Monday, April 7, 2014

Concentra the fast food model of health care

I think I have found the perfect example of what happens when you combine a Fast Food business plan with healthcare, it is called Concentra. Concentra is owned by Humana, which as most people know is a for profit managed care and health insurance company. They are in the process of rapidly expanding nation wide, kind of like Subway with one in every strip mall. When I visited two of their clinics recently it was evident by the take a number, sit by the plastic plant, and one of our employees who all dress in the same uniform will help you shortly.  Healthcare has been going down this quicker, cheaper and dehumanizing path for a while.  

There are large companies that operate similar services like United Heath who do a good job of not turning  people into a commodity and hopefully there will be a rebellion against this type of plastic drive-thru model of care. What happened to the real family physician? 

Monday, February 17, 2014

Scam Cell Phone Calls

I remember when mobile phones were immune to solicitors and credit card service scams. Not any more now they are a regular thing. It is bad enough to have people in the states calling and scamming, but these area codes look like local US area codes but are not. The scam is they call and do not leave a message, and then when you call back you could be hit with a big one time charge. There are apps you can download or simply do not call them back. As for those local scam calls maybe an air horn into the phone.

242- Bahamas 441 – Bermuda 784 - St. Vincent & Grenadines
246 – Barbados 473 – Grenada, Carriacou and Petite Martinique 809, 829, 849 – Dominican Republic
264 – Anguilla 649 – Turks and Caicos 868 - Trinidad and Tobago
268 – Antigua 664 – Montserrat 876 - Jamaica
284 – British Virgin Islands 758 – St Lucia 869 - St. Kitts & Nevis
345 – Cayman Islands 767 – Dominica  

Thursday, January 30, 2014

ANCC or AANP NP Certification Exam

The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) are the two organizations that administer the tests to become board certified as a nurse practitioner. There are several tests depending on your educational qualifications. Tests areas include Family, Adult-Gerontology, Pediatrics, Midwifery and Psychiatric, and in those areas tests can then be classified into Acute or Primary care, again depending on your degree. You only need to be certified by one, but I took the primary care test from both organizations. Why both, well I got cocky and failed the AANP the first time. That made me focus, study and get serious. I also said to hell with this and registered to take both the ANCC and AANP tests in the same week. Logic told me I can’t fail both, luckily I passed both and I am now 2 for 3.

Looking back most of my classmates were taking the ANCC test and I started hearing people saying it was easy and not what they expected. First mistake, do not listen to people. I should have looked at the websites and noticed that 80% pass. So that means next time you're in a lecture count off your classmates and realize that on average every 5th person is going to fail. Like those awful group project, count off 1, 2, 3, 4. . (Shit it’s me).

Mistake number two is I studied wrong. You need to use more than one resource, and especially do not get stuck on practice test questions for your studying. Master your material from school and clinicals. Because although Fitzgerald and others books are decent, not one question from those books are on the tests. They may be similar enough to confuse you, but they are not the same.  

You will hear that it does not matter which test you take, which is true. The ANCC has been around longer than the AANP test, so there was a time when organizations like the Veterans Administration only recognized the ANCC. Today because they are both certifying boards companies cannot discriminate against one or the other; or they would probably be sued. 

The AANP is 150 timed questions and the ANCC is 175 timed questions. Some of the questions for both tests do not count, and you do not know which ones. They mix sample questions into the tests to see how people will answer them, and if they are viable test questions then they can be added in the future. This testing is also not like the NCLEX test, where the computer might turn off at 75 questions, or adjust based on how you are doing. You will answer all questions, and they are all random multiple choice. I did hear that they might be adding some pictures in the future, which would have been nice with those dermatology questions. For example reading erythematous scattered raised papules could be a couple things, give me a picture please.  

Truthfully, I really wanted to like the AANP test, because their organization seems geared towards Nurse Practitioners, and they have local and state chapters for NPs to network. The ANCC on the other hand is all over the place and seems to certify everything and anybody including the hospital itself. They are the ones behind the whole Magnet Hospital certification. Magnet status cost hospital a lot of money and research is showing Magnet status has not improved patient outcomes, but it does look good in the advertising and letterhead.

 Having now seen 475 of the board questions it is true, the AANP test is concentrated more on assessment, diagnostic and treatment based questions. While the AANC, while still having assessment, diagnostic and treatment questions, also includes therapeutic communication, research, policy, cultural issues, epidemiology, psychology and some regulatory questions mixed in. I liked this format, because as an NP only part of your business is assessing and treating patients. Also, look at your program it may be pushing you towards one or the other test. Besides the core curriculum our program had lots of research and cultural components.

It might be my background, but the ANCC seemed easy compared to the AANP. Since I took the AANP test twice their questions seemed redundant and they like to play word games. Instead of checking your knowledge base, they would ask several questions one topic, like TSH, T3, T4, or COPD and only change some words or answers. (Those are examples do not over study in those areas). 

Have to renew in 5-years, but for hundreds of dollars each it will not be with both organizations. We will see who does a better job of supporting and promoting NPs and probably renew with them.

Wednesday, January 22, 2014

85 vs 3,500,000,000

I found it shocking that the richest 85 people in the world, and many of them are in the pharmaceutical and various healthcare industries, now have the same wealthy as 3.5 billion or half the world's population. Will be hard not to think of that as I treat some of my patients who are struggling between the cost of food and housing, versus paying for healthcare services

Saturday, December 21, 2013

Saturday, December 14, 2013

What nursing shortage?

The hospital system where I pick up shifts as an RN recently went through a round of asking nurses and other staff to take ”voluntary severance packages”, or more accurately early retirement. They needed more than 200 people to accept this offer or they would need to start layoffs soon. This is not unusual as many hospitals including one of the largest systems in the country, Kaiser Permanente, has been recently been doing the same thing at their 37 hospitals and asking people to take severance packages and leave.

This is a good and a bad thing for nursing. Why is getting rid of RN’s a good thing? Because a lot of these retirement packages were aimed at nurses and staff who were hanging on, and needed encouragement to leave. I can’t blame them when in the bay area a nurse can easily make over six figures. But, healthcare is a business in this country and money will always be a factor in how decisions are made. It is hard to see some of them go because of the wealth of knowledge they had for newer nurses. However, maybe in a few years this will open up jobs again for new grads in this area.

The bad is if there was a nursing shortage do you think they would be getting rid of nurses, even expensive ones? You can Google nursing shortage myth or not, and get many reasons for the pros and cons of whether there is a nursing shortage now or in the future. All I know is around here new grads are not finding jobs. This may be different other parts of the country, but if you are going into nursing do some research. Because nursing schools will cry shortage, but they need students and their money. People need to make sure nursing is what you want to do and not because it is a job or you can’t think of anything else. 

Saturday, December 7, 2013

Nurses are sick people, it keeps us sane

Floated to a floor with a nurse who was taking early retirement. Her daughter and a friend made two cakes to say goodbye. I had to take a picture and add an appropriate caption.

Preface: Nurses work with body fluids on a daily basis, and most have a sick sense of humor to go along with this type of work. We do not laugh at patients, but we do laugh at some of the things we have to put up with (OK, we do laugh at some patients), it is a pressure valve for a job most could not do.

Anyway, this is one of the cakes. It is a carrot cake with blue fondant icing in the shape of a bedpan, mango syrup in a colostomy bag, and a Baby Ruth candy bar in mango syrup filling the bedpan. Although tasty many could not eat it after the realism.

Tuesday, December 3, 2013

Fat and Fit. . . probably not

"Obese" is not a bad word, but being obese is bad. I'm finding that being touchy feely with some people just does not work. If you are obese you need to hear it, and you also need to know that your health will most likely be affected by it. Meta-analysis studies are finding that being fat and fit is a myth.

"So your body mass index says you're obese, but you don't have "pre-diabetes" - a mix of factors such as hypertension, high cholesterol and high glucose levels that indicates you're on the road to metabolic illness. And you're thinking you've beaten the odds, right?

Wait 10 years, a new study says. Odds are, you'll be proven wrong." 

Read the rest of the story here

This picture gets me everytime I see it.

What to do?

I have been MIA on this blog for a while getting through the paperwork of both the state and federal government of my NP license. Now that I am an NP and have furnishing privileges , I wonder. No longer about the journey to get here or that I can write scripts. But what should I do now?  I need a job and to get experience. A minimum of 2-years if I want to practice in one of the independent states.
I see many independent practice state are trying to lure NPs away from restricted states (as in the article below), but the pay rate is about the same. I would love to be independent but the comfort of a doctor's availability and knowledge is invaluable.
I need to stop thinking about what if's and just get a job.

"New Mexico governor wants to recruit Oklahoma's nurse practitioners by Jaclyn Cosgrove

Governor Martinez wants to market New Mexico beyond its ski vacations, hot air balloons, beautiful desert sunsets and art museums.
Simply put, Martinez wants Oklahoma's nurse practitioners. Unlike Oklahoma, New Mexico allows nurse practitioners to practice with “full authority,” not requiring them to have a physician sign off on care in order for them to have prescriptive authority. Martinez specifically mentioned Oklahoma in her recent announcement of the campaign, adding that she hopes to further reform her state's laws to remove any barriers that nurse practitioners moving to New Mexico might face when opening their practices. “The full implementation of (New Mexico's Medicaid program), coupled with Medicaid expansion, will further increase the demand for highly trained and qualified health care professionals in New Mexico,” Martinez said in a news release. “By streamlining the requirements for nurses seeking to bring their talents and skills to New Mexico, we can further ensure that more New Mexicans, especially in rural and underserved areas, will have access to the high quality of health care our families and communities deserve.”

Time to move?

Moving to a state like New Mexico was, at least for a moment, in the back of nurse practitioner Damarcus Nelson's mind. Nelson graduated about two years ago and was thinking about where he wanted to practice medicine. But he had family in Oklahoma and a wife, pregnant with twins. Moving wasn't an option at the time. “I feel like if we stay here, we can push the envelope better to get independent practice here, as opposed to trying to run to another state,” Nelson said.
Nelson, who has a doctor of nursing practice degree, works near Yukon with Toni Pratt-Reid, the first nurse practitioner in Oklahoma to open a private practice more than 10 years ago.
Under Oklahoma law, a nurse practitioner cannot practice medicine unless he or she has a physician willing to supervise him or her for that prescriptive authority. However, the law doesn't require physician supervisors to review patient charts or even practice in the same building.
At Pratt-Reid's office, there is not a medical doctor or doctor of osteopathic medicine who works in the office with them. “We wouldn't practice any differently if we had full autonomy,” Pratt-Reid said. “Nothing that we did here would be different, other than we wouldn't have to jump through extra hoops to get the same amount of care ... . The sooner we get to where New Mexico is, the better.”

Many states open to practice

Oklahoma is one of about 12 states that requires a nurse practitioner to have a team leader or management from an outside health discipline — such as supervision from a medical doctor — in order for that nurse practitioner to provide care, according to the American Association of Nurse Practitioners. About 15 states — some that require stringent restrictions and some that simply curtail one element — have bills in 2014 that would reduce restrictions, according to the group.
No bill has been discussed or announced in Oklahoma. New Mexico and Oklahoma face similar problems, with large shortages of medical professionals across both states. Thirty-two of New Mexico's 33 counties are designated by the federal government as Health Profession Shortage Areas, according to the governor's office. Only four of 77 counties in Oklahoma are not designated as Health Profession Shortage Areas, according to the state Health Department.
Rep. Doug Cox, R-Grove, has focused many of his efforts at the Capitol on Oklahoma's doctor shortage. Cox, a medical doctor for more than 30 years, said medical “extenders” — nurse practitioners or physician assistants who extend the care medical doctors provide — are a necessary part of the health care system. Cox is the physician supervisor for a nurse practitioner in Grove, a city of 6,600 in northeast Oklahoma. More than 1,200 doctors in Oklahoma are supervising about 1,000 nurse practitioners, according to data from the state medical board.
Cox said he saw a need for a medical professional to help treat people, and he felt like supervising a nurse practitioner would be a way of doing his part to address the provider shortage in his area.
“The No. 1 reason I see people in the ER is because they can't get into a doctor's office,” Cox said. “There just aren't health care providers to serve the need, but our nurse practitioners have liberal prescribing authority.” Nurse practitioners in Oklahoma are not allowed to prescribe certain drugs, including oxycodone, a strong pain medication, and Adderall, a drug prescribed to children with attention deficit hyperactivity disorder.
Tulsa nurse practitioner Mindy Whitten said such restrictions regularly create a problem at her job.
Whitten works at an urgent care medical office, a setting where health care providers regularly prescribe Schedule II drugs like oxycodone. If a medical doctor isn't at the office when a patient who is allergic to codeine and hydrocodone comes in suffering pain, there aren't many other options for her to prescribe.
“I don't have a pain medicine I can write for them because the next one is oxycodone, and that is a Schedule II drug,” Whitten, the legislative chairwoman of the Oklahoma Nurse Practitioners, said. “I have to tell them, ‘I'm sorry, I can't write a prescription for you. You'll have to go over to the ER.'” Another obstacle that nurse practitioners face is in paying physicians for signing off to supervise them, she said.
For example, some physicians charge nurse practitioners between $2,000 and $3,000 each month, she said. It's a charge they wouldn't have to pay if they lived in states like New Mexico.
“Nurse practitioners are starting their own clinics in rural and underserved communities,” she said. “If I'm going to pay $24,000 a year, I can live in New Mexico and not worry about it and own my own practice.”

Dr. Gabriel Pitman, a trustee on the board of the Oklahoma Osteopathic Association, said if a doctor is playing a role and is available to a nurse practitioner, they deserve compensation for participating in the nurse practitioner's practice. Under Oklahoma law, a physician supervising a physician assistant is required to be on site at the clinic for a certain amount of time each week, whereas with nurse practitioners, a physician isn't required to be at the clinic.
Pitman, an Oklahoma City neurologist, said a physician is necessary to supervise a nurse practitioner or physician assistant because they aren't as rigorously trained as medical doctors and doctors of osteopathic medicine. In Oklahoma, nurse practitioners are required to have a master's degree along with clinical hours. Requirements are expected to change in 2015 to require a doctorate.

The Oklahoma Osteopathic Association supports nurse practitioners and physician assistants in the roles they serve in the health care system — just not without supervision, he said.
“We feel that a physician must always serve as the team leader, as they are the only comprehensively trained health care professional prepared to make a diagnosis and establish a treatment plan,” he said. “We feel direct access to nonphysician health care professionals endangers patients' health. We feel direct access also puts the patient in the unfortunate and confusing position of being forced to choose among the series of health care professionals, not all of whom are adequately trained to make well-informed diagnoses.”

Sunday, September 29, 2013


Because of school a bunch of people I would never have been friends with in the real world, I now consider friends. However, reality is only a few of us will stay in touch now that it is over and most go on their way with family and professional life.

Still studying and jumping through hoops of paperwork, verifications and government regulations so I can finally sit and write my boards. After a vacation I should be able to write the boards by the end of October.

This blog helped me get through school and in its current form I think this blog has run its course. I have other ideas to explore, like Twitter which seemed interesting for about 2-weeks. However, other sites and platforms will work better for what I am thinking.