True Anomaly

Our re-certification process continues to evolve, but this evolution takes time. How rapidly this whole process evolves is subjective- for some, it’s too slow and for others it’s pretty fast. Maybe some day we won’t have to recertify at all. But that day isn’t today. In my own humble opinion, the re-certification process has gotten better since I became a PA. I have taken the PANRE previously, but I’m not old enough to have taken Pathway 2. Making the PANRE have a home option is at least a step in the right direction to me It’s not perfect, but it will continue to evolve. And I trust that there are enough vocal PAs out there who will continue to push for this whole process to be more fair and equitable So in the meantime….yes, I’m very happy that at least I’m still passing.

I would rather this than being hooked on a benzo

I’m on my second year of PANRE-LA, and this most recent quarter was the toughest for me as well. Multiple questions that have multiple correct answers that I would get tripped up. But other questions seemed reasonable. Maybe this was a “test question month”. I’m still passing, so to me that’s all that matters

The cartoon below - to me- highlights a big part of the problem that you’ve also noticed Rev: we as medical practitioners are not equipped overall to help people with nutrition counseling. Set aside that there is a whole profession dedicated to this (RDs), but I do feel that the primary medical practitioners who see patients should have a better overall understanding of how it actually works. That’s WAY easier said than done of course, and would require a fundamental shift in how we view nutrition My n=1 experience for how I was able to do it successfully is just one tiny data point. It’s not a “one size fits all” approach (no pun intended). But with the overall knowledge out there, and especially with what I’ve learned over the past year, I know there are better ways to teaching people how this works- and not just other medical practitioners, but our patients in general. I also don’t know what that looks like, but I’m at the point where I’m ready to change my entire career around to figure it out

I’ve watched the whole thing, and I definitely have some thoughts- especially as someone who’s been morbidly obese before I agree that BMI is a bad term, and the utility of it has been watered down to where it’s now too emotionally charged for many people to be effective when discussing this very issue with patients. I think a more correct term is “increased adiposity”, since it’s the presence of more body fat that does correlate with increased negative health outcomes. And while he is correct that people with increased adiposity aren’t guaranteed to have worse incidence of T2DM or cardiac disease or even hypertension, the risk is still greater than if they had a lower percentage of body fat. And the “healthy at any size” discussion ignores the numerous other ways that increased body fat hinders someone’s ability to simply live and function. Simply put, it is harder to do daily activities while carrying excess body fat. He is also correct that there are many people- and I’ve certainly experienced this too- who feel hopeless and shamed for being overweight or obese or have increased fat or whatever you wish to call it. You do indeed feel more afraid to seek healthcare because you’ve been convinced that any discussion about your health starts with your weight, and you feel ashamed that you can’t control it. So his approach to being more open about health discussions with patients like this does make it easier to develop trust and hopefully compliance about how to handle it. HOWEVER….where I vehemently disagree is this idea that there is a “set point” where you can’t seem to lower your weight no matter what you do. And during the Q&A afterwards, someone did ask about whether set point was truly “set” or if it can be adaptable, and he really didn’t have a good answer. Sure, leptin and ghrelin are powerful satiety/hunger hormones and definitely impact someone’s ability to either gain or lose weight….but telling people that there is a “set point” that they have little control over is actually a mentally damaging thing IMHO. I totally bristle at anyone who suggests that just because there is a propensity for people to gain the weight back after losing it means that they can’t do it long term. It just means they haven’t found the long-term strategy that works best FOR THEM- which is a much harder thing to do, but is entirely achievable. What I sincerely fear is people who truly want to lose weight who are going to be caught up in the idea that “healthy at any size’ means that they can’t find a way to lose weight, so they give up and accept that “this is my reality” when they probably don’t want it at all. The science between weight gain and weight loss is not up for debate in my mind. What IS up for debate is how we teach nutrition to people.

Don’t need to convince me that Press Ganey needs to go away. ESPECIALLY in emergency medicine where we are BY LAW directed to see every patient who walks in the door. This has never squared correctly in my mind

Never seen it happen before since it started At least we’ll be around, like we have for over 20 years

The window to change it has passed for now- we did have an opportunity a few years ago, and it did get hotly debated around the profession including during a House of Delegates meeting with resolutions to start a new certifying body through AAPA….but I think with trying to pass OTP and then the name-change issue sometimes it just becomes financially unfeasible to do it all at once

Scrubs look professional, especially for an actual licensed medical provider. And get it embroidered. Don’t overthink it- just wear them and put your mind at ease One more plug for Medelita- great fitting scrubs, and the company was founded by an emergency medicine PA

As down as i’ve been about my current place of employment on prior posts- I still enjoy amazing autonomy and respect, and am compensated well. OP- your ideal job is out there. But as with anything worthwhile, it takes work

This has been my experience as well. I work with multiple NPs who have all been NPs for >10 years, and had experience as ER nurses for many years prior to that- and it clearly shows because they’re all awesome. And to a T, they all also lament the fast-tracking of these new-grad NPs who may or may not have some actual nursing experience prior to getting their NP. Our group won’t ever hire a new-grad NP, but at least they’ll consider a new-grad PA- even with prior healthcare experiences being weighted the same. And as noted above, I think more and more practices are recognizing this

To answer your specific question- the SP would have a total of 9- 4 in one state, and an additional 5 in another. I’ve never heard of a state limiting supervision number for a doctor just because they oversee other PAs in another state

Oh there’s definitely a provider shortage- the question is if anyone is willing to spend the money to hire more providers to offset the workload on their staff

Scrubs are truly one of the best parts of my job. It’s actually completely taken over my style of dressing when I’m not at work And by that I mean finding clothes that more mirror a loose and comfy and solid style- not ones that come caked with blood and vomit

Thanks for that Reality Check (no pun intended). I think that perfectly highlights - for me - why it isn’t about being a PA that is burning me out- it’s just healthcare in general. I have zero doubts that if I was an MD also doing emergency medicine I’d feel exactly the same way Seriously- y’all can have this name change argument stuff. There are so many deeper issues that we all kinda felt before, but this pandemic has just exacerbated it