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bjmcell

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About bjmcell

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  1. Same thing happened to me 1 year ago as a new grad. Took the new job and don't regret it one bit. I basically had the same post last year.
  2. Thanks for the replies. I currently get 21 days PTO that are not differentiated. I get 5 days CME and $1,500 CME money. My current company contributes 40 cents for every dollar I put in up to 6% of my salary. One unique thing is that my current company provides me with a pension that is fully vested after 5 years. Malpractice is fully covered and health insurance is about $120 per month. The new company gives me 4 weeks vacation and 2 weeks sick time. I would get 1 week CME with $1,000 of CME money. They would contribute $1.20 for every dollar that I contribute up to 7%. My malpractice would still be fully covered and my health insurance would be about half at $60 dollars per month.
  3. Hello, I was hired as a new grad 1 year ago to work in the fast track area of the ED and as a provider in triage. I have been seeing fast track patients without physician oversight for about the past 6 months. Over the course of the year I have started to see main ED patients in the fast track with physician oversight. When I was hired one year ago it was the first time that this ED had any PA's working in the ED. Because of that, my scope was fairly narrow as they did not know how knowledgable PA's were and how well that we worked along with me being a new grad. When I was hired as a new grad the contract was for 93,600 a year which comes out to 45 dollars an hour. I work four 10 hour shifts per week. After I hit my 1 year mark I applied to a few jobs. I recently recieved an offer from another ED for $54 dollars an hour with a $2,500-3,000 guarenteed quaterly bonus. I would be working at a base of 140 hours per month with the oppurtunity to pick up extra shifts if I want. The job would integrate me more so in the main ED rather then just the fast track. This ED has a large amount of PA's working there. The PA's there are very well established. The ED enviroment there seems to have a great environment for learning as a PA with monthly meetings driven towards PA's education on various topics. It sounds like a great place to work and learn. I accepted the offer. I just sent my letter of resignation about a week ago giving my current job 90 days notice. After submitting my resignation, my current boss says he would do everything in his power to keep me at my current job. He says that they would transition me to working strickly in the main ED with no fast track shifts. He also offered me $65 dollars per hour to stay. He is making it very difficult for me to leave with an offer like that. Some of the problems that have come up is that I have only been working here one year and I am the longest tenured PA so I dont quite have the oppurtunity to work with and learn from other established PA's. The new job would also been about 15 minutes closer of a commute. Thoughts on the above scenario? Anything in particular I should be thinking about when making this decision? Thanks in advance.
  4. If I believe that its strep, I go with VK. I use the center criteria a decent amount of the time. If I am what so ever suspicious of mono I go with Clinda to avoid the rash. Last month I had a 6 year old girl who was positive for Mono and strep and I went with Clinda. Some of my patients are ok with getting a one time dose of IM PCN due to it being one time which they prefer. I also use a fair amount of IM dexamethasone based on clinical presentation to help with their discomfort.
  5. Ventana, I am able to see 20-30 patients per day in the first 6 months due to a high amount of visits that require little intervention by me. I see probably 5-7 patients per day that are there for penile/vag discharge that require a gonorrhea/chlamydia send off/ a wet mount and then treatment. Male penile d/c's without any testicular pain take very little time to see and dispo. Those 5-7 patients per day inflate my numbers along with simple things like suture or staple removals that return to the ED rather then going to their PCP for removal.
  6. Hello all, I was hired as a new grad in the ED. I have been there almost 6 months now. I have been working mostly in fast track/provider in triage position up to this point. I have my first performance review coming up and I was wondering do I ask for anything additional or do I wait till my 1 year? My current salary is 94,000 per year. Four 10 hour shifts per week. Anything after 40 hours in a week is paid at 47 dollars per hour. I get 22 days PTO per year with 5 days CME with 1,500 for CME. I get all licensing paid for. We get pretty low differentials on the weekends ($2 an hour) and they are expanding the times that PAs work in the ED to also cover nights at $3 an hour. I have been seeing between 20-30 patients each shift. One thing that I do not like is that we do not get any cut of RVU's which is not ideal. I was told that administration is looking to change this so that we do. With this being my first job, I am not sure if 6 months is to early to ask for a raise. I wanted to work in the ED coming out of school so I basically took the first ED job I was offered in order to get my foot in the door. According to the AAPA salary report I am fairly close to the middle 50% of pay for new grads in the ED. I am part of one of the largest medical groups in my state and the weird thing is that they never had me sign a contract when I started. I have asked the other PA's I work with and none of them have had a contract to sign either. Any suggestions on things I should say/ask for during this performance/chart review?
  7. Thanks for all of the replies. My SP is not the family docs I am referring to. If they were, I would already be looking for another job. I tend to only work with this particular FM doctor about once per week. Since PA's are new to the EDs at the hospitals I am working at the EM doctors who were working in the fast track with the FM doctors are now only in the main ED. I believe that the FM doctor is trying to transition to being our supervisor but without actually being our supervising physician. The situation that I wrote about in the opening post is not at all how the ED is ran, it is basically about a singular individual. Every other EM trained MD is awesome and very evidence based and they take the time to talk about why you do and do not do certain tests and order certain medications. If anything changes going forward I will go to my SP with concerns. During my PA training, I was trained by amazing EM PA's and MD's who were all very evidence based and it will leave a lasting impact on how I practice and I don't intend to change due to money or press-gainey scores. I would consider working solo in the distant future but I still have a lot to learn before I do. Thanks for all the comments!
  8. I have a few questions. I am a new graduate and have been in the ED for almost 5 months now. As of right now I am primarily in working in the fast track and as a provider in triage. I love working in the ED and I love almost all of the attendings. For another week or so until I hit 5 months I run almost every case by whoever the attending that is on shift. Some of the attendings have started to trust me and don't have me run the cases by them and let me work on my own except for when I have questions. There are 1-2 doctors that also work in the fast track and only in the fast track that are family practice doctors and are not board certified that I have been having disagreements with. How all have you approached this in the past? I will give you a few scenarios of what have been going on: 1) The Nexus/Canadian C-spine/Ottawa ankle/knee rules are not followed. If someone complains of neck/knee/ankle pain, they get imaging. Even if they have right trapezius pain after lifting weights and have no midline pain and full ROM. It doesn't matter, Cervical CT. If I am in triage they want imaging no matter what. No trauma? Doesn't matter. Every single patient with a complaint gets imaging. 2) Every patient with a HA gets a head CT. No questions asked. Doesn't matter if they have a hx of migraines and they come to the ED because they are out of their Imitrex, they still need a CT 3) Every single patient gets antibiotics. Literally every patient. URI for 1 day without a fever and a normal PE, they get Augmentin. I feel as if this undermines the patients PCP's. Patients will go to their PCP and their PCP will tell them they don't need antibiotics so they come to the ED for antibiotics, and they get it every time. Every single laceration gets antibiotics. And not appropriate antibiotics. Strong antibiotics that are not indicated. When this happens, patients that have been coming to the ED for years expect antibiotics at every visit. When the non ED trained doctors are not there, I do not give them antibiotics because they are not indicated. Then the patients complain because they are not getting amoxicillin like it is candy. 4) More of a continuation on my third scenario, every single conjunctivitis patient gets Tobradex eye drops. I asked this attending why not erythromycin and he said "It doesn't matter, erythromycin and Tobramycin are in the same class, they are both Macrolides." I know they are not, this is just frustrating. 5) Every person that comes in with a gout flare, even if they have a hx of gout and and have a red hot joint with painful passive ROM needs to have a Uric acid level. I know there is no correlation with the level and an acute attack. 6) Someone comes in with vaginal DC and a suspected STD gets treated with Azithromycin, Rochephin, Flagyl, and Difllucan because they don't want to wait for the results and want to keep the patients moving. I feel like this is how resistance gets built up and is not safe. The list goes on and on with the two doctors that are not emergency trained. Their priority is seeing as many patients as possible during each shift. I feel as if this is not how you are supposed to practice medicine and it takes away all of the clinical reasoning and thinking out why I love EM. I am worried that coming up, when I have a performance evaluation that one of these doctors will be in charge of my evaluation. How do I bring this up to someone/or one of the other attendings without coming off like I am going behind the doctors back? Also is there a way to approach these doctors without coming off like a smart ass? I know I am a new grad and have a lot to learn but I feel as if this is ridiculous. Thanks for the feedback, I appreciate it.
  9. EMEDPA, I noticed that you were saying you were yelled at for both ordering and not ordering a d-dimer in triage. I was wondering what is the protocol at your job regarding this. At my ED it is "consider d-dimer with consultation of physician." Is there a way that you can document for instance "Patient has a X Well's score for PE" in order to bypass this? Thanks
  10. My second week working in fast track after taking the PANCE. 45 year old morbidly obese female who smokes and is on OCP's presents to triage. She speaks very broken english presents with "knee pain" with no history of trauma. Triage nurse quickly writes down the first thing that she can understand from the patient....."Pain in the back of my knee" and she orders a knee x-ray from triage. But she but did not wait to hear the rest of the pts' sentence...."that goes down my calf. It started on my flight back from Mexico."
  11. Hey all, I am a new grad and am starting in an ED soon. I graduated in August and have been in the credentialing process and am scheduled to start in about a month. I have a four seperate 4-6 hour days of your basic generic hospital orientation over the next two weeks where I won't be in the ED seeing patients or anything like that. I am being paid a salary and I was wondering what the protocol is on getting paid during these half days of orientation. With not starting to work yet, I was hoping that I would get paid for these days (I need money lol). I sent an email to someone at the hospital who simply said she would try and find out and has yet to get back to me. Just wondering what everyone else has experienced so I can have an expectation on the situation. Thanks
  12. I was also just hired by an ED who told me that I should attend this conference. Since the regular ED bootcamp was in September, I was looking in to attending the advanced EM boot camp course this coming December. I am a new grad and was wondering from those who have attended these in the past, what is the major difference between the regular and advanced course? Should I wait and attend the regular conference before attending the advanced course? Ideally I would like to get a bunch of practice with procedures. Thanks
  13. Thanks, I have received my state license but I am still waiting on my CSL.
  14. Hey, I am a new grad. I graduated a month and a half ago. While waiting for my license and hospital credentialling I have already finished 65 CME hours. So far they have all been free. I've done about 60 on the AAPA website (roughly 30 SA) and the other 5 on Medscape. I know this doesn't entirely answer your question but I think you can probably get them all for free if you wanted to.
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