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Showing content with the highest reputation on 06/17/2018 in all areas

  1. 2 points
    Hello everyone! I realized that it has been over a year since I finished the residency, so I wanted to give a bit of an update on what things are like post residency life. As I think I had mentioned, we moved across the country and the wife and I are loving life out here! The job actually hired me before I even moved, so I really didn't have time to shop around hospitals to see which might be the best fit, but in the end I have come to really love my job. The people that I work with are great, the leadership team is wonderful, and the patients are still challenging. Since we cover a few different EDs, I get a nice variety from low acuity to high acuity depending on where I go and what I want out of the shift. We work in the main ED, and always have docs available for consult when we need them - the support is really quite good. I have still been able to do advanced procedures, and the docs love that they don't have to walk me through them, whereas the majority of the other APPs do not feel comfortable performing advanced procedures on their own. Here's my favorite part: NO NIGHT SHIFTS! The hours are of course much less than residency, so I have finally been able to get back in shape, cook, travel, and just all around enjoy life more. Life is good! I've been getting PMs / questions asking me about the residency and if I think it was worth it now that I can look back after the fact. I can definitely say YES without a doubt for me it was worth it. Everyone is different and has different circumstances so it might not be right for everyone but for me it definitely was. All of the benefits I have listed throughout the blog have held up to be true... it provided me a great base of knowledge in a safe structured atmosphere, gave me with a great network of contacts/friends in medicine, will always be a big resume buffer that helps me stand out from the majority of EM PAs, etc etc. I have noticed that the doctors I work with really respect the fact that I went through a lot of the same path that they went through, and visa versa, I have a ton of respect for them since I know how long and hard their path has been. Overall, it has been incredibly valuable to me. The downsides of residency, namely the long hours and low pay, have already been more than recuperated considering I was able to land an amazing job with great pay and a great work life balance, and I'll be able to enjoy these benefits for the rest of my career. Since I still have had the energy to learn new things, I've been trying to get involved with our group in a few nonclinical ways as well. First, for whatever reason, I've really enjoyed being a part of the morbidity and mortality committee - the group that reviews bad outcomes, referred providers, pitfalls, lawsuits, etc. It has been a really excellent learning experience and I'd recommend everyone go to these if their group has them. It really helps open your eyes to the many ways that things can go wrong with cases, have an eye out for the pitfalls waiting out there for us, and how to chart effectively / defensibly. Medical malpractice is a very interesting field indeed. I've also been lucky enough to get a position as APP lead and will be helping in the medical direction / process improvement for one of our sites. This is a relatively recent development for me, but I'm looking forward to learning more about the business, the metrics, how to improve efficiency, etc. I know I know all of the negative sides of the "bean counter" approach to medicine and I have felt the pressure of that, but I still think it will help me to be a more well rounded EMPA if I am able to really understand all of these different perspectives in the practice of medicine. Since these are new waters for me, any tips would be appreciated from those of you out there who have done this type of thing before! Feel free to PM me. Anyways, thats the update for now. Feel free to ask me anything (AMA) like the other bloggers have done - post away with any questions that you might have. I do miss writing these types of educational posts on the site. If there is interest for a thread on a given topic (like certain EM topics, medical malpractice, or admin/medical direction, or anything really) let me know and maybe we could start up a new educational thread. -SN
  2. 1 point
    I thought I would start a new thread for the 2018-2019 cycle. Can any current students give insight about the program? Best of luck everyone!
  3. 1 point
    It's less about how many but which ones. Your HCE is weak so don't go all in at programs where the average matriculating student has 4000+ hrs of high quality HCE - you won't likely fare well there for example.
  4. 1 point
    If all you're worried about are man hours and no actual fee payments, you're over thinking this.
  5. 1 point
    It's better to be overdressed than underdressed. Always. Wear a suit. You can always take off the tie or the jacket once you get there.
  6. 1 point
    I find the work/life balance kinda tough with a family. I think it would be much easier as a single man or just a spouse. Trying to make time for my kid who has her own school schedule is difficult, but doable. It’s certainly more than PA school where I felt I had a decent amount of free time. This is not to say I don’t have any. I take my kid to the park or something outside at least once per week and we play video games together plenty. My wife doesn’t work, so I don’t need day care which would be a must if she did. the number of hours aren’t bad. We do the same as physician residents and averages to 60 hours. Plus conference every Thursday morning and journal club once per month. That’s the average from Sunday to Sunday. Sometimes you can end up 5-6 in a row. Once I had 4 days off in a row and it was awesome, but then I paid for it on the ends. What gets me though is the frequent flipping. Your following shift is always equal or later than your previous, so you always have time for adequate time for sleep, but sometimes I can’t. Then my kid is up and I’ll sacrifice sleep to spend time together. I go through melatonin like candy. There are many different shifts. Day, slightly later day, eve, slightly later eve, night.There is no call in the ED really, but you have to cover minimum 10 call shifts in 18 months. Not hard. Just do your thing and don’t drink in case they need you to come in. another procedure I forgot to add that I’ve done is US. Tons of it. Eyes, heart, lung, fast, gallbladder, appendix, kidneys, soft tissue, dvt. It’s basically my stethoscope now.
  7. 1 point
    Cool, best of luck! Let us all know if you make it. Feel free to contact me with questions you have about the program or the area. Maybe not the area so much, I don't really have time to leave post (Literally, I will go weeks not going anywhere else but the schoolhouse and my office at home). Busy, but learning. Maybe I'll see you here in January!
  8. 1 point
    Independent rural health clinic.
  9. 1 point
    I just interviewed on the 15th. It’s really nothing to stress about. I was a little worried about the group interview but it was really simple they ask the students two questions and just go down the line. They asked how we prepare for big tests and what we do to relieve stress, nothing complicated just be honest about it. As far as the behavioral interview, it is during the 1:1 where these questions are asked. You will have two separate 15 min 1:1 interviews with diff fac members. They asked me a few things about my application and then some behavioral type questions and if you google them you can find a whole list of some type of questions you could be asked. The essay isn’t really an essay, it’s more of a response to an ethical problem to see what you would do in that situation. Overall it was a nice day and went really fast, everyone was super nice and inviting. Biggest advice would be to be yourself and be “likeable” other than that just know how you will answer the behavioral questions and you will do fine. Hope this helps.
  10. 1 point
    what part of the country did you end up landing in? Can you be specific as to state? Always great to hear there are practices out there utilizing EMPAs well in the main dept, because there are too many fast track and low acuity EMPA jobs out there.
  11. 1 point
    watch your tramadol use, it has many interactions, does not mix well with muscle relaxers, don't forget the cumulative effects of tylenol with NSAID ( a very effective regime), ISTOP/UA/hands on evaluations with good charting should be enough to cover all bases Ramble complete
  12. 1 point
    I'd like to say it gets better, but in my experience the longer we practice the more the anxiety seems to steamroll. It's kinda like when I was younger I "didn't know what I didn't know..." So I was never anxious. Now, older and wiser I know what I don't know and I also know what the eventual outcome of most patient care is and that produces anxiety. One thing I disagree with above...I would NOT recommend talking to your doc about it. Whoever recommended that, have you ever met an Ortho surgeon? They are your employer, not your counseler. At the first sign of any mental instability, they will drop you. See a counselor and try to get it fixed (or managed) without anyone at work knowing. I know this sounds harsh, but trust me, you don't want them knowing. Hell in Texas you could literally be reported to the medical board for "mental issues" even if it's just anxiety. No joke, I've seen it happen.
  13. 1 point
    You need to shadow some PAs and Drs if you think NPs are the only ones who care about patients, how their lives are affected, and are teaching preventive medicine to patients. Do you think that primary care PAs or physicians aren't teaching their patients the value of a healthy diet, exercise, and smoking cessation? Only NPs do that?
  14. 1 point
    You made a comment during your post that pretty much hits the nail on the head. You shouldn't need a school to teach you how to be compassionate or even that disease prevention is key. The problem is there is so much to learn in medicine. So that time spent learn holistics is time not spent learning disease processes, pharmacology, anatomy and physiology. So don't get me wrong I respect my NP collegues, they are my teammates and we work well together. But the reason I am at least able to keep up with my NP collegues who have been doing this a lot longer than me as a new grad is because the rigors of PA school plus independently studying medicine gave me the strong medical foundations necessary to succeed. The holistic stuff I pretty much knew or picked up pretty quickly on my own.
  15. 1 point
    If you're referring to the supplemental application, I don't believe you need too much deatil. The information you put on CASPA should be detailed enough. They just want a general idea of what you did and how many hours.
  16. 1 point
    I don't want to screw everyone else cause I have mine, I work in a RHC in a town of 600 people, solo practice with a HSPA of 18, 3rd poorest county in the state. I know what poor is and I understand that cause I came from that also, 1st generation college student here. It is a hard nut to crack, but obamacare did not work for my patients, that is all I can say. I just want change and positive change for ALL. I am a political atheist, I do not vote, so he is not my guy or any other president. I keep out of these arguments/discussions cause most people believe if you don't vote you have not say, and I am fine with that.
  17. 1 point
    I received an email from them after my CASPA was verified that they said interview invites would be sent via email and regular mail during the third week of August.
  18. 1 point
    Young and healthy means less visits as they are healthy and this should translate into their older years...the pre-existing conditions I do agree with that should have a higher premium as those patients on average cost more money. I agree with Trumps views on this and think it is better than obamacare and I have seen obamacare hurt a lot of people in my little town of 600. I have stated this on previous post about how peoples premiums tripled over night including one of my MAs making $9.50 and her rate was $51 per month and went to > $150 per month...I mean how is that suppose to help her and the coverage was NO better. This also happen to multiple in my town. I do not think the young and healthy will have troubles getting into a PCP or UC for certain matters, but the goal is to get people on health plans and ESTABLISH care with a PCP at least once per year so you can get in quicker! That is the education part I tell my patients all the time.
  19. 1 point
    Hi everyone! I'm a 2nd year PA student and I've just received an interview for my top choice EM fellowship! I'm assuming that the questions are going to be essentially the same in a phone interview as compared to a face-to-face conversation, but I just wondered if anyone else had experience with a similar interview style for postgraduate training. Any advice would be greatly appreciated. Thanks!
  20. 1 point
    Has anyone else chosen the Friday the 13th morning session??
  21. 1 point
    So My employer wouldn't budge Isolated me and came down on me with iron fist Instead I gave my notice I move to sin city this July Sign on $30k Yearly Salary: with one weekend a month call 8a-12p sat and sun (just some rounds) OR, clinic, floors depending on week Includes bonus disbursed quarterly: $155k (No state tax in NV). Other average/usual bennies
  22. 1 point
    True enough. But it does seem like the push-back against telemedicine is at least a little bit about the same old uneasiness with technology changing the way we've always done things. It's a healthy and necessary discussion to have, but it works way better if more people participate in the discussion, and bring more experience to it. I feel pretty strongly that as long as we get out in front of a new technology, and create protocols and rules about how to use it that are based on evidence, we can prevent the lawyers or the administrators or the corporate overlords telling us how to practice. I understand finding the change to be uncomfortable, or having philosophical reasons for being against something. Patient satisfaction surveys are a decent example, if we want to get away from clinical tools. But the end result is the same. If we just refuse to participate, we run the risk of setting ourselves up for a future where someone else tells us we have to use a tool, and we have no basis for arguing for using it in a better way.
  23. 1 point
    Okay. I've been holding my tongue, for a few reasons, but this categorical, black and white thinking is silly. Assuming this is one of your primary care patients, and this isn't her first UTI ever, I would argue that it's ridiculous to ask a patient to take time off from work to get this treated. I also agree that treating a UTI without so much as a UA is bad medicine, and very easily becomes malpractice. So instead, why not do it this way: - talk on the phone, or over secure patient email to get the basics of history, pertinent positives and negatives, etc. - (even better, have an RN you know and trust do it, and have standing orders agreed upon up-front) - let the patient drop by any of the affiliated lab locations/ come in for a lab-only appointment to give the sample. You put in the lab order ahead of time. - meanwhile, once the labs are cooking, if the story sounds good for UTI and you have no concerns about pyelo, you release the Rx for Bactrim. - you set yourself (or your rockstar RN) a reminder to check in with the patient in 48 hours, and discuss what's up with lab results, and how she's feeling. At any point if you feel like it's important to put your hands on the patient, by all means have them come in for a "real" visit. But don't throw out the baby with the bath water here. Plenty of stuff (including a lot of follow up on chronic issues) can be done in newer ways. You save time and money, both yours and the patient's. If you insist everyone who thinks they might have a UTI has to schedule a visit with you, I guarantee a non-trivial proportion will just go elsewhere.
  24. 1 point
    While I agree with you in that I want no part of telemedicine, the basis of your rant is a little suspect IMO. The risk of choosing an incorrect abx can happen anywhere, unless you are advocating withholding treatment until you have the culture back...
  25. 1 point
    Time for an update. I just finished my first full month in the ED. It has been a much bigger learning curve than I ever would have imagined. There is just so much to learn to be able to do this job. There is the EMR, the hospital system + statewide policies and procedures, and of course the medicine itself. One of the reasons the medicine is so challenging is the extremely wide range of pathologies that can walk through the ED doors. From 10 days old to 100 years old, and from severed extremities to guillan barre... there is just so much to know! And as if that isn't hard enough in and of itself, the patients that get filtered into the part of the ED that we work in (the sickest part of the ED) never come in with an isolated chief complaint... there are always confounding factors and a laundry list of symptoms. It seems like every one of my patients has renal failure, CHF, COPD, polypharmacy, and/or cancer of some sort. I've found myself feeling overwhelmed and wishing there was a way to learn the straightforward approaches to these chief complaints before jumping into the sick/complex patients of this ED. To make it even more difficult, the hours we've been working have been brutal! The shifts themselves are technically 12 hours, but we are expected to be there early and I never leave sooner than 1 hour late to finish up charting... add in 30 min commute both ways and its easily 14 hour days x6-7 days in a row. I am so tired by the end of the day that I have little energy to read up on the things I saw. When the 3 days off finally comes, the first day is spent catching up on sleep after the night shift, 2nd day on charting and practical life things you let slide the past week, and 3rd day to finally study, read tintinelli assignments, and sneak in a phone call to loved ones. Anyways, I recognize that these feelings are likely just because its my first month and I'm feeling overwhelmed with it all - I know it will get better. I am not going to give up, thats for sure! On the bright side, the people here are wonderful and they make it all worth it. The nurses are nice here. The techs are great. The fellow EM residents/seniors have been very kind and outgoing, always willing to slow down to teach me things and help me with procedures. The same has gone for almost all of the attendings. I've been doing a ton of procedures like splinting, complex suturing, central line placement, and tons of ultrasounds. Ultrasound is really cool. Its awesome to be able to admit/discharge a pt w/ abdominal pain home within 20 min of coming to the ED, all with POC testing. I have been really enjoying our Wednesday conference lectures. We have been making our way through tintinelli, reading high yield journal articles, and listening to some pretty awesome lecturers. If there is one thing I know about myself, its that I will forever be a student at heart.


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