• Workflow: Every time you are on a new locum assignment at a new hospital or healthcare organization, you’ll have to learn a new workflow. Remember that it will take some time to get acquainted with staff and learn how everything works.

MedCare Staffing has exclusive contracts with various hospitals, FQHCs, Urgent Care Facilities, and Dental Clinics. Sign up with MedCare Staffing and start your movie star status locum tenen assignment today.

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Healthcare is Growing Globally

Healthcare is one of the fastest-growing occupations in the United States. Currently, 14 % of adults in the United States are employed in healthcare. According to the United States Bureau of Labor Statistics, jobs in healthcare between 2022 and 2032 are projected to grow faster than jobs in any other industry, with an average annual opening of 1.8 million. 

Always Negotiate

Mastering the art of negotiations is the key to success, especially for a new healthcare graduate. If you can negotiate a career package that will help you financially and personally, you’ll be on the path to a healthy and happy career in healthcare.

Top Insights to Consider Before Entering Contract Negotiations

• Know what you want: It’s vital to assess what you desire in a job opportunity: Do you like to work full-time, part-time, or per diem? Do you want to work weekends and holidays? Are you ok with being on ‘call’? What base salary are you willing to accept? Are you willing to travel to different facilities? Do you want a certain amount of training before you are left to work on your own? Do you want an on-the-job mentor? Is the facility you are applying to close to your home, or will you have to commute? Do you use public transportation? Does the facility have access to public transit? Does the facility offer superchargers if you have an EV (electric vehicle)?

• Research is vital: Before entering a contract negotiation, it’s essential to research what other facilities are paying and offering as benefits compared to what you are being presented. Learn about the organization you are applying to: Do they share your values? Do you agree with the organization’s mission statement?

What are you bringing to the table?

• Know your value: Do you have a specific skill set that may benefit the organization? Do you speak different languages? Do you have any professional certifications? What computer programs and EMR (Electronic Medical Record) systems are you proficient in? Do you have any skillset in AI or VR (virtual reality)? Have you researched or published articles helpful to the hospital and or organization? What skills and job sets from previous employers could you use as a skillset in the position you are applying for? What type of internship or residency experience are you bringing with you? Do you have academic achievements that may help you stand out?

• Industry Knowledge: Did you complete your residency or clinical internships in a specific specialty? Are you specialized in one field like pediatrics, geriatrics, or women’s health? Have you done any community outreach work in the area where you are seeking employment? Have you created a product through innovation that could benefit the organization you are applying to?  

What should you expect from the organization?

• Patient population: What type of patient population will you be servicing? How many patients are you mandated to see in one day or care for on one shift? Does the facility have issues with staffing ratios and safe staffing? Have they been in the media for safe staffing issues? Have employees gone on strike recently? What safety precautions does the organization have to keep you and other employees safe? Have there been incidences of random acts of violence at the facility? How have these incidents been handled? Does the facility offer specific training for self-defense?

• What common complaints does the organization have? What keeps the management team up at night? Do you have a specific skill set that you can offer the management team? For example, if you become an expert at organizing grand rounds during your past clinicals or residencies, you could offer to start an educational symposium if one does not already exist. This skill could provide you with greater bargaining power.

Show Me the Money

Of course, the compensation you want to earn is essential when negotiating your first healthcare contract. But you may like to know what other benefits and ‘perks’ the healthcare organization can offer you, like:

• Licensing fee reimbursement

• School loan reimbursement

• CEU’s or CME’s

• Compensation to attend healthcare conferences related to your specialty

• Vacation and or sick time

• Health Insurance benefits, family leave of absence, and maternity leave

• Breastfeeding rooms and allotted time during your workday to pump

• Does the organization offer accessible on-site mental health services during working hours?

• Compensation for professional memberships

• Cellphones and personal laptops

• Transportation reimbursement

• Book subscriptions

• Mileage reimbursement for travel to another clinic

The Secret to Negotiating Your Contract

According to Carolyn Bupert, CRNP, JD, contract  negotiation attorney expert, it’s best to follow the 3 Ps of negotiation:

Prepare: It’s essential to familiarize yourself with how the revenue is generated and brought into the practice or healthcare facility. Ask the practice management for data. Become familiar with CPT codes, dates, and fee schedules. The clinician’s billing regarding salary and overhead costs will determine whether the facility is profitable. A clinician’s salary should come to about one-third of their total billings, and the benefits should equate to about 25% of the base salary.

Nonmonetary contributions to the practice, such as patient satisfaction, increases in repeat customers, and declines in no-show appointments, should be measured. Patient testimonials are a great way to demonstrate value regarding these points.

Probe: During the interview, ask about the clinic or healthcare facility’s financial health. Determine what the expectations are regarding employer profits.

-Threats and opportunities?

-What does the budget look like?

-Strategic goals for the organization?

Propose: After doing your research and showing your value to the company in the interview sessions, don’t be afraid to ask what you want and get what you deserve.

Renegotiation Clause

Typically, after 90 days, 6 months, and a year, you may be reevaluated for your work performance and be reevaluated for a promotion or potential salary increase. This is your chance to show the organization how you have benefitted them and if you’ve made the organization money. Essential questions to ask include:

1. How does the process of performance evaluation work?

2. Ask to see the scoring tools used to evaluate you.

• Who does the performance evaluations?

• Who will be evaluating your EMR charts and patient cases?

• Will you have to submit patient charts?

• Is your credentialing process going to be affected?

What Happens Next?

Silence. After negotiating your contract, you might not hear back from the facility immediately. Don’t panic! Always remember that silence is golden.

After receiving an offer, it’s always best to take time process the offer and give it at least 1 to 2 days. Don’t just jump in when you hear back from the facility with an acceptance or a declination. Ensure the offer you get is right and you are satisfied before accepting.

Are you curious about locum tenens? MedCare Staffing has you covered! Click the link to speak to a recruiter today.

The post The Secret to Successful Contract Negotiations for Newbie Healthcare Providers appeared first on Medcare Staffing.

This legislation would grant permission for a physician and surgeon to oversee a maximum of eight physician assistants concurrently, provided that all the physician assistants are exclusively dedicated to conducting in-home health assessments to collect patient data and conduct annual wellness check-ups or health evaluations that do not entail direct patient treatment or medication prescription. Previously, the law prohibited physicians and surgeons in California from overseeing more than four PAs simultaneously.

These evaluations encompass comprehensive physical examinations, health conditions and social determinants of health assessments, medication reviews, screening tests, and health education.

The exemption is unique to California and will go into action on January 1, 2024. The legislation applies to PAs focused on conducting health evaluations corresponding to Medicare’s “annual wellness visits.”

The Birth of the Physician Assistant: A New Role for Ex- Military Corpsmen

The PA role started as a ‘suggestion‘ offered by Dr. Charles Hudson in 1961 at a conference on medical education hosted by the American Medical Association. An internal medicine doctor, Dr. Hudson, recommended ‘assistants to doctors’ to offset the growing healthcare gap. He proposed ex-medical corpsmen as the perfect candidates because they were highly trained with little to no opportunity to practice their skills once they left the military and returned home. The first PA program took place at Duke University as a two-year program in 1965. The first three graduating students graduated on October 6, 1967.

The Impact of Physician Assistants in Healthcare

The PA role is experiencing a rapid growth spurt in the United States. The National Commission Board on Certification of Physician Assistants reported 168,318 PAs at the end of 2022. Mississippi, South Carolina, and Indiana experienced the highest percentage of growth of board-certified PAs from 2018 to 2022.

According to various research studies, employed PAs are expected to grow 31.3 % by 2029. PAs are competent associates in the ever-evolving healthcare delivery system landscape. Due to the current physician shortage, PAs are filling in the provider gaps.

Common Places PA’s are Employed

• Hospitals: Many PAs work in various departments, including emergency rooms, surgery, internal medicine, pediatrics, etc. They assist in patient care, perform procedures, and collaborate with physicians and other healthcare providers.
• Physician Offices/Clinics: PAs often work in outpatient settings, providing primary care, specialty care, and preventive services. They can be found in family medicine, cardiology, dermatology, and many other specialties.
• Urgent Care Centers: Urgent care facilities employ PAs to provide immediate, non-emergency healthcare services. They diagnose and treat a wide range of illnesses and injuries.
• Community Health Centers: PAs play a significant role in community health centers providing primary care services to underserved populations. They address the healthcare needs of diverse communities.
• Surgical Settings: Some PAs specialize in surgical procedures and work closely with surgeons in the operating room. They may assist in surgeries, conduct pre-operative and post-operative care, and provide surgical consultations.
• Long-Term Care Facilities: PAs can care for elderly and chronically ill patients in nursing homes, assisted living facilities, and rehabilitation centers.
• Mental Health Settings: In mental health and psychiatry, PAs work alongside psychiatrists to diagnose and manage mental health conditions, prescribe medications, and provide therapy.
• Rural and Underserved Areas: PAs are often deployed to rural and underserved regions with a shortage of healthcare providers. They help bridge the gap in healthcare access.
• Education and Research: Some PAs work in academic and research institutions, where they may be involved in training future PAs, conducting clinical research, or developing healthcare policies.
• Government and Military: PAs can serve in various government agencies, such as the Department of Veterans Affairs or the military, providing healthcare to veterans and active-duty personnel.
• Corporate Health: Some large companies employ PAs to oversee employee health and wellness programs, conduct physical exams, and provide healthcare services to their staff.
• Telemedicine: With the growth of telehealth, PAs are increasingly offering virtual healthcare services, diagnosing and treating patients remotely via video consultations.

It’s important to note that PAs specific roles and responsibilities may vary depending on the setting and state regulations. PAs can adapt to different healthcare environments and contribute significantly to improving patient care and healthcare access.

Roles and Responsibilities

• Patient Care: PAs are trained to perform thorough medical evaluations, order and interpret diagnostic tests, and diagnose and manage various medical conditions. They can also provide preventive care, such as vaccinations, health screenings, and counseling.
• Treatment Planning: Physician assistants work closely with physicians to develop and implement patient treatment plans. This may involve prescribing medication, recommending therapies, and making necessary referrals to specialists.
• Procedures: In some cases, PAs can perform medical procedures, like suturing wounds, setting fractures, and assisting in surgery. This helps in ensuring that patients receive prompt and effective care.
• Education and Counseling: PAs often educate patients about their conditions, treatment options, and ways to maintain good health. They provide valuable information to help patients make informed decisions about their healthcare.

Physician assistants are instrumental in improving healthcare accessibility and quality. Here’s how they make a difference:

• Meeting Growing Healthcare Demands: PAs help alleviate the physician shortage and extend the reach of healthcare services to underserved communities.
• Cost-Effective Care: They offer cost-effective healthcare, reducing the burden on patients and the healthcare system.
• Enhanced Patient Experience: PAs often spend more time with patients, offering a more personalized and empathetic approach to care.
• Team-Based Care: They work collaboratively with physicians, nurses, and other healthcare professionals, creating a more comprehensive and efficient approach to patient care.

Education and Training

• Bachelor’s Degree: PAs usually start with a bachelor’s degree in a healthcare-related field, which includes prerequisite coursework in biology, chemistry, and other science subjects.
• Master’s Degree: They then enroll in a Master of Physician Assistant Studies (MPAS) program, which typically takes two years to complete. These programs include both classroom instruction and clinical rotations.
• Certification: After graduation, aspiring PAs must pass the Physician Assistant National Certifying Examination (PANCE) to become certified PAs. This certification is required in all states.
• Licensure: PAs must also obtain a state license to practice, which may include passing a state-specific exam.

Are you a healthcare facility looking to hire a Physician Assistant? Are you a PA interested in working locum tenens? Medcare Staffing is here to help you with all your staffing and locum tenens needs. Click here to connect with a recruiter today.

The post California’s Bold Move: How It’s Shaping the Future for Physician Assistants appeared first on Medcare Staffing.

In 2020, the DEA temporarily relaxed some of its telemedicine regulations in response to the COVID-19 pandemic. This allowed for greater flexibility in prescribing controlled substances via telemedicine. These temporary changes included the following:

1. In-Person Examination Waiver: During the public health emergency, the DEA allowed for telemedicine evaluations without a prior in-person examination. The waiver is typically required in most cases.

1. Partial Waiver of Ryan Haight Act Requirements: The Ryan Haight Act had stringent requirements for prescribing controlled substances via telemedicine. The DEA provided a partial waiver of these requirements during the public health emergency.

1. DEA Registration Requirements: Telemedicine providers were temporarily allowed to treat patients in any U.S. state, regardless of the provider’s DEA registration location.

The Telemedicine Revolution

 Although telemedicine had been in practice for decades, it debuted into the healthcare landscape during the COVID-19 pandemic. With stay-at-home orders across the United States, healthcare providers use telemedicine to stay committed to their patients and continue offering quality healthcare services. Telemedicine delivers medical care to patients at a distance, providing enhanced quality care, decreased patient readmissions, and decreased healthcare costs for patients and healthcare facilities.

During the COVID-19 pandemic, access to telemedicine decreased the number of in-patient visits and consultations. Telemedicine was instrumental in reducing the spread of disease through more efficient surveillance of patients, early identification of infectious disease processes, allowing for immediate care, and continuing care for patients with chronic illness.

Prescribing Controlled Substances Using Telehealth

The telemedicine flexibilities that were in place during COVID-19 state that:

– A healthcare provider can prescribe a controlled substance to a patient using telemedicine even if the patient is not in a clinic or hospital registered with the DEA.

– Buprenorphine can be prescribed by qualifying healthcare providers to existing and new opioid use disorder patients based on telephone evaluations.

According to a study in JAMA Psychiatry 2023, patients who were treated for opioid-use disorder through a telehealth provider and seen between September 2019 and February 2021 were found to have a 33% lower rate of fatal overdose than patients who received no medication.

 Patients who had an opioid use disorder were able to start buprenorphine treatment with decreased delays compared to in-person visits and evaluations. Studies have found that the standard issue patients with abuse disorders face is access to transportation and childcare.

Overall, drug overdose deaths were found to have increased during the COVID-19 pandemic, spanning over one hundred thousand deaths in 2021. Approximately 755 of those deaths were related to opiate abuse. The Centers for Disease (CDC) reported that the increased deaths were a result of social distancing, disruption of healthcare, and stay-at-home orders.

The ‘Darkside’ of Telemedicine

Many researchers also argued that online interactions are impersonal and potentially dangerous because an online provider may need an accurate health history and physical exam from the patient.

Along with the COVID-19 telehealth revolution came an increase in equity funding for various telehealth startups, which reached over 18 billion dollars. Unfortunately, practices at these new telehealth ‘startups’ have been known to engage in evil activities such as liberal prescribing at Cerebral and Done Health, which created possible violations of the Controlled Substance Act, which alerted the U.S. Department of Justice to launch an investigation. They further noted that the private health information of patients was being distributed to advertisers by BetterHelp, which prompted an intervention from the Federal Trade Commission.

The DEA’s Proposed Rules

The DEA is proposing a rule that all patients prescribed non-narcotic schedule III through V drugs must be seen by a prescribing healthcare provider and have undergone an in-person evaluation by the telemedicine provider. The rule also states that the telemedicine provider can prescribe up to a 30-day supply of non-narcotic schedule III through V medications.

Patients who are receiving buprenorphine for the strict purpose of opioid use disorder must also be seen in person and can receive a 30-day supply of medication.

Controlled substances bring with them increased risks of misuse and dependency, which can have fatal consequences. The DEA’s focus is to limit inappropriate prescribing practices.

In-person healthcare visits and medical examinations decrease the risk of misuse by:

-Assessing risks of misuse

-Ruling out medical causes of symptoms

-Provides accompanying data to audio and telehealth examinations and visits

“Listening Sessions”

Earlier this fall, the DEA held two days of ‘listening sessions’ where over thirty-eight thousand comments regarding the proposed telemedicine rules were received. The American Academy of Medicine’s (AMA) president, Dr. Jesse Ehernfeld urged the DEA to adopt a federal policy regarding the prescribing of controlled substances based on telehealth visits that will continue to support patients’ access to evidenced-based care. The AMA’s focus is to provide access to care with a mix of in-person and telehealth visits to better meet the needs of every patient.

The DEA states that they will continue to monitor all input received and are working to put together a final set of telemedicine regulations by the fall of 2024. This allows ample time for patients and healthcare providers to plan and prepare for the new rules and regulations once they are executed.

Are you looking to add travel and adventure to your life? MedCare Staffing has a variety of long-term and short-term locum tenens assignments. Click here for more information.

The post DEA Telemedicine Flexibilities: Lifesaving Facts That All Healthcare Providers Should Know appeared first on Medcare Staffing.

The 1099 Worker and Taxes

If you work for a locum tenen company as a healthcare provider, you’re probably a 1099 worker, also known as an independent contractor. Independent contractors are self-employed workers who work on a freelance basis. They typically sign contracts and agree to complete a project or provide a service in a certain amount of time in exchange for payment of fees negotiated upon.  

It’s important to realize that as a 1099 worker, your employer does not deduct your taxes from your paycheck. For that reason, YOU are responsible for all your tax deductions on a 1099 form. The 1099 is an IRS tax form that reports payments to independent contractors and other miscellaneous income in the United States. You can expect to receive a 1099 form with all your earnings mailed to you from your locum tenens company at the end of the year.

Business Deductions and Tax Savings

Mark Twain once jokingly said, “The only difference between a taxidermist and a tax collector is that the taxidermist only takes your skin.”

As a 1099 worker, the IRS sees you as a small business owner. The secret to keeping more of your ‘skins,’ or more of your income, is a better understanding of your business deductions.  

Specifically, you pay taxes only on your profit. For example, if you earned $10,000.00 and spent $ 2,000.00 as a business expense, you only must pay taxes on the $ 8,000.00 earned.

Remember To Put Money Aside

Without a doubt, all private contract 1099 workers should get into the habit of putting money aside for tax season. Preparedness is key. Approximately 30 to 40 percent of your income should be set aside for potential tax payments.

Keep Good Records and Track Receipts

Of course, keeping track of receipts can take time and effort. Therefore, don’t stuff receipts or important documents in your wallet or throw them in a paperback. Unquestionably, come tax season; you’ll miss essential expenditures. Here are some tips on how to keep track of receipts during the year leading up to tax season:

Should You Start An LLC?

An LLC is a ‘limited liability company,’ a business structure in the United States. Particularly, it protects its owners from personal responsibility for its debts or liabilities. In essence, LLCs are hybrid companies that combine the qualities of a corporation with those of a partnership or sole proprietorship.

For the Most Part, Set Up is Simple

• Choose a business name that is not a duplicate of an existing LLC
• Your state will let you know if your business name is acceptable
• LLC or Limited Liability company must appear in your business name
• Create and file articles of organization, including LLC’s name, address, and names of the owners of the business standard forms for each state can be found online.
• Appoint a registered agent. This person is typically one of the owners and represents the LLC.
• Payment of fees, this may vary from state to state
• Publish a notice of intent to start your LLC in a local newspaper. It may vary from state to state.
• Create an operating agreement.

Pros and Cons of an LLC

It’s important to realize that regulations of LLCs vary from state to state. Undoubtedly, one of the pros of starting an LLC is that it offers your company limited liability. LLCs prevent the owners from being personally responsible for the company’s debts. In the event that a company goes bankrupt or is sued, the owner’s assets will not be affected. Also, profits can be directly passed to owners to be taxed as personal income to avoid ‘double taxation.”

On the negative side, starting an LLC includes profits subject to Medicare and Social Security taxes. In some cases, the owners of an LLC may pay more taxes than a corporation.

Side Gigs and Other Services

In the long run, getting the most benefits out of your LLC is critical. Services that you can provide include consulting, freelance writing, or selling products. As an LLC, you are more than just a private contractor; you are a legitimate business.

Take the Stress Out of Taxes and 1099 Status

Above all, good organization is the solution to keep your yearly taxes stress-free. For this reason, If you’re a 1099 worker, save all your expense receipts and put money aside for tax payments. By assessing your monthly taxes and receipts, you will alleviate stress during tax season.

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Breastfeeding is always best. Breast milk has an infinity of health benefits for both moms and babies. The Centers for Disease Control (CDC) states that breastfeeding is the key strategy to improve public health. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend that all babies be exclusively breastfed for the first six months of life.

Most infants born in 2019, approximately 83.2 %, were reported to receive some breast milk. However, the most common reason for lactating mothers to stop breastfeeding their babies is the complaint of working in a work environment that does not support breastfeeding or offer an adequate place to pump their breasts.

The Break Time for Nursing Mother’s Law and All It’s Gaps

Workplace lactation laws are known to increase the breastfeeding rate. This allows nursing women to earn a living for their families, and emphasize that workplaces acknowledge women’s and men’s needs as essential. Federal Law requires that all workplaces provide reasonable break times for an employee to express milk for her nursing child. This is good for one year after birth each time such an employee needs to express milk. “The Break Time for Nursing Mother’s Law” was created in 2010 for all workplaces in the United States to allow for a reasonable break time and a private non-bathroom space for all lactating employees to pump milk during their workday.

However, the law contains several ‘gaps.’ More than 9 million women of childbearing age were not covered by the Federal Break Time for Nursing Mother’s Law. Around 27.6 million women workers of childbearing age in America need the basic protections all breastfeeding women need, including break time, space, and reasonable accommodations to stay healthy for breastfeeding.

According to an article in USA Today, Brian Dittmeier, senior public policy counsel for the National WIC Association, a nonprofit group that provides nutrition and education services to pregnant women and mothers, states:

“The original extension of protections in 2010, as part of the Affordable Care Act, was tied to the definition of employee in the Fair Labor Standards Act (FLSA),” he said. The difference between those covered and not is “a distinction around overtime pay and eligibility. But no distinction applies to whether a worker needs access to a place to pump or not.”

The Gap: The Break Time for Nursing Law does not cover employees who qualified for overtime.

Nurses, nurse aides, teachers, farm workers, and various other lactating women in this category may have had to previously pump their breasts for breast milk in unusual and possibly unsanitary places like supply closets, bathrooms, and empty classrooms. Many may have  even had to pump in their vehicles.

Breastfeeding should provide a feeling of relaxation. Many lactating mothers who had to pump their breast milk in unsanitary conditions would report a feeling of anxiety when pumping. The tension was mainly due to a lack of privacy and the fear of someone walking in on them while their breasts were exposed during pumping.

Exposed: Discrimination Against Breast Feeding In the Workplace

After giving birth, most women have six weeks of ‘disability,’ which is considered an average length of leave after delivery per the American Gynecological Association. A supportive work environment for lactating mothers to pump milk is vital for mothers to continue to breastfeed their babies. When lactating mothers were told they could have a space to pump, that space often turned out to be a public space and not a private one.

Breastfeeding discrimination includes:

• Denial of pump break requests from employees who are experiencing pain

• Terminating an employee for asking for a pump break

• Refusing to provide privacy, leaving workers to pump milk with their breast exposed to coworkers, clients, and the public in physically unsafe conditions.

• Commenting on an employee’s breasts, comparing breast feeding workers to animals and making animal sounds like mooing while they are breast feeding.

Over two-thirds of breastfeeding discrimination lawsuits have led to a breastfeeding employee’s job loss. Unfortunately, due to the gap in the law, these employees could not take their employers to court for monetary compensation.

The PUMP Act

The “Providing Urgent Maternal Protections to Nursing Mothers (PUMP) Act” passed the House in October of 2022. The PUMP Act amends the coverage gaps in the previous Break Time for Nursing Mother’s Law. It ensures all women can access private nursing or pumping spaces at work.

Unfortunately, the law does not apply to flight attendants and crewmembers. There are specific rules that apply to rail carriers and motor coaches.

The law also:

– Allows employees to file lawsuits against an employer who violates the law.

– Expands the legal right to receive pumping and private space to 9 million women. That include nurses, teachers, farm workers, and many other women.

– Defines and explains that pumping time also counts as work time when minimum wage and overtime pay if the employee is not relieved from work duties.

Undue Hardship

Employers of all sizes must provide break time and a private, clean environment for lactating women to pump. The law covers employers with less than 50 employees and must provide break times and space. If an employer claims an ‘undue hardship,’ meaning that the time and space needed for the PUMP Act would cause significant difficulty or expense, they could be excused from complying with the law.

What Can You Do If An Employer Does Not Follow The PUMP ACT?

File a complaint with the U.S. Department of Labor Wage and Hour Division (WHD)Contact free helplines from centers from Work Law

1. Contact free helplines from centers from Work Law
2. Employees may choose to file a lawsuit against their employer.

State and Local Laws

Workers nationwide are protected under the PUMP ACT. Additional protections provided under state and local laws remain in effect and do not change under the PUMP Act.

Medcare Staffing is committed to supporting the PUMP Act. If you are interested in working locum tenens, click the link and speak to a Medcare Staffing  recruiter today.

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The United States is in the middle of a primary healthcare provider shortage, and Americans are worried. Evidently, A recent Health Day/ Harris Poll reported that fifty-two percent of consumers are concerned that staffing shortages will prevent them from receiving medical care and services.

• Data published by the AAMC (Association of American Medical Colleges) suggest that the United States may encounter a shortage of 37,000 and 124,000 primary care physicians by 2034.
• At this time, there are currently 6,486 dental care health professional shortage areas (HPSA) as reported by Health Resources and Service Administration (HRSA).
• According to Cornell University School of Industrial Relations and Labor (ILR) strike tracker reports, there have been approximately 30 strikes so far in 2023.

Granted, not all states are being affected equally. Due to their rural locations, some states, cities, and zip codes are experiencing extreme primary care provider shortages. According to the Bureau of Health , Workforce, Health Resources, and Services Administration, these ten states include:

1. Delaware
2. Missouri
3. Alaska
4. Nebraska
5. New Jersey
6. Washington
7. North Dakota
8. Florida
9. New York
10. South Dakota

Locum Tenens Saving the Day in Rural America

The term locum tenen means ‘place holder’ in Latin. Typically, a Locums provider temporarily fills the place of another provider and is employed at a hospital, private practice clinic, or community healthcare facility that is short-staffed or in need of temporary coverage.

Locum tenens originated in America in the mid-1970s. The Health Systems Research Institute (HRSI) was funded by a grant from the Robert Wood Johnson Foundation for the University of Utah, emphasizing decreasing physician burnout in rural areas. The program assembled a network of doctors to cover the practices of rural physicians so that rural physicians could attend CME courses.

Pack Your Bags and Get Your Wanderlust On; It’s Time for A ‘Workcation.’

Reasons Why Healthcare Providers Chose to Work Locum Tenens:

• More flexibility
• Greater work-life balance
• Extra income
• Mini vacation experiences
• Test out living in a new area before committing to a permanent position
• Gaining a new perspective on life

Presently, Medcare Staffing has assignments in areas of the U.S. experiencing extreme primary healthcare provider shortages, which include New Jersey, South Dakota, and many others.

For more information on working with Medcare Staffing, click the link and speak to a staffing recruiter today.

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Nurses Leaving Healthcare

What would a typical day in a hospital look like if there were no nurses? For one thing, alarms would be beeping. As well as patients screaming. Much like a heart afflicted by a cardiac arrest, the world inside a hospital would stop. 

The U.S. Bureau of Labor Statistics is projecting that there will be a shortage of 1.1 million nurses created by over 500,000 experienced nurses who are on the brink of retirement. 

According to a new study released by the National Council of State Boards of Nursing (NCSBN): 

• 100,000 Registered Nurses (RNs) left the healthcare workforce during the COVID-19 pandemic
• By 2027, 610, 388 RNs intend to leave the healthcare workforce 
• Approximately one-fifth of the RNs surveyed are considering leaving the nursing profession.

Safe Staffing Ratios

One of the most common reasons nurses leave their bedside nursing jobs is due to unsafe patient-to-nurse ratios. Shortages in healthcare not only affect patients but also affect staff and staffing ratios. Many hospitals allow nurses to work short-staffed, which can be dangerous and lead to burnout.

Safe staffing improves patient outcomes and saves hospitals money. The odds of a patient dying increase by 7% for each additional patient a nurse takes at once. Studies show that nurse job turnover decreases with better nursing-staff ratios.

• California and Massachusetts are the only two states in the U.S. to have passed laws regulating nurse-to-patient ratios.
• The Massachusetts nurse-to-patient ratio law was passed in 2014 and limited nurses working in intensive care units to only care for one patient per shift.
• California’s nurse-to-patient ratio law was passed in 1999 and implemented in 2004. California is the only state to pass legislation mandating comprehensive minimum nurse-to-patient ratios in hospitals.

Boomerang Nurses

On the contrary, The Wall Street Journal reports that many nurses who initially left the bedside for higher-paying temporary travel positions during the COVID-19 pandemic are returning to hospital staff jobs. These Nurses are being called ‘boomerang nurses.’ Falling pay rates offered through temporary agencies are some of the reasons these nurses are ‘boomeranging’ back to the bedside and returning to their staff jobs 

Hospitals are trying to win back nurses to staff positions by awarding attractive perks like better pay, childcare, flexible work schedules, and even paying off student loan debt. One California hospital offers a $100,000.00 bonus over three years to retain and recruit permanent positions. By offering perks and added incentives, hospitals hope to solve the nursing shortage.

Advanced Practice Nurse Jobs Are Growing

The U.S. Bureau of Labor Statistics projects an increased growth of Nurse Practitioners, Nurse Anesthetists, and midwives’ employment to 40% from 2021 to 2031.

For the second year in a row, the U.S. News & World Report 2023 Best Health Care Jobs ranked Nurse Practitioners as the number one healthcare job in the U.S. NPs bring clinical expertise, leadership, and robust solutions to the challenges experienced in the healthcare universe. The NP focuses on reducing healthcare disparities with patient-centered care at the heart of the practice. Currently, there are 27 states, including Washington, D.C., where they have full practice authority and can practice independently.

Mental Health Issues and Burnout

Nurse burnout continues to be a growing concern. This encourages the need to recognize symptoms of burnout and mental health issues early on. Some early signs include missing work deadlines, delays in updating credentials, and attending continuing education courses, which lead to delays in licensing updates. Many physical symptoms of burnout include insomnia, headaches, increased fatigue, isolation, irritability, struggle with daily tasks, and depression.

It’s important to realize that approximately 1 in 18 American nurses experience suicidal ideation within a year compared to the general workforce. Some hospital systems, like UCSD, encourage nurses to seek counseling for suicidal ideation through special programs. 

Many studies show that poor workplace conditions negatively impact mental health. Nurses also report that they have inadequate emotional support on the job. For example, a police officer or firefighter may get time off after witnessing a death, while a nurse is expected to continue with their shift with no extra time off. Mental health apps geared towards nurses offering peer support and self-care are excellent resources for nurses. 

Travel Nursing and Per Diem Staff Are Still Needed

The shortage is projected to continue throughout 2023. According to a survey conducted by the American College of Healthcare Executives, CEOs of healthcare systems ranked workforce challenges and personnel shortages as the number one concern. Although several travel nurse companies have decreased their pay rates, demand for travel and per diem nurses still exists. The flexibility of ‘gig’ work allows nurses to pursue higher education, spend quality time with family and allows a nurse to have more control of their work schedule, giving them a better work-life balance.

Looking for A New Nursing Adventure? 

Are you looking for more flexibility and adventurous travel? Working locum tenens could be your next great work adventure offering:

• Greater Flexibility
• Travel Opportunities
• Work-Life Balance
• New and Exciting Work Environments
• Greater Compensation
• More Diversity
• Less Administrative Responsibilities

Recent studies showed that patients treated by locums providers exhibited shorter hospital stays, decreased hospital costs, and no increase in readmission or mortality. Multiple healthcare facilities around the United States employ locum tenens nurses. As placeholders, locum tenens nurses temporarily fill the space of another. Hospitals, Federally Qualified Clinics, Urgent Care Facilities, dental Clinics, rural healthcare clinics, and correction facilities all employ locum nurses. 

Are you ready to start your new locum tenens assignment? MedCare Staffing has many exciting long- and short-term locum assignments. Click here for more information.

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At the end of 2022, the FDA seized over 50.6 million Fentanyl laced fake prescription pills and over 10,000 pounds of Fentanyl powder. The DEA further estimates that 379 million of those seizures contain potentially dangerous doses of Fentanyl. Most of the Fentanyl is mass-produced in the United States and is manufactured in Mexico and China

The Theory of Three

Looking at the growing number of opiate-related deaths, you may ask yourself, “Where did it all begin?” The author Cicerone has come up with the “Theory of three” overlapping waves, which will help explain how the opioid crisis began:

• Wave One: The opioid crisis kicked off the first wave in 2000, with doctors overprescribing painkillers, leading to mass addiction.
• Wave Two: overlapping opioid deaths involving heroin intensified in 2007 and exceeded opiate deaths by 2015.
• Wave Three: illicit synthetic opioids, which include Fentanyl

A fourth wave is on the horizon and further complicated by stimulants.

Dr. Paul Janssen, The Father of Fentanyl

In Sam Quinones’s book “The Least of Us, True Tales of America and Hope in the Time of Fentanyl and Meth,” he describes Dr. Paul Janssen as ‘obsessed with chemistry and finding new painkillers. Dr. Paul Janssen is the founder of Janssen Pharmaceuticals and the inventor of Fentanyl. “The Least of US” chronologically details how Dr. Paul Janssen obsessively studied the molecular structure of morphine and other opiates. He was trying to create a drug that penetrates the blood-brain barrier at a faster rate.

The image of a ‘mad scientist’ may pop into your head as you read more about Dr. Paul Jansen in Sam Quinones book. A typical non-conformist, Dr. Paul Janseen believed that “good scientists do not need to be supervised.” The author Sam Quinones further explains that “Dr. Paul Janssen was able to envision three-dimensional images of the molecules he was struggling to modify. He would often doodle chemical structures on napkins during meetings.” If you’ve ever watched a science fiction horror movie, the ‘mad scientist’s protagonist is always a genius of some sort, like Dr. Frankenstein in ‘Frankenstein’ or Dr. Emmet Brown in ‘Back to The Future.’ They are all eccentric-looking men working with fictional technology, crossing boundaries while trying to play God.

A Potent Painkiller

Dr. Paul Jansen discovered that when drugs like heroin cross the blood-brain barrier, once in the brain tissue, the drug eventually converts into morphine, slowing the absorption rate. The new molecule crossed the blood-brain barrier more effectively and did not convert into anything other chemical. Fentanyl binds to the body’s opioid receptors controlling pain and emotions. The brain tends to adapt to the drug after chronic use. The euphoric high eventually diminishes, decreasing Fentanyl sensitivity and making it hard to feel pleasure outside of drug use.

A more potent painkiller than morphine, Fentanyl allows a patient to be rapidly sedated for surgery and then walk away post-op with lesser aftereffects. Fentanyl changed surgical anesthesia forever. Before Fentanyl’s anesthetic intravenous use in 1960, anesthesiologists used flammable gas for various surgeries like coronary bypass surgeries. Though Fentanyl is short-acting, it can be reversed quickly with Naloxone.

Fentanyl Addiction and Overdose Symptoms

Fentanyl is 50 to 100 times more potent than heroin. Actiq, Duragesic, and Sublimaze are the prescription names for Fentanyl. A Doctor or healthcare provider typically prescribes Fentanyl in an injection form, a transdermal patch, or oral tablets. Drug dealers mix Fentanyl with heroin, cocaine, methamphetamine, and MDMA. Synthetic Fentanyl sold illegally is found in a powder form and sold in eye drops, blotter paper, nasal sprays, and pill format.

Symptoms related to Fentanyl overdose include:

• Euphoria
• Nausea
• Drowsiness
• Decreased level of consciousness
• Constipation
• Confusion
• Sedation
• Respiratory problems
• Loss of consciousness

When a person overdoses on Fentanyl, their breathing slows down and stops. The person can then become hypoxic. Naloxone can treat Fentanyl overdose and is available as an injectable needle and nasal spray (NARCAN). Unfortunately, many drug dealers mix Fentanyl with other drugs, increasing its potency; in these cases, Naloxone may or may not work.Naloxone should be monitored for at least 2 hours to make sure they do not stop breathing. Healthcare providers or anyone administering a dose of Naloxone to a person who remains hypoxic after administration  should call 911 and start CPR. Patients who are receiving

FDA Alerts Regarding Xylazine aka “Tranq,” The “Zombie” Drug

Used primarily for animal anesthesia, Xylazine is a pharmaceutical drug that increases sedation and relaxation in cattle, horses, and other non-human mammals. Veterinarians also use Xylazine as an antiemetic for cats.

Xylazine also goes by the street name “Tranq” and is called the “Zombie drug.” The drug goes by the nickname “Zombie Drug” because it slows down breathing, and the person influenced by the drug takes on a “Zombie,” like the appearance of being zoned out or in a trance. Xylazine lengthens the Fentanyl high, which can lead to a person’s demise.

There have been increasing reports to the FDA regarding the inclusion of Xylazine into heroin, Fentanyl, and other illicit drugs. The FDA further warns healthcare professionals to be aware of the possible overdoses in patients due to Xylazine inclusion because it is unknown if the side effects are reversible with Naloxone. Toxicology screens do not detect Xylazine.

Healthcare providers are encouraged by the FDA to continue to treat suspected drug overdoses with Naloxone. If the patient does not respond, it’s best to question Xylazine exposure and provide appropriate measures. Signs and symptoms of Xylazine use include chronic and severe skin ulcerations.

Although the FDA continues to investigate whether Xylazine is produced illegitimately, it is unknown if the Xylazine taken is illegal or if it comes from the animal drug supply.  

Rainbow Fentanyl

Rainbow Fentanyl debuted in August of 2022 as multicolored pills, chalk, and blocks. The DEA suggested that the drug cartels and traffickers use “rainbow-colored” tablets to mask Fentanyl and lure young children and teenagers into drug addiction. Two milligrams of Fentanyl, equal to 10-15 grains of table salt, is considered a lethal dose.

Teenage Fentanyl Deaths

In 2021, overdose deaths for teenagers from 14-18 years old increased to over 94%. With Fentanyl overdoses at an all-time high in California and responsible for almost all drug overdoses in teenagers, Governor Gavin Newsom has signed a budget proposal of 3.5 million dollars to supply middle and high schools with Naloxone. Currently, schools can get Naloxone for free through public health grants.

Some young teens buy pills from drug dealers on social media thinking they are oxycodone, Adderall, or Xanax, laced with Fentanyl. The main problem is not more teens using drugs; the problem is that the drug supply is much more potent.

Solutions To a Growing Problem

Proposals for legislation are to curb the sale of ‘fentapills’ to young adults on social media sites. Republicans have introduced bills to extend sentences for traffickers and sellers who violate the proposed legislation. Schools also need to start educating students regarding Fentanyl. Lawmakers are also seeking laws allowing all amusement parks, stadiums, concert venues, and universities to have Naloxone available in case of an overdose.

Much like how Dr. Frankenstein lost control over his creation “Frankenstein,” this drug has become lethal and dangerous, turning some people into ‘zombies.’ Dr. Paul Jansen probably never considered that his pain killer, Fentanyl, would be addictive or for sale as a street drug and cause people to overdose. Nor did he ever conceive young adults and children would be consuming the drug recreationally.

Perhaps we need go back in time with Dr. Emmet Brown from “Back to the Future,” to bring Dr. Janssen into the present moment. What would Dr. Paul Janssen think about the current Fentanyl crisis? What would he think about the thousands of people who have lost their lives due to Fentanyl overdoses? Would he have gone back in time to make any changes to his invention Fentanyl? Would he offer any solutions? We’ll never know.

Are you looking to add travel and adventure to your life? MedCare Staffing has a variety of long-term and short-term locum tenens assignments. Click here for more information.

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