1. I have thought of hiring a NP/PA for Wednesdays only with Well child care obviously not on those days. I would, of course, still see them.
Why would you still see them if the NP has done that, it would be OK initially so you are comfortable with their level of care, but afterword, just review the chart.
The mid-level would see only acutes that day. Given I see 25 (18 minus the wcc that would be slotted elsewhere, would her/he (hereinout called her) bring in enough revenue to make it doable? It would allow me to take two vacations per year and maybe allow some paper-free nights.
I somewhat agree with Travis, can you find someone that part time. Another issue is are you going to have them to WCC or sick visits. They are often more appropriate for WCC since sick can run the gamut. That depends on the midlevel. As to money... See what medicaid pays. Often private only pays half but if you sign off on the notes they can be billed under you. Typically a midlevel will work at about 1/2 to 2/3 your efficiency. My NP is scheduled 3 patient an hour.
2. As I make my new schedule,I am thinking that any calls after 2:30 pm get seen if there are slots. If not, we would offer slots the next day if they could wait (anything can for the most part), but if not they can go to the ED. I have NEVER done this, and find it bad medicine.
That would be fine, some of it depends on the schedule. Maybe you walk in 1 patient an hour. It is NOT bad medicine not to see a NON urgent patient the same day. It is bad care for the parent to wait until 1430 for a problem that has been going on for days. There is a legitimate reason for ER's but they can be abused.
3. I have dismissed patients for acts such as being rude to my patients or a one-time egregious event.
ONe of the differences in Peds is that many of out PARENTS are very immature themselves. Many do not understand that their behavior is rude. This is multiplied in medicaid patients because they often do not have education or are from disadvantaged situations. Some of our parents are just pushy. We tend to try to ignore them unless they are just unreasonable. At that time we tell them to find another provider. Where the line of "unreasonable-ness" is has to be determined on an individual basis. ONE thing though is that parents ALWAYS act better with us than with our staff. We do need to both take that into account and treat accordingly.
