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Updated: 14 min 55 sec ago

Dilemma of whether to practice in Primary Care or switch to specialty Dermatology with challenges facing in trying to give my clients the best holistic care!

Sun, 09/21/2014 - 4:13pm

Hello everyone reading,  

           I am a FNP also, who took a job in Primary Care, a practice owned by an ARNP! I can say that I love it, as NPs are surely forward thinking. I see client's in the office on Friday's who want their suspicious lesions looked at or who want a skin tag or bothersome Nevi removed. I use a dermatoscope and take pictures with the DL3 model with my iPhone 4s (Awaiting my iPhone 6 Plus to arrive). Deciphering skin lesions is a passion of mine! I am so thrilled that we are offering our client's the option of a one stop shop without having to refer client's out to dermatologists for a second co-pay and long wait times.Additionally, we may offer Botox soon, as I have been trained in that also. I precepted at a derm office and was leary of specializing in just skin as I enjoy treating my clients holistically. As an FNP and previous pediatric experience, rashes are not new to me...in fact 1/2 of the questions for the board seemed to be on skin complaints or dermatological diagnosis and treatment of such. It is very difficult to get into a derm office in Florida with the new Dermatology DNP program at USF, many dermatologists require more than an MSN/FNP. When I attended the 2014 National Association of Dermatology Nurse Practitioner Symposium (which is a great forum for furthering skills and knowledge), I spoke to several Family NPs from around the country who experienced similar difficulty in trying to transition into a dermatology practice. I hope to get some good pointers from the posts, as I my see patients in rehab centers also - where the facility has consulted an organization of NPs who have no further training (as wound care consults) who prescribe my patients the wrong pharmacological treatment in misdiagnosis. I am very frustrated with this, as no one in my office consulted them, and they are not limiting themselves to wound care (e.g., pressure ulcers). Any ideas? Trying not to step on toes, but, the LPNs should not be able to order the consults without the Primary Care Practitioner authorizing it, correct? The company has a dozen NPs with Protocols as FNPs or NPs doing gynecological and other exams and primary care type protocols without any other certifications listed. In Florida it is required NPs practice under the supervision of a physician. Their supervising physician is a primary care physician (Adult). Many of these so called "wound care" NPs are prescribing steroid creams for everything calling it Psychogenic pruritis (diabetic patient with an Hgb A1c of 10.4) when it was Folliculitis and candidal intertrigo- where topical corticosteroids made it worse. Had to d/c their script and write for econizole 1% topical with rash gone in 3 days. Yet, they billed for 2 visits in one month consulting on the patient, which no practitioner of the patient's ordered. How is the Medicare $$$'s going to last? Seems like greed, as well as bad politics/ethics going on! Would love to hear your thoughts ... everyone! Am I alone on this bad feeling... is it so bad out there...this kind of bad business is creeping up? I look forward to your advice!

In Shock,  Diane

 

 

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