Author Archives: Jennifer DeFrates

Why are we still prescribing unnecessary antibiotics? and how to stop
13 Dec

Why are we still prescribing unnecessary antibiotics? and how to stop

You don’t plan to prescribe unnecessary antibiotics, but we know it happens. Why? and How do we stop it?

Flu season is in full swing. Your waiting room is bursting at the seams with sniffling, coughing patients. Most need fluids and rest, a few could benefit from anti-virals, but they expect the magical cure: antibiotics.

and more often than not, we give it to them . . .

We know that prescribing unnecessary antibiotics is dangerous, but we do it anyhow. WHY?

Unnecessary antibiotics are actually worse than doing nothing.

We know this. We know it can lead to more severe problems for the individual patient as well as the greater medical community. Antibiotics kill necessary bacteria within our bodies in addition to the infections.

Unnecessary antibiotics can also lead to allergic reactions and the creation of antibiotic resistant bugs. Super diseases kill 23,000 patients a year according to an article from the New York Times on overprescribing antibiotics.

Antibiotics are kind of medical magic, but when prescribed unnecessarily, are creating health nightmares. Click To Tweet
Approximately, one-third of all antibiotic prescriptions are unnecessary, according to researchers at the CDC, and nearly one-half of all outpatient antibiotic prescriptions are inappropriate. 

While recent research from UCLA and Harvard show that advanced practitioners, like physician assistants and nurse practitioners, provide quality of care comparable to physicians, a CDC study shows that NPs and PAs are no better at over-prescribing antibiotics. In fact, we’re slightly more likely to do so.

We know better! So why are we still doing it?

One potential reason may be that PAs and NPs are seeing more of the kinds of cases that often seek antibiotics unnecessarily. Another reason is that programs aimed at reducing antibiotic prescriptions have been primarily targeted at physicians alone.

But overwhelmingly, providers at every level are prescribing inappropriate or unnecessary antibiotics.

We have to ask WHY in order to practice more effectively.

We know better, so WHY are we STILL prescribing unnecessary antibiotics? and how can we stop? Click To Tweet

Recent studies show that when pharmaceutical companies financially compensate physicians for prescribing medications that those doctors are more likely to prescribe their medications. Even when doctors believe they acting without bias, we find that even the proverbial free lunch affects their prescribing.

Peter Loftus writes in the Wall Street Journal about recent JAMA findings that demonstrate free meals influence prescribing. It is often unconscious bias in favor of the medication discussed by a friendly face in a personal setting.

Some voluntary restrictions have prevented for-profit pharmaceutical companies’ gross manipulation of doctors. However, even small perks are inherently manipulative towards that name brand medication.

While this bias is true for all kinds of name brand medications not just antibiotics, it doesn’t explain why we find it so hard to stop prescribing generic antibiotics in the face of overwhelming evidence that it’s an unsafe practice.

Flu season is in full swing. Your waiting room is bursting with sniffling, coughing patients. Most need fluids and rest, not unnecessary antibiotics.

We get tired.

The first few patients with viral illnesses get a rested, patient practitioner. We are willing to carefully explain the reasoning behind refusing to prescribe an unnecessary medication.

However, hours into a shift that is growing busier with each urgent patient newly wedged into the schedule, a difficult patient sees a provider who starts to surrender battles to win the war. Subconsciously, we give in and prescribe an antibiotic for a similar patient/ complaint who was denied earlier. We get worn down by the sheer number of times we make the same argument over and over.

What should we do?

First, we need to acknowledge if we are, in fact, part of the problem. Take ownership of all our prescribing practices.

Secondly, make a concerted effort to make some small changes in your practice.

Tips to Avoiding the Unnecessary Antibiotics Prescription:

  1. In each exam room, place a visible, signed pledge to prescribe more thoughtfully.
  2. Patient education pamphlets and posters about the differences between bacterial and viral infections and appropriate treatments for each.
  3. Based on diagnosis, electronic pop-up on medical charts requiring additional explanation for antibiotic prescriptions to include in patient files.
  4. Monthly peer review of prescription rates to compare individual provider prescribing rates.
  5. Daily personal review of prescription necessity, efficacy, and appropriateness.

Governmental mandates and oversight can’t fix this problem without creating more problems.

We each have to take steps to reduce unnecessary antibiotics with our patients.


“CDC: 1 in 3 antibiotic prescriptions unnecessary.” 3 May 2016

New York Times. 25 March 2016.

Japsen, Bruce. “Nurse Practitioners, PAs No More Wasteful Than Physicians.” Forbes. 20 June 2016.

Loftus, Peter. “Even Cheap Meals Influence Doctors’ Drug Prescriptions, Study Suggests.” Wall Street Journal. 20 June 2016.

8 interview Questions to help you hire the Best Candidate for your practice
15 Oct

8 interview Questions to help you hire the Best Candidate for your practice

Nothing is more discouraging than wading through hundreds of applications and suffering through an excruciating interview process, to realize you hired the absolutely WRONG person for your practice.

Standard interview questions are easily searchable and can be entirely too predictable. For a more genuine interview, ask some different versions of those questions.

According to research from SHRM, hiring the wrong candidate can cost up to five times the salary for that position. Avoid that costly mistake by asking interview questions that gain better insight into your candidates’ mindsets. Find someone who wants to build a career at your practice.

Before you ask them questions, ask yourself a few. What kind of provider am I? #InterviewQuestions Click To Tweet

Hiring the best candidate for your practice takes some forethought about your practice –

  • Who are you as a provider?
  • What are your core values as a provider and employer?
  • What words describe your work environment?
  • Who are your patients?
  • What are the demands on a new member of your practice?
  • What skills are you looking for?
  • Which weakness do you want to avoid?

Once you have some ideas about who you are, you are in a better position to find someone that truly meets the needs of your practice.

Then, add these 8 interview questions (or versions of them) to your interview process for additional insight into the applicants as practitioners and people.

1. What makes our practice different/same from your last practice?

This questions offers insight into how the candidate viewed not only his/her last work environment, but also what areas he/she has honed in on already about your practice.

Follow up with how their approach would differ based on their observations of your practice/specialty. Candidates who go from practice to practice with the exact same approach are often inflexible and unwilling to learn new habits.

2. What would your last supervising physician say was your greatest strength and weakness?

By asking what someone else would say, candidates are more likely to give genuine answers and carefully consider the strengths and weaknesses that will blend with your team. If their greatest strength was autonomy at their last practice, but you’re looking for a member of a very collaborative team, then that trait might not be a strength for your practice.

In contrast, if his greatest weakness was working without daily access to the supervising physician, he might do really well in a team environment. Personality can be just as crucial as professional proficiency.

When interviewing, remember personality can be just as crucial to fit in as professional proficiency. Click To Tweet

3. In what area(s) do you personally see a need for growth or would like mentoring to improve?

The answer to this question reveals self-awareness, humility, and willingness to learn, and can demonstrate how a candidate sees your unique capabilities as a provider and mentor.

4. What is your approach to a new patient? Or here is a typical case we see, how would you approach this case?

Without additional qualifying, listen to how they view this question. You want someone who reads through charts before meeting with a patient, and really listens, letting the patient ask questions and gives considerate answers.

Potentially, this answer is an opportunity to see any apparent knowledge gaps. If a provider is a new graduate or changing specialties, expect some room for growing his/her knowledge base, but an experienced provider in your specialty should be independently knowledgeable and able to tackle a typical case.

Use this time to talk about coding and their comfort level with EMR systems. Also, what the practice training protocol is or their personal training needs, expectations, etc.

Instead of interview questions, ask candidates to do on-the-job interviewing.

Ask the NP or PA to come spend an unpaid day in the office, seeing patients and presenting cases to the supervising physician. This approach helps both sides more accurately assess the “fit” of candidate and practice as well as demonstrates bedside manner and competency.

One best practice is an on-the-job interview. Both sides get a clearer picture of each other. Click To Tweet

Recent studies suggest doctors who care about their patients have healthier patients because patients who believe their doctor is invested in their health tell the truth more often and are more willing to follow their doctor’s instructions.

Hiring the wrong person is worse than a waste of time, it's expensive. Use these 8 Interview Questions to help hire the best candidate for your practice.

5. We are a collaborative team environment – What is your approach to working in a team environment?

or We are an autonomous practice – What is your approach to working with very little supervision?

You want an applicant who is capable of working comfortably in your practice environment either collaboratively or independently, but knows a healthy balance between autonomy and consultation, not one who will be a lone ranger or looking for lots of hand holding.

6. What compensation (salary, benefits, etc.) do you anticipate?

Of course salary negotiations are always part of the hiring process at some point, but often providers can waste a lot of time and money with candidates whose salary expectations are not compatible with what your practice is offering.

Both sides of the table need to consider all that’s included in compensation as well, like loan repayment and paid CME training, etc.

7. No job is perfect – what area of this position would you change and why?

This question gives you an opportunity to discuss and negotiate aspects of the position that might be negotiable and to find out if a candidate is unwilling (or would find challenging) to accept the non-negotiable aspects of your open position.

Also take time here to talk about what excites the PA or NP about joining your practice.

This answer also helps clarify if this job is one that the candidate will love. You don’t want to hire someone who will still be job seeking on the side or leave in six months. Here you might take the opportunity to discuss how long this provider plans to stay with your practice.

Hiring mistakes are especially costly for small practices. Better #interviewquestions can help. Click To Tweet

8. Lastly, How do you view work/life balance?

Someone who is excited about work and strives to be a difference-maker is punctual and prepared everyday. But you also want someone who will recharge and come back to work refreshed with clearer perspectives.

Even a driven, career-centered candidate should have outside skills and interests.

Many candidates are seeking more of an integration of work and life. Someone might ask for a schedule with a longer midday break to run errands or spend lunches with their children. Depending on your practice, you might be able to accommodate some of these ideas.

Everyone will likely hire the wrong person at some point. However, asking these interview questions and carefully evaluating candidate responses might help you make a more informed decision for your next hire.

What are your favorite go-to interview questions to shake up a stale interview? Share with us on social media!


How to Crush your Interview in Style
04 May

How to Crush your Interview in Style

You’ve combed through hundreds of job postings, sent out carefully crafted cover letters and resumes. The HR manager just called to set up an interview. So now, do you know how to crush your interview in style?

Dress for Success

Don’t skim over this topic. Too many candidates think the way they dress is acceptable, while HR managers shake their heads. Before you go, does your outfit follow these guidelines?

Wear your most professional attire.

No one ever failed a professional interview for dressing too conservatively with too much class.

For the ladies: tasteful blouses with high necklines should be subtle, solid colors or minimalist prints. Skirts should come to the knee or below. Solid, straight legged pants tend to be the most flattering on any figure. Make sure clothes fit comfortably.

Impress them with your personality with your personality, not your clothes.

For the men: Suits and ties in dark colors tend to be timeless. A bolder tie can be interesting with a solid suit and light shirt, but save silly ties for #FunFriday AFTER you land the job. Wear socks with your dress shoes. Again, stay simple; a patterned sock like argyle, might be acceptable if it coordinates with your shirt, but don’t try to be witty with your sock choice.

Crush your interview: Dress for success - no one ever failed an interview for being too classy! Click To Tweet

Of course, dressing for success includes fastidious personal grooming and hygiene. Minimal use of fragrances is important, especially in the medical field. Nails should be clean, trimmed and clear or neutral colors for female applicants.

Be Prepared

Take time to study the practice and specialty. Get to know recent medical advancements in their specialty or be able to discuss related current events and your related interests or experience. If the practice is on social media, follow them, get to know what matters to them.

If possible research the careers of the supervising physicians for whom you’ll be working. Be able to talk about why you would like to work with this physician or what types of physicians you have successfully worked with in the past.

If you go into the interview with the attitude that you just want any job, you won’t look like you want this one.

You've sent hundreds of carefully crafted resumes. The HR manager just called to set up your interview. So do you know how to crush your interview in style?

If you go into the interview like you'd be happy with ANY job, you won't land this one! Click To Tweet

Read over some common interview questions (check out these from and have an idea of a general answer for them. Don’t sound too rehearsed, but prepared.

Prepare your own questions!

Be ready to ask about the practice and expectations for you as a provider.

  • How much training will be required? What is the salary during the training period?
  • How much supervision and time with the physician will I have each week? Is the physician open to mentoring and guiding new hires?
    • If so, what does that look like? (You want autonomy, but also a physician who will help you grow as a provider because ultimately you want to provide excellent care for every patient. Some chart review and time with the physician each week should be part of a truly collaborative practice.)
  • What is the turnover for Physician Assistants or Nurse Practitioners?
    • If there is high turnover, the practice may have high expectations or the supervising physician may be unreasonably demanding. It may be appropriate to ask “To what do you attribute the turnover?” and let them add details.
  • Avoid too many questions about call times and schedules. Ask once about the expected schedule, then let it go. Making call seem very important gives the appearance of laziness to the HR manager. Save further questioning and clarification for the second interview or hiring negotiations.

*EASY HACK – Take a notepad. Your questions for the interviewer can be on the pad. Plus, you can take notes during the interview, which will make your interviewer feel important and give you the appearance of studious professionalism.

When you discuss salary, be realistic. A new grad without any autonomous experience will earn near the bottom of a proposed salary range. If you can negotiate some because of special skills or exemplary transcripts, great! But have fair expectations. Make sure to include vacation, paid continuing education, loan repayment, rate of raises, and cost of living for the area into your equation. A fair salary might look different depending on specialty as well.

Personal presence speaks volumes before you do. #CrushyourInterview #JobInterview Click To Tweet

Lastly, personal presence speaks volumes before you ever open your mouth: be confident, walk tall, have a confident firm handshake, make eye contact. Your resume landed you the interview, but presence can land the job. Portray yourself with confidence. FAKE IT if necessary.

They don’t know you’re nervous. Smile, breathe, take a second to consider a question before answering. Answer each question with appropriate details for clarity without divulging too much personal information.

And turn off your cell phone or silence it without vibrations. If you can’t give the interview undivided attention, they won’t expect you can offer it to your profession either.

Accept that finding a perfect fit means an interview is a first date. Present yourself accurately and trust the right job will recognize your unique qualities.

After the interview – Take the time to send an electronic follow-up within 24 hours, something simple, like I appreciated meeting you, thank you for your time. Send a more formal written follow up a few days later, include some personal notes about your meeting here. Following up shows the HR manager and physician that you are conscious of the time they have spent to recruit and interview. Even if you do not get an offer initially, building relationships is always good. If you do not accept an offer, always send an additional thank you, keeping the door open for the future.

For more interviews, upload a resume and search PANP World today.


Write a Better Job Description: Improve Your Hiring Process
04 Apr

Write a Better Job Description: Improve Your Hiring Process

Writing a better job description may not sound like the most important part of hiring a new member for your practice, but filling a vacant position doesn’t start with interviews, it starts with attracting the right applicants.

Hiring quality candidates for your practice starts with attracting applicants. Write a better job description today. Click To Tweet

That open position needs to be filled. Patients are waiting extra days to be seen. Cases are piling up, but you don’t just want any applicant, you want the right one. And you don’t want to spend weeks weeding through stacks of the wrong resumes either.

You need the right applicant to see your job and want to apply.

Okay, but how do I do that?

Write a great job description.

Simple enough, but as someone whose job it is to read through job descriptions, many employers are missing out on candidates based on lackluster job descriptions.

Physician assistants and nurse practitioners are in growing demand. We see thousands of jobs posted a year. Applicants feel like they have a lot of choices.

Make them want to choose your job.

Grab their attention with some aspect of your practice or community that is unique and appealing. Does your practice see a lot of challenging, interesting cases? Do you offer a great work/life balance perfect for applicants with families? Share those kinds of details to draw interest from applicants who are excited to join your type of practice.

However, find a balance with the details in your job description. Some employers share so little information applicants literally know the practice has an opening in a specific specialty and the required certifications, but has zero information on the practice or area.

While other job descriptions go the other direction and include everything just shy of a legal disclaimer, which is unnecessarily wordy for an online job posting. Strive for 3-5 main ideas with a few points per section.

Think movie trailer, not feature film!
Finding the right applicant doesn't start with interviews. It starts with getting the right applicants. Write a better job description today.

Don’t waste a lot of time on the wrong resumes. Clarity is crucial on the important qualifications you are seeking, such as experience or certifications required, position title and responsibilities, shift/call hours, and expectations for providers working with your patients. These are great for a bullet point list.

Don't waste a lot of time on the wrong resumes. Clarity about requirements and expectations is crucial. Click To Tweet

A better job description should include some of the details of your compensation package. A salary range is only a starting point. Include vacation time, loan repayment, moving expenses and if you offer compensated time for continuing education or offer at work classes for credit, these can be great selling points.

Applicants will see that you’re interested in caring for their careers and professional skills.

Lastly, intersperse the unique style and personality of your practice or community throughout the job description. Is it a fast-paced urgent care environment or laid-back family practice? Does the job offer lots of room for autonomy or is it a team environment?

Remember to see your description through the eyes of an applicant. “Busy practice” might sound good to you, but sound like “You’ll never see your family” to an applicant, so clarify what you mean – “bustling 9-5 practice” gives applicants the idea that they will see many patients but also be able to count on a regular schedule.

Finally, mastering the Millenial mindset!

Millenials will comprise 40% of the workforce by 2020, so learning what they are seeking from a job/career is essential in writing a job description that speaks to them.

Most millenials want to either work autonomously or work for a mentor figure in a collaborative environment rather than a traditional boss-subordinate role.

Work-life balance is important to them, but not how we might think. They want work and life as integrated parts of a whole, meaning more flexible schedules and respect for the life portion of their life.

In writing a job description that speaks to millenials, use words like team, collaboration, autonomy, and clearly state schedule expectations.

But they also really seek to make the world a better place and want to do important work, and are willing to work hard in an meaningful position. Show them the importance of your practice, how they will make a difference.

#MedicalRecruiters, find ways to attract #Millenials by writing job descriptions that speak to them. Click To Tweet

Writing a better job description will help you hire someone who will make your practice more than a job, but as a home for their career.

And if you still need help, ask us! We are more than happy to help you with your posting. Contact PA-NP World today.

The Zika Virus, Pregnancy, Microcephaly and the Olympics
27 Jan

The Zika Virus, Pregnancy, Microcephaly and the Olympics

In recent months and even in recent days, the story of the Zika Virus pandemic has been gaining international attention. The WHO expects the virus to spread to every country in the Americas quickly. Several cases have already presented in the United States, (Hawaii and Illinois) from women who have traveled abroad.

This flavivirus is mosquito borne and appears to be mostly innocuous flu-like illness for infected adults, but the effects on fetal development are devastating. It was in November 2015 that Zika was first linked to the uptick in microcephaly cases in Brazil; a congenital defect that affected 146 Brazilian infants in 2014, but has affected over 4000 in 2015-2016, according to CNN. Researchers are still in the process of linking causality officially, but some connection appears undeniable.

Especially concerning to the medical community is that currently Zika is not treatable, no vaccine exists, and once a pregnant woman has contracted the illness, nothing can be done to prevent it from affecting her fetus, although quality of life for the infant could be positively affected by early intervention.

Zika has been recently found in 25 Central and South American countries: Barbados, Bolivia, Brazil, Cape Verde, Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, Samoa, the U.S. Virgin Islands and Venezuela.

This outbreak has health officials concerned. It is a pandemic across the southern North American continent and South America. A major concern is how quickly the Zika virus could spread globally.

However, most media outlets have yet to mention is the terrifying concern that the location of the largest outbreak of the Zika virus and microcephalic births is also the host nation of the 2016 Summer Olympics.

The Zika virus pandemic and what you need to know as a medical professional about pregnancy, microcephaly and the Olympics - PA NP World

Affected visitors and athletes risk carrying the virus home and affecting their native mosquito populations. Airlines are already refunding passengers for tickets purchased for travel to affected countries with physician notes regarding pregnancy and travel, but additional precautions may be needed before the Olympic athletes converge for the games.

Brazil is already taking aggressive steps to eradicate the source of the virus, the Aedes mosquito, but this particular variant has adapted to living indoors with humans and can use even the water in a vase as a breeding ground. The females prefer to bite indoors during the day, so typical mosquito prevention will be less effective in combating the spread of the illness.

As medical professionals what can we do?

  • Stay informed of the progression of the Zika virus
  • Advise all patients about the disease so that they are aware of the travel concerns and risks associated with potential to spread the disease within their community
  • Provide up-to-date travel warnings for any pregnant patients
  • Promote strict adherence to mosquito prevention measures especially for pregnant patients

Scientists are scrambling to develop a vaccine while entomologists are busy using various methods to eradicate the Aedes mosquito populations, the efficacy and effects of which remain to be seen.



Outbreak of Microcephaly Connected to Zika Virus in Brazil | HealthMap. (n.d.). Retrieved January 27, 2016, from

Prevention. (2016). Retrieved January 27, 2016, from

The relatively new mosquito-borne virus is connected with a neurological disorder that results in babies being born with abnormally small heads. There is no vaccine to prevent Zika or medicine to treat the infection. (n.d.). Zika virus: Airlines are refunding tickets to Latin America. Retrieved January 27, 2016, from

Zika virus. (n.d.). Retrieved January 27, 2016, from

When to Look for a New Job
29 Dec

When to Look for a New Job

Are you considering changes in the new year? Is a new job on your list of resolutions?

We’ve all thought about quitting after a rough shift, but most of the time, we just need to go home, reset, and come back to fight another day.

So when is it time to really consider a new job?

Here are some basic guidelines to consider.

If you are not being respected in your role as a medical professional.

If you’re a recent grad, it can be humbling to learn how much you still need to learn after an intensive PA or NP program, but whether you are a recent graduate or have many years of experience, you should be treated with respect by the staff and your supervising physicians.

Are you able to ask questions, learn, make decisions, and grow? Does your collaborating physician welcome questions? Offer supportive criticism? Give you chances to expand your expertise? Are you encouraged to grow autonomously?

Is this job a position you would recommend to a friend? Take stock of your position from an outside perspective. Every job has its ups and downs, office politics, and personality conflicts, so you have to consider how those weigh on your experience before thinking about a new job.

If your job is not helping you meet your career goals.

Are you getting the experiences you need to further your career, your growth as a professional? Reflect on your current practice.

Freshen up your resumé.

By focusing on what others would see in your career, you can more easily decide if your current position is bringing you opportunities to learn and develop as a medical professional. A new job might add to that resumé if you find it looking a bit scant, but you do not want too short a tenure at any position either.

Are you too safe and comfortable in this position? An ideal job would be secure, but ask you to step outside your comfort zone once in awhile to treat something new, explore new treatment options, to get better at your job.Have you considered looking for a new job in 2016? We all have bad days at work, but when is leaving really a good idea? When should you look for a new job?

If your job doesn’t have the work/life balance you desire.

Some jobs are more work and less life, but they are exciting, interesting career builders or are temporarily hard as the person having the lowest seniority in the practice, but will shift as you’ve been there longer. Some jobs are just challenging. People’s lives hang in the balance. Do you thrive on work or want more time at home?

If you’re too stressed to be at your best.

If the sound of your pager sends you into a panic or turns your stomach into knots, that may NOT be the right place for you.

Humbly starting at the bottom is part of the process. But if you’re finding yourself completely burned out, it might be time to explore other options.

Each of us thrive in different environments. Don’t make yourself sick to make others well. Find a job that pushes you to excel, not crash, whatever that means for you.

We all thrive in different environments. Don't make yourself sick to make others well. #TimeforaNewJOB Click To Tweet

Time to find a new job?

Ask yourself what the ideal situation would be for you and create parameters for a job search:

  • Call/No call?
  • 7 on/7off or standard office 40 hr/wk?
  • No weekends/ evenings or standard hospital shifts?
  • Is location the issue? too far from family?
  • Want lots to do in your spare time? or a quiet place to raise a family?
  • Need more compensation/benefits/retirement? Loan repayment?

Take the time to evaluate these components before starting a job search this year, and if you decide the time for a change is right, remember not to burn your bridges at your current position: give plenty of notice, be positive about what you learned at this job, and what you were looking for in a new position.

Be sure to search PA NP World for just the right fit for you. We have jobs from across the entire country, every shape, size and compensation to fit your career needs.