The Pressure Cooker

Before she has a chance to place coffee and breakfast on her desk, she is met by a triage nurse frantically explaining how a patient walked into the triage booth with bloody clothes requesting help after being stabbed during an altercation. Dr. Green drops her coat, scarf, and breakfast and springs into action. By the time the stabbing victim is stabilized, and hospital bound, she has nine patients on her queue who need medical attention. Three patients are already roomed, one of which swings the exam door open and begins yelling ,cursing, and threatening to sue “the incompetent doctor that doesn’t give a damn about sick people.” Dr Green checks all three patient charts, reviewing their past medical histories and their reason for today’s visit. The patient yelling obscenities has checked in for migraine treatment. Her list of medication allergies include six non-narcotic medications used to treat pain and migraine headaches. Also, there is an eight-year-old child in the adjacent room with complaints of vomiting, fever, and abdominal pain.

Dr Green takes a deep breath and springs into action.

Meanwhile, in the 3rd exam room sits a twenty-nine year old woman with her four year old daughter, who has checked in to have her child examined for signs of child abuse, after spending the weekend with her father two weeks ago. She did not seek care sooner because she did not have time to make an appointment. She also requests a full written report that she can show her divorce attorney.

Tired from having slept only five hours and hungry from having skipped breakfast, Dr. Green decides to evaluate the eight-year-old patient suspected of acute appendicitis. As she walks past the migraine patient’s room who is shouting into her cell phone, she hears the patient say, “be careful in the parking lot tonight.” Dr. Greene suspects the patient is referring to her. She feels tension build-up in her temporomandibular joints.

Before she can attend to her first patient of the day, she has been shouted at, cursed at, and threatened.

Her charts from last night are still not done and a myriad of emails have not been answered, despite cutting back on her sleep to arrive early to complete her administrative tasks. She works in a department dubbed “the trenches” or “the pressure cooker” by other departments in her large organization because daily life for her and her colleagues often feels like a battle in the trenches. During the years she is worked there, multiple staff members have taken medical leave due to stress, depression, heart palpitations, and a host of gastrointestinal and musculoskeletal illnesses. A colleague has decided to apply for permanent disability due to health issues. Another previously well accomplished and respected doctor in the department is in rehab for prescription drug abuse and dependence. Many doctors have simply quit.

Unfortunately, Dr. Green’s experience is not uncommon and days like these have become the norm, leading to a never-ending cycle of emotional and physical exhaustion. This never-ending occupational stress has resulted in an epidemic of physician and medical provider burnout.

What Constitutes Physician Burnout?

To understand this occurrence better, we must know what “Burnout” actually means. According to the World Health Organization, burnout is an occupational syndrome where the medical provider suffers from emotional and physical exhaustion. Typically, there is a sense of cynicism or negativity related to his/her job. Physicians experiencing burnout will often grapple with a lack of personal sense of accomplishment. They will distance themselves from the offending cause, in this case, their work and, most likely display a marked loss of interest in their work to avoid further stress.

Additional Signs of Burnout

1. Feeling drained and exhausted even when not working.
2. Fatigue that does not respond to adequate rest, sleep, or even time off.
3. Feelings of helplessness.
4. Feeling trapped in one’s current circumstances.
5. Changes in appetite and sleep.
6. Procrastination and loss of motivation.
7. Withdrawing from, and isolating from, work functions, family, and friends.
8. Physical manifestations, such as increased muscle aches, headaches, gastrointestinal disturbances, and even lowered immunity.

Who Is at Risk?

In a word, everyone, given the current environment. Burnout does not spare physicians in training either. In a survey, 25% of medical residents said they would choose a different career if given the chance. Almost half of Gen X physicians report experiencing burnout. Another survey revealed approximately 46-50 % of physicians exbibit at least one of the symptoms of burnout. Unfortunately, this malady has not improved since the World Health Organization defined burnout in 2018.

In 2020, 42% of physicians reported suffering from burnout. That number rose to 46% in 2021. To elaborate, the Medscape 2021 Physician Burnout and Suicide Report exposed an increase in this problem. Medscape surveyed 12,000 physicians across different specialties.

The results were tallied and reported in various statistical breakdowns with the six most significant findings described below:

1. The highest rates of burnout were reported among Critical Care, Pulmonary Medicine, Neurology, Infectious Diseases, Rheumatology, Internal, and Family Medicine.
2. Female physicians reported higher rates of burnout. Not surprising, since most female physicians carry added childcare and domestic responsibilities. Additionally, female physicians often end up caring for elderly and sick parents.
3. Work settings can often contribute to burnout. According to the National Institute for Health Care Management Foundations, medical providers who work at hospitals, large integrated systems, outpatient community clinics, outpatient academic settings, and multispecialty group practices report the highest rates of burnout.
4. Burnout is not due to Covid! In the 2021 Medscape survey, 79% of the physicians surveyed said their burnout started before the pandemic. The remaining 21% of physicians who reported experiencing burnout as a result of the pandemic cited factors such as lack of adequate PPE, stressful work conditions due to Covid cases and watching their patients die alone without their families to comfort them. Of those surveyed, only 8 % reported treating Covid patients a source of burnout, compared to 58 % citing too many bureaucratic tasks as a burnout source.
5. Sources of burnout are not a result of treating patients. Top causes of burnout included bureaucratic tasks, as mentioned previously. Long hours at work, 37%. Lack of respect from administrators/employers, 37%. Another top cause of burnout was insufficient compensation, 32%. The next common source of burnout was the lack of autonomy or control over physician medical decision making, 28%. Next in the survey results was the everlasting increasing computerization of the medical practice, 28%. Lack of respect from patients was another cited source, 17%. Yet another source of burnout was increasing governmental regulations pertaining to healthcare delivery, 14%. Out of all the cited causes, only 8 % of those surveyed cited stress from patient treatment.
6. The causes of burnout have remained constant year to year. Regardless of the pandemic, physicians have cited the ever-increasing bureaucratic tasks as a top contributing factor. This is not to say that the pandemic did not worsen this problem. But the cracks in the system were already there; Covid-19 just deepened the already existing angst and hopelessness among health care providers.

The Mental Health Toll of Burnout

Ongoing helplessness and frustration on the part of overwhelmed, underpaid, and disrespected physicians have led to increased rates of depression. Unfortunately, medical professionals tend to feel inadequate if they ask for help. Other factors keeping affected physicians in an endless cycle of depression, depersonalization, and guilt, are the fear of being judged harshly by peers and superiors if
they seek mental health services. Some even fear retaliation and damage to their reputation and careers
if they are found to be suffering from depression and anxiety. Unfortunately, the consequences of not
seeking help can lead to self-medication and even suicide. In fact, physicians are more than twice as
likely to fall victim to suicide than the population at large.

The Wide-Reaching Impact of Physician Burnout

The ability to care for and cure what ails our patients is a source of great personal satisfaction and joy for medical providers. However, regardless of good intentions, it has been shown repeatedly that burned out providers become less effective in their communication with their patients. When information exchange between patients and doctors is compromised, the quality of care given to patients also suffers. What is more, burnout coupled with the pressure of time constraints has been shown to jeopardize patient safety and increase unintentional errors in the delivery of care. It stands to reason that when doctors keep “a stiff upper lip” and push past their fatigue, they can ignore patients’ feelings and wishes in the process.

The adverse effects of burnout on quality medical care has been demonstrated in other countries as well

According to the Canadian Medical Journal, physician burnout decreased productivity, as more physicians call out sick, forcing remaining colleagues to treat a higher number of patients in a shorter amount of time, which led to an increase in medical errors.

Given this unsustainable scenario, one of two things happen. Either more physicians experience burnout and mental health problems, rendering them unable to provide the quality care patients deserve, or the remaining physicians choose to change jobs or careers in order to avoid burnout. Neither scenario is good for health care and will harm the overall health of our communities.

It would not be an exaggeration to say that our health care system needs help!

One way of improving health care is to start focusing on the wellbeing of healthcare providers. For example, if multiple surveys have shown that bureaucratic tasks take time away from the physician’s ability to focus on quality health care, shouldn’t administrators be held to task with regard to simplifying said tasks? Similarly, if long hours on EMR impact the time a medical provider has to interact with patients, shouldn’t we enable EMR to be user friendly and intuitive? In short, when we make physician health and wellbeing a priority, solutions can and will emerge.

Until positive changes occur in the delivery of care, medical providers ought to keep a few things in mind:

1. Remember who you truly are. Who you were before you became a medical provider and where you’d be in life if you didn’t possess the knowledge and credentials you have today.
2. On your worst days, try and remember why you chose your profession and know even the worst days are only 24 hours long.
3. Remember that one of your greatest super-powers is remaining calm. Practice this elusive skill and you will immediately notice the positive impact on your patients, your team, and your wellbeing.
4. Keep in mind, that on your worst days, you still possess the power to treat an asthmatic child who is gasping for breath, you have the power to safely lower your patient’s high blood pressure and high blood sugar. You have the power to calm nerves and to treat pain. You have the power to change the trajectory of your patients’ lives.
5. Remain hopeful that many advances in medicine are headed your way which may be a game changer in how easily you can diagnose and treat a particular disease.
6. Practice self-compassion. It is perfectly OK to set aside time to try new hobbies, make exercise a priority, plan for time away from work, and even time just to be alone and rest. Start planning before experiencing any symptoms of burnout.
7. Incorporate diversity into your medical practice. Consider a salaried part time position while you scale back from private practice. Consider a sabbatical in order to branch out into non-clinical projects, such as teaching or research. Look into an interesting locum assignment either in your area or in another state or country. Locum assignments allow for a great deal of freedom and flexibility, while providing a chance to practice medicine in settings that are new to you.
8. Consider stepping down from a leadership position that no longer gives your life meaning. Conversely, step up to a leadership role.
9. Complete your CME requirements in other states and countries if feasible.

Above all, value your peace of mind and your health.

There is no one else quite as remarkable as you are.

To all health care superheroes, thank you for all that you do.

Ela Grigorian 

Check out my blog at www.thevitaminchannel.com !!

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Nurse Practitioners Bridging the Gap

The NP role has been ranked  the number one “best healthcare job” for 2022 by U.S. News. NPs are registered nurses who are licensed by the Board of Registered Nursing in the state where they may be practicing. With an expanded scope of practice, the NP’s role can vary from state to state depending on the Full Practice Authority laws in that state.

If it wasn’t for the great visionary Dr. Loretta Ford, the nurse practitioner role would not exist. Dr. Ford discovered that there was a need for healthcare providers in underprivileged communities. She then realized that nurses with expanded roles who gained specialized training to make clinical decisions on their own would be the perfect solution.

With the passage of the Medicare and Medicaid legislation in 1965, the need for NP’s increased. A major barrier to practice was direct reimbursement due to NP’s not being licensed. NP’s started advocate for themselves at the state level beginning in the late 1980’s and early 1990’s. 

Full Practice Authority

NP’s have been lobbying for FPA and advocating for the expansion for their role since 1994. According to the American Association of Nurse Practitioners, Full Practice Authority (FPA) authorizes nurse practitioners to evaluate patients, diagnose, interpret and order diagnostic labs, initiate and manage treatments. This includes prescribing medications exclusively under the licensure under the authority of the state board of nursing.

Current states with FPA include: Alaska, Arizona, Colorado, Connecticut, Delaware, District of Columbia, Guam, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts. Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington. and Wyoming.

The Newcomers

The Golden State

Due to the serious shortage of primary care physicians in California, AB290 granting FPA to NP’s was signed into law on September 29, 2020 by Governor Gavin Newsom. The main focus of AB290 is to improve quality access to healthcare. California’s FPA will go into full effect in January 2023. AB290 requires the California Board of Registered Nursing to define the minimum standards for an NP to transition to independent practice. Once that has been met, the NP can prescribe specific functions which include “ordering and interpreting diagnostic procedures, certifying disability, prescribing, administering, dispensing and furnishing controlled substances.”

The Big Apple

New York is now the 25^th state to grant NP’s full practice authority. On April 9, 2022 Governor Kathy Hochul signed into the state budget of New York that NPs who have more than 3,600 hours of experience no longer are required to have a formal relationship with a medical doctor to practice. According to the AANP, NP’s in the state of New York can now evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage patient treatments as well as prescribe medications.

Prior to waiving this law, New York NP’s had a “reduced” practice authority. NP’s were required to have a ‘written practice agreement’ with a physician in their specialty area. This stated that the physician would review patient records, make referrals, be on hand for consultations. Furthermore, if there was a disagreement, the physician would have the final word. Stephen Ferrara, DNP FNP-BC, president-elect of the AANP stated: “NP’s in New York, often times were required to pay physicians in order to have this contract agreement which did not serve the healthcare system very well. New Yorkers now have a greater advantage to access healthcare for both their physical and mental well-being.

The Sunflower State

Kansas is experiencing a healthcare shortage in its rural areas. On April 22, 2022 Governor Laura Kelly signed Senate Substitute for House Bill 2279, a bipartisan bill, which expands the role of advanced practice registered nurses (APRN’s) removes barriers for them to practice independently. Governor Kelly stated that House Bill 2279 “will empower APRN’s to decrease local and reginal care gaps.” Under HB2279, APRN’s are required to comply with the Federal Drug Enforcement Administration requirements for safely prescribe controlled substances, as well as maintaining malpractice insurance and national certification for licensure as an APRN.

The First State

Governor John Carney signed HB141 and H21 into law on August 4, 2021, improving access to primary healthcare to the 1 million residents of Delaware. Bethany Hall is Delaware’s Lt Governor and a nurse. When both HB141 and H21 were approved by 20-1 votes, Lt. Governor Hall was present presiding over the state senate.

HB141 allows NP’s and APRN’s to practice to the full extent of their training removing the prior oversight contract previously needed between a physician and an NP. Some employers in Delaware may still require a physician NP practice contract. HB 21 allows for a ‘multistate” licensure entering the APRN interstate licensing compact. North Dakota and Delaware are the only 2 states to pass legislation even though 37 states are members of the Nurse Licensure Compact for both Registered Nurses and Licensed Vocational Nurses. AARP recently conducted a study in Delaware and found that 86 percent of the senior residents of Delaware stated that having greater access to healthcare was important to them.

States on the FPA Horizon

The Great Lakes State

Michigan introduced SB680, a bill allowing FPA to NP’s on October 5, 2021. The bill is sponsored by Senator Rick Otman and co-sponsored by Senator Jeff Irwin, Senator Sylvia Santana, Senator Jim Runestad, and Senator Tom Barett. The bill will amend Public Act 368 0f 1978, inserting and changing language which states “The administrator may issue a controlled substances license to an individual licensed as a registered nurse under part 172 if the individual has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing under section 17210.”

Improving Access to Healthcare Through FPA

The U.S. is facing a significant healthcare crisis with physician shortages in primary care and psychiatry. Currently, there are more than 355,000 licensed NP’s in the U.S. who provide healthcare in communities of various sizes and demographics nationwide. NP’s are known to provide a high level of service and care to over 1 billion patients a year. Research shows that states who adopt FPA have a better advantage to improve access to healthcare, address healthcare disparities as well as increase their workforce.

MedCare Staffing Providing the Highest Quality of Healthcare Providers

MedCare Staffing provides a hands-on professional leadership team. Whether you are a healthcare provider looking to work locum tenens or you are looking to hire healthcare coverage, MedCare Staffing offers dedicated professional support through the entire tenure. With 70 years of combined recruiter experience, we have a reputation for success. To speak to a recruiter today click here.

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What Is Locum Tenens?

Locum tenems in Latin means place holder. A locum tenen’s healthcare provider is a person who temporarily fulfills the space of another. Many organizations like hospitals, Federally Qualified Healthcare Centers (FQHC), Dental clinics, and Urgent Care Centers employ locum tenem’s healthcare professionals.

Doctors, Dentists, Nurse Practitioners, Certified Nurse Anesthetists, Nurses and Physician assistants can all be employed by locum tenens agencies.

Perks of Working Locum Tenems

Locum Tenens companies offer healthcare professionals many benefits. Some of these include:

• Travel: Who doesn’t love a work-vacay? The best part about working for a locums company for most healthcare professionals is the opportunity to travel. Locum tenens companies have assignments in various locations across the country. A change of scenery can work wonders for your career and perhaps help you breathe new life into your practice.
• Better Flexibility: Healthcare professionals have more control over their workload assignments. They have the autonomy controlling their work schedules and tailoring it to their personal needs.
• Trying out new workplaces: It’s kind of like dipping your toe in the pool to test the waters temperature without the full-time commitment. The organization can also see if your personality fits their culture.
• Greater compensation: Healthcare professionals may have a greater earning potential working through a locum tenens agencies. Though agency rates and salary compensations may vary from state to state.
• Less administrative responsibilities: Locums work is temporary and for many this means less administrative responsibilities like teaching, taking call time, and paperwork.

. Locum tenens can be a great way to slowly ease into retirement for many healthcare providers without the fulltime work responsibilities.

NALTO: National Association Of Locum Tenems Organization

Although many locum tenem businesses are independtly owned and operated, NALTO, National Association Of Locum Tenems Organization was created in 2001 to enforce strong industry standards and practices for the locum tenens healthcare professionals. NALTO’s main goal is to set clear and effective parameters of behavior for all individuals affected by the industry, including both healthcare professionals and clients.

Locum Tenens agencies, who are affilitated with NALTO will strive to protect the integrity of their relationships with phycians by completly disclosing information relevant to the healthcare provider, requesting permission before distributing a CV, and striving to maintain strong relationships with a large network of clients.

Choosing A Locum Tenems Firm

In today’s healthcare landscape, there are thousands of locum tenens companies to choose from. So, how do you pick the right company without getting overwhelmed? NALTO has these suggestions that can be helpfull when picking a locum tenens company that provides the right fit. These include:

1. NALTO affiliation? Due to all members having to follow and ethical code, you can rest assured that these companies follow the highest standards of service.
2. Malpractice insurance coverage? Does the company cover the healthcare professional and are they concerned if you carry your own coverage?
3. Can the company pay their employees on a regular basis? Does the company have the financial resources to do so?
4. How accessible is your recruitment representative? Are they available to answer your questions and help you through the locum tenes process?
5. Will the locum tenems company be taking care of all your sign on details which include: licensure, credentialing, hospital privileges, proper travel and housing arrangements? 

Best Practices

NALTO enforces ‘best practices’ for all their affiliated Locum Tenen’s organizations which include:

• Obtaining signed contracts and fee agreements before CV’s are submitted for considerations.
• Healthcare workers permission must be requested before submission of CV
• Seek to resolve disputes between companies with minimal involvement from healthcare workers.
• Honor all contract agreements with clients and maintain communication
• Represent all client agreements and opportunities accurately and completely.

Furthermore NALTO offers standards of practice for both clients and healthcare providers to ensure the best possible business relationship. Clients and physicians should:

• Agreements and contracts with locum tenem companies should be honored and other forms of communication from companies where no formal working agreement exists should be rejected.
• Keep good records of all communication
• Communicate to the locum tenems company any changes in intention and or search criteria
• Respond promptly to communications from the locum tenens company
• Report any violation or infraction of the NALTO code of ethics.

COVID-19 has exasperated the healthcare workforce at many healthcare organizations. Locum tenens offers a fresh alternative for healthcare organizations to replenish their workforce. Healthcare professionals can also explore locum tenems work as a way to take break from their regular healthcare employment or as an alternative to extra income

The post Is Your ‘Normal’ Healthcare Gig Getting You Down? Try Giving Locum Tenens A Shot! appeared first on Medcare Staffing.

COVID-19 has caused many people to look at their lives more closely and how they have been living them. About 25 percent of physicians are planning to retire earlier than planned as a result of their experience treating COVID-19 patients. Twelve percent are considering leaving medicine according to a Medscape report. The report also indicated that 62 percent of physicians said their income decreased since the beginning of the pandemic, with 33 percent reporting their income decreased by 11 to 25 percent. 

Doctors Having To Close And Or Sell Their Businesses

Thousands of medical practices have closed during the pandemic, according to a survey from the Physicians Foundation of America, which surveyed 3,500 physicians. The survey found that 8 percent of the doctors reported closing their offices in recent month, which the foundation estimated could equal some 16,000 practices. Another 4 percent said they planned to shutter within the next year. The Paycheck Protection Program authorized by Congress to help businesses, including medical practices, with the economic fallout of the pandemic, helped many doctors remain afloat.

Burnout And Strict Practicing Guidelines

Approximately 64 percent of physics report higher burnout since the pandemic started. Forty six percent said they are lonelier due to stay at home social distancing guidelines. Other doctors report that their reasons for leaving stem from strict practice guidelines which left them feeling constrained in their careers. Some have left their conventual physician roles in order to pursue start up ideas in healthcare.

Physician Shortages Are Predicted To Become Worse

There’s an increased number of people looking for primary care doctors after the Affordable Care Act became viable. An aging population that requires more care and more medical students choosing specialties rather than primary care are also reasons why there is a looming primary care physician shortage. A survey completed in 2015 predicts there could be a shortage of 33,000 primary care physicians by 2035.

So, what’s the solution? Several family medicine organizations have launched a long-term initiative called 25 X 2030. Leaders in this effort will work for the next 10 plus years to ensure that by 2030 25 percent of combined U.S. allopathic and osteopathic medical school seniors select family medicine as their specialty.

Could Locum Tenens Be The Answer For Doctors To Stay In The Healthcare Game?

The word “Locum” comes from the Latin term meaning ‘place holder.’ A provider working as locum tenens is a person who temporarily fulfills the obligations of another. Therefore, In healthcare, a locums provider can be employed at a hospital or community healthcare facility that may be short staffed or need temporary coverage when another provider is on leave.

Locum tenens offer a variety of diverse experiences and the opportunity to see how various healthcare systems work. Locums also offers a diverse patient population from working in inner city to working in rural farmlands. If you are a health care provider looking for a change, are open minded, adventurous and flexible, you should definitely give Locum Tenens a try.

Some locum tenens assignments could be part time or offer a short-term assignment. Perfect if you are thinking about retiring from your full-time position, but you’d like to still keep one foot in the game. Locum Tenens can also be considered the ultimate ‘Work-Vacay’ experience. It’s literally paid tourism. You can work in amazing places that offer historical and local attractions that will add to your work life balance.

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“Coming together is a beginning, staying together is progress, and working together is success.” Henry Ford

It’s always best to employ patient centered teamwork and communicate this with your team so that everyone is aware of what the common goal is. An effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. 

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient – to accomplish shared goals within and across settings to achieve coordinated, high-quality care.

Organizations Core Values And Mission Statement

When you’re working a new locums gig, it’s best to educate yourself on the organizations core values and mission statement. Some clinics may have you go through an orientation process where the facilities mission statement will be discussed. In order for you to succeed and be in alignment with the organization, it’s best to incorporate these values into your daily practice.

Know Who Is Playing On Your Team

The players on your patient centered team can vary from clinic to clinic. Knowing who will be working with you and what their skillset is, will be the key to efficient patient care. Medical assistants, mental health care workers or social workers, lab services, front office staff, child life specialists, IT, security, custodial and cleaning staff are some examples of who can be playing on your team.

Some Important Questions To Ask About Your Patient Centered Team Are:

Will you be working with one medical assistant or two? Do they speak multiple languages? Are they also phlebotomists, or will you have to send patients to the lab for blood draws? It’s important to know what skills your medical assistants and what their scope of practice is in their clinic. You may have complete patient tasks that they are not permitted to do by their clinic. Mental health care workers or social workers, lab services, front office staff, child life specialists,

Fostering Patient Centered Team Dynamics

Healthcare Team dynamics are those psychological forces influencing the direction of your team’s performance and behavior. Those dynamics are created by the personalities involved and how they interact. Understanding a team’s dynamics can alert you to how successful it might be.

A healthcare team with positive group dynamics tend to have team members who trust each other. They work towards a collective decision and are held responsible for their actions. A team with good group dynamics may be constructive and productive, and it may demonstrate mutual understanding and self-corrective behavior.

Communication Is Key To A Cohesive And Successful Team

Encourage open discussions, enhancing a team culture and enthusiasm will help you to have a better day. Addressing any problems that may occur quickly as well as keeping team members alerted to any changes can avoid miscommunication. Always remember to speak to team members directly and invite them to reflect on their behavior is also a good practice to employ.

Who are we? MedCare Staffing is a small, veteran-owned, family-oriented team. We start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.What we do: We place Physicians, Dentists & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs

To contact MedCare Staffing call 888.474.3380 or visit or website by clicking here!

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“A significant percentage of physicians are over retirement age and new physicians are not keeping up with the need,” said Wood. “Of course, we can increase funding for medical residencies and loan repayment programs, and I have always supported those, but the reality is it’s not only an expensive solution but the number of residency programs will never be enough to meet the current and future need in California.”

A majority of physicians practice a specialty where incomes are usually higher. Nurse Practitioners are often found working in underprivileged rural areas. “Quality of Primary Care by Advanced Practice Nurses: A Systematic Review,” have concluded that nurse practitioners provide care of comparable quality as physicians, even when practicing without physician oversight.

On February 19, 2019 a final report was released by the California Future Health Workforce Commission which addressed the states shortages of primary care and behavioral health providers. The expansion of the Nurse Practitioner role was on the top 10 list. More than 80 organizations supported AB 890, including individual physicians.

The History Of The Nurse Practitioner Profession

Currently, there are more than 290,000 licensed nurse practitioners in the United States. Back in 1965, the United States expanded their Medicare coverage to include low income women, children and the elderly. At this time the US was experiencing a physician shortage particularly in urban areas servicing children.

Loretta Ford, EdD, PNP, FAAN and Henry Silver MD were called to action and founded the first NP program in 1965 at the University of Colorado. It became a master’s degree program in the early 1970’s. The U.S. federal government contributed money to NP education in 1987 and spent $100 million.

Although the NP profession continued to grow, Nurse Practitioners did not have full provider status in the eyes of the federal government and were not eligible for reimbursement. NP’s continued to fight to legitimize their profession. The role of the Nurse Practitioner has become important as more patients are covered by The Affordable Care Act and more states grant NP’s full practice authority. Today, 82.9% of full-time NPs are accepting Medicare patients and 80.2% are accepting Medicaid patients.

The term “Full Practice” means state practice and licensure law provides for all Nurse Practitioners to evaluate patients, perform diagnostic tests, initiate and manage treatments, including prescribing medications under the exclusive licensure authority of the state. Full practice authority varies in every state and due to tireless legislative advocacy, the state practice environments are constantly evolving.

What Nurse Practitioners Offer

Along with increased access to care, the AANP also lists these additional benefits to having full practice authority NPs: 

• Streamlined care. Allowing FPA removes the delay in care that can occur when an NP must consult or work with a physician to deliver necessary care. 
• Cost savings. NPs are more cost-effective in general, but FPA also avoids unnecessary service duplication. 
• Upholds patient autonomy. Some patients prefer to work directly with NPs and may even feel more comfortable sharing health care concerns with primary care NPs. 

California is the 23rd state in the U.S. to offer full practice authority to its Nurse Practitioners when it goes into effect in January 2023. AB290 requires the California Board Of Registered Nurses to define the minimum standards for an NP to transition to independent practice and once that has been met the NP can perform specific functions “ordering and performing and interpreting diagnostic procedures certifying disability and prescribing, administering, dispensing and furnishing controlled substances.” Full practice authority details vary from state to state. It’s best to contact the local boards of nursing to find out more regarding practice, prescriptive licensure, Practice acts and other details.

Who are we? MedCare Staffing is a small, veteran-owned, family-oriented team. We start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.

What we do: We place Physicians, Dentists & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs

To contact MedCare Staffing, call 888.474.3380 or visit or website by clicking here

References

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The experience of working at a Community Health Center usually starts on the streets before you enter the clinic. You drive by acres of rural farmlands that offer the sweet scent of manure as migrant workers pick their crops. You may pass many make-shift tents that serve as housing for the homeless population in an inner city. You may walk by street vendors making savory tacos that make your mouth water while small children walk hand in hand with their parents. As they see you, they may start screaming “Doctora, Doctora” and offer a sweet smile and a kind waive with their hands because they remember who you are. This scenic landscape before entering through the community health center’s doors begins to tell a story of what terrain your patient’s may have conquered before presenting themselves to you in your exam room.

“I usually have diarrhea from my mouth, but today it’s coming from my butt!” A quirky 5-year-old Latino American girl sits on my exam table and blurts out the phrase trying to stifle a laugh with her hands pulled immediately to her face. Her mother just rolls her eyes and smiles while her ‘abuela,’ sits back in her chair, eyes bulging, looking mortified. I laughed and ask, “Are you trying to be Sarah Silverman?” “Who’s that?”  she squeals as she proceeds to giggle and spew off several more jokes as I try and examine her. This family of 3 had to take several buses through an overcrowded urban city to show up at the clinic as a walk in. It also saved them a visit to the Emergency Room.

Community health centers are unique and special places. And yes, on many days they can resemble comedy shows which adds to the fun of working at them! One of their main purposes is to serve underprivileged communities, increasing access to timely care and to avoid costly Emergency Department (ED) admissions.

When you are working at a Community Health Center, it’s not just about the patient you are seeing, but about the whole family structure. It’s not uncommon for a mother, father, siblings, grandparents and even great grandparents to be present at a newborn’s first well check. This offers a great opportunity for assessment and teaching on so many levels as a practitioner.

Originally, community health centers were started in 1965. They were launched as a small demonstration program in conjunction with President Johnson’s ‘Office Of Economic Opportunity’ with a main focus on medically underserved communities. Today, clinics can be found in inner suburban cities servicing the homeless population to rural locations servicing migrant farmworkers.

Approximately 1400 community health centers provide healthcare to 28 million people throughout the United States. The main source of funding for these clinics is Medicaid along with other sources of funding which include Federal Community Health Center Program 330 Grants, Ryan White Funding, Title X Funding, and local county funds. The Affordable Care Act also offers additional funding.

Many clinics deliver a broad area of services which include mental health, dental, podiatry, maternal child health, pediatrics, HIV services, and Transgender services. They specialize in diagnosis and management of chronic illnesses such as diabetes, asthma, heart and lung disease, depression, cancer and HIV/AIDS. One of the main goals is to reduce mortality, health disparities and risk of low birth weight with the care they deliver. Services such as transportation, translation, case management, and health education are offered to ensure continuity of care.

Working with a lower socioeconomic population can offer challenges as well as a variety of learning opportunities which may include language barriers, poverty, and compliance to healthcare regimens. Community Health Clinics offer healthcare providers an opportunity to flex their creativity, employ a sense of humor and have an open mind in order to better meet a patient’s needs.

Community health clinics are great places for Physician’s, Nurse Practitioners, Nurses, Dentists, and Psychologists to practice. They offer an abundance of experience that can only be acquired at the rural clinic level and inner city. It’s a rich cultural exposure that can be incredibly humbling. You don’t necessarily have to be a comedian to work at one, but it doesn’t hurt.

Ersilia Pompilio RN, MSN, PNP

References

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What is Locum Tenens?

The word “Locum” comes from the Latin term meaning ‘place holder.’ A provider working as locum tenens is a person who temporarily fulfills the obligations of another. Therefore, In healthcare, a locums provider can be employed at a hospital or community healthcare facility that may be short staffed or need temporary coverage when another provider is on leave.

Locums providers are employed by private agencies. Working as a locums offers many opportunities to experience working in a variety of environments and specialties which may include for-profit agencies, academic health centers, state agencies, federal sites such as the Indian Health Service, individual hospitals, and or international staffing companies.

Are you a new physician not sure what area to work in? Or an Advanced Healthcare Provider looking for a change of scenery? Do you want to travel and work in a diverse area in your state or try a new state? Are you a provider who is ready to semi retire but would like to still maintain some kind of professional practice? Locum tenens may just be your sweetest gig!

Locum tenens work offers a broad range of experiences. Flexibility is also a desirable advantage. This ‘gig’ can fulfill your career and economic goals. It offers short term assignments as well as long term assignments that can lead to permanent placement is so desired. If you are looking for a healthier more controllable lifestyle, locum tenen is your gig.

What is Locum Tenens?

 Locums may open up many career opportunities you never thought were possible. The gig can lead you to bigger and better career journey with an opportunity. You can meet interesting patients, learn about local culture, see how practices are organized, learn adaptability, and broaden clinical skills.

As a provider, you may be approaches by your facility for a more long term assignment that can turn permanent. It’s best to evaluate what type of lifestyle you are looking for? If you are just looking to make extra money on a short-term assignment or an opportunity into something more long term. Those are all possibilities. It’s best to communicate your availability and career goals with your locums recruiter and facility you may be assigned to.

A long-term repeat assignment may offer you creative ways to contribute that may benefit both you and the facility you are working assigned to. It’s best to evaluate your personal career goals as well as family obligations.

Credentialing

Credentialing is the process of assessing the academic qualifications and clinical practice history of a healthcare provider. Any licensed, independent, healthcare professional who has been permitted by law and regulated by a licensing organization to provide services and care without supervision or direction within the scope of the individual’s license needs to be credentialed.

While every state has unique laws regarding medical practice, simply having a license in a healthcare profession does not mean one can start doing anything they want. For example, an advanced nurse practitioner cannot independently start to prescribe medications, or a family physician cannot begin inserting central lines. Even independent nurse practitioners have to follow specific rules, and in certain states, they work under a physician. Simply being licensed does not mean the healthcare professional is at liberty to perform all types of clinical services.

Locum Tenens have in house licensing teams that will professionally walk you through the credentialing process. They do all the work for you and send all your appropriate credentials to specific licensing boards. They may also proactively license you for assignments paying the state fees.

Work-Vacay

Always wanted to travel and get paid for it? Locum Tenens can also be considered paid the ultimate ‘Work-Vacay’ Experience. It’s literally paid tourism. You can work in amazing places that offer historical and local attractions that will add to your work life balance.

All Roses Have Thorns

While working locum tenens may seem all roses, there are some ‘thorns’ to consider. Various assignments may have you learn new EMR (Electronic Medical Records) programs. The facility may offer you a training period to learn their system. Each facility may have a different credentialing process. You may have to undergo drug testing, and physical exams for each new facility you are assigned too.  Flexibility is key when working for locum tenens.

Locum Tenens offer a variety of diverse experiences and the opportunity to see how various healthcare systems work. Locums also offers a diverse patient population from working in inner city to working in rural farmlands. If you are a health care provider looking for a change, are open minded, adventurous and flexible, you should definitely give Locum Tenens a try. It just might be your sweetest gig!

Ersilia Pompilio RN, MSN, PNP

References

The post Can Locum Tenens Be Your Sweetest Gig in Healthcare? appeared first on Medcare Staffing.

With the COVID19 pandemic many nurses and healthcare providers in general were denied Personal Protective Equipment. Providers were told that they would lose their jobs or be placed on suspension for bring their own from home. Others were told to clean and recycle masks.

There are more than 18 million healthcare workers in the United States. PPE’s are used to protect healthcare providers from disease as well as protect immunocompromised patients. Improper use or lack of there of place employees and patients at greater of transmitting disease. Dysfunctional safety standards in healthcare settings have recently imploded like a weeping abscess. Fearing for their safety and the safety of their families, healthcare providers have walked off their jobs.

In recent years the number of violent assaults against Nurses and healthcare providers has increased. The Occupational Safety and Health Administration reports of nearly 25,000 workplace assaults reported annually. 75% occur in health care and social service settings. Workers in healthcare settings are 4 times more likely to be victimized than workers in private industry. A 2014 survey on hospital crime attributed 75% of aggravated assaults and 93 % of all assaults against health care workers to patients or customers.

What Can You Do To Ensure A Healthy And Safe Workplace Environment While On A Locums Assignment?

Nurses and Advanced Healthcare Providers need to empower themselves to take full accountability of their own personal safety and of their work environment. Employees perceptions and attitudes can differ regarding current safety standards. For example, what an administrator who has had no patient care may see as safe, a Nurse or advance healthcare professional with many years of patient care experience may beg to differ.  

Locums work can take you to a variety of healthcare environments which may not be so safe. Some tips Nurses and Healthcare Professionals can employ when working in a healthcare new healthcare care setting are:

-Be aware of your surroundings: Always be aware of your surroundings when you are on assignment. If you are working in a city or neighborhood you are not familiar with, do your research. Do a computer research on crime statistics, ask fellow coworkers regarding safety of the area. Make sure you have proper supplies and protective equipment before starting your workday.

-Propper PPE’s: Before taking an assignment, it’s best to ask your recruiter and or healthcare facility where you will be working, what their PPE availability along with quantity and reuse.  If they are lacking in supply, you may need to ask if you can supply your own.

-Trust your intuition: Your intuition is your best guide to safety. Per Gavin De Becker the author of “The Gift Of Fear, he states “Nature’s greatest accomplishment, the human brain is never more invested than when it’s host is at risk. A strong intuition comes from experience. If you are feeling uneasy about your surroundings or a certain situation, it’s best to stop and evaluate how you feel and why?

-Ensure your own safety: You are in charge of your own personal health and safety. If you do not feel safe in, then it is your responsibility to report it to your supervisor, office manager and your recruiter. If you and your management team cannot agree on proper safety measures then you may have to re consider your assignment and your options.

The safety of Nurses, Advanced Healthcare Providers, Doctors and Dentists is not an option, it’s a requirement. When healthcare employees are made to feel safe on the job, their patients and patient care will also be safe. All healthcare providers need to take full accountability of their own PPE’s and the safety of their environment.

Ersilia Pompilio RN, MSN, PNP

The post Safety in The Healthcare Workplace While on A Locums Assignment… It’s Crucial. appeared first on Medcare Staffing.

While locum tenens professionals work with a staffing agency, they are not employees of that agency or the healthcare facilities they work in; they are independent contractors. This brings its own fiscal responsibilities, so we have compiled some tips for being money-smart while working locum tenens jobs.

Set Aside Funds for Taxes

Locum tenens workers are compensated in gross, which means that they are paid in full for the hours they work without any state and federal tax deductions. You are still responsible for paying taxes on your income earned during each contract. Most contract workers and financial advisors suggest that you set aside a portion of each paycheck to account for tax payments. That way, when April 15 rolls around, you won’t be caught off guard with a hefty tax bill. The IRS has a helpful form, IRS Form 1040-ES, that helps you calculate how much you will owe in taxes. 

Pay Estimated Quarterly Taxes

Most state tax agencies and the IRS encourage contract workers to make estimated payments every quarter, which means paying them in April, June, September, and January of the following year. There could even be late fees applied for missing these deadlines. It is also essential to know that contract workers are required to pay self-employment tax. This tax covers social security and medicare, and this payment typically occurs when filing your annual tax return.

Contribute to Retirement Accounts

A great idea to make sure that you have a retirement fund set up. An easy way to make sure that you pay into it is by putting away some money when paying your quarterly taxes. Not only are you helping to set yourself up in the future, but most of these contributions can be considered tax-free, thus lowering your overall taxable income. 

Keep Track of Records While on the Road

Conveniently, locum tenens staffing companies take on the cost of housing and transportation for assignments. While they take care of the basics, you are going to inevitably have some expenses while on contract, including meals. The IRS allows you, as a contract worker, to deduct costs of doing business away from home that are not typically reimbursed (i.e., meals). 

You should be keeping track of your receipts for the purchases made while you’re on contract. Still, you should also maintain a record of healthcare insurance premiums, licensing, and professional services, such as hiring a lawyer or accountant. These can be submitted as deductions, which are typically done with a profit and loss statement in your tax return. 

Dailyfinance.com states that contract workers who claim less than $5,000 in business expenses and who do not report net losses can use the Schedule C-EZ Net Profit From Business form.

Whenever taxes or finances are involved, it is always a good idea to be safe and check in with a tax specialist or a certified financial advisor, to make sure that you are on track.

While a locum tenens lifestyle requires you to assume a more proactive approach to managing finances, it is also true that this lifestyle can provide an impressive return on your investment in it. 

Who are we? MedCare Staffing is a small, veteran-owned, family-oriented team. We start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.

What we do: We place Physicians, Dentists & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs

To contact MedCare Staffing call 888.474.3380 or visit or website by clicking here!

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